Commentary: acne, isotretinoin and suicide attempts

Abstract

Acne is a fascinating and common illness. Its importance as a severe health concern is often trivialized by the medical community. Several severe adverse events have been postulated to be associated with the use of isotretinoin as a treatment for severe acne. For example, partially based on case reports and sensational discussions in the lay press, there has been a growing concern that isotretinoin when used to treat acne is associated with depression and suicidal ideation. Because isotretinoin is often used to treat individuals with severe acne, separating a direct association between acne and this severe adverse event from one associated with isotretinoin use to treat acne using observational designs may be difficult due to several forms of selection bias including confounding by indication and protopathic bias. Sundström et al.1 hypothesized that people with severe acne may be at higher risk of attempted suicide. In their recently published study, they attempt to answer this question by carefully evaluating a population of patients who used isotretinoin as a treatment for acne. Information on attempted suicide was available before the commencement of therapy with isotretinoin, during therapy with isotretinoin, and after therapy. They also carefully compared the rates of suicide with a standard population as well as within their cohort of isotretinoin users.