{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T12:35:56Z","timestamp":1793104556248,"version":"4.5.0"},"reference-count":23,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T00:00:00Z","timestamp":1780099200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,27]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Acne vulgaris is among the most common chronic inflammatory skin conditions worldwide. It is consistently associated with depression, anxiety, shame, social withdrawal and impaired quality of life \u2013 factors that are frequently underestimated in routine clinical practice. Simultaneously, isotretinoin, the most effective systemic treatment for severe or scarring acne, remains at the centre of a longstanding debate about psychiatric safety. This narrative review examines evidence on acne-\u00adrelated psychological burden, the bidirectional interaction between acne and mental health, and contemporary data on psychiatric outcomes during isotretinoin therapy. Pooled analyses confirm that patients with acne have substantially elevated rates of depressive symptoms (approximately 22%), anxiety (approximately 29%) and suicidal ideation (approximately 12%), often disproportionate to physician-rated lesion counts. In contrast, the best available population-level evidence does not support a generalized increase in suicide risk or psychiatric disorders among people using isotretinoin; some data suggest a reduction in rates of suicide attempts in the years following treatment. Pharmacovigilance signals persist but are hypothesis-generating rather than causal, and principally support structured monitoring in vulnerable subgroups. The core clinical task is not to determine whether isotretinoin is universally safe or dangerous, but to distinguish three concurrent forces: psychosocial burden attributable to acne itself, pre-existing psychiatric vulnerability, and rare treatment-emergent events. A pragmatic monitoring model that integrates baseline psychiatric screening, longitudinal follow-up and shared decision making is more useful than binary risk labelling. Addressing visible inflammation and invisible psychiatric burdens together represents the standard to which acne care should aspire.<\/jats:p>","DOI":"10.1093\/ced\/llag231","type":"journal-article","created":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T11:46:32Z","timestamp":1780055192000},"page":"1983-1990","source":"Crossref","is-referenced-by-count":0,"title":["Acne, mental health and isotretinoin: disentangling disease burden, treatment effects and psychiatric risk"],"prefix":"10.1093","volume":"51","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-1077-876X","authenticated-orcid":false,"given":"Rafael","family":"Tonella Vezzoli","sequence":"first","affiliation":[{"name":"Clinica COPE, Centro de Oftalmologia e Pediatria Especializado, Cana\u00e3 dos Caraj\u00e1s , PA ,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,5,30]]},"reference":[{"key":"2026102707591249000_llag231-B1","doi-asserted-by":"crossref","first-page":"1006","DOI":"10.1016\/j.jaad.2023.12.017","article-title":"Guidelines of care for the management of acne vulgaris","volume":"90","author":"Reynolds","year":"2024","journal-title":"J Am Acad Dermatol"},{"key":"2026102707591249000_llag231-B2","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1111\/j.1365-2230.1994.tb01167.x","article-title":"Dermatology Life Quality Index (DLQI): a simple practical measure for routine clinical use","volume":"19","author":"Finlay","year":"1994","journal-title":"Clin Exp Dermatol"},{"key":"2026102707591249000_llag231-B3","doi-asserted-by":"crossref","first-page":"766","DOI":"10.1111\/ced.13919","article-title":"The mental health burden in acne vulgaris and rosacea: an update","volume":"44","author":"Singam","year":"2019","journal-title":"Clin Exp Dermatol"},{"key":"2026102707591249000_llag231-B4","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1046\/j.1365-4362.2000.00907.x","article-title":"Anxiety, depression, and nature of acne vulgaris in adolescents","volume":"39","author":"Aktan","year":"2000","journal-title":"Int J Dermatol"},{"key":"2026102707591249000_llag231-B5","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1111\/j.1473-2165.2010.00478.x","article-title":"Acne vulgaris and depression: a retrospective examination","volume":"9","author":"Uhlenhake","year":"2010","journal-title":"J Cosmet Dermatol"},{"key":"2026102707591249000_llag231-B6","doi-asserted-by":"crossref","first-page":"1083","DOI":"10.1093\/ced\/llae531","article-title":"Global prevalence of mental health comorbidity in patients with acne: an analysis of trends from 1961 to 2023","volume":"50","author":"Chen","year":"2025","journal-title":"Clin Exp Dermatol"},{"issue":"Suppl. 1","key":"2026102707591249000_llag231-B7","doi-asserted-by":"crossref","first-page":"i11","DOI":"10.1093\/bjd\/ljad251","article-title":"Is it really ever \u2018just acne\u2019? Considering the wider psychodermatological burden of acne","volume":"189","author":"Hughes","year":"2023","journal-title":"Br J Dermatol"},{"key":"2026102707591249000_llag231-B8","doi-asserted-by":"crossref","first-page":"1","DOI":"10.5070\/D34HP8N68P","article-title":"Acne in adolescents: quality of life, self-esteem, mood, and psychological disorders","volume":"17","author":"Dunn","year":"2011","journal-title":"Dermatol Online J"},{"key":"2026102707591249000_llag231-B9","doi-asserted-by":"crossref","first-page":"746","DOI":"10.1016\/j.jaad.2008.07.013","article-title":"Self-esteem and body satisfaction among late adolescents with acne: results from a population survey","volume":"59","author":"Dalgard","year":"2008","journal-title":"J Am Acad Dermatol"},{"key":"2026102707591249000_llag231-B10","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1159\/000104863","article-title":"From the brain\u2013skin connection: the neuroendocrine\u2013immune misalliance of stress and itch","volume":"13","author":"Arck","year":"2006","journal-title":"Neuroimmunomodulation"},{"key":"2026102707591249000_llag231-B11","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1001\/jamadermatol.2023.4579","article-title":"Risk of suicide and psychiatric disorders among isotretinoin users: a meta-analysis","volume":"160","author":"Tan","year":"2024","journal-title":"JAMA Dermatol"},{"key":"2026102707591249000_llag231-B12","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1016\/j.jaad.2022.10.031","article-title":"Isotretinoin and the risk of psychiatric disturbances: a global study shedding new light on a debatable story","volume":"88","author":"Kridin","year":"2023","journal-title":"J Am Acad Dermatol"},{"key":"2026102707591249000_llag231-B13","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1111\/ijd.16997","article-title":"No association between isotretinoin and impulsivity in patients with moderate-to-severe acne vulgaris","volume":"63","author":"Ogut","year":"2024","journal-title":"Int J Dermatol"},{"key":"2026102707591249000_llag231-B14","doi-asserted-by":"crossref","first-page":"e70106","DOI":"10.1111\/jocd.70106","article-title":"Factors associated with completion of isotretinoin therapy in acne patients reporting mood disturbance","volume":"24","author":"Farrell","year":"2025","journal-title":"J Cosmet Dermatol"},{"key":"2026102707591249000_llag231-B15","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1111\/bjd.21049","article-title":"Isotretinoin and adverse neuropsychiatric outcomes: retrospective cohort study using routine data","volume":"187","author":"Palj\u00e4rvi","year":"2022","journal-title":"Br J Dermatol"},{"key":"2026102707591249000_llag231-B16","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1016\/j.jaad.2024.05.042","article-title":"Neuropsychiatric diagnoses after isotretinoin initiation in pediatric acne patients: a retrospective cohort study","volume":"91","author":"Palj\u00e4rvi","year":"2024","journal-title":"J Am Acad Dermatol"},{"key":"2026102707591249000_llag231-B17","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1016\/j.jaad.2025.02.072","article-title":"Reported psychiatric adverse events among isotretinoin users: monitoring priorities from a 20-year FDA Adverse Event Reporting System database study","volume":"93","author":"Nie","year":"2025","journal-title":"J Am Acad Dermatol"},{"key":"2026102707591249000_llag231-B18","doi-asserted-by":"crossref","first-page":"455","DOI":"10.46747\/cfp.710708455","article-title":"Update to acne vulgaris treatment for Canadian practice","volume":"71","author":"Keow","year":"2025","journal-title":"Can Fam Physician"},{"key":"2026102707591249000_llag231-B19","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1093\/bjd\/ljae326","article-title":"A retrospective review of isotretinoin treatment-related mental health and sexual function outcomes in a tertiary acne clinic","volume":"192","author":"Mitsaki","year":"2025","journal-title":"Br J Dermatol"},{"key":"2026102707591249000_llag231-B20","first-page":"719","article-title":"iPLEDGE program: where are we now?","volume":"153","author":"Bona","year":"2018","journal-title":"G Ital Dermatol Venereol"},{"key":"2026102707591249000_llag231-B21","first-page":"e26561","article-title":"The analysis of acne increasing suicide risk","volume":"100","author":"Xu","year":"2021","journal-title":"Medicine (Baltimore)"},{"key":"2026102707591249000_llag231-B22","first-page":"e50740","article-title":"The psychological impact of isotretinoin therapy on acne vulgaris patients","volume":"15","author":"Alamri","year":"2023","journal-title":"Cureus"},{"key":"2026102707591249000_llag231-B23","first-page":"1214063","article-title":"Physiological and psychological effects of isotretinoin in the treatment of patients with acne: a narrative review","volume":"14","author":"Ding","year":"2023","journal-title":"Front Pharmacol"}],"container-title":["Clinical and Experimental Dermatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ced\/advance-article-pdf\/doi\/10.1093\/ced\/llag231\/68437769\/llag231.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ced\/article-pdf\/51\/11\/1983\/68437769\/llag231.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ced\/article-pdf\/51\/11\/1983\/68437769\/llag231.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T11:59:20Z","timestamp":1793102360000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ced\/article\/51\/11\/1983\/8698745"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,30]]},"references-count":23,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2026,5,30]]},"published-print":{"date-parts":[[2026,10,27]]}},"URL":"https:\/\/doi.org\/10.1093\/ced\/llag231","relation":{},"ISSN":["0307-6938","1365-2230"],"issn-type":[{"value":"0307-6938","type":"print"},{"value":"1365-2230","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,11]]},"published":{"date-parts":[[2026,5,30]]}}}