Inflammatory Back Pain in Patients Treated with Isotretinoin

ObjectiveThe aim of the present study was to evaluate histopathological and biomechanical effects of isotretinoin on Achilles tendon.Materials & methodsSixteen rats were divided into two groups including the control group (n = 8) and isotretinoin group (n = 8). The control group received 1.42 ml/kg soy oil per day whereas the isotretinoin group received 15 mg/kg/day (gavage dose 1.42 ml/kg) isotretinoin dissolved in soy oil through gavage method for 6 weeks. Achilles tendons were excised at the end of week 6. The tendon samples were evaluated by hematoxylin-eosin under a light microscope. Quantitative evaluation was performed via Movin and Bonar scoring. A computer-monitored tensile testing machine was utilised for biomechanical testing. Biomechanical characteristics of the tendon samples (elastic modulus, yield force, ultimate tensile force) were measured.ResultsHistopathological evaluation revealed a significantly higher Movin and Bonar scores in histopathological evaluation. Movin score in isotretinoin group was 4.1 ± 2.5 and it was 2.3 ± 1.0 in control group (p = 0.032). Bonar score in isotretinoin group was 2.9 ± 1.4 and it was 1.6 ± 0.7 in control group (p = 0.022). In line with histopathological evaluation, biomechanical measurements in isotretinoin group (elastic modulus, yield force, ultimate tensile force) were significantly lower than the control group. Elastic modulus in isotretinoin group was 227 ± 27.7 N/mm2 and in control group it was 281.7 ± 38.7 N/mm2 (p = 0.006). In isotretinoin group; yield force was 33.7 ± 4.3 Pa and in control group it was 40.8 ± 5.9 Pa (p = 0.021). Ultimate tensile force in isotretinoin group was 35.7 ± 4.2 Pa and in control group it was 44 ± 7 Pa (p = 0.009).ConclusionThe present study detected histopathological and biomechanical negative effect of isotretinoin on Achilles tendon. Therefore, isotretinoin should be questioned in medical history of patients with tendinopathy.

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“… 1 , 6 , 14 , 17 Furthermore, calcification on tendons and ligaments were commonly reported. 14 , 17 , 18 …”

Section: Discussionmentioning

confidence: 99%

Isotretinoin induced achilles tendinopathy: Histopathological and biomechanical evaluation on rats

Beytemür

Yüksel

Tetikkurt

et al. 2018

Acta Orthopaedica et Traumatologica Turcica

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“…Retinoids that are extensively used in the treatment of skin disease and cancer can cause toxicity and produce sensory hypersensitivity associated with burning, pruritus, and inflammation in humans when applied topically or systemically (6)(7)(8)13). Oral or intrathecal application of vitamin A derivatives also was shown to increase nocifensive responses in rodents with or without tissue inflammation (14,15).…”

Section: Discussionmentioning

confidence: 99%

“…Topical application of retinoids often causes severe local irritation manifested as burning sensation, pruritus, erythema, peeling, or dryness (5), which is commonly termed "retinoid dermatitis." Retinoids also cause severe headache, muscle pain, joint pain, bone pain, and inflammatory back pain when used systemically (6)(7)(8). Retinoid-elicited irritation has become a major clinical issue and is the main reason that many patients discontinue retinoid treatment (9)(10)(11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

Retinoids activate the irritant receptor TRPV1 and produce sensory hypersensitivity

et al. 2013

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Retinoids are structurally related derivatives of vitamin A and are required for normal vision as well as cell proliferation and differentiation. Clinically, retinoids are effective in treating many skin disorders and cancers. Application of retinoids evokes substantial irritating side effects, including pain and inflammation; however, the precise mechanisms accounting for the sensory hypersensitivity are not understood. Here we show that both naturally occurring and synthetic retinoids activate recombinant or native transient receptor potential channel vanilloid subtype 1 (TRPV1), an irritant receptor for capsaicin, the pungent ingredient of chili peppers. In vivo, retinoids produced pain-related behaviors that were either eliminated or significantly reduced by genetic or pharmacological inhibition of TRPV1 function. These findings identify TRPV1 as an ionotropic receptor for retinoids and provide cellular and molecular insights into retinoid-evoked hypersensitivity. These findings also suggest that selective TRPV1 antagonists are potential therapeutic drugs for treating retinoid-induced sensory hypersensitivity.

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“…3 Pehlivan Y. et al described 4 cases of sacroilitis. 4 There are reports on the fact that oral isotretinoin may increase the risk of bowel disease 5 and Ratner and Sambandan draw attention to the possible number of vascular complications in elderly patients. 6 Beer et al present a case of an unusual a significant perioral abscess, 7 which could was interpreted associate with significant colonization by Staphylococcus bacteria in this patient.…”

Section: Discussionmentioning

confidence: 99%

Psoriasis Induced by Isotretinoin in Acne

2017

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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 patients mother suffered from psoriasis for 30 years.J MEDICINE January 2017; 18 (1) : 37-38

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Inflammatory Back Pain in Patients Treated with Isotretinoin

Cited by 13 publications

References 5 publications

Isotretinoin induced achilles tendinopathy: Histopathological and biomechanical evaluation on rats

Isotretinoin induced achilles tendinopathy: Histopathological and biomechanical evaluation on rats

Retinoids activate the irritant receptor TRPV1 and produce sensory hypersensitivity

Psoriasis Induced by Isotretinoin in Acne

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