Plasma homocysteine level is elevated in patients on isotretinoin therapy for cystic acne: A prospective controlled study

Abstract

Hcy levels are elevated in patients on Iso treatment for CA. It may be due to either the inhibition of cystathionine-beta-synthase, an enzyme required in the metabolism of Hcy, by the drug and/or the liver dysfunction. Daily supplementation with vitamin B12 and folate, which are the cofactors of the enzymatic reactions involved in Hcy metabolism, can lower plasma levels of Hcy, so it is recommended to take these vitamins in case of deficiency along with Iso to prevent premature occlusive vascular disease.

Effect of isotretinoin treatment on plasma holotranscobalamin, vitamin B12, folic acid, and homocysteine levels: non‐controlled study

“…Based on these findings, the investigators concluded that elevated levels of Hcy despite normal values of the responsible vitamins for the amino acid metabolism might be a result of an inhibitor action of Iso on cystathionine‐β‐synthase. In another study, including 74 patients on Iso therapy for cystic acne, plasma Hcy, liver enzymes, triglycerides, total cholesterol, LDL‐C, and VLDL‐C levels increased significantly after treatment; however, there were no changes in the vitamin levels 7 . Conversely, a 28‐day treatment with Iso was reported to decrease plasma folic acid levels without any change in plasma Hcy levels 21 .…”

Homocysteine may accelerate skin aging: A new chapter in the biology of skin senescence?

“…Hcy is metabolized in the liver by cystathionine beta-synthase (CBS), a process that requires folate, vitamin B6, and vitamin B12. 6 Genetic defects in CBS and dietary defects of the cofactors (folic acid, vitamins B6 and B12) involved in metabolic pathways can impair Hcy clearance. 6 Homocystinuria as a result of CBS deficiency is an autosomal recessive disorder.…”

“…6 Genetic defects in CBS and dietary defects of the cofactors (folic acid, vitamins B6 and B12) involved in metabolic pathways can impair Hcy clearance. 6 Homocystinuria as a result of CBS deficiency is an autosomal recessive disorder. 7 The skeletal manifestations of this disorder include osteoporosis and limitation of joint mobility, and its skin manifestations include thin, transparent skin and striae, which are the consequences of collagen underproduction.…”

Slit-skin smear in diagnosis of cutaneous mastocytomas

“…[7] Hcy levels are shown to be elevated in patients on isotretinoin treatment for acne, which may be due to the inhibition of cystathionine beta-synthase by the drug and/or the drug-induced liver dysfunction. [7] Hcy levels are shown to be elevated in patients on isotretinoin treatment for acne, which may be due to the inhibition of cystathionine beta-synthase by the drug and/or the drug-induced liver dysfunction.…”

“…[9,10] Epidemiological and randomized clinical trials suggest that hyperhomocysteinemia increases fracture risk, but has minor effects on bone mineral density. Daily supplementation with vitamin B 12 and folate, which are the cofactors of the enzymatic reactions involved in Hcy metabolism, can lower plasma levels of Hcy [7] and prevent osteoporosis [11] induced by retinoid and other potential untoward effects of hyperhomocysteinemia such as atherosclerosis. In addition, hyperhomocysteinemia seems to have adverse effects on extracellular bone matrix by disturbing collagen crosslinking.…”