Tuesday, April 7, 2020
Doctors urged to reconsider controversial acne drug
Acne treatment including the highly
effective acne medication isotretinoin should be made more readily available
despite reports of its association with depression and teen suicide. That’s the
implication of a study 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.
Natsuaki’s
research team conducted the first meta-analysis, analyzing 42 studies involving
more than one million people, to resolve sometimes-conflicting data related to
studies of how acne is related to depression and anxiety. The studies showed a
significant association with acne and mental health.
“Acne may not
cause physical pain or impairment, but you do not want to leave acne untreated
because that’s a risk for mental health,” said Natsuaki, an associate professor
of psychology and director of the UCR Developmental Transitions Laboratory.
“Undertreatment of acne itself is related to depression and anxiety, especially
in females.”
Isotretinoin,
often referred to by the since-discontinued brand name Accutane, is an
effective acne medication that hit the market in 1982. It can reduce the new
acne after a standard six months treatment by reducing the size of oil glands
and the amount of oil they produce, and making pores less hospitable to the
Propionibacterium acnes bacteria. In up to 90% of cases, all or nearly all of
acne is eliminated. Its brand names include Absorica, Claravis, Amnesteem,
Myorisan, and Zenatane.
But in 1998, the
Food and Drug Administration issued a warning to doctors regarding a possible
association with depression, psychosis, suicidal ideation, and suicide. One estimate
— not based on a study — attributed 10 suicides in 2019 to isotretinoin.
The
anti-Accutane phenomena, and regulatory action, grew 20 years ago after a
congressman attributed his son’s suicide to the medication. A subsequent suit
was dismissed years later. In 2006, the FDA created the iPledge monitoring
program, a risk management system specifically for Isotretinoin. With a goal of
enforcing control over prescribing, dispensing, and using isotretinoin, the
program requires all prescribers, pharmacists, and patients to register and log
detailed information into the site.
Natsuaki’s
meta-analysis found both depression and anxiety heightened in acne sufferers at
an effect size similar to the ill effect of cyberbullying on victim’s
depression, anxiety, and loneliness. Contrary to expectations, the researchers
found that acne is associated with greater anxiety and depression among adults
than adolescents.
“We speculate
that, although no one likes to have acne on his or her face, the prevalence of
acne is high in adolescent years and it’s somewhat expected to happen in
teens,” Natsuaki said. “However, for adults, acne may appear as a deviation
from social norm.”
The study also
found the emotional cost of acne is higher in Middle Eastern regions, though
that may have been impacted by the inclusion of a disproportionately high
number of studies from countries including 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 utilization of
isotretinoin.”
Journal article: https://www.jaad.org/article/S0190-9622(20)30279-6/pdf
Subscribe to:
Posts (Atom)