Search

Background: Acne vulgaris is a common chronic inflammatory skin disorder of pilosebaceous units. Isotretinoin (13-cis retinoic acid) is the most effective multifunctional treatment for moderate-to-severe and nodulocystic acne. Vitamin D plays a role in the immune system, and its deficiency might contribute to the pathogenesis of acne. Objective: To investigate whether isotretinoin improves serum 25-hydroxyvitamin D levels in acne vulgaris patients. Methods: This prospective cohort study included 68 patients with acne vulgaris. Lipid profiles, liver function tests, and serum 25-hydroxyvitamin D [25 (OH) D] levels were measured at baseline and three months after starting isotretinoin treatment. Results: There was a significant increase in serum vitamin D levels three months after starting isotretinoin treatment in mild acne patients (P=0.0003). Conclusion: Vitamin D levels are altered in acne vulgaris. Isotretinoin therapy is associated with an increase in vitamin D levels, which was statistically significant in mild acne patients. Considering the role of vitamin D in acne, effective treatment with isotretinoin might highlight vitamin D as a possible target for acne therapy or as a biomarker for disease activity and remission.

Background: The value of creatine phosphokinase (CPK) monitoring during isotretinoin therapy is still a matter of debate because of the rarity of muscular and kidney damage in this setting. The aim of the study was to investigate the incidence of CPK elevation during a low starting dose isotretinoin regimen and to discuss the clinical approach to patients with increased CPK. Methods: We reviewed the records of the acne patients from 2015 to 2018 at the University of Ferrara and at the University of Modena and Reggio Emilia. Routine clinical and laboratory follow-up was analyzed. Results: The records of 328 patients were included in the study. Abnormal CPK levels were observed in 5.5% of cases. Revised Leeds acne scores and visual assessment scale (VAS) measurements decreased significantly after isotretinoin therapy. Discussion: The adoption of the low starting dose isotretinoin regimen is associated with low incidence of CPK elevation. The finding of CPK over the conventional value of 5 times above the limit was rarely observed and was never associated with kidney damage. Therefore, it should be interpreted as a relatively benign phenomenon that does not require the interruption of isotretinoin therapy and that should be managed mainly through the reassurance of the patient.

Mohammed Elshafie,1 Azza Srour,2 Hussien el-Ansarey,2 Mostafa Abdel-kader,2 Ibrahim Kabbash,3 Mohamed Mashaly4 1Ophthalmology, Faculty of Medicine, KafrELSheikh University, Mansoura, Egypt; 2Faculty of Medicine, KafrELSheikh University, KafrELSheikh, Egypt; 3Public Health & Community Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt; 4Dermatology, Andrology and STDs, Faculty of Medicine, Port Said University, Mansoura, EgyptCorrespondence: Mohamed Mashaly 35511 Tel +201067123134Email mohamed.mashaly@med.psu.edu.egAim: The FDA approved isotretinoin for moderate and severe nodulo-cystic acne, in which it proved effective. However, this misled the dermatologists into using isotretinoin for mild cases as well. This misuse increased the risk of developing adverse effects, especially on the ocular system. These adverse effects vary from mild reversible eye dryness to severe irreversible loss of night vision. Also, it causes contact lens intolerance and corneal ulcer on top. Both ophthalmologists and dermatologists have different perceptions of the drug.Purpose: To evaluate dermatologists’ knowledge and attitude toward ocular adverse effects of isotretinoin in Egypt.Methods: This cross-sectional study was conducted via an online questionnaire. The questionnaire had three parts: 1) demographic data, 2) knowledge about isotretinoin dry eye disorders, contact lens intolerance, and refractive surgery precautions and 3) dermatologists’ management of a case on isotretinoin therapy. We contacted 111 participants from Facebook dermatologists’ groups between March and April 2021.Results: We surveyed 111 dermatologists. One hundred and five (94.6%) reported their knowledge about ocular side effects. One hundred of them (90.1%) informed their patients about the drug’s adverse effects. Eighty-three (74.8%) reported their knowledge about contact lens intolerance. Forty-one dermatologists (36.9%) screened their patients for recent refractive surgery before isotretinoin therapy. Nearly, all dermatologists routinely prescribed lubricant eye drops for the patients, and 63 (56.8%) dermatologists sometimes referred their patients to an ophthalmologist. We found an association between knowledge about contact lens intolerance and years of experience (p=0.012). As well, we found that the academic degree of dermatologists is directly proportional with warning patients about ocular side effects (p=0.003) and refractive surgery (p=0.039).Conclusion: Egyptian dermatologists were knowledgeable about the effects of isotretinoin on eyes with inappropriate clinical practice.Keywords: awareness, ophthalmic adverse effects, ocular dryness, academic

Background: The safety of laser therapy in patients taking isotretinoin is controversial. Recent evidence suggests that laser during isotretinoin treatment is safe. Our study aims to assess public perception and willingness to undergo laser intervention while receiving isotretinoin.Methods: An online-based cross-sectional survey was conducted between November 2019 and March 2020. Information on participants knowledge about isotretinoin precautions with laser therapy and their willingness to undergo laser intervention while on isotretinoin therapy was collected.Results: Out of 509 respondents, almost one-third used laser therapy while on isotretinoin treatment. Those who did not use laser therapy most commonly attributed to isotretinoin treatment (43%). Forty-two percent of participants thought that laser therapy while on isotretinoin is harmful. Almost half of the participants were aware that current guidelines recommend waiting for six months after isotretinoin. Nearly, half of the participants decided to postpone laser therapy for acne scars even after knowing that recent studies reported the safety of laser therapy for acne scars while on isotretinoin.Conclusion: Even with the knowledge of recent safety data of laser during isotretinoin therapy, a significant proportion of patients are still concerned about potential complications. Increasing awareness regarding the safety of laser skin therapy during isotretinoin treatment might be needed.

Background Acne vulgaris is a chronic inflammatory disorder of the pilosebaceous unit that affects predominantly adolescents and young adults. Oral isotretinoin is a highly effective treatment agent for patients with nodulocystic acne and moderate to severe acne resistant to conventional therapy, isotretinoin might have side effects of oxidative stress and lipid peroxidation. . Malondialdehyde is the end product of lipid peroxidation and is a good marker of free radical-mediated damage and oxidative stress. Objective The purpose of this study to estimate malondialdehyde level in patients on Isotretinoin treatment for moderate to severe acne and compare them with healthy control group. Patients and Methods The case-control study was conducted at Ain. Shams University Faculty of Medicine, Egypt, from October 2017 to April 2017, and comprised male or non-pregnant female patients more than 18 years of age. 88 participants were included in the study; 44 cases, categorized by the Global Evaluation Acne (GEA) into 22 patients with moderate acne vulgaris and 22 patients with severe acne in comparison to equal healthy matching group. Isotretinoin was started in a dosage of 0.5mg/kg/day, and1.0mg/kg/day in patients with moderate and severe acne vulgaris respectively. Malondialdehyde, liver function tests, lipid profile and CBC were tested at the baseline for all participants and after 3 months for the patients who started isotretnoin therapy. Results In the current study, the mean baseline level malondialdehyde among all cases was 141.39 µmo1/m1±88.90, (range: 34.5 -360) and in controls it was 40 [µmo1/m1 ±11.3, (range: 9.5-90.4) this difference was statistically highly significant (P = 0.001). There was highly significant difference in malondialdehyde serum level (p = 0.0001) among all cases after 3 months of isotretnoin therapy, also there was a significant increase in MDA serum level among moderate cases (p = 0.021) and highly significant increase of MDA in severe cases (p=.001).ALP, ALT, serum cholesterol and triglyceride significant increases were seen in all cases. Conclusion low dose isotretinoin seems to have less side effects on basic laboratory data such as CBC, liver function tests, lipid profile and Malondialdehyde serum levels than high dose.

Progression of phycoemotional state of 22 patients with severe acne was assessed based on changes in rates of CADI, APSEA, DSQL. Monotherapy with isotretinoin (Acnecutan) is effective in treating severe acne resistant to therapy providing stable remission which is shown by decrease in rates of CADI, APSEA, DSQL.

WOS: 000501595400001, PubMed: 31769896, The aim of the present study was to investigate the potential effects of isotretinoin on the biliary system in patients with acne vulgaris receiving isotretinoin therapy. This was a preliminary retrospective study involving 40 patients with severe acne vulgaris who attended the dermatology clinic and were administered different doses (20 or 30 mg/day) of isotretinoin. Serum levels of AST, ALT, ALP, GGT, total bilirubin, direct bilirubin, and indirect bilirubin at the beginning and at the first month of therapy were scanned, recorded, and statistically analyzed. Total and indirect bilirubin levels at the first month of treatment in 30 patients, receiving isotretinoin at a dose of 20 mg/day, were significantly lower compared to the baseline values (p = .02 and p = .03, respectively), whereas AST and GGT serum levels were significantly higher (p = .003 and p = .006 respectively). No significant reduction in total and indirect bilirubin levels was detectable at the first month of treatment in 10 patients receiving isotretinoin at a dose of 30 mg/day; however, AST, ALP, and GGT levels were significantly elevated in these patients (p = .023; p = .004; and p = .001, respectively). To our knowledge, there is no previous study investigating the effects of isotretinoin on the biliary system, and, therefore, the present study is a preliminary one. Our findings implicate that low dose (20 mg/day) isotretinoin therapy can potentially reduce total and indirect bilirubin levels. Long-term, large-scale, prospective studies with patients receiving different doses of isotretinoin may provide more reliable information regarding the bilirubin lowering effects of isotretinoin and optimum dosing for achieving this clinical effect.

In this article, the first coauthor, a young woman with acne vulgaris, shares her experience with the condition; she not only describes the clinical presentation and the eventual successful treatment of her acne, but also the emotional consequences that this skin disorder caused. The second coauthor, the patient’s dermatologist, reviews some of the features of acne vulgaris: morphologic manifestations, pathogenesis, and treatment options. He also summarizes the patient’s response to isotretinoin therapy. In addition, he reveals his subsequent enlightenment regarding the acne-related non-dermatologic effects that the patient experienced and the significant improvement of her self-image that occurred following the successful treatment of her acne.

Background Isotretinoin has been reported to elevate creatine kinase, which may lead to fatal rhabdomyolysis. Objective To review the literature and propose practice guidelines for management of elevated creatine kinase during isotretinoin therapy. Findings Patients have intrinsic and extrinsic qualities that may synergistically work with isotretinoin to elevate serum creatine kinase. Darker skin types and males on isotretinoin are more likely to have elevated creatine kinase. Isotretinoin may induce oxidative stress within muscle tissue, thereby leading to elevations in serum creatine kinase. Conclusion Evidence supports a tenuous correlation between isotretinoin, elevated creatine kinase, and exercise. Physicians should consider obtaining baseline creatine kinase on elite athletes and counseling patients on risk factors that may elevate creatine kinase. However, the potential for elevated CK is not a contraindication for isotretinoin therapy.

To investigate the effects of systemic isotretinoin therapy on retina by measuring retinal nerve fiber layer (RNFL) and macular thicknesses.This prospective, cross-sectional study was conducted in patients prescribed systemic isotretinoin therapy. Seventy-two eyes of 36 patients were included in the study. The patients were followed during three months. Detailed ophthalmologic examination including anterior and posterior segment examination, best corrected visual acuity and intraocular pressure measurement, RNFL and macular thicknesses measurement by Spectral Domain Cirrus Optical Coherence Tomography Model 400 (Carl Zeiss Meditech, Jena, Germany) were performed at baseline, first, second and third months after the beginning of systemic isotretinoin therapy in ophthalmology clinic.Thirty (83.3%) of the 36 patients were women and six (16.7%) of them were men. Mean age was 21.17 years. Mean RNFL thickness in the temporal quadrant at first, second, third months after beginning of treatment were found as significantly lower compared to baseline (p = .001). Mean macular thicknesses in superior outer, nasal outer and temporal outer quadrants at second and third months after beginning of treatment were found to be significantly lower compared to baseline and first month after beginning of treatment (p ≤ .001, .002 and .001, respectively). Macular thicknesses in superior inner quadrant at first, second and third months were found to be significantly lower than baseline values (p .01). No significant difference was detected between groups in other quadrants (p .05).The effect of oral isotretinoin therapy may cause regional thinning in RNFL and macula, directly visible part of central nervous system.

For decades it has been widely accepted that elective procedures should be delayed for at least 6-months following completion of isotretinoin therapy. However, numerous 2017 publications demonstrate the need for change in best practice. The evidence has yet to be succinctly summarized in a single article or in a stand-alone quick reference algorithm for physicians. This article's review of all 2017 publications confirms that the 6-month delay is not necessary for all procedures and provides a simple algorithmic approach to summarize the updated recommendations for procedural delay of cosmetic procedures following systemic isotretinoin therapy. This is a useful tool for clinicians and allows patients to receive the most appropriate and timely cosmetic therapy to minimize the psychosocial impact of the skin condition.

Acne is the most common skin disease, and isotretinoin is the most powerful drug among the various drugs used for its treatment. A causal relationship has not yet been established between isotretinoin use and depression. The aim of this study is to research the effect of isotretinoin treatment on depression in a group of patients undergoing isotretinoin therapy. Behavioral tests measuring anxiety and depression, and the measures assessing acne severity and quality of life were applied to 112 acne patients consulted at Dermatology Clinic of Beyazit Medico Social Center of Istanbul University. In this study, 72 acne patients (61 females and 11 males) were evaluated. A significant decrease was observed in HAD-D, GAGS, and CADI scores at the end of the therapy. There was no significant relationship between patients' depression history and HAD-D scores at the end of first month of therapy and at the end of treatment. Although the psychiatrists are concerned about the potential psychiatric side effects of isotretinoin, our data support no causal relationship between isotretinoin use and depression in acne patients.

Nodulocystic acne is a severe form of acne which can result in significant damage to the skin with great impact on quality of life. Oral isotretinoin considered to be the best treatment for such cases. Although it has a high rate of success and its efficacy is well established in the treatment of nodulocystic acne, it may occasionally fail to control the disease. We report a case of a patient who presented to our skin clinic with severe facial nodulocystic acne in which treatment with isotretinoin failed to achieve disease control and caused worsening of his baseline condition. Therefore, oral dapsone was administered as an alternative treatment, and we reached a complete remission of acne lesions within six months. Oral dapsone could be an adequate and safe drug in severe acne, and it might also be a promising and hopeful alternative treatment for nodulocystic acne when isotretinoin fails.

Isotretinoin is an effective treatment for severe and scarring acne. In this report, we describe a case developing vitiligo after isotretinoin therapy for scarring acne. It is not known whether this was a coincidence or might be precipitated by the treatment.

A 15-year-old male individual treated with isotretinoin for acne vulgaris presented with persistent pancytopenia and circulating myeloblasts after discontinuation of the drug. Marrow assessment revealed myelofibrosis (MF) and myeloblasts exhibiting monosomy 7, diagnostic of myelodysplastic syndrome (MDS). Although a popular website seems to associate isotretinoin with MF, no published cases of MF or MDS attributable to this drug were identified. Although we expect that he would eventually have developed MDS and MF, this patient was perhaps identified sooner due to cytopenias accelerated by isotretinoin. This case illustrates that patients exhibiting cytopenias persisting following isotretinoin therapy merit evaluation for underlying hematopoietic disorders.

Objective. Evaluation of changes of morphometric skin indicators of patients with moderate severity of acne in the course of treatment with systemic isotretinoin in the LIDOSE form. Materials and methods. 30 patients have been under study in the course of isotretinoin therapy ( LIDOSE form) with the dosage of 0.6-0.8 mg/kg per day till the course dose was reached 100-120 mg per kg of the body mass. Control group comprised 30 apparently healthy people. Results. The research conducted has revealed a high efficacy and tolerance of the therapy, and a valid positive tendency of changes in morphometric skin indicators has also been traced in the course of treatment. Conclusion. The conducted research has indicated that isotretinoin LIDOSE form has a positive effect on pathogenic mechanisms acne.

We described a case of psoriasis possibly resulting from isotretinoin therapy in acne. A 17-year-old patient started treatment with oral isotretinoin (30mg of drug) due to acne vulgaris. After 4 weeks, of treatment, the patient complains for the presence of scattered erythematous plaques and papules. The clinical picture suggested psoriasis (this is also confirmed by histopathological study). The history revealed that the patient’s mother suffered from psoriasis for 30 years.J MEDICINE January 2017; 18 (1) : 37-38

Isotretinoin has revolutionized the treatment of severe acne vulgaris, a condition which if left untreated may result in significant socio-psychological implications for those affected. Timely access to isotretinoin therapy is important to avoid the risks of potential physical and emotional scarring. However, due to its high risks of teratogenicity, isotretinoin must be used with care in females of childbearing potential. Since isotretinoin's introduction, numerous risk management programs have been implemented across the world in an attempt to prevent isotretinoin use in pregnancy. This paper aims to provide an evidence-based review of the risk management programs for isotretinoin in Australia, Europe, Singapore, New Zealand, and the United States of America. The effectiveness of these programs and the factors leading to isotretinoin exposure in pregnancy are critically analyzed in an effort to inform the future direction with respect to designing the ideal regulatory program. Stringent risk management programs, such as the iPLEDGE in the US and Pregnancy Prevention Program (PPP) in Europe, may not be effective in reducing the risks of fetal exposure to isotretinoin when used alone. There is evidence that such strenuous regulation results in increased fear of teratogenic risks but does not translate into a reduced rate of pregnancies exposed to isotretinoin. A successful program must prioritize education about effective contraception, while minimizing any extraneous requirements, to ensure that women are not inadvertently undertreated for acne.

Introduction and Background: Isotretinoin is an oral medication used for the treatment of severe acne unresponsive to other medications. This drug is teratogenic and should be prescribed with appropriate caution in selected group of patients. The washout period for pregnancy post isotrenoin therapy has always been a topic of controversy. Several guidelines have recommended a wash out period of one month if pregnancy is planned in a patient being administered with the drug. Objective: This article discusses the available evidence for different recommended wash out periods and addresses important clinical questions that arise. Methods: Pubmed research was carried out to collect relevant data using the keywords isotretinoin, pregnancy, contraception, pharmacokinetics and guidelines. Conclusion: Our research based on the published data concludes that a wash out period of 35 days post isotretinoin therapy is adequate in routine clinical practice.

We report a patient with severe acne who developed facial paralysis after two months of treatment with oral isotretinoin. Drug withdrawal resulted in a complete clinical recovery. Our case and a review of the literature indicate that oral isotretinoin might be capable of causing a dysfunction of predominantly sensory nerve fibers in some individuals. Clinicians should be aware of possible neurological sensorial symptoms during isotretinoin therapy.

Summary Monitoring of triglycerides for patients on isotretinoin is practised primarily to avoid hypertriglyceridaemia-associated pancreatitis. The aim of this study was to describe clinically the published cases of hypertriglyceride-associated pancreatitis. A comprehensive search strategy using MEDLINE, Embase and grey literature was conducted (1960 to January 2016) to identify all case reports of isotretinoin-associated pancreatitis and all relevant studies of isotretinoin and triglycerides for any indication (≥ 20 patients). Terms related to isotretinoin, triglycerides and pancreatitis were searched with all available synonyms. Any studies that used isotretinoin and mentioned triglycerides or pancreatitis were searched in full text, where available, for cases of pancreatitis. Studies from all countries and published in any language were included, but Korean and Turkish studies could not be analysed. Two authors independently reviewed the publications to determine eligibility, and for data extraction. In total, 125 papers fulfilled the inclusion criteria and were searched for cases of pancreatitis. Eleven papers with 25 cases of pancreatitis associated with isotretinoin were identified; four of these cases were likely due to hypertriglyceridaemia. Three patients had elevated baseline triglycerides, but no monitoring. Pancreatitis occurred 6 and 7 weeks, and 6 months after initiation of therapy. For the fourth patient who was treated for glioblastoma and died, no detailed clinical information was available. Idiosyncratic pancreatitis associated with isotretinoin is the most frequent pancreatitis on isotretinoin, and patients should be warned about it. Hypertriglyceride-associated pancreatitis is an exceedingly rare adverse event of isotretinoin therapy. Our data cannot give a frequency or risk for either adverse event. Based on the clinical information of the patients available, we conclude that for patients without elevated baseline triglycerides, or risk thereof, monitoring of triglycerides during therapy is of little value.

Lymphangioma circumscriptum (LC) is a superficial form of lymphatic malformation that can be difficult to treat. Therapeutic approaches to LC such as laser therapy, sclerotherapy, and surgical excision give varying results. This is the first description of a case of LC successfully treated with oral isotretinoin. Further studies are needed to confirm whether this is a reproducible treatment option.

Objective: In this study, we aimed to investigate the efficiency and side effects of intermittent low dose isotretinoin therapy in moderate acne. Materials and Methods: Patients followed up at our acne outpatient clinic between September 2007 and April 2009 were evaluated. Those treated with 20 mg/day isotretinoin three times a week were included in the study. Relevant data were recorded from patient files. We recorded the age and weight of the cases, duration of acne, previous treatments, acne grading based on global acne scoring system, side effects and pretreatment and posttreatment Dermatology Life Quality Index scores. Hemogram, liver function tests, lipid profiles at baseline and monthly follow-ups were noted. Results: Global acne scoring of complete response rate in 94.3% of 35 patients was achieved after one year of therapy. The partial response rate was 5.7%. The earliest clinical response was observed after four weeks. The Dermatology Life Quality Index was 7.8 at baseline and 1.8 at the end of the treatment. Cheilitis was the only side effect observed. We observed mild degree relapses in 5 cases in the evaluation 17 months after the end of the treatment.Conclusion: Our results show that low dose intermittent isotretinoin therapy is an effective and tolerable treatment in moderate acne.

Isotretinoin (13-cis-retinoic acid) is a synthetic vitamin A derivative that is effective in the treatment of recalcitrant, nodulocystic acne. To our knowledge, there are no reports in the medical literature of milia as a side effect of isotretinoin. We report a case of eruptive facial milia in the setting of isotretinoin treatment for acne.

Confluent and reticular papillomatosis is a rarely seen dermatosis. It is characterised by the joining together of brown, hyperkeratotic papules and plaques in a reticular pattern. It is generally seen in females in the 10-35 years age range and the etiology is not fully known. The case is here presented of a 40-year old female, diagnosed with confluent and reticular papillomatosis who responded well to isotretinoin treatment. [Med-Science 2017; 6(2.000): 367-8]

A 33-year-old male was treated with isotretinoin (20mg daily) for hidradenitis suppurativa. After 6 weeks on the medication, he developed symmetrical erythematous tense blisters on the lower legs. Report of biopsy done was of intraepidermal blisters with superficial dermal lymphohistiocytic infitrates. He was commenced on oral prednisolone 30mg daily and Isotretinoin was withdrawn. The blisters resolved over a 2week period. The lesions of hidradenitis suppurativa were noticed to have improved with the short course of isotretionoin.