Efficacy, psychological and physical adverse effects of isotretinoin in the treatment of acne: a cross-sectional study from Syria

This study aims to evaluate the effectiveness of isotretinoin in the treatment of acne, while also monitoring its associated physical and psychological adverse effects. A descriptive cross-sectional study was conducted using an online questionnaire distributed to individuals who are currently experiencing acne or have experienced it in the past. The questionnaire included items regarding acne severity, type and duration of treatment, adherence, side effects and overall satisfaction. Data were statistically analyzed. A total of 377 participants, aged ≥ 15 years, were included in the study. 89.1% of them followed isotretinoin treatment, of whom 316 found an overall improvement (262 as marked). Side effects were experienced by 309 with most commonly reported ones were physical (supplementary Table 1). 189 (56.3% of isotretinoin users) reported psychological symptoms such as anxiety, mood changes, depression or even suicidal thoughts. Despite side effects, 86.2% were satisfied with the treatment's efficacy, while 19.9% discontinued the medication due to adverse effects. Isotretinoin is widely regarded as an effective treatment for moderate to severe acne. However, its use requires strict medical supervision before and during the treatment period due to its wide range of potential physical and psychological adverse effects. The findings underscore the critical importance of comprehensive awareness among patients, physicians and pharmacists regarding the potential risks-particularly psychological ones-that may escalate to suicidal tendencies in vulnerable individuals. This highlights the necessity for integrated management approaches that include regular medical and psychological monitoring. Given the persistent neglect of mental health in many communities, especially low-income countries, these results are concerning and call for increased public awareness and a shared responsibility among healthcare providers and patients. Healthcare providers should inform patients (and parents if possible) about such adverse effects and encourage them to immediately report any concerning symptoms so that the most suitable decision can be made, including discontinuation of the drug and referring to psychologists.