MultiHub Forum

I'm a dermatology resident, and I'm preparing a presentation on treatment-resistant acne vulgaris for our weekly case conference. The patient is a young adult with severe nodulocystic acne on the face and trunk that has failed multiple courses of oral antibiotics and topical retinoids. We're considering isotretinoin, but the patient has a history of depression, which complicates the risk-benefit discussion. I'm looking for insights on alternative or adjunctive therapies, like hormonal treatments or advanced procedural options, and how others navigate the psychiatric contraindications with isotretinoin.

Isotretinoin remains the most effective option for refractory nodulocystic acne, but a history of depression makes the risk‑benefit discussion more nuanced. If you’re considering it, build a plan with mental health input: baseline mood assessment, monthly mood screens, and a clear stop rule if mood worsens. Involve psychiatry early and secure informed consent that includes potential mood changes.