Abstract
BackgroundIsotretinoin is the most effective treatment for moderate to severe acne. However, isotretinoin has many side effects related to its use. Since 1983, when Hetzen reported the first occurrence of new depressive symptoms in patients treated with isotretinoin, a lot of controversies emerged regarding the causal relationship between isotretinoin and depression.ObjectiveTo evaluate depression among acne patients treated with isotretinoin versus doxycycline at King Fahad Hospital of the University between December 2019-March 2020.MethodsUsing the Global Acne Grading System, patients aged 18 - 30 years old with moderate to severe acne vulgaris who have not received isotretinoin previously and has no personal or family history of any psychiatric illnesses, were evaluated for depression using the patient health questionnaire-9 before starting treatment and 8 weeks after. Twenty-nine patients had met the inclusion criteria and were included in the study.ResultsOf the 29 patients included, 18 patients completed the study (nine males, nine females). Twelve patients received isotretinoin 0.5mg/kg (study group) and six patients received doxycycline 100mg (control group). The mean depression score for the isotretinoin group has decreased from (4 ± 2.48) to (3.08 ± 2.84) but the result was statistically insignificant with a p-value of 0.19, CI (-5.28, 2.36). For the doxycycline group, the mean depression score has decreased from (5.5 ± 2.5) to (2.83 ± 0.75) with a p-value of 0.043, CI (0.12, 5.21). There was no statistically significant difference in the mean depression score between the two groups after 8 weeks of starting treatment [p-valve 0.837, CI (-2.28, 2.78)].ConclusionThis study showed that, after 8 weeks of starting treatment, isotretinoin at 0.5 mg/kg has no risk of developing depression. The results of this study did not reveal a direct relationship between the use of isotretinoin and the development of depression. Furthermore, optimum control and treatment of acne vulgaris have shown to improve depression scores.
Highlights
Acne Vulgaris is a disease of the pilosebaceous units of skin, affecting around 85% of adolescents and young adults globally [1,2]
The mean depression score for the isotretinoin group has decreased from (4 ± 2.48) to (3.08 ± 2.84) but the result was statistically insignificant with a p-value of 0.19, CI (-5.28, 2.36)
This study showed that, after 8 weeks of starting treatment, isotretinoin at 0.5 mg/kg has no risk of developing depression
Summary
Acne Vulgaris is a disease of the pilosebaceous units of skin, affecting around 85% of adolescents and young adults globally [1,2]. It is characterized by the development of multiple comedones, papules, pustules, and nodules, which can be occasionally complicated by scarring. These lesions appear on the face, the upper trunk, or the proximal upper extremities and can lead to psychological disturbances in some patients [3,4,5]. Since 1983, when Hetzen reported the first occurrence of new depressive symptoms in patients treated with isotretinoin, a lot of controversies emerged regarding the causal relationship between isotretinoin and depression
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