Isotretinoin updates

Abstract

Acne vulgaris is a chronic inflammatory disease of pilosebaceous follicles commonly affecting adolescents and young adults. This disease has a profound psychological impact on affected individuals and treatment has been shown to significantly improve both self-esteem and quality of life. Isotretinoin is an effective medication used primarily in severe cystic acne patients. Over the past 30 years, this medication has revolutionized the treatment of acne. However, despite its popularity there are numerous side effects associated with its use. Most of its side effects are predictable and dose dependent, which has led to the development of variable dose regimens. Unfortunately, rare but significant side effects (e.g., depression, inflammatory bowel disease) do occur and necessitate careful monitoring to improve clinical outcomes and minimize potential adverse events.

Side effects of retinoid therapy on the quality of vision

“…Isotretinoin is an effective and generally well tolerated drug (6,13). Many of the adverse effects can be predicted before they occur (13).…”

“…The effectiveness of isotretinoin in the treatment of acne was first observed in 1970. In 1982, the Food and Drug Administration (FDA) approved its oral form as a drug used for acute forms of nodular acne (6). Actually, isotretinoin is mainly administrated to treat severe acne vulgaris according to recommendations for the use of retinoids in acne, which are contained in ref.…”

Premature ventricular contractions associated with isotretinoin use

“…4 Several studies have been conducted to study the safety and efficacy of isotretinoin in treating moderate to severe acne vulgaris. 2,4,5 According to case reports, systemic isotretinoin therapy can cause cardiac side effects, like atrial tachycardia, congenital heart disease, cardiac remodeling and sinus tachycardia. 5 Charalabopoulos et al described an 18-year old man who developed sinus tachycardia with transient right bundle branch block after three months of isotretinoin treatment.…”

“…Thus, careful monitoring is necessary to improve clinical outcomes and minimize potential adverse events. 4 Systemic isotretinoin therapy may cause cardiac side effects on rare occasions, like atrial tachycardia, sinus tachycardia and congenital heart disease. 5 The literature includes 1 reported case of PVCs linked to isotretinoin use.…”

A double-blind, randomized, Phase III, multicenter study in 358 pediatric subjects receiving isotretinoin therapy demonstrates no effect on pediatric bone mineral density

“…However, as a result of reported adverse effects, it has been used with caution in the pediatric patient population. While the most severe adverse effects have been reported outside the skeletal system, purported skeletal adverse effects include osteopenia, bone mineral density changes (BMD) in the spine and proximal femur, enthesopathy, and premature epiphyseal closure [2][3][4][5][6]. The growing skeleton is more sensitive to agents effecting bone development, which may limit isotretinoin utilization [1].…”