Important controversies associated with isotretinoin therapy for acne

Stephen Wolverton, Julie C. Harper

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Isotretinoin is a remarkably effective drug for severe, recalcitrant acne vulgaris. Soon after the drug's release in the early 1980s, a number of important adverse effects were reported subsequently leading to a variety of medical and medicolegal controversies. Three of these controversies will be highlighted concerning the putative role of isotretinoin in (1) depression and suicide, (2) inflammatory bowel disease, and (3) iPledge and pregnancy prevention programs. It appears that a very small subset of patients receiving isotretinoin for acne are at risk for depression, which is very manageable provided there is adequate patient awareness of the possibility, maximum communication between the patient and physician, and cessation of therapy if clinically important depression occurs (after which the depression rapidly resolves in a week or less). Multiple controlled studies actually suggest a very favorable effect of isotretinoin on depression and anxiety common in the population requiring isotretinoin. With regard to inflammatory bowel disease, in just one study, only ulcerative colitis association with isotretinoin reached statistical significance. The actual incidence of this association is strikingly low. Finally, it is clear that even the most recent pregnancy prevention program (iPledge) is no more successful than prior programs; there will likely always be a small number of female patients becoming pregnant while receiving isotretinoin for acne vulgaris.

Original languageEnglish
Pages (from-to)71-76
Number of pages6
JournalAmerican Journal of Clinical Dermatology
Volume14
Issue number2
DOIs
StatePublished - Apr 2013

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Isotretinoin
Acne Vulgaris
Depression
Therapeutics
Pregnancy
Ulcerative Colitis
Inflammatory Bowel Diseases
Suicide
Anxiety
Communication
Physicians
Incidence
Pharmaceutical Preparations
Population

ASJC Scopus subject areas

  • Dermatology

Cite this

Important controversies associated with isotretinoin therapy for acne. / Wolverton, Stephen; Harper, Julie C.

In: American Journal of Clinical Dermatology, Vol. 14, No. 2, 04.2013, p. 71-76.

Research output: Contribution to journalArticle

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