The Effect of Oral Isotretinoin on Quality of Life in Patients With Acne Vulgaris: A Systematic Review and Meta-Analysis of Patient-Reported Outcomes.

Acne vulgaris is a highly prevalent chronic inflammatory skin disorder that can adversely affect psychological well-being, social functioning, and overall quality of life. Oral isotretinoin is widely regarded as an effective treatment for moderate to severe acne, yet its influence on patient-reported quality-of-life outcomes remains incompletely characterized because published studies have reported variable findings. We performed a systematic review and meta-analysis following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 recommendations. PubMed, Scopus, Web of Science, the Cochrane Library, and Google Scholar were searched from database inception to April 5, 2026. Eligible studies included patients with acne vulgaris treated with oral isotretinoin and reporting quality-of-life outcomes using validated instruments. Risk of bias was evaluated using ROBINS-I (Risk Of Bias In Non-randomized Studies of Interventions) for non-randomized studies and the Cochrane Risk of Bias 2 (RoB 2) for the randomized trial. For studies reporting sufficient independent Dermatology Life Quality Index (DLQI) data, pooled effect estimates were calculated using a random-effects model. Fourteen studies with varying designs, settings, and patient populations met the inclusion criteria for the systematic review. Across studies, oral isotretinoin treatment was generally associated with improved quality of life, with the most consistent benefits observed with dermatology-specific and acne-specific instruments. Four studies contributed sufficient independent data to the quantitative synthesis. Meta-analysis showed a significant reduction in DLQI scores following isotretinoin treatment, corresponding to improved quality of life (standardized mean difference (SMD) = -1.49, 95% confidence interval (CI): -2.48 to -0.51). Heterogeneity was substantial (I² = 98.1%). In exploratory subgroup analyses, improvements were observed in both mixed-severity and severe or treatment-resistant acne populations, with no statistically significant difference between subgroups. Oral isotretinoin appears to be associated with meaningful improvements in quality of life among patients with acne vulgaris, particularly when assessed using dermatology- or acne-specific instruments. However, the substantial heterogeneity and predominance of non-randomized studies warrant cautious interpretation of the pooled effect. Further well-designed prospective and randomized studies using standardized quality-of-life measures and longer follow-up are needed to better establish the magnitude and durability of these benefits.