Dermatologists’ Knowledge and Attitude Toward Isotretinoin Ocular Side Effects in Egypt

Abstract

Aim 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.

Physiological and Psychological Effects of Isotretinoin in the Treatment of Patients with Acne: A Narrative Review

“…Nearly all dermatologists prescribed lubricant eye drops routinely for patients in ISO treatment in Egypt. 55 Villani et al 30 also found that patients might experience dry mucous membranes, such as eyes, nose, and mouth, when the dose was too high for them. This might be because systemic ISO administration altered the function and structure of meibomian glands and inhibited lipid production, resulting in rapid tear evaporation.…”

Prescribing Patterns of Isotretinoin for Acne Among Dermatologists in Central Jordan

“…In the Jordanian context, it seems necessary for dermatologists to sharpen their understanding of isotretinoin, including its potential side effects and associated conditions, by raising the level of awareness of potential side effects, and the urgent need to take the necessary precautions for side effects. In this study, only a few of the participating dermatologists advised the patients not to use contact lenses (n=6, 4.08%), and few prescribed moisturizing eye drops (n=17; 11.57%); in any case, the most important side effect of the drug is teratogenicity [ 26 ].…”

Cross-Sectional Assessment of Dermatologists’ Knowledge and Attitude Towards Isotretinoin-Related Ocular Side Effects in Aseer, Saudi Arabia

“…The results showed that 73.33% of children in Group C experienced acne scars and post-acne hyperpigmentation [ 22 ]. Elshafie et al [ 21 ] reported that among 103 Egyptian dermatologists, 92.8% of them sometimes prescribed isotretinoin alone for moderate to severe nodulo-cystic acne, 4.5% rarely prescribed it (only for a case with primary comedone), and 2.7% always prescribed the drug for all acne types. With regard to knowledge of ocular side effects, 94.6% of dermatologists reported their knowledge and 5.4% did not know about them [ 23 ].…”

“…A cross-sectional study in Egypt found that 94.6% of dermatologists were aware of ocular side effects, 91.1% informed patients about the drug's adverse effects and 74.8% knew about contact lens intolerance. Most dermatologists routinely prescribed lubricant eye drops and 56.8% referred patients to an ophthalmologist [ 21 ]. This study’s hypothesis is that there is a lack of sufficient knowledge about the ocular side effects of isotretinoin among dermatologists in Saudi Arabia.…”