Acne, isotretinoin and suicide attempts: a critical appraisal

Abstract

Sundström et al. (BMJ 2010; 341: c5812) conclude that there was an increased risk of suicide attempts up to 6 months after the end of treatment with isotretinoin and advise close monitoring for up to a year after completing a course of treatment. Patients with a history of suicide attempts before treatment made fewer new attempts at suicide than those where suicidality was observed in connection with treatment, suggesting that patients with severe acne with a history of attempted suicide should not automatically be refused isotretinoin treatment. The authors also state that suicide risk was already rising prior to treatment and that the additional risk cannot therefore be attributed to isotretinoin use.

Photodynamic therapy with methyl aminolaevulinate 80 mg g−1for severe facial acne vulgaris: a randomized vehicle-controlled study

“…[4][5][6][7] However, oral isotretinoin has recognized problematic side-effects and is a proven teratogen, and reimbursement issues may limit its use. [8][9][10][11][12] Antibiotic monotherapy is generally not recommended for treatment of severe acne. 6 There is a need for alternative approaches with improved tolerability and practicability.…”

Increased frequency of Attention Deficit Hyperactivity Disorder (ADHD) in acne versus dermatologic controls: analysis of an epidemiologic database from the US

“…Acne is a common disorder of childhood and adolescence that is associated with psychiatric morbidity and increased suicide risk, which have been considered in some instances to be an adverse event associated with certain acne therapies such as isotretinoin (1). Recent population-based studies suggest that psychiatric morbidity and suicide in acne are related to the psychosocial burden of substantial acne, rather than the effects of medication, as patients with more severe and disfiguring acne were more likely to report suicidal ideation (2).…”

Risk of suicide attempt associated with isotretinoin: a nationwide cohort and nested case-time-control study

“…On the issue of isotretinoin-related risk for psychological disturbances, confounding resulting from severe acne is an intractable difficulty that no design can fully take into account. [55][56][57] Severe acne has an impact on psychological equilibrium. [31][32][33][34][35][36][37]48 Therefore, ideally, a control group with severe acne not treated with isotretinoin would be necessary.…”