1 August 2018

Where dermatologists stand on isotretinoin

Clinical Dermatology

Australian dermatologists have sought to redress some the negative press isotretinoin has copped in the media around purported links to severe mental health issues. 

Earlier this year the legal team for a teen facing murder charges in the US announced they were pointing fingers at the drug for its possible role in the crime.

The accusation feeds into alarm raised anecdotal reports linking the medication to significant psychiatric side-effects, including almost two decades earlier when a US congressman blamed it for the suicide of his 17-year-old son. 

But the Australasian College of Dermatologists have released a position statement saying research into the causal link between mental health and isotretinoin has been “contradictory”. 

College spokesperson Associate Professor Stephen Shumack said it was important to screen patients for depression and mental health issues prior to starting the treatment given how common these conditions were in teens and young adults, but there was “really no evidence that people are more likely to become depressed” from taking the drug.  

A major factor muddying the findings of an association between the medication and depression, was the role acne itself had in affecting patients’ quality of life, he added. 

Aside from addressing the alleged psychiatric effects of isotretinoin, the major change outlined in the new position statement was a relaxing of the restrictions around skin treatments in the period immediately following completion of treatment. 

Previously, patients were advised to wait for around six months before getting any waxing, physical dermabrasion, cutaneous laser or aggressive chemical treatments. 

But in light of a new systematic review, the college now says there is no reason patients should avoid laser hair removal, superficial chemical peels, cutaneous surgery and fractional ablative and non-ablative laser procedures while taking isotretinoin. 

However, the new guideline still recommends against mechanical dermabrasion and fully ablative laser treatments while on the treatment. 

In addition, the position statement reiterates the need for “strict compliance” to reliable contraception among women who have child-bearing potential. While, despite warnings, a small number of the very many patients taking the medication did get pregnant, Professor Shumack said the new position statement wasn’t in response to any notable increases in pregnancies. 

Isotretinoin remains contraindicated for breastfeeding women, those with severely impaired liver function and those who have chronic abnormally elevated blood lipids.  

The college also drew attention to the fact that patients taking the medication would be unable to donate blood due to the possible teratogenic outcomes.