Abstract
The possibility that diffuse idiopathic skeletal hyperostosis (DISH) could be a complication of isotretinoin therapy was not appreciated until after the drug had been introduced. We report 120 patients with acne, who were X-rayed within 1 year of a 4-month course of isotretinoin (mean dose 0·5 mg/kg/day). Since DISH is an age-dependent disease, we compared the data with age-matched controls who were X-rayed for a non-significant soft tissue injury. In the vast majority of the treated group, any detectable changes were subtle, and consisted of minimal hyperostoses in the anterior spinal ligaments and tibial spines and either calcaneal or Achilles'spurs. Fourteen (9%) had some relevant skeletal change, but 5% of the control group had similar changes. We have now X-rayed again nine of the original 14 patients who were noted to have skeletal changes. One was noted to have some radiological deterioration, four were unchanged, and four showed some slight improvement. The single patient who did show deterioration had back problems preceding therapy and his radiographs demonstrated marked DISH changes in the lumbar spine. These data fit with the report by Cope, Cunningham and Kilcoyne1 who also showed a 9% incidence of DISH-like changes. This study was also retrospective, but had no control data. We suggest that although prospective studies are needed, and are in hand, DISH is unlikely to be a significant complication of isotretinoin therapy for acne. We recommend X-raying all patients over 35 years old, prior to therapy, and younger patients only if complaining of joint symptoms. We would recommend X-rays of the dorso-lumbar spine, and ankles.
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