Isotretinoin as a Possible Environmental Trigger to Autoimmunity in Genetically Susceptible Patients

Abstract

Introduction. Isotretinoin is commonly used to treat cystic acne. Definitive mechanisms of action for isotretinoin are not known though despite many side effects having been documented. Various case reports have noted autoimmune diseases succeeding isotretinoin treatment. Case Report. A 16-year-old female presents with symptoms of tremors, lack of focus, sleeplessness, emotional liability, bulging eyes, loose stools, heat intolerance, and missed menstrual periods. Symptoms manifested shortly after the patient finished a course of oral isotretinoin treatment for acne. Physical exam showed resting tremors, bilateral proptosis, hyperactivity, and rapid speech. A diagnosis of Graves' Disease was made by correlating symptoms, physical exam findings, ultrasound, and positive family history of autoimmune thyroid disease. Conclusion. Emergence of autoimmune thyroid diseases depends upon genetic predisposition and environmental triggers. Mechanism of action for isotretinoin is not known but the drug may play a role in triggering autoimmunity in genetically susceptible individuals.

Successful treatment with rituximab for autoimmune cytopenia after autologous hematopoietic stem cell transplantation

“…The majority of patients are reported to have a combination of ITP and AIHA, whereas 6.6% had ITP plus AIN, as was observed in our patients 5 . There are several reports describing autoimmune disease, such as diabetes, hepatitis, Guillain–Barre syndrome, and thyroiditis caused by isotretinoin 6 . We could not completely exclude the possibility of AIC induced by 13‐ cis ‐retinoic acid in our patient, although in a study of 130 patients with high‐risk neuroblastoma who received 13‐ cis ‐retinoic acid, no patients were reported to have developed autoimmune disease 7 …”

Causal associations of autoimmune thyroiditis and papillary thyroid carcinoma: mRNA expression of selected nuclear receptors and other molecular targets

“…Several case studies have noted the development of AIT in patients following or within the last few weeks of isotretinoin treatment (28). Moreover, retinoid receptor (RAR) and retinoid X receptors (RXR) subtypes are differentially expressed in thyroid cancer and in thyroid carcinoma cell lines when compared to non-tumour thyroid tissue and cells (29,30).…”

Incidence and Clinical Implications of Autoimmune Thyroiditis in the Development of Acne in Young Patients

“…The results of the present study indicate increased incidence of AIT in the studied population with acne; 59.3% patients had high serum levels of anti-TG antibodies and 62.2% of anti-TPO antibodies. The observed differences may be caused by genetic factors, environmental conditions (i.e., iodine intake), or by the methods used for antibody dosing [ 13 , 14 , 20 , 21 ].…”

“…The connection between the two has not been fully elucidated so far. On the other hand, the treatment of acne often involves oral medication with an intestinal dysbiotic role, a possible trigger for autoimmune diseases [ 13 , 14 , 15 ].…”