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a satisfa&#231;&#227;o com o tratamento e a incapacidade relacionada ao tratamento foram avaliados por quest&#245;es e escalas do tipo Likert desenvolvidas pelos pesquisadores &#40;n&#227;o validada&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Os escores de depress&#227;o foram comparados entre as diferentes visitas de maneira bivariada e por modelos generalizados mistos com distribui&#231;&#227;o do tipo gama para melhor ajuste&#44; considerou&#8208;se a anormalidade da vari&#225;vel dependente&#46; Os modelos multivariados foram definidos pela inclus&#227;o de vari&#225;veis com p &#60; 0&#44;2 nas an&#225;lises bivariadas&#46; A normalidade das distribui&#231;&#245;es foi avaliada pelo teste de Shapiro&#8208;Wilk e a confiabilidade dos escores usados pelo alfa de Cronbach&#46; Foram considerados significativos valores de p &#60; 0&#44;05&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Foram inclu&#237;dos 42 participantes com pelo menos uma visita ap&#243;s o in&#237;cio do tratamento&#44; 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p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;24&#41;&#46; A <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a> ilustra a influ&#234;ncia das vari&#225;veis estudadas no escore de Beck ao in&#237;cio do tratamento&#44; destacam&#8208;se a renda familiar&#44; os antecedentes psiqui&#225;tricos e o escore de Cardiff&#46; J&#225; a <a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a> ilustra a influ&#234;ncia dessas vari&#225;veis durante o tratamento&#44; destacam&#8208;se a dura&#231;&#227;o pr&#233;via da acne&#44; a intensidade dos efeitos adversos mucocut&#226;neos&#44; a dose acumulada de isotretino&#237;na e o escore de Beck inicial&#46; Todos os escores usados no estudo apresentaram confiabilidade aceit&#225;vel ou superior &#40;alfa de Cronbach &#62; 0&#44;7&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">A grande maioria dos pacientes &#40;6&#47;7&#41; que apresentaram n&#237;veis clinicamente significativos na escala de Beck &#40;&#60; 19&#41; j&#225; se apresentara assim ao in&#237;cio do tratamento&#44; houve uma melhoria dos escores da maioria desses pacientes nas avalia&#231;&#245;es subsequentes&#46; Curiosamente&#44; n&#227;o houve correla&#231;&#227;o desse com a gravidade cl&#237;nica da acne no momento inicial&#44; indicaram&#8208;se fatores subjacentes no impacto psicol&#243;gico da doen&#231;a&#44; como o n&#237;vel socioecon&#244;mico&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Durante o tratamento&#44; verificou&#8208;se precoce e significativa redu&#231;&#227;o dos escores de depress&#227;o j&#225; nos primeiros meses&#44; sugerindo que a expectativa e a percep&#231;&#227;o de melhoria continuada podem ter um importante impacto psicol&#243;gico&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Com rela&#231;&#227;o aos sintomas depressivos durante o tratamento&#44; n&#227;o se verificou associa&#231;&#227;o significativa com a gravidade ou a incapacidade relacionada &#224; acne&#44; por&#233;m com maiores efeitos adversos do tratamento&#44; maior dura&#231;&#227;o pr&#233;via da acne&#44; maiores escores iniciais de depress&#227;o e menores doses acumuladas de isotretino&#237;na&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">A identifica&#231;&#227;o da associa&#231;&#227;o da intensidade dos efeitos adversos mucocut&#226;neos com os sintomas depressivos ressalta a import&#226;ncia de se estar atento a esses&#44; aplicar medidas para mitig&#225;&#8208;los efetivamente e orientar o paciente antecipadamente&#44; principalmente no in&#237;cio do tratamento&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">O estudo apresenta limita&#231;&#245;es quanto a perdas de seguimento e uso irregular da medica&#231;&#227;o por alguns participantes&#44; al&#233;m de ser monoc&#234;ntrico&#46; Por outro lado&#44; trata&#8208;se de estudo observacional de car&#225;ter pragm&#225;tico&#44; de modo que os modelos estat&#237;sticos mistos possibilitaram a an&#225;lise robusta das s&#233;ries com dados faltantes&#46; Al&#233;m disso&#44; o desenho usado permitiu avaliar varia&#231;&#245;es internas e temporais nas vari&#225;veis estudadas&#44; com resultados compat&#237;veis com a literatura dispon&#237;vel&#44; al&#233;m de trazer novas informa&#231;&#245;es sobre o perfil dos sintomas depressivos em pacientes em uso de isotretino&#237;na oral para acne&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Suporte financeiro</span><p id="par0060" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Contribui&#231;&#227;o dos autores</span><p id="par0065" class="elsevierStylePara elsevierViewall">Juliano Vilaverde Schmitt&#58; An&#225;lise estat&#237;stica&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; concep&#231;&#227;o e planejamento do estudo&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; revis&#227;o cr&#237;tica da literatura&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Priscilla Pereira Luvizotto&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; concep&#231;&#227;o e planejamento do estudo&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; revis&#227;o cr&#237;tica da literatura&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflitos de interesse</span><p id="par0075" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0030">Como citar este artigo&#58; Luvizotto PP&#44; Schmitt JV&#46; Depressive symptoms before and during treatment of acne with isotretinoin and its correlations&#58; a prospective study&#46; An Bras Dermatol&#46; 2020&#59;95&#58;760&#8211;3&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0035">Trabalho realizado no Departamento de Dermatologia e Radioterapia&#44; Faculdade de Medicina&#44; Universidade Estadual Paulista&#44; Botucatu&#44; SP&#44; Brasil&#46;</p>"
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          "pt" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Evolu&#231;&#227;o do escore de depress&#227;o de Beck durante o tratamento &#40;&#42;p &#60; 0&#44;01&#41;&#46; Avalia&#231;&#227;o <span class="elsevierStyleItalic">post hoc</span> &#40;sequencial Sidak&#41;&#58; p &#60; 0&#44;05 nas compara&#231;&#245;es 0&#8208;3&#44; 0&#8208;6&#44; 0&#8208;9&#44; 0&#8208;12&#46;</p>"
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                  \t\t\t\t">0&#44;70&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>I&#8208;II&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7 &#40;2&#8208;15&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>III&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10 &#40;5&#8208;20&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>IV&#8208;V&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;1&#8208;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Hist&#243;ria familiar acne</span><a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;23&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sim&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">7 &#40;2&#8208;12&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>N&#227;o&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">10 &#40;3&#8208;20&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Escolaridade</span><a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">d</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;30&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>At&#233; m&#233;dio incompleto&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8 &#40;3&#8208;12&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>M&#233;dio completo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9 &#40;4&#8208;20&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Superior&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#44;5 &#40;0&#8208;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Renda familiar &#40;sal&#225;rio m&#237;nimo&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>0&#44;31<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;13&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8804; 2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">11&#44;5 &#40;2&#8208;20&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62; 2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5 &#40;2&#8208;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>0&#44;65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Antecedente psiqui&#225;trico</span><a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;09&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;2&#8208;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Idade in&#237;cio acne &#40;anos&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>At&#233; m&#233;dio incompleto&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
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Carta – Investigação
Sintomas depressivos antes e durante o tratamento de acne com isotretinoína e suas correlações: estudo prospectivo
Priscilla Pereira Luvizotto, Juliano Vilaverde Schmitt
Autor para correspondência
julivs@gmail.com

Autor para correspondência.
Departamento de Dermatologia e Radioterapia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil
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de ambos os sexos e com mais de 13 anos&#44; recrutados de 2015 a 2017&#46; O projeto foi aprovado pelo Comit&#234; de &#201;tica &#40;parecer n&#176; 712&#46;311&#41;&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Os pacientes foram avaliados antes do in&#237;cio da isotretino&#237;na e nos meses 1&#44; 3&#44; 6&#44; 9 e 12&#44; at&#233; a data final do uso da medica&#231;&#227;o&#46; A avalia&#231;&#227;o se deu segundo dados demogr&#225;ficos&#59; gravidade da acne&#44; segundo escala baseada na classifica&#231;&#227;o do FDA de 2002&#44; e quantifica&#231;&#227;o das les&#245;es na hemiface esquerda&#59; gravidade das cicatrizes&#44; baseada na escala de cicatrizes de acne &#40;ECCA&#41; publicada em&#160;2007&#44; al&#233;m do <span class="elsevierStyleItalic">Cardiff Acne Disabilty Index</span> &#40;CADI&#41; e da escala de depress&#227;o de Beck&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2&#8211;5</span></a> Os efeitos adversos mucocut&#226;neos da isotretino&#237;na&#44; a satisfa&#231;&#227;o com o tratamento e a incapacidade relacionada ao tratamento foram avaliados por quest&#245;es e escalas do tipo Likert desenvolvidas pelos pesquisadores &#40;n&#227;o validada&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Os escores de depress&#227;o foram comparados entre as diferentes visitas de maneira bivariada e por modelos generalizados mistos com distribui&#231;&#227;o do tipo gama para melhor ajuste&#44; considerou&#8208;se a anormalidade da vari&#225;vel dependente&#46; Os modelos multivariados foram definidos pela inclus&#227;o de vari&#225;veis com p &#60; 0&#44;2 nas an&#225;lises bivariadas&#46; A normalidade das distribui&#231;&#245;es foi avaliada pelo teste de Shapiro&#8208;Wilk e a confiabilidade dos escores usados pelo alfa de Cronbach&#46; Foram considerados significativos valores de p &#60; 0&#44;05&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Foram inclu&#237;dos 42 participantes com pelo menos uma visita ap&#243;s o in&#237;cio do tratamento&#44; observou&#8208;se uma amostra com 18 mulheres &#40;43&#37;&#41;&#44; idade mediana de 18 &#40;p25&#8208;p75&#58; 16&#8208;21&#41; anos e dura&#231;&#227;o da acne de 4 &#40;2&#8208;6&#41; anos&#46; Apresentavam um escore de Cardiff m&#233;dio de 7&#44;79 &#40;dp<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#44;62&#41; e de Beck mediano de 7&#44;5 &#40;2&#8208;16&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">A <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a> ilustra a regress&#227;o do escore de Beck durante o tratamento&#46; A correla&#231;&#227;o entre o escore de Beck e CADI ao in&#237;cio do tratamento foi de 0&#44;38 &#40;<span class="elsevierStyleItalic">Rho</span> de Spearman&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41; e entre o escore de Beck e a gravidade cl&#237;nica da acne foi de<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>0&#44;19 &#40;<span class="elsevierStyleItalic">Rho</span> de Spearman&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;24&#41;&#46; A <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a> ilustra a influ&#234;ncia das vari&#225;veis estudadas no escore de Beck ao in&#237;cio do tratamento&#44; destacam&#8208;se a renda familiar&#44; os antecedentes psiqui&#225;tricos e o escore de Cardiff&#46; J&#225; a <a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a> ilustra a influ&#234;ncia dessas vari&#225;veis durante o tratamento&#44; destacam&#8208;se a dura&#231;&#227;o pr&#233;via da acne&#44; a intensidade dos efeitos adversos mucocut&#226;neos&#44; a dose acumulada de isotretino&#237;na e o escore de Beck inicial&#46; Todos os escores usados no estudo apresentaram confiabilidade aceit&#225;vel ou superior &#40;alfa de Cronbach &#62; 0&#44;7&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">A grande maioria dos pacientes &#40;6&#47;7&#41; que apresentaram n&#237;veis clinicamente significativos na escala de Beck &#40;&#60; 19&#41; j&#225; se apresentara assim ao in&#237;cio do tratamento&#44; houve uma melhoria dos escores da maioria desses pacientes nas avalia&#231;&#245;es subsequentes&#46; Curiosamente&#44; n&#227;o houve correla&#231;&#227;o desse com a gravidade cl&#237;nica da acne no momento inicial&#44; indicaram&#8208;se fatores subjacentes no impacto psicol&#243;gico da doen&#231;a&#44; como o n&#237;vel socioecon&#244;mico&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Durante o tratamento&#44; verificou&#8208;se precoce e significativa redu&#231;&#227;o dos escores de depress&#227;o j&#225; nos primeiros meses&#44; sugerindo que a expectativa e a percep&#231;&#227;o de melhoria continuada podem ter um importante impacto psicol&#243;gico&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Com rela&#231;&#227;o aos sintomas depressivos durante o tratamento&#44; n&#227;o se verificou associa&#231;&#227;o significativa com a gravidade ou a incapacidade relacionada &#224; acne&#44; por&#233;m com maiores efeitos adversos do tratamento&#44; maior dura&#231;&#227;o pr&#233;via da acne&#44; maiores escores iniciais de depress&#227;o e menores doses acumuladas de isotretino&#237;na&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">A identifica&#231;&#227;o da associa&#231;&#227;o da intensidade dos efeitos adversos mucocut&#226;neos com os sintomas depressivos ressalta a import&#226;ncia de se estar atento a esses&#44; aplicar medidas para mitig&#225;&#8208;los efetivamente e orientar o paciente antecipadamente&#44; principalmente no in&#237;cio do tratamento&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">O estudo apresenta limita&#231;&#245;es quanto a perdas de seguimento e uso irregular da medica&#231;&#227;o por alguns participantes&#44; al&#233;m de ser monoc&#234;ntrico&#46; Por outro lado&#44; trata&#8208;se de estudo observacional de car&#225;ter pragm&#225;tico&#44; de modo que os modelos estat&#237;sticos mistos possibilitaram a an&#225;lise robusta das s&#233;ries com dados faltantes&#46; 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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p &#40;biv&#46;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Coef&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> &#40;multi&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Sexo</span><a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Masculino&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Feminino&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">8 &#40;2&#8208;16&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Idade atual &#40;anos&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;04 &#40;&#8722;0&#44;27&#8208;0&#44;34&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Idade in&#237;cio acne &#40;anos&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;06 &#40;&#8722;0&#44;24&#8208;0&#44;36&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Dura&#231;&#227;o &#40;anos&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;07 &#40;&#8722;0&#44;26&#8208;0&#44;35&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Fototipo</span><a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">d</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>I&#8208;II&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7 &#40;2&#8208;15&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>III&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10 &#40;5&#8208;20&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>IV&#8208;V&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;1&#8208;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Hist&#243;ria familiar acne</span><a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7 &#40;2&#8208;12&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10 &#40;3&#8208;20&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Escolaridade</span><a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">d</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>M&#233;dio completo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Renda familiar &#40;sal&#225;rio m&#237;nimo&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Antecedente psiqui&#225;trico</span><a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>N&#227;o&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Gravidade geral acne</span><a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">d</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">N&#250;mero de p&#225;pulas &#40;hemiface&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Hist&#243;ria familiar acne</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>N&#227;o&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>At&#233; m&#233;dio incompleto&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Renda familiar &#40;sal&#225;rios m&#237;nimos&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Antecedente psiqui&#225;trico</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>N&#227;o&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sim&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;16&nbsp;\t\t\t\t\t\t\n
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Modelos generalizados mistos bivariados e multivariados com distribui&#231;&#227;o tipo Gama e fun&#231;&#227;o de liga&#231;&#227;o logar&#237;tmica&#46; Os indiv&#237;duos com o intercepto foram inclu&#237;dos como fatores aleat&#243;rios&#46; Akaike corrigido<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>273&#44;17&#59; p&#160;&#40;modelo&#41; &#60; 0&#44;01&#46;</p>"
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ISSN: 26662752
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