(44) Mental Health Outcomes Following Isotretinoin and Antibiotic Use in Pediatric Acne: A Retrospective Cohort Study

Background: Amongst adolescents, acne vulgaris is one of the most common dermatologic conditions, affecting up to 85% of patients aged 12-24 years, with large impacts on psychosocial development and quality of life. Treatment options for acne include oral antibiotics and isotretinoin: the latter is recognized as highly effective, but concerns have raised regarding neuropsychiatric side effects. Yet large-scale epidemiologic studies rarely yield a significant association between isotretinoin and increased risk of psychiatric morbidity.

Objectives: Our study sought to compare the short-term incidence of psychiatric conditions following isotretinoin versus systemic antibiotic treatment in pediatric acne patients using a propensity score–matched control design and ICD-10–based outcome definitions.

Design/Methods: Utilizing the TriNetX Global Collaborative Network, a comprehensive analysis of de-identified electronic health records from 86 healthcare organizations was conducted on patients aged 12–21 years with a diagnosis of acne (ICD-10-CM: L70) who initiated treatment with either isotretinoin or systemic antibiotics and compared against matched control groups without exposure to systemic acne therapies. Covariate balance was assessed using standardized mean difference (SMD), with < 0.01 considered acceptable. Outcomes were assessed at 3- and 6-months post-index. Adjusted odds ratio (aOR) and 95% Wald-based confidence intervals (CI) were calculated for pigmentary comorbidities using multivariate logistic regression modelling. Statistical significance was set at P <.05.

Results: Isotretinoin-treated patients showed no statistically significant increase of most psychiatric outcomes compared to controls; however, an increase of emotional state was seen at 6 months (OR 1.70). Reduced risk of adjustment and sleep disorders also trended towards significance (OR 0.67, p = 0.0209 at 3 months and OR 0.83, p = 0.0623 at 6 months).

Patients treated with antibiotics exhibited consistent elevated risks across multiple categories of psychiatric conditions. At 6 months, antibiotics were associated with increased odds of depressive episodes (OR 1.16, p < 0.0001), major depressive disorder (OR 1.20, p = 0.0006), anxiety disorders (OR 1.11, p < 0.0001), and sleep disorders (OR 1.13, p = 0.0055).

Conclusions: These findings support the re-evaluation of the psychiatric risk profile of isotretinoin, especially in light of rising antibiotic resistance and need for effective acne treatment in adolescents.