Isotretinoin-associated proctosigmoiditis

Martin, P.; Manley, Paul; Depew, William T.; Blakeman, J.M.

doi:10.1016/0016-5085(87)90925-5

Cited by 56 publications

(23 citation statements)

References 2 publications

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“…Animal studies have indicated that excessive intake of retinoids can have inhibitory effects on both osteoblast and osteoclast activity that may pose a theoretical risk for fractures or hyperostosis. [99][100][101][102][103][104][105][106][107][108][109][110][111][112] Well-designed clinical studies involving human subjects have generated conflicting data on the association between excessive intake of vitamin A with the incidence of fractures. In evaluating isotretinoin specifically, 1 small prospective cohort study associated isotretinoin with minimal-to-mild bone demineralization at specific sites (such as Ward' s triangle of the femur), but revealed that these effects may be reversible.…”

Section: Bone Effectsmentioning

confidence: 99%

Evidence-Based Recommendations for the Diagnosis and Treatment of Pediatric Acne

et al. 2013

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INTRODUCTION: Acne vulgaris is one of the most common skin conditions in children and adolescents. The presentation, differential diagnosis, and association of acne with systemic pathology differs by age of presentation. Current acknowledged guidelines for the diagnosis and management of pediatric acne are lacking, and there are variations in management across the spectrum of primary and specialty care. The American Acne and Rosacea Society convened a panel of pediatric dermatologists, pediatricians, and dermatologists with expertise in acne to develop recommendations for the management of pediatric acne and evidence-based treatment algorithms. METHODS: Ten major topic areas in the diagnosis and treatment of pediatric acne were identified. A thorough literature search was performed and articles identified, reviewed, and assessed for evidence grading. Each topic area was assigned to 2 expert reviewers who developed and presented summaries and recommendations for critique and editing. Furthermore, the Strength of Recommendation Taxonomy, including ratings for the strength of recommendation for a body of evidence, was used throughout for the consensus recommendations for the evaluation and management of pediatric acne. Practical evidence-based treatment algorithms also were developed. RESULTS: Recommendations were put forth regarding the classification, diagnosis, evaluation, and management of pediatric acne, based on age and pubertal status. Treatment considerations include the use of over-the-counter products, topical benzoyl peroxide, topical retinoids, topical antibiotics, oral antibiotics, hormonal therapy, and isotretinoin. Simplified treatment algorithms and recommendations are presented in detail for adolescent, preadolescent, infantile, and neonatal acne. Other considerations, including psychosocial effects of acne, adherence to treatment regimens, and the role of diet and acne, also are discussed. CONCLUSIONS: These expert recommendations by the American Acne and Rosacea Society as reviewed and endorsed by the American Academy of Pediatrics constitute the first detailed, evidence-based clinical guidelines for the management of pediatric acne including issues of special concern when treating pediatric patients.

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Section: Bone Effectsmentioning

confidence: 99%

Evidence-Based Recommendations for the Diagnosis and Treatment of Pediatric Acne

et al. 2013

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“…However, there are rare cases that have a strong association between treatment with isotretinoin and exacerbation of inflammatory bowel disease (Martin et al 1987).…”

Section: Other Gastrointestinal Adverse Effectsmentioning

confidence: 99%

Adverse Reactions to Oral Retinoids An Update

Mills

Marks

1993

Drug Safety

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Retinoids, both naturally occurring and synthetic, are analogues of vitamin A. They represent a major advance in the treatment of acne and psoriasis, as well as rarer conditions such as the ichthyoses. The more frequent and widespread use of these drugs requires that the dermatologist be aware of the wide spectrum of adverse events that may be encountered with their use. Some are serious and irreversible, such as teratogenicity, necessitating great care if these drugs are given to women of childbearing potential. Other effects may be less severe, dose dependent and reversible. Although not devastating to the patient, appropriate advice may reduce morbidity.

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“…A similar case has been reported. 29 Musculoskeletal symptoms, defined as any complaint about bones, muscles, or joints, occurred in approxi¬ mately 40% of our subjects, indicating a higher risk than the 15% to 28% risk reported by others.5'7,24 One of the possible explanations for this discrepancy may be that we grouped any muscle, bone, or joint ache or pain into this category, whereas some of the other investiga¬ tors have primarily evaluated "arthralgias." Our data suggest that the risk for musculoskeletal symptoms is increased as the isotretinoin dosage is increased.…”

Section: Resultsmentioning

confidence: 72%

An Observational Study of Isotretinoin Recipients Treated for Acne in a Health Maintenance Organization

McElwee

Schumacher²,

Johnson³

et al. 1991

Arch Dermatol

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From September 1982 to June 1987, all members (N = 513) of the Group Health Cooperative of Puget Sound, Seattle, Wash, who were prescribed isotretinoin for acne were observed throughout the first 4- to 5-month course of therapy for effectiveness and adverse effects. The highest rates of use were among male subjects aged 15 to 24 years. Excluding 47 subjects whose prescriptions were stopped because of noncompliance or who left the care of Group Health Cooperative physicians, 39 (8.4%) of the remaining 466 discontinued taking the drug because of the following adverse effects: mucous/skin/musculoskeletal effects (17); elevated triglyceride levels (eight); headaches (five); increased liver enzyme levels (three); amenorrhea (two); and other (four). One subject, excluded from the 466 because of noncompliance, became pregnant while using medication from a previous prescription and had a therapeutic abortion; she was not under the care of a physician at the time of pregnancy. Most subjects (97%) developed a mucocutaneous symptom, and 42% developed musculoskeletal symptoms. Moderate elevations in liver enzyme levels developed in six (1.8%) of 341 subjects with normal baseline values. Of 389 subjects with normal baseline triglyceride values (less than 2.25 mmol/L), nine (2.3%) developed moderate elevations (4.5 to 9.0 mmol/L), and one (0.3%) developed a severe elevation (greater than or equal to 9.0 mmol/L). Of 24 subjects with elevated baseline triglyceride levels, three (12.5%) developed moderate elevations. Of an additional 53 subjects whose baseline serum triglyceride levels were not determined, two developed elevations during therapy, one up to 13.4 mmol/L. Subjects who were overweight or had elevated baseline serum triglyceride values had an increased risk of developing elevations in triglyceride levels during therapy (odds ratio, 6.0; 95% confidence interval, 1.6 to 22.0; and odds ratio, 4.35; 95% confidence interval, 0.9 to 20.2, respectively). Acne was improved for at least 94.0% of subjects.

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Isotretinoin-associated proctosigmoiditis

Cited by 56 publications

References 2 publications

Evidence-Based Recommendations for the Diagnosis and Treatment of Pediatric Acne

Evidence-Based Recommendations for the Diagnosis and Treatment of Pediatric Acne

Adverse Reactions to Oral Retinoids An Update

An Observational Study of Isotretinoin Recipients Treated for Acne in a Health Maintenance Organization

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