Safety and efficacy of fluoxetine in the treatment of acne excoriée: a double-blind, placebo-controlled study

Background: Self-inflicted acne excoriée is often observed in patients with compulsive skin picking, posing a challenge for diagnosis and treatment as the exact psychiatric cause remains unknown. Studies have suggested that serotonin reuptake inhibitors such as fluoxetine may help in the management of this condition. The aim of this study was to determine the efficacy and safety profile of fluoxetine in the treatment of acne excoriée and to study the psychological profiles of patients. Methods: 􀀵􀁋􀁚􀁖􀁛􀀂􀁒􀁃􀁖􀁋􀁇􀁐􀁖􀁕􀀂􀁑􀁈􀀂􀁇􀁋􀁖􀁊􀁇􀁔􀀂􀁕􀁇􀁚􀀂􀁃􀁉􀁇􀁆􀀂􀅮􀀓􀀘􀀂􀁛􀁇􀁃􀁔􀁕􀀂􀁙􀁋􀁖􀁊􀀂􀁃􀁅􀁐􀁇􀀂 excoriée were assigned to either group A (n = 30), which received oral fluoxetine (F) (20 mg/day) and oral doxycycline (D) (100 mg/ day) with topical clindamycin (1%), or group B (n = 30), which received a placebo (P), oral doxycycline (100 mg/day), and topical clindamycin (1%). Patients were evaluated for standardized rating scales and followed up every two weeks for 12 weeks. Results: Female gender predominance was observed in both groups, with most patients exhibiting anxiety and depression. With each follow-up visit (2nd, 3rd, 4th, and 5th) in both groups (A and B), the mean Acne Excoriée Severity Index (AESI) (91.4% vs. 26.7%), Hamilton Anxiety Rating Scale (HAM-A) (80% vs. 27.7%), Montgomery-Asberg Depression Rating Scale (MADRS) (68.1% vs. 28.2%), Yale-Brown Obsessive-Compulsive Scale (YBOCS) (98.27% vs. 15.63%), PGA (88.47% vs. 31.38%), and visual analogue scale (VAS) (99.17% vs. 37.67%) scores decreased from baseline by the final visit, indicating improved patient conditions. Significant differences were observed between the two groups (P < 0.001) in the overall response, indicating that fluoxetine was more efficacious than the control. No remarkable side effects were noted. Conclusion: Fluoxetine efficiently managed acne excoriée without remarkable side effects.