Thread by @DrJohnBarbieri

Just out in @JAADjournals, interesting cohort study led by @ArielleNaglerMD evaluating whether there is an increased risk of suicidality among #acne patients treated with #isotretinoin. A quick thread 1/7
#dermtwitter #dermatology
pubmed.ncbi.nlm.nih.gov/33727021/

The authors conducted a cohort study evaluating the rate of psychiatric disorders and suicidality among 3 cohorts: those with acne treated with isotretinoin, those treated with antibiotics only, and those in the general population. 2/7

After adjusting for age and sex, they found that those treated with isotretinoin had increased odds of a psychiatric disorder (e.g. depression) but decreased odds of suicidality compared to those treated with antibiotics and those in the general population. 3/7

However, in this analysis, they did not separate diagnoses before or after starting the treatment, which is an important limitation that makes it challenging to differentiate effect associated with treatment versus acne alone. 4/7

Fortunately, they also conducted an separate analysis examining rates of suicidality before, during, and after treatment, which found no increased risk of suicidality during treatment with isotretinoin. These are probably the most reassuring findings of the study. 5/7

However, it is important to keep in mind that these data are at a POPULATION level. There are also studies describing depressive symptoms in INDIVIDUAL patients being treated with isotretinoin, including positive challenge/dechallenge responses. 6/7

sciencedirect.com/science/articl…

Therefore, while this study can further alleviate our worry about depressive symptoms and suicidality with isotretinoin, it is prudent to educate patients about these risks and to evaluate for depressive symptoms in any patient with acne (including those on isotretinoin) 7/7