Isotretinoin-based treatment in patients with acne: main physiological and psychological effects

Abstract

Isotretinoin remains the most effective systemic therapy for moderate to severe acne, with the potential to achieve long-term remission. However, its clinical utility is limited by a broad spectrum of adverse effects that involve both physiological and psychological domains. Objectives were to review the principal physiological and psychological effects associated with isotretinoin therapy and discuss their clinical implications for patient selection and monitoring. A narrative synthesis was conducted using recent evidence, with emphasis on adverse events such as teratogenicity, mucocutaneous manifestations, ocular alterations, metabolic and hematologic changes, as well as the debated relationship between isotretinoin and mood disturbances. Physiological side effects consistently reported include teratogenic risk, cheilitis, xerosis, ocular surface changes, dyslipidemia, musculoskeletal pain, and alterations in hepatic function. Psychological outcomes remain controversial: while some studies suggest increased risk of depression and suicidality, others highlight improvement in psychosocial well-being due to acne resolution. These discrepancies appear to be influenced by the underlying psychological burden of acne itself. Isotretinoin is a cornerstone in acne management but requires strict monitoring and patient education. Future research should prioritize disentangling the psychiatric effects attributable to the drug from those inherent to severe acne, while optimizing strategies to mitigate physiological toxicity.