Doctors urged to reconsider controversial acne drug


Treatment for acne, including isotretinoin, a highly effective acne drug, should be made more readily available despite reports of its association with depression and suicide in adolescents. This is the implication of a study that was just published in the Journal of the American Academy of Dermatology.

Isotretinoin has been linked to depression and suicide. But UCR researcher Misaki Natsuaki, one of the study’s authors, said severe acne itself, when left untreated, poses a serious risk for depression and anxiety.

Misaki natsuaki

Natsuaki’s research team conducted the first meta-analysis, analyzing 42 studies involving over a million people, to resolve sometimes conflicting data linked to studies on how acne is linked to depression and to anxiety. Studies have shown a significant association with acne and mental health.

“Acne may not cause physical pain or impairment, but you don’t want to leave acne untreated because it’s a mental health risk,” said Natsuaki, associate professor of psychology and director. from the UCR Developmental Transitions Laboratory. “The undertreatment of acne itself is linked to depression and anxiety, particularly in women.”

Isotretinoin, often referred to as the brand name Accutane, is an effective acne drug that hit the market in 1982. It can reduce new acne after standard six-month treatment by reducing the size of the sebaceous glands. and the amount of oil they produce and make the pores less welcoming to the bacteria Propionibacterium acnes. In up to 90% of cases, all or almost all of the acne is eliminated. Its brand names include Absorica, Claravis, Amnesteem, Myorisan, and Zenatane.

But in 1998, the Food and Drug Administration warned doctors about a possible association with depression, psychosis, suicidal thoughts, and suicide. One estimate – not based on a study – attributed 10 suicides in 2019 to isotretinoin.

The anti-Accutane phenomenon and regulatory action developed 20 years ago after a congressman attributed his son’s suicide to the drug. A subsequent lawsuit was dismissed years later. In 2006, the FDA created the iPledge Surveillance Program, a risk management system specifically for isotretinoin. In an effort to strengthen control over the prescribing, dispensing and use of isotretinoin, the program requires all prescribers, pharmacists and patients to register and record detailed information on the site.

Natsuaki’s meta-analysis found that depression and anxiety increased in people with acne with a similar size effect to the detrimental effect of cyberbullying on the victim’s depression, anxiety, and loneliness. . Contrary to expectations, researchers found that acne was associated with greater anxiety and depression in adults than in adolescents.

“We believe that while no one likes having acne on their face, the prevalence of acne is high in adolescents and is somewhat expected to occur in adolescents,” he said. Natsuaki said. “However, in adults, acne can appear to be a deviation from the social norm.”

The study also found that the emotional cost of acne is higher in regions of the Middle East, although this may have been affected by the inclusion of a disproportionate number of studies from countries such as Turkey, Iran and Egypt.

The study concludes, “Given the psychiatric risk of acne itself, it is important for clinicians to optimize acne management, which may include the use of isotretinoin.”

The article is titled “Acne Vulgaris and the Risk of Depression and Anxiety: A Meta-Analytical Analysis.” In addition to Natsuaki, study researchers include lead author Danielle V. Samuels, senior lecturer at the University of Massachusetts, Amherst, and a former student in Natsuaki’s lab; Robert Rosenthal, UCR professor of psychology; and Rick Lin and Soham Chaudhari, both dermatologists affiliated with the University of North Texas Health Sciences Center.


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