Retinoids in the Management of Acne with Depressive Symptoms: A Treatment Conundrum

Introduction: Isotretinoin (ITT) a first‑generation synthetic retinoid derived from Vitamin A for the treatment of Acne Vulgaris (AV). It effectively treats acne by acting on the pathogenetic mechanisms like comedolytic effect, anti‑inflammatory effect, sebostatic effect and the inhibitory effect on proliferation of Propionibacterium acnes. The first occurrence of depressive symptoms associated with isotretinoin was seen in 1983 and since then a lot of controversies have emerged regarding the causal relationship between isotretinoin and depression.

Materials and Methods: All patients presenting to the Dermatology Out Patient Department in a Rural Private Hospital in South India with diagnosed Grade III-IV acne non-responsive to Oral Tetracyclines and Topical Clindamycin were taken to be part of the study after obtaining adequate consent. Each patient filled a Hamilton Depression Rating Scale (HDRS) and Dermatology Life Quality Index (DLQI) before the commencement of treatment. Patients with mild depression secondary to acne were considered. They were started on Oral Isotretinoin 10 mg and Topical Adapalene 0.1% for 16 weeks. The same scale was given at the end of 16 weeks for data completion.

Results: The mean DLQI score before the commencement of treatment was 13.34 and it came down to 6.94 at the end of 16 weeks, an improvement of 47.87%. The mean HDRS score before the commencement of treatment was 18.10 and it went up to 19.32 at the end of 16 weeks, a deterioration of 6.74%.

Conclusion: Based on the collected data, it can be said that although Retinoids significantly help in the management of severe Acne, they can possibly have a negative effect on the mood of the individual and worsen the symptoms of Depression slightly. A sort of double-edged sword, it can be left to the Dermatologist to alter the dosage of the Retinoids used and also have proper Psychiatric consultations including Psychotherapy for the patient to achieve success in treatment.