Isotretinoin use does not significantly change patients' impulsivity severity in acne vulgaris: Study

However, the researchers found no significant change in patients' impulsivity severity based on self-reports and behavioral performances based on the Go/No-go Task (GNG) and Balloon Analog Risk Task (BART).

Acne vulgaris is one of the frequent dermatologic diseases that usually impacts people during adolescence. Reports have shown that isotretinoin, the first-line therapy option for moderate-to-severe AV, could lead to suicidality and mood disturbances. Impulsivity is the tendency to act prematurely without foresight and is a significant risk factor for suicidality.

Against the above background, Çağrı Öğüt MD, Neslihan D. Öğüt from Uşak University Faculty of Medicine in Uşak, Turkey, and colleagues aimed to test the hypothesis that isotretinoin would lead to an increase in impulsivity.

For this purpose, the researchers enrolled seventeen patients with acne vulgaris. The study was planned as a naturalistic 3-month follow-up study. Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Go/No-go Task (GNG), Barratt Impulsiveness Scale (BIS), and balloon Analog Risk Task (BART) were administered before and after the isotretinoin treatment.

The study led to the following findings:

• There was a significant improvement in the severity of anxiety and depression symptoms in acne patients at the end of 3 months.
• Self-report impulsivity characteristics with BIS stayed unchanged.
• No statistically significant difference was found in behavioral task results associated with response inhibition with GNG and impulsive decision-making with BART.
• There was a significant decrease in omission errors, with GNG suggesting improvement in the attention domain after the follow-up.

In conclusion, the study showed an improvement in the patients' attention performance after isotretinoin treatment.The finding is consistent with studies showing increased attention performance with isotretinoin treatment. Attention is one of the main symptoms of depression and anxiety disorders. Therefore, improvement in attention performance may be related to mood symptoms.

"It has been reported that months are needed for isotretinoin treatment to lead to behavioral changes in patients," the researchers wrote.

According to the data from the Food and Drug Administration (FDA), the median duration of isotretinoin use was 3 months in patients who attempted suicide. Therefore, patients were re-evaluated at the end of three months.

The researchers showed an improvement in the death thoughts at the end of isotretinoin treatment detected in four patients at the beginning of the study. At the end of the follow-up, no patient with death thoughts or suicidal ideation was observed.

The finding indicates that isotretinoin is a safe treatment option in patients with AV. Nevertheless, it has been reported that some subgroups may be specifically vulnerable to suicidal thoughts triggered by isotretinoin. Suicide risk may increase in certain subgroups with increased impulsivity with isotretinoin treatment.

Reference:

Öğüt, Ç., & Öğüt, N. D. (2024). No association between isotretinoin and impulsivity in patients with moderate-to-severe acne vulgaris. International Journal of Dermatology, 63(4), 484-490. https://doi.org/10.1111/ijd.16997