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Treatment of the depressed and dysmorphophobic acne patient
S M Hull1, W J Cunliffe, B R Hughes
1Leeds Foundation for Dermatological Research, General Infirmary, Leeds, UK.
Abstract:
Sixteen patients with minimal facial acne but with symptoms of dysmorphophobia related to their acne were treated with isotretinoin, 0.5 mg/kg/day, (n = 5); 1 mg/kg/day (n = 11) for 16 weeks. All 16 had previously received long-term antibiotic therapy with no 'perceived' improvement in their acne. Formal psychiatric assessment was not possible through lack of cooperation. Fourteen of 16 patients derived benefit from isotretinoin therapy in that all 14 were subsequently satisfied with the cosmetic results achieved. However, the incidence of relapse was greater than that for a control group, 14 requiring additional therapy in the form of antibiotics or further isotretinoin (seven patients) within 20 months of completing the original course. Patients with acne and dysmorphophobia represent an important group of patients who benefit from treatment with isotretinoin; if possible this should be in conjunction with psychotherapy.
Insights
Isotretinoin effectively treats acne and dysmorphophobia in patients dissatisfied with prior antibiotic therapies. While beneficial, higher relapse rates necessitate further treatment or psychotherapy.
Area of Science:
- Dermatology
- Psychiatry
Background:
- Acne with dysmorphophobia presents a unique challenge, often unresponsive to traditional antibiotic treatments.
- Patients may experience significant distress and dissatisfaction with cosmetic outcomes despite minimal physical acne severity.
Purpose of the Study:
- To evaluate the efficacy of isotretinoin in treating patients with acne and comorbid dysmorphophobia.
- To assess patient satisfaction and relapse rates following isotretinoin therapy.
Main Methods:
- A cohort of 16 patients with acne and dysmorphophobia received isotretinoin (0.5 or 1 mg/kg/day) for 16 weeks.
- Patients had previously failed long-term antibiotic therapy.
- Outcomes included cosmetic satisfaction and need for further treatment.
Main Results:
- Fourteen of 16 patients reported satisfaction with cosmetic results after isotretinoin treatment.
- A higher incidence of relapse was observed compared to control groups.
- Seven patients required additional therapy (antibiotics or further isotretinoin) within 20 months.
Conclusions:
- Isotretinoin is a beneficial treatment for acne patients experiencing dysmorphophobia, improving cosmetic satisfaction.
- Combined treatment with psychotherapy may be advantageous.
- The potential for relapse highlights the need for ongoing management strategies.