Depression and the dermatologist: a critical analysis of contemporary isotretinoin prescribing practices

Management of patients with current or previous depression who require isotretinoin treatment for acne is a challenging area. Current opinion favours the view that isotretinoin-induced mood disturbance is a rare, idiosyncratic reaction, not reliably related to the presence of pre-existing depression. Nonetheless, in the absence of a definitive high-quality study, there remains a degree of legitimate uncertainty. With input from a psychiatrist, we created and administered a detailed survey featuring a range of low-, medium- and higher-risk clinical scenarios, designed to capture a snapshot of current dermatological practice. Respondents indicated a wide variability in their approach, with a substantial proportion referring on to Psychiatry where this was not deemed necessary. Few dermatologists appreciated the importance of behaviours suggesting impaired impulse control. We hope this study helps to refine guidance for isotretinoin prescribing, both to maximize safety and to ensure that deserving patients with acne are not excluded from appropriate treatment.