Abstract
We relay the case of a teenage female with severe facial acne vulgaris and a past psychiatric history of major depressive disorder who presented to the emergency department with a primary complaint of ongoing suicidal ideation. Defining features of this case stem from the patient endorsing that her suicidal ideation was a result of her severe acne and the coinciding social perturbation it caused. Additionally, the patient reported that just four months prior to the current presentation, her dermatologist started her on isotretinoin therapy for the management of acne vulgaris. To the best of the authors' knowledge, there have been no reported cases which describe a teenage female presenting with active suicidal ideation secondary to severe acne vulgaris while concurrently undergoing treatment with isotretinoin. Given the controversial but reported association between isotretinoin and increased suicidality, we considered the appropriateness of continuing this medication for our patient. We then conducted a literature search evaluating the evidence concerning this association. In what follows, we present a unique case report and provide a thorough review of the evidence—or lack thereof—surrounding the relationship between isotretinoin and suicidality. Additionally, the authors aim to provide recommendations for the management of future patients who may present under similar circumstances.
Highlights
Isotretinoin (13-cis-retinoic acid) is a synthetic vitamin A analog that was approved for the treatment of severe acne by the US Food and Drug Administration (FDA) in 1982 [1, 2]
The authors aim to explore the current literature and provide recommendations for patients such as ours, whose underlying core contributor of major depressive disorder and suicidal ideation were rooted in the debilitating effects of severe acne vulgaris
Our patient endorsed feelings of hopelessness, helplessness, and worthlessness, and suicidal ideation attributed to her severe acne vulgaris
Summary
Isotretinoin (13-cis-retinoic acid) is a synthetic vitamin A analog that was approved for the treatment of severe acne by the US Food and Drug Administration (FDA) in 1982 [1, 2]. Since it has been regarded as an antiacne therapy that boasts excellent clinical efficacy and long-term results in even the most refractory cases. The adverse effects of isotretinoin are among the most highly contested topics in psychiatric literature. Some adverse effects, such as teratogenicity and mucocutaneous xerosis, have been well documented. The authors aim to explore the current literature and provide recommendations for patients such as ours, whose underlying core contributor of major depressive disorder and suicidal ideation were rooted in the debilitating effects of severe acne vulgaris
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