Adverse outcomes more to do with acne than isotretinoin


By Mardi Chapman

27 Apr 2022

Isotretinoin exposure does not add to the risk of neuropsychiatric adverse outcomes in patients with acne, new research has found.

The evidence should help allay ongoing concerns over the possibility of psychiatric adverse events with use of the controversial retinoid.

The study of 30,866 individuals with acne aged 12–27 years included those exposed to isotretinoin, oral antibiotics for acne, topical anti-acne agents, or no acne medications.

After propensity score matching for baseline confounders, the odds ratio (OR) for any incident neuropsychiatric outcomes in patients with acne exposed to isotretinoin was 0·80 compared with those on oral antibiotics; 0·94 compared with those using topical anti-acne medicines; and 1·06 compared with those without a prescription for anti-acne medicines.

The study, published in the British Journal of Dermatology, found patients in the isotretinoin treated group had more physical symptoms than those on antibiotics, other acne medications or no medications (OR 1.51, 1.84 and 2.01 respectively).

Patients on isotretinoin also had increased odds for incident prescriptions for antidepressants compared to patients on no anti-acne medicines (OR 1.83) but a lower odds compared to patients prescribed oral antibiotics (OR 0.90).

The study also found “no clear difference” in inpatient mortality between patients with acne exposed to isotretinoin and patients with acne prescribed oral antibiotics during the 12-month follow-up period.

“We observed a consistent association between increasing acne severity as indicated by anti-acne treatment options and incidence of adverse neuropsychiatric outcomes, but the findings showed that isotretinoin exposure did not add to the risk of neuropsychiatric adverse outcomes over and above what was associated with oral antibiotics.”

“Instead, we observed that isotretinoin was associated with reduced incidence of anxiety, depression, sleep problems, nonfatal self-harm, and prescriptions for psychotropic medicines, when compared with patients with acne who were propensity score matched and prescribed oral antibiotics.”

The researchers said isotretinoin treatment therefore appeared to mitigate the excess neuropsychiatric risk associated with recalcitrant moderate-to-severe acne.

“Patients with acne with prescriptions for oral antibiotics, but without prescriptions for isotretinoin, had the highest incidence of adverse neuropsychiatric outcomes over the 1-year follow-up period.”

“These patients also had an increased odds for nonfatal self-harm compared with those with less severe acne. This finding further highlights the need for timely and effective acne management,” it concluded.

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