Exploring The Effect Of Oral Isotretinoin Therapy On Depression Mood And Quality Of Life In Moderate And Severe Acne Vulgaris Patients

Objective This study was undertaken to explore the effect of oral Isotretinoin and Xinhuangpian treatments on depression and quality of life in moderate and severe acne patients. So as to supply scientific evidences for a comprehensive, systematic treatment of acne, improving the patients’depression and quality of life.Methods This study was a clinical randomized controlled trial. According to the inclusion and exclusion criteria, patients with moderate and severe acne who visited doctors in dermatology department of the Third Xiangya Hospital of Central South University between April and August2013were selected as participants of this study. Patients were recruited and randomly divided into two groups:51cases for experimental group and52cases for control group. Learnt the basic conditions of these patients and the relevant factors of the onset detailly, and explained the considerations to these patients carefully before treatment. In this study,103patients with moderate and severe acne were prescribed a16-week treatment. Except for regular care, patients in experimental group received oral Isotretinoin therapy and patients in control group received oral Xinhuangpian therapy till the end. Data collection instruments included general questionnaire designed by researchers, Pillsbury acne classification standard, Adolescent Self-Rating Life Events Check (ASLEC), Beck Depression Inventory (BDI), Dermatology Life Quality Index(DLQI). At the initiation of drug treatment, week8review and termination of treatment (week16), patients completed the questionnaires. Statistic analysis were performed with SPSS19.0. Statistical methods included statistical description, Χ2test, one way analysis of variance, repeated measurement ANOVA and Nonparametric test.Results1.The comparison of social demographic characteristics of patients with moderate and severe acne showed that the differences between two groups were insignificant statistically (P>0.05). The comparison of clinical acne classification standard and course of patients with moderate and severe acne before the study showed that the differences between two groups were insignificant statistically (P>0.05). The comparison of BDI score, the depression classification and DLQI score of patients with moderate and severe acne before the study showed that the differences between two groups were insignificant statistically (P>0.05). Two groups were well-balanced and comparable.2.The average BDI total score for103patients before treatment was10.68±7.879.74patients had an varying degrees of depression (BDI score≥5) and the detection rate was71.8%, of which mild depression44cases(42.7%), moderate depression18(17.5%) and severe depression12cases (11.7%). The suffering caused by acne were mainly sad, sleep disorders and a decrease of attention to others (social withdrawal).3.The average DLQI total score for103patients’quality of life before treatment was7.42±4.552. The main impact of Acne on the patients’quality of life were embarrassment, pain or itching and the effect on their social and leisure activities.4.Results of repeated measurements analysis of variance showed that the main effect of intervention on total BDI score had no significant difference (P>0.05). The time’s main effect of total BDI score was significantly different (P<0.001), suggesting that the outcome variable (total BDI score) was changed with the trend of time. There were significant interactions between time and intervention (P<0.01).The presence of an interaction was directly confirmed by the interaction contour map:total BDI score of different groups basically displayed the same trend with time, gradually decreasing as the time went by.5.The results of Bonferroni showed that in experimental(Isotretinoin) group the total BDI score of treatment course8weeks was significantly lower than the total BDI score before treatment (P<0.001), the total BDI score of treatment course16weeks was significantly lower than the total BDI score before treatment (P<0.001), and the total BDI score of treatment course16weeks was lower than that of treatment course8weeks(P<0.001).In control(Xinhuangpian) group the total BDI score of treatment course8weeks was significantly lower than the total BDI score before treatment (P<0.001), the total BDI score of treatment course16 weeks was significantly lower than the total BDI score before treatment (P<0.001), and the total BDI score of treatment course16weeks was lower than that of treatment course8weeks(P<0.001).6.The results of two independent sample T-test showed that both before the treatment and course8weeks the comparison of total BDI score showed no difference between two groups(P>0.05). There was significantly difference of total BDI score between two groups in treatment course16weeks. The average difference between two groups was-2.189(P<0.05).7.Results of Wilcoxon signed-rank test showed that the patients’ depression classification was significantly improved after16weeks treatment in both experiment and control groups (P<0.001). Results of Mann-Whitney U showed that the experiment group had better improving effect than the control group of patients’depression classification after16weeks treatment(P<0.001), of which the number without depression was higher than that of control group, and the number of mild, severe patients were lower than the control group (P<0.05).8.Results of repeated measurements analysis of variance showed that the main effect of intervention on total DLQI score had no significant difference (P>0.05). The time’s main effect of total DLQI score was significantly different (P<0.001), suggesting that the outcome variable (total DLQI score) was changed with the trend of time. There were significant interactions between time and intervention (P<0.001).The presence of an interaction was directly confirmed by the interaction contour map:total DLQI score of different groups basically displayed the same trend with time, gradually decreasing as the time went by.9.The results of Bonferroni showed that in experimental(Isotretinoin) group the total DLQI score of treatment course8weeks was significantly lower than the total DLQI score before treatment (P<0.001), the total DLQI score of treatment course16weeks was significantly lower than the total DLQI score before treatment (P<0.001), and the total DLQI score of treatment course16weeks was lower than that of treatment course8weeks(P<0.001).In control(Xinhuangpian) group the total DLQI score of treatment course8weeks was significantly lower than the total DLQI score before treatment (P<0.001), the total DLQI score of treatment course16weeks was significantly lower than the total DLQI score before treatment (P<0.001), and the total DLQI score of treatment course16weeks was lower than that of treatment course8weeks(P<0.001).lO.The results of two independent sample T-test showed that both before the treatment and course8weeks the comparison of total DLQI score showed no difference between two groups(P>0.05). There was significantly difference of total DLQI score between two groups in treatment course16weeks. The average difference between two groups was-1.886(P<0.01).Conclusions l.Oral isotretinoin therapy relieves depression mood degree and improves life quality of patients with moderate and severe acne.2.The improving effect of oral isotretinoin therapy on depression mood and quality of life in moderate and severe acne patients is better than that of Xinhuangpian.