A simple, self-reported monthly survey has been shown to help dermatologists identify, monitor, and document adverse effects – including potentially serious psychiatric ones – among young adults being treated with oral isotretinoin.
The 13-question survey was completed monthly, at clinician visits, by 102 patients aged 11-21 years undergoing a course of isotretinoin, according to a study published in the September issue of the Journal of the American Academy of Dermatology (2011;65:517-24 [doi:10.1016/j.jaad.2010.06.040]).
As a group, the study participants completed 760 treatment-months, representing 123 courses of isotretinoin. A total of 729 surveys were returned with complete responses; however, responses from 30 partially completed surveys were counted among the results, reported Ms. Chelsea J. Hodgkiss-Harlow, of the University of California, San Diego, School of Medicine.
The 13-question simple survey included the following symptoms:
• Dry lips
• Dry or bloodshot eyes
• Dry skin
• Muscle aches or pains
• Nosebleeds
• Frequent headaches
• Mood swings
• Depression
• Suicidal thoughts
• Paronychia
• Rash
• Trouble with night vision
• Severe sun sensitivity or sunburn
Mood swings were reported in 7.8% of the 729 surveys, and depression was reported in 1.7%, with no significant difference in incidence seen between patients with a prior mental health diagnosis (n = 12) and those without.
Reports of mood swings or depression were generally transient from survey to survey, "often resolving without a change in isotretinoin dose," the investigators wrote. No reports of suicidal ideation were recorded.
The most frequently reported adverse events mirrored those seen in adults treated with isotretinoin. Dry lips (reported in 94% of surveys) and dry skin (in 72%) were the most common complaints. Younger patients (11-15 years old) and older patients (16-21 years old) had similar adverse event profiles.
The authors noted that the low incidence of psychiatric symptoms among the patients, and the fact that there was no statistical difference in self-reported psychiatric symptoms between patients with a mental health history and those without, suggests extensive psychological screening of isotretinoin-treated adolescents may not be necessary as a first step when monitoring this group.
Instead, they wrote, in-depth screening could be initiated when the simple survey reveals a potential psychiatric problem requiring further evaluation.
Psychiatric screening of adolescents undergoing isotretinoin treatment – particularly those with mental-health histories – has been advised following concerns of possible associations between isotretinoin and depression, psychosis, suicidal ideation, and suicide, they noted.
While the authors conceded that their simplified survey – which asks patients to report experiencing only "mood swings," "depression," or "suicidal thoughts" – lacks the thoroughness of other published depression surveys used in clinical settings to monitor young patients taking isotretinoin, they nonetheless argued that their study’s incidence results were "comparable with those reported in previous studies with more intricate collection methods."
The authors acknowledged that their study’s small size and retrospective design are weaknesses. However, they wrote, the simplified survey could nonetheless be a useful screening tool, "easily implemented in an outpatient clinical setting, and effectively completed by the patient or family at the beginning of their appointment."
The importance of an easily completed survey "should not be underestimated for a screening tool that aims to provide optimal results with monthly patient compliance," they wrote.
The study was funded in part by a grant from the National Institutes of Health. The authors reported no conflicts of interest.