Avaliação de sintomas depressivos em pacientes com acne vulgar sob tratamento com isotretinoína oral
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Data
2018-08-01
Autores
Pereira, Priscilla Alves
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Universidade Estadual Paulista (Unesp)
Resumo
Fundamentos: Apesar da isotretinoína oral ser um tratamento eficaz para casos graves e persistentes de acne, existe significativa preocupação e controvérsia sobre seus efeitos adversos psicológicos. Por outro lado, a acne apresenta significativo impacto psicossocial nos portadores. Objetivos: Avaliar adolescentes e adultos jovens sob tratamento com isotretinoína oral para acne moderada a grave quanto a sintomas depressivos e suas relações com variáveis demográficas e clínicas. Métodos: Estudo tipo coorte com portadores de acne tratados com isotretinoína oral. Foram avaliados Cardiff Acne Disability Index (CADI), escala de depressão de Beck (EDB), gravidade da acne e cicatrizes e escore de efeitos adversos mucocutâneos (EEAM). Resultados: Foram incluídos 42 pacientes, 43% do sexo feminino, com idade mediana de 18 [1q-3q:16-21], seguidos por um período de 9 [6-9] meses. EDB passou de 7,5 [2-16] pré-tratamento para 1 [0-5] ao final do seguimento (p<0,01), sendo que 43% apresentavam pontuação para depressão leve ou superior pré-tratamento, contra 14% ao final do seguimento (RP=0,33 (IC 95%: 0,15 a 0,76); p<0,01). EDB pré-tratamento associou-se à presença de antecedentes psiquiátricos, menor renda familiar e maior CADI (p<0,05), enquanto durante o tratamento associou-se à maior duração prévia da acne, a maiores EEAM, à menor dose acumulada e a maiores EDB iniciais (p<0,05). Limitações: Perdas de seguimento, não apresentar grupos controle, monocêntrico. Conclusões: Há melhora nos escores de depressão no tratamento da acne vulgar com isotretinoína oral. Durante o tratamento, os sintomas depressivos estão associados à duração prévia da acne, aos efeitos adversos mucocutâneos e aos escores de depressão iniciais.
Background: Despite the effectiveness of oral isotretinoin for severe and persistent acne, there is concern and controversy about its possible psychological adverse effects. On the other hand, acne causes significant psychosocial impact on patients. Objective: Assess treatment with oral isotretinoin for moderate to severe acne in adolescents and young adults regarding depressive symptoms and their relationships with demographic and clinical variables. Methods: Cohort study with patients with acne under treatment with oral isotretinoin. Four aspects were considered: Cardiff Acne Disability Index (CADI), Beck Depression Inventory (BDI), acne and scars severity and Mucocutaneous Adverse Effects Score (MAES). Results: Forty-two participants were included, 43% were female, median age 18 years old [1q-3q:16-21], followed up for 9 [6-9] months. The BDI went from 7.5 [2- 16] before the treatment to 1 [0-5] after the follow up (p<0.01). 43% had score for mild depression or worse before treatment – the number dropped to 14% in the end of the study (RP=0.33 (IC 95%: 0.15 to 0.76); p<0.01). The BDI before treatment correlates to psychiatric history, lower family income and higher CADI (p<0.05), while during the treatment it correlates to the duration of acne, higher MAES, lower cumulative dose and higher initial BDI (p<0.05). Study Limitations: Loss of follow-up, lack of a control group, monocentric. Conclusion: There is improvement on the depression scores when acne vulgaris is treated with oral isotretinoin. During the treatment, the symptoms of depression are associated with previous duration of acne, adverse mucocutaneous effects and initial depression scores.
Background: Despite the effectiveness of oral isotretinoin for severe and persistent acne, there is concern and controversy about its possible psychological adverse effects. On the other hand, acne causes significant psychosocial impact on patients. Objective: Assess treatment with oral isotretinoin for moderate to severe acne in adolescents and young adults regarding depressive symptoms and their relationships with demographic and clinical variables. Methods: Cohort study with patients with acne under treatment with oral isotretinoin. Four aspects were considered: Cardiff Acne Disability Index (CADI), Beck Depression Inventory (BDI), acne and scars severity and Mucocutaneous Adverse Effects Score (MAES). Results: Forty-two participants were included, 43% were female, median age 18 years old [1q-3q:16-21], followed up for 9 [6-9] months. The BDI went from 7.5 [2- 16] before the treatment to 1 [0-5] after the follow up (p<0.01). 43% had score for mild depression or worse before treatment – the number dropped to 14% in the end of the study (RP=0.33 (IC 95%: 0.15 to 0.76); p<0.01). The BDI before treatment correlates to psychiatric history, lower family income and higher CADI (p<0.05), while during the treatment it correlates to the duration of acne, higher MAES, lower cumulative dose and higher initial BDI (p<0.05). Study Limitations: Loss of follow-up, lack of a control group, monocentric. Conclusion: There is improvement on the depression scores when acne vulgaris is treated with oral isotretinoin. During the treatment, the symptoms of depression are associated with previous duration of acne, adverse mucocutaneous effects and initial depression scores.
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Palavras-chave
acne vulgaris, isotretinoin, depression, acne vulgar, isotretinoína, depressão