Changes of psychiatric parameters and their relationships by oral isotretinoin in acne patients

Oral isotretinoin is a highly effective agent for the treatment of moderate to severe acne, but ever since oral isotretinoin was introduced as a modality for acne, the relationship between oral isotretinoin therapy and psychiatric problems, especially depression, has been controversial. The purposes of this study were to know the acute effects of oral isotretinoin therapy on psychiatric symptoms and to investigate the relationships among them, which have not been reported in the published work. This cohort study included 38 acne patients who started oral isotretinoin therapy. Individual patients were examined before administering oral isotretinoin and 2 and 8 weeks after commencement. Acne severity was graded using the Leeds revised acne grading system. Acute psychiatric effects of oral isotretinoin were assessed using a questionnaire authorized by two psychiatrists. This questionnaire included assessments of acne-related quality of life (Assessment of the Psychological and Social Effects of Acne [APSEA]), depression (Beck`s depression inventory [BDI]), anxiety (Beck`s anxiety inventory [BAI]) and psychopathology (Symptomchecklist-90-revised [SCL-90-R]). Acne grading and APSEA showed similar change patterns. Both improved after 8 weeks of oral isotretinoin treatment. On the other hand, the severity of depression decreased after 2 weeks of treatment. A significant correlation was found between BDI and APSEA, but no correlation was found between BDI and acne grade. These results indicate that oral isotretinoin therapy alleviates depressive symptoms. Improvements in depression are directly related to acne-related life quality improvements rather than to improvement in acne grade.ANTONIO J, 2007, J EUR ACAD DERMATOL, V21, P556Kaymak Y, 2006, J EUR ACAD DERMATOL, V20, P1256, DOI 10.1111/j.1468-3083.2006.01784.xO`Reilly KC, 2006, NEUROPSYCHOPHARMACOL, V31, P1919, DOI 10.1038/sj.npp.1300998Yen JY, 2006, PSYCHIAT CLIN NEUROS, V60, P147Ferguson SA, 2005, TOXICOL SCI, V87, P451, DOI 10.1093/toxsci/kfi262Chia CY, 2005, ARCH DERMATOL, V141, P557Aarstad HJ, 2005, ACTA OTO-LARYNGOL, V125, P557, DOI 10.1080/00016480510027547Sahin M, 2005, NEUROTOX RES, V7, P243Crandall J, 2004, P NATL ACAD SCI USA, V101, P5111, DOI 10.1073/pnas.0306336101Sakai Y, 2004, ANN NY ACAD SCI, V1021, P436, DOI 10.1196/annals.1308.059Wysowski DK, 2001, J AM ACAD DERMATOL, V45, P515Wysowski DK, 2001, NEW ENGL J MED, V344, P460Jick SS, 2000, ARCH DERMATOL, V136, P1231Patton GC, 2000, AUST NZ J PSYCHIAT, V34, P741Layton AM, 2000, J DERMATOL TREAT, V11, P3Kellett SC, 1999, BRIT J DERMATOL, V140, P273MIDDELKOOP T, 1999, J PHARM PRACT, V12, P374O`Brien SC, 1998, J DERMATOL TREAT, V9, P215Gupta MA, 1998, BRIT J DERMATOL, V139, P846Zouboulis CC, 1998, DERMATOLOGY, V196, P21Layton AM, 1997, DERMATOLOGY, V195, P15BYRNE A, 1995, CAN J PSYCHIAT, V40, P567SITZMANN JH, 1995, BRIT J DERMATOL, V133, P241KOO J, 1995, J AM ACAD DERMATOL, V32, pS26RHEE MK, 1995, KOR J PSYCHOPATHOL, V4, P77ALLENBY G, 1993, P NATL ACAD SCI USA, V90, P30HULL SM, 1991, CLIN EXP DERMATOL, V16, P210CRETTAZ M, 1990, BIOCHEM J, V272, P391BECK S, 1990, MANUAL BECK ANXIETYHIRSCHELSCHOLZ S, 1989, BRIT J DERMATOL, V120, P639RUBINOW DR, 1987, J AM ACAD DERMATOL, V17, P25DEROGATIS S, 1983, SCL90R CLIN PYCH RESHAHN H, 1982, J KOREAN NEUROPSYCHI, V25, P487BECK AT, 1961, ARCH GEN PSYCHIAT, V4, P561