Psychological and Neurological Impact of Oral Isotretinoin in Jordanian Subjects with Acne Vulgaris

Abstract

Background: Acne Vulgaris is the most frequent skin disease worldwide, reaching 70–87%. Isotretinoin a first class synthetic 13-cis-retinoid originated from Vitamin A is used for the management of Acne Vulgaris. The incidence of overall major depressive diseases worldwide is 13–16%. The incidence of psychological adverse effects in subjects managed using oral isotretinoin is 25.16%. Aim: To assess the psychological and neurological influence of oral isotretinoin in Jordanian subjects with Acne Vulgaris. Methods: Our retrospective investigation included 185 Jordanian subjects, of both sexes, aged 16-24 years, with severe nodulocystic Acne Vulgaris and on oral isotretinoin for (A) determination of: (1) intensity of Acne Vulgaris using the visual analog scale score (VAS-S: 0-100), (2) psychological impact using the Hamilton anxiety rating scale score (HAM-ARS-S:0-56) with the Montgomery Asberg depression rating scale score (MADRS-S:0-60) and (3) neurological adverse effects, all through baseline up to the fourth interview during a period of 4 months, one month apart and (B) screening for the need of antipsychotic medication after withdrawal of oral isotretinoin, at Prince Talal military hospital, JRMS, Mafraq, JORDAN, during the period Mar.2021-Aug.2023. Results: There was a remarkable enhancement in VAS-S through baseline up to the fourth interview (P<0.005). At first interview, the average VAS-S increased from 0 to 22.65. There was a remarkable increase in MADRS-S through baseline up to the fourth interview (P<0.005) with mild depression in 3 subjects (1.6%) and moderate depression in 1 subject (0.5%). There was a remarkable reduction in HAM-ARS-S during all interviews. (P<0.005). At the 3rd interview, 11 subjects (5.9%) were in the range of moderate anxiety and at the fourth interview, 4 subjects (2.2%) were in the range of severe anxiety. The most common neurological adverse effect was headache with most frequency at the fourth interview (135(72.97%)). ............