Creatine Phosphokinase Values during Low Starting Dose Isotretinoin Therapy

Abstract

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 as-sociated 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.

Is routine laboratory testing in healthy young patients taking isotretinoin necessary: a critically appraised topic

“…Significant elevations are much less frequent, with Manfredini et al. 73 detecting CK over five times the upper reference range in 1·2% of patients, and Landau et al. 81 noting CK > 5000 IU L −1 in 1·6% of patients (although Landau’s was a military population).…”

“…Isotretinoin has been associated with a range of musculoskeletal side‐effects, including precipitation of acne fulminans, arthralgia, Achilles tendonitis, 72 myalgia without CK elevation, and hyperCKaemia, both with and without development of rhabdomyolysis 47,73–82 …”

“…47,[73][74][75][76][77][78][79][80][81][82] Myalgia and mild transient elevations in CK are common, and were observed in 20% of patients in a small series. 47 Significant elevations are much less frequent, with Manfredini et al 73 detecting CK over five times the upper reference range in 1Á2% of patients, and Landau et al 81 noting CK > 5000 IU L À1 in 1Á6% of patients (although Landau's was a military population). Multiple factors can influence CK including ethnicity, age, sex and physical activity.…”

“…Isotretinoin has been associated with a range of musculoskeletal side-effects, including precipitation of acne fulminans, arthralgia, Achilles tendonitis, 72 myalgia without CK elevation, and hyperCKaemia, both with and without development of rhabdomyolysis. 47,[73][74][75][76][77][78][79][80][81][82] Myalgia and mild transient elevations in CK are common, and were observed in 20% of patients in a small series. 47 Significant elevations are much less frequent, with Manfredini et al 73 detecting CK over five times the upper reference range in 1Á2% of patients, and Landau et al 81 noting CK > 5000 IU L À1 in 1Á6% of patients (although Landau's was a military population).…”

Low‐dose oral isotretinoin in the treatment of recalcitrant facial flat warts: A clinical case and review of literature

“…6 It is recommended to reduce the dose of isotretinoin in addition to changes in lifestyle and diet in case of increased levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), triglycerides, cholesterol and creatine phosphokinase (CPK). 7,8 Although the doses used for the treatment of recalcitrant facial flat warts are considered low, 9 two cases are reported where the doses of isotretinoin were further decreased (0.3−0.4 mg/kg/day); In both patients the lesions disappeared and there were no side effects. 10 To find out if at low doses of isotretinoin, it is possible to reduce the adverse effects without affecting the efficacy, we present a case and perform an exhaustive review of the literature to assess the current evidence on the use of low doses of isotretinoin in the treatment of recalcitrant flat facial warts.…”