Isotretinoin In Treatment Of Acne Research Articles

Re-evaluating the necessity of routine laboratory monitoring during isotretinoin therapy for acne.

In this letter, we discuss the topic of necessity of routine laboratory monitoring during isotretinoin treatment for acne. According to Park and colleagues, it is advisable to monitor the levels of triglycerides, alanine aminotransferase, and aspartate aminotransferase every 5 to 6 months. Additionally, the levels of total cholesterol and low-density lipoprotein should be checked within the first two months of treatment. Isotretinoin is a commonly prescribed agent mainly used to treat acne. Despite its high effectiveness, it necessitates regular monitoring of laboratory parameters due to its side effect profile. Currently, there remains a lack of consensus on the appropriate frequency for monitoring these parameters during treatment with isotretinoin. This letter will provide insight into this complex and controversial topic. Based on existing literature, we concluded that the incidence of changes in lipid and liver aminotransferase levels during isotretinoin treatment for acne was low and likely clinically insignificant. For generally healthy people, we recommend testing lipid and liver profiles once at baseline and a second time at the peak dosage. However, frequent testing might still be beneficial in certain populations of patients.

Treatment of a Population of 32 Patients with ALS and Spine Injury Grafting Stem Cells through Neuroendoscopy

Introduction: Isotretinoin, a potent acne treatment, has notable side effects, including depression and teratogenicity. Idiopathic Intracranial Hypertension (IIH), characterized by elevated intracranial pressure, has been linked to isotretinoin. This study explores the awareness of IIH among isotretinoin users in Saudi Arabia, addressing a crucial healthcare concern. Methodology: It is a cross-sectional study conducted in Saudi Arabia using a self-administered questionnaire shared via social media and in dermatology clinics. Data is cleaned in excel and analyzed in IBM SPSS 29. Results: Our study included 420 Isotretinoin users, primarily females (76.9%), aged 18-25 (64.3%), from Eastern (29.5%) and Western (26.7%) regions, with high school (49.3%) and university graduates (46.7%). All used Isotretinoin for acne treatment, with varied usage durations. Some used additional medications like Vit. A (Retinol) (23.1%). Notably, only 26.7% were aware of Idiopathic Intracranial Hypertension (IIH), and 18.1% believed Isotretinoin increased IIH risk. Educational level significantly impacted IIH awareness (p<0.001), while age, gender, and regional factors had less impact. Acne presence did not notably affect IIH awareness. Conclusion: Our study emphasizes the necessity of enhancing Idiopathic Intracranial Hypertension (IIH) awareness among Isotretinoin users. Despite some sociodemographic influences on awareness, there is a pervasive lack that requires targeted education for safer medication use and improved patient outcomes.

The occurrence of mental health symptoms in isotretinoin-treated adolescents.

Isotretinoin treatment for acne can reduce adverse psychiatric outcomes in adults, but there has been little investigation of the incidence of psychiatric outcomes in treated adolescents. This retrospective cohort study using the Rochester Epidemiology Project identified 606 patients aged 12-18 prescribed isotretinoin over a 10-year period between January 1, 2008 and December 31, 2017. Medical records were reviewed to identify psychiatric diagnoses before and during isotretinoin therapy, as well as psychiatric symptoms not captured by formal diagnoses and changes to isotretinoin dosing because of psychiatric diagnoses or symptoms. One hundred seventy-seven (29.2%) had a psychiatric diagnosis prior to isotretinoin initiation, but 98 (16.2%) had a new psychiatric diagnosis or psychiatric symptom while taking isotretinoin. Patients with a psychiatric history were no more likely than those without to receive a new psychiatric diagnosis during treatment (4.5% vs. 3.7%; p = .650), but did experience more psychiatric symptoms, primarily low mood and mood swings (23.7% vs. 7.7%; p < .001). Only 25.5% of the 98 with a new psychiatric diagnosis or psychiatric symptom had a subsequent dose change. A dose change was more likely if patients received a new psychiatric diagnosis (41.7% vs. 20.3%; p = .037) or patients did not have a psychosocial explanation for psychiatric symptoms (34.4% vs. 10.8%; p = .009). A substantial proportion of adolescent patients prescribed isotretinoin had a prior psychiatric diagnosis.This predicts more psychiatric symptoms during isotretinoin treatment. Adolescents with a psychiatric history who have worsening symptoms and those with new-onset psychiatric symptoms would benefit from close monitoring while taking isotretinoin.

40 years’ experience of using isotretinoin in treatment of acne: efficacy, optimal dosage, relapses

Objective — to analyze domestic and foreign literature sources on the use of systemic isotretinoin (SI) in the treatment of acne, focus on aspects of the evolution of the isotretinoin molecule, new routes of action and dosing regimens of the drug, the effectiveness of therapy, relapses and prognostic factors of their development. Materials and methods. We conducted the analysis of publications (systematic reviews, clinical trials and observational studies) from the databases of the Vernadskyi National Library of Ukraine, PubMed, MEDLINE, Web of Science and Scopus by June 2023. The search criteria were the words «acne», «systemic therapy», «isotretinoin», «isotre­tinoin-LIDOSE», «mechanism of action», «efficacy», «daily dose», «cumulative dose», «relapses» and their analogues in the English language. The final choice of 60 sources was based on the author’s judgments about their completeness and significance for solving the goals. Results and discussion. The clinical efficacy of SI is due to its powerful effect on the leading links of the pathogenesis: hyperproliferation of follicular keratinocytes, hyperactivity of sebocytes, excessive colonization of Cutibacterium acnes and immune-mediated inflammation. A comparative analysis of two forms of SI existing in Ukraine was carried out, the advan­tages of isotretinoin-LIDOSE over standard isotretinoin in clinical practice were determined. It is not possible to draw a clear conclusion about the indications for SI use in acne because there are conflicting recommendations in national guidelines (USA, UK, Canada) and the international consensus of the Global Alliance. At present, in addition to the standard daily doses of SI, a number of regimens have been proposed in the treatment of moderate and mild acne, suggesting a certain reduction in the corresponding doses that decreases the risk of side effects and has sufficient therapeutic efficacy. The advantages and disadvantages of standard, high-dose and low-dose isotretin regimens are described in terms of effectiveness, duration of remission, and relapse rate. Conclusions. Isotretinoin has a high profile of clinical efficacy. It is a treatment for severe and moderate forms of acne that provides a stable therapeutic effect at standard (0.5—1 mg/kg/day) or high doses (more than 1 mg/kg/day). The treatment of acne of moderate and mild severity with low daily doses of SI (less than 0.5 mg/kg) leads to the preservation of the effectiveness of therapy while improving tolerability and reducing the possible risk of side effects. It was determined that the rate of regression of clinical manifestations of acne does not depend on the daily dose (low, standard, high), but the frequency of relapses increases in patients who received low doses. The effectiveness of treatment is higher with the use of fixed (daily) standard, low or high doses of SI compared with intermittent use (every other day, 1 week or 10 days per month). Achieving a cumulative dose (120 to 150 mg/kg) is supported by clinical studies, consensus and dermatological practice. The duration of therapy with standard doses is 16—24 weeks, in the low-dose regimen — for a long time (more than 8 months). It is determined individually until a clinical effect is achieved. In cases of earlier regression of acne manifestations, when patients have not reached the cumulative dose, treatment with SI should be continued until complete regression of the rash and for the following 4—8 weeks. The use of isotretinoin-LIDOSE due to extrabioavailability, high solubility, independence from food intake allows obtaining better clinical results and improving compliance in the treatment of acne patients.

How safe and effective is prescribing oral isotretinoin to treat acne in patients on renal dialysis? A systematic review.

Patients on renal dialysis often develop severe acne. In spite of this, the literature remains scarce about the use of isotretinoin for the treatment of acne in this group of patients, and many clinicians remain apprehensive and hesitant to use it. To systematically review the literature surrounding the safety and efficacy of isotretinoin for the treatment of acne in patients on renal dialysis. Four electronic databases (MEDLINE, Embase, CINAHL, Emcare) were systematically searched in March 2021. The search strategy incorporated the terms 'isotretinoin', 'renal', 'kidney', 'dialysis' and 'acne', along with terms closely related to these. Studies were considered eligible if they reported the use of isotretinoin for treatment of acne in patients with renal impairment or on renal dialysis, and if they had relevant implications to this topic. The search resulted in a total of 63 results. Using the PRISMA approach, 11 articles were deemed relevant to this review: 1 randomized single-blinded placebo-controlled trial, 2 case series, 2 retrospective studies and 6 case reports. Hence the level of evidence was mostly low (Grading of Recommendations, Assessment, Development and Evaluations level 3). This review of the literature suggests that low-dose isotretinoin (10-20 mg) can safely and successfully be used to treat severe acne in patients on renal dialysis, leading to a significant improvement in their quality of life. As the current literature on this topic is scarce, more studies would be beneficial to further establish the safe use of isotretinoin in patients on renal dialysis.

Systematic review of low-dose isotretinoin for treatment of acne vulgaris: Focus on indication, dosage, regimen, efficacy, safety, satisfaction, and follow up, based on clinical studies.

Oral isotretinoin is the most effective treatment for moderate to severe acne and its side effects are mostly dose-dependent. Low dose isotretinoin (0.5 mg/kg/day for 1 week every 4 weeks for 6-months) could be effective and even in its end result, comparable with high or optimal doses. In this systematic review, we aimed to sum up the results of clinical trials regarding indications, dosage, prescription protocol, effectiveness, side effects, patient satisfaction, recurrence rate, and follow-up period of low dose isotretinoin in treatment of acne. Cochrane, Google Scholar, Science Direct, PubMed, and Medline were searched. A total of 460 articles were searched electronically and 382 articles were excluded. About 4 were non-English and 2, before 1980. The full text of 72 articles was reviewed. Finally 15 documents met the inclusion criteria for entering this systematic review. The standard dose of isotretinoin is 0.5-1 mg/kg/day for 4 months with a total dose of 120-140 mg/kg/day. Daily doses between 0.1 and 0.3 mg/kg can be recommended for more than 6 months due to the occurrence of fewer side effects and more economical concerns. For greater effectiveness, it could be combined with other medications.

Retrospective analysis of smell and taste disturbances associated with dermatologic medications reported to the United States Food and Drug Administration and relevance to COVID-19 infections

Retrospective analysis of smell and taste disturbances associated with dermatologic medications reported to the United States Food and Drug Administration and relevance to COVID-19 infections

Awareness of Taibah University Female Students toward Risks and Safety of Using Oral Isotretinoin for Acne Treatment

Awareness of Taibah University Female Students toward Risks and Safety of Using Oral Isotretinoin for Acne Treatment

Efficacy and safety of synchronous use of the fractional carbon dioxide laser with low, medium or high-dose isotretinoin for treatment of acne and acne scars: A retrospective study of 80 patients from the Indian population

Introduction: Isotretinoin is an approved drug from the United States (US) Food and Drug Administration (FDA) for the treatment of severe recalcitrant nodular acne. Based on reports of poor wound healing and scarring, many practitioners believe that the majority of cutaneous laser treatments should be delayed at least six to 12 months after a patient discontinues isotretinoin treatment. The purpose of this study was to investigate the safety and the efficacy of fractional carbon dioxide laser combined with the low (6mg/day), medium (18mg/day) or high dose (30mg/day) of isotretinoin for the treatment of acne and acne scars and, investigation of the factor associated with the synchronous use of isotretinoin and fractional CO2 laser. Settings and Design: The study was retrospective, non- randomized, single-centre, open case series performed in our private clinic. A retrospective chart review was conducted for all patients registered at our private clinic for assessment of acne from April 2016 through March 2018. Materials and Methods: In this study, 80 patients with acne scarring were treated with 10,600nm fractional CO2 laser. Out of eighty, 60 patients in three experimental groups received different dose of isotretinoin (n=20, low dose: 6mg/day; n=20, medium dose: 18mg/day; n=20, high-dose: 30mg/day) prior to the initial fractional CO2 laser treatment. 20 patients with acne scarring who was treated only with the fractional CO2 laser served as control. Acne scars improvement, healing period and presence of keloids formation was taken in account as outcome measured after 6 months follow-up. Statistical analysis: Comparisons of differences in the demographic profile, efficacy and healing period among four groups was done by Kruskal–Wallis test. Multiple comparisons were performed using Kruskal-Wallis test followed by the p-value was adjusted using the Holm-Bonferroni sequential correction “P” to identify independent factors associated with synchronous u

Modern approaches to use of systemic isotretinoin for treatment of acne

Objective — for an in­depth analysis of the domestic and foreign literature, including reports of the results of randomized controlled clinical trials on the application of the system of the drug isotretinoin acne treatment focusing on both short­term and long­term therapeutic effects of different schemes, and modes of therapy, as well as minimizing side effects.Materials and methods. Analysis of global experience of the effectiveness of the application of systematic isotretinoin acne treatment and minimization of side effects by data retrieval (2000—2017) the Cochrane register (The Cochrane Library) controlled trials by keyword isotretinoin, acne; in resource requirements for PubMed, High Wire Press, Google Scholar directory terms and medical topics: isotretinoin + acne + treatment ; reports on the results of randomized controlled clinical trials, Research Center and literature reviews.Results and discussion. Taking into account the analysis of the results of numerous foreign and domestic research, systematic isotretinoin is a highly effective drug in treating moderate and severe forms of acne. Currently, in addition to the standard daily and cumulative doses of isotretinoin in systemic acne therapy of mild and moderate severity, a number of regimens have been suggested that suggest a slight reduction in the corresponding doses, which avoids the risk of side effects while maintaining a sufficiently high therapeutic efficacy.Conclusions. The results of numerous foreign and domestic studies indicate that at the present stage of systematic isotretinoin is most pathogenetically justified drug in the treatment of moderate and severe forms of acne, which allows reach the therapeutical effect when applying the standard regimens.The duration of treatment of moderate to severe forms of acne with standard doses (0.5—1 mg/kg/day) is 6 to 8 months, and in low doses (below 0.5 mg/kg/day) — until the required cumulative dose is reached, which is determined individually based on the state of the clinical picture and the possible side effect, may 8—11 months or more.In mild forms of acne, the use of isotretinoin is possible in the mode of low doses (below 0.5 mg/kg per day), the duration of therapy — until the clinical effect.In the treatment of acne of moderate and severe severity, as well as resistant acne, reducing the risk of side effects by reducing the daily and cumulative dose (by 20 % compared to traditional forms of isotretinoin) while maintaining the effectiveness of therapy is possible with the use of isotretinoin IDOSE® (in Ukraine is marketed under ТМ Acnetin®).These possibilities, as well as the less dependent on the absorption of isotretinoin LIDOSE® from food intakes, determine the minimum of predicted side effects; result in high drug compliance and rapid improvement of CADI, APSEA indices. The results of the studies allowed recommending isotretinoin LIDOSE® as the first­line drug for the treatment of acne with moderate to severe severity.The question remains whether Isotretinoin LIDOSE® can be used to treat acute low­dose acne severity (20 % less than normal isotretinoin) and without cumulative dose compliance.

Evaluation of the effects of isotretinoin for treatment of acne on corneal sensitivity

PurposeTo determine the effect of isotretinoin on corneal sensitivity in acne patients. MethodsFifty patients (13 men and 37 women) with a mean age of 23.24 ± 3.4 years were selected among patients receiving isotretinoin (1.0 mg/kg) for acne according to inclusion criteria. The Cochet-Bonnet esthesiometer was used to measure corneal sensitivity (in mm filament length) two times (the measurements were done immediately before starting the medication, then 3 months after that), including 3 measurements each time, between 11 a.m. and 1 p.m. by an experienced operator. The average of the 3 measurements in each time was recorded as the final value. One-way analysis of variance and Chi square were used for quantitative and qualitative comparison of corneal sensitivity before and after isotretinoin use, respectively. ResultsThe mean corneal sensitivity was 5.54 ± 0.05 before medication consumption which decreased to 5.41 ± 0.05 after isotretinoin treatment for 3 months (P < 0.005). After controlling the effect of age and sex, the decrease of corneal sensitivity was markedly significant (P = 0.003) as decreased corneal sensitivity was more pronounced at higher ages and in female gender. In non-parametric evaluation, corneal sensitivity was categorized as substantial (5.5–6 mm), intermediate (4.5–5.5 mm), and low (3.5–4.5). About 72% of the participants had substantial corneal sensitivity before drug consumption, which decreased to 60% after 3 months of treatment. ConclusionsAccording to the results of this study, corneal sensitivity decreases after three months of treatment with isotretinoin. This decrease is more pronounced at higher ages and in women.

Association between leptin gene rs7799039 polymorphism and lipid profile changes induced by isotretinoin treatment in acne patients.

IntroductionIsotretinoin, a vitamin A-derived medication, is one of the effective treatments for severe acne. However, in a fraction of patients, this treatment causes significant adverse effects. Leptin is a pro-inflammatory cytokine that plays a role in apoptosis of adipose cells and sebaceous lipid metabolism. Thus, genetic polymorphisms in the leptin (LEP) gene may modulate the response to isotretinoin therapy. Here, we explore the contribution of rs7799039 polymorphism of the LEP gene in the adverse effects of the oral isotretinoin therapy among acne patients.Materials and methodsClinical parameters were obtained from 200 patients before and after isotretinoin treatment for acne. In addition, circulatory lipid profile and aspartate transaminase (AST) and alanine aminotransferase (ALT) enzymes from acne subjects before and 1 month after oral isotretinoin treatment were also measured.ResultsAn association between the rs7799039 polymorphism and the following lipid parameters: high-density lipoprotein (HDL) at baseline and after treatment, HDL % change, low-density lipoprotein % change and total cholesterol % change (P < 0.05). In addition, there was an association between the LEP polymorphism and higher AST and ALT at baseline and after treatment (P < 0.05).ConclusionIn conclusion, rs7799039 LEP polymorphism might modulate lipid parameters and liver enzymes, but not other major side effects of oral isotretinoin therapy.

Isotretinoin treatment for acne and risk of depression: A systematic review and meta-analysis

The relationship between isotretinoin treatment for acne and depression is controversial. Quantitative analysis has not yet been conducted. To conduct a meta-analysis, evidence-based examination of the relationship between isotretinoin and depression. A systematic review and meta-analysis of the literature published from inception to September 30, 2016, was conducted. Controlled or prospective non-controlled trials on ≥15 acne patients receiving isotretinoin treatment were included. The prevalence of depression and change in depression scores were calculated. Thirty-one studies met the inclusion criteria. In the controlled studies, the change in depression scores from baseline was not significantly different between patients receiving isotretinoin treatment and those receiving an alternative treatment (standardized mean difference [SMD] -0.334, 95% confidence interval [CI] -0.680 to 0.011). The prevalence of depression after isotretinoin treatment significantly declined (relative risk [RR] 0.588, 95% CI 0.382-0.904). The mean depression scores significantly decreased from baseline (SMD -0.335, 95% CI -0.498 to -0.172). No randomized controlled trials were reviewed; a large inter-study variation was observed. Isotretinoin treatment for acne does not appear to be associated with an increased risk for depression. Moreover, the treatment of acne appears to ameliorate depressive symptoms.

Increased prescribing of systemic tetracyclines and isotretinoin for treatment of acne.

To investigate the prescribing of systemic drugs for the treatment of acne in adolescents in the period 2005-15. The study population consisted of 14-24-year-old users of tetracyclines, isotretinoin or hormonal therapy retrieved from the Norwegian Prescription Database. The 1 year period prevalence was calculated as the number of patients who had redeemed at least one prescription during the year divided by the mean population. If the user had no prescriptions in the preceding 12 months he/she was defined as a new user. The incidence rate was defined by the number of new users during the year divided by the mean population. Increased prescribing rates for systemic tetracyclines and isotretinoin were observed in the period 2005-15, while a decreased prescribing rate for hormonal therapy was observed from 2007. The majority (75%) of the tetracycline prescriptions were prescribed by general practitioner specialists or physicians with no specialty/under training for a specialty. The average durations of treatment in men and women who only used tetracyclines were 3.3 and 2.8 months, respectively. For men and women that switched to isotretinoin, the average durations of treatment were 4.3 and 3.9 months. The increased use of systemic tetracyclines in general, and the prolonged use of tetracyclines in patients who later switch to isotretinoin, raise the question of whether isotretinoin treatment should be considered at an earlier stage to reduce the use of systemic tetracyclines.

Periungual Pyogenic Granuloma-Like Lesions During Isotretinoin Treatment for Acne: Two Case Reports and a Literature Review

Abstract Periungual pyogenic granuloma-like lesions are not uncommon side effects of isotretinoin therapy, but these cases are relatively infrequently reported. Excessive granulation tissue appeared in two patients receiving oral isotretinoin therapy for severe acne. Once isotretinoin was discontinued, the outgrowths resolved spontaneously in both patients. It is probably an idiosyncratic reaction to isotretinoin which renders the skin more susceptible to extracellular matrix and blood vessel formation. Moreover, similar lesions may be observed particularly with newer targeted therapies, such as inhibitors of epidermal growth factor receptor (EGFR) and mitogen-activated protein kinase kinases (MEKs). EGFR inhibitors associated painful periungual inflammation (paronychia), which often arises from the nail wall during newer targeted therapies, has been classified in the third major group of dermatologic toxicity. Cutaneous toxicity may be interpreted as a stress response that affects epidermal homeostasis. In the cell, stress signals are transmitted to effectors which then produce an inflammatory response. In conclusion, paronychia and excessive granulation tissue in the nail folds are not uncommon side effects of oral retinoids. It is therefore particularly important for practicing dermatologists to be aware that the best management approach is drug discontinuation.

Concomitant antibiotic usage does not augment the risk of inflammatory bowel disease with isotretinoin treatment for acne: a review of the Food and Drug Administration Adverse Event Reporting System

To the editor: Evidence varies on whether isotretinoin and/or antibiotics are associated with inflammatory bowel disease (IBD). While earlier studies linked isotretinoin exposure with a subsequent development of IBD [1], other case– control studies have either failed to show this association [2] or only showed it with ulcerative colitis (UC) but not Crohn’s disease (CD) [3]. A study by Margolis et al. utilizing the General Practice Research Database suggested the observed link between isotretinoin and IBD could be the result of previous antibiotic exposure (specifically with the tetracycline family) before isotretinoin usage rather than a primary association with isotretinoin usage [4]. Bernstein et al. utilizing the Manitoba database demonstrated that IBD patients were more likely to have received antibiotics in the 2–5 years prior to the IBD diagnosis [5]. We reviewed all reports of isotretinoin and antibiotic associated IBD in patients with acne in the Food and Drug Administration (FDA) Adverse Event Reporting System (AERS). We sought to investigate whether there is an augmentation in the risk of IBD development with exposure to isotretinoin alone versus isotretinoin and oral antibiotics. We downloaded 2,562,390 files between January 2003 and June 2011 from the FDA AERS and analyzed them using SPSS 20 (IBM Co. Armonk, NY, USA). Because of a potential reporting bias with lawyer initiated reports, only reports from medical professionals and consumers were included in this analysis. A search was conducted for cases of IBD reported with generic and trade names of isotretinoin and oral antibiotics (cephalosporins, penicillins, teracyclines, metronidazole, lincosamides, nitrofurantoin, macrolides, quinolones, and sulfonamides) with an indication of acne. Only cases in which either isotretinoin was listed as primary suspect or one of the oral antibiotics (defined above) were listed as primary suspect were included in the analysis. The cases with antibiotic exposure were stratified into exposure to one, two, or three or more antibiotics. Cases were subdivided between UC and CD, to identify differences in the risk between the two. Furthermore, control reactions (calculus, hernia, joint dislocation, viral infection, herpes, and neoplasm) were pre-defined that were not known to have any association with any of the study drugs. Reports for these control reactions with the study drugs as primary suspect were also included in the analysis. The association for the study drugs with the development of IBD was tested in a two by two table using Fisher’s exact test. Further analysis specific to exposure to tetracycline antibiotics (along with isotretinoin) was also performed. There were 266 cases of IBD with isotretinoin treatment, 37 of which were with antibiotic usage. Compared to isotretinoin usage alone, neither oral antibiotics (p-value00.1209) nor tetracyclines in particular (p-value01.00), augmented the risk of D. J. Stobaugh : P. Deepak : E. D. Ehrenpreis (*) Center for the Study of Complex Diseases, NorthShore University HealthSystem, Evanston, IL, USA e-mail: ehrenpreis@gipharm.net

Concomitant Antibiotic Usage Does Not Further Increase the Risk of Inflammatory Bowel Disease with Isotretinoin Treatment for Acne: A Review of the Food and Drug Administration Adverse Event Reporting System

Concomitant Antibiotic Usage Does Not Further Increase the Risk of Inflammatory Bowel Disease with Isotretinoin Treatment for Acne: A Review of the Food and Drug Administration Adverse Event Reporting System

Evaluation of the clinical effects of isotretinoin on chronic rhinosinusitis

This study aims to evaluate the clinical effects of isotretinoin (13-cis-retinoic acid), a derivative of retinoic acid, on the clinical features of chronic rhinosinusitis. The study group included 25 chronic rhinosinusitis patients (16 females, 9 males; mean age 25.2 ± 6.8 years; range 15 to 25 years) who were on isotretinoin for acne treatment, while the control group consisted of 25 chronic rhinosinusitis patients (15 females, 10 males; mean age 25.2 ± 6.8 years; range 15 to 25 years) who were not on isotretinoin treatment. The patients' symptom scores in visual analog scale (VAS), Lanza and Kennedy nasal endoscopic scores and Newman computed tomography (CT) scores were obtained in order to evaluate the their symptom, examination and radiological findings. These patients' symptom and examination results were evaluated first day, week two and at months 3-5 and 6-10. Paranasal sinus CT results were studied first day and at months 6-10. In the group of patients being administered isotretinoin, no significant change in the mean symptom and examination scores was detected during the acute phase (week 2), while there was a significant regression in the long-term (months 3-5 and 6-10). There was a significant regression in the mean CT score after isotretinoin therapy. In the control group no significant change was seen in any of the scores. The number of acute sinusitis attacks were significantly lower in the isotretinoin group than in the control group. No significant difference was found between the two groups in terms of the duration of the healing period of acute sinusitis attacks. We conclude that the long-term administration of isotretinoin has positive effects on the clinical results of chronic rhinosinusitis.

Obsessive-compulsive disorder with bipolar diathesis following isotretinoin therapy remitting upon treatment with olanzapine and fluvoxamine

Isotretinoin, a drug used for moderate to severe acne, has been repeatedly associated with various psychiatric complications, although a definitive causal relationship has not been established to date. This case report describes a 25-year-old male who developed obsessive-compulsive disorder at the age of 23 years following isotretinoin treatment for acne (10–20 mg/day) since the age of 16 years. Although standard treatment for obsessive-compulsive disorder caused mood swings, the combination of fluvoxamine 300 mg/day and olanzapine 15 mg/day significantly improves the clinical picture. Although rare, severe adulthood psychiatric complications may occur following isotretinoin treatment, requiring management which is individually tailored to the patient.

Creatine phosphokinase values during isotretinoin treatment for acne

Muscle-related complaints and high creatine phosphokinase (CPK) blood levels have been reported in 15-50% of patients with acne treated with isotretinoin. Clinical investigations about CPK levels in isotretinoin therapy were few, and most of them were case reports. The aim of this study was to investigate the incidence, course, and clinical significance of severe hyperphosphokinasemia in isotretinoin therapy for acne. A total of 89 patients were treated with isotretinoin for moderate or severe acne at our dermatology department. At the initial visit and during the monthly follow-up visits, hemoglobin, hematocrit, leukocytes, thrombocyte, renal function tests (urea and creatinine), direct and indirect bilirubin, liver enzymes [serum glutamate oxaloacetate (SGOT), serum glutamate pyruvate transaminase (SGPT), gamma glutamil transpeptidase (GGT), and alkaline phosphotase (ALP)], lipid profile [total cholesterol, very low density lipoproteins (VLDL), low density lipoproteins (LDL), high density lipoproteins (HDL), and triglycerides], urine analysis, and CPK were requested. We asked all patients about muscle-related complaints, weakness, exercise, and compared CPK levels. Elevated CPK levels were recorded in only five patients during treatment period. Maximum serum CPK values recorded for each patient ranged between 292 and 569 IU/l. Only one patient out of five had myalgia and four patients were completely asymptomatic. In conclusion, marked hyperCPKemia with or without muscle-related complaints in isotretinoin-treated patients with acne is a benign phenomenon; therefore, it is logical to reserve measurement of CPK levels as well as renal tests for cases with severe muscle pain.