Safety and side effects of the acne drug, oral isotretinoin

Abstract

Isotretinoin is a very effective medication for the treatment of severe recalcitrant acne. However, its use is associated with many side effects, some of which can be very serious. The most important issue is its teratogenicity, which has resulted in new pregnancy prevention policies and programmes implemented by the manufacturer. Recently, the association of isotretinoin with depression has been recognised and new guidelines have been adopted for this possible side effect. The most common adverse events, observed during treatment, are mucocutaneous and ophthalmological. In addition, laboratory abnormalities and effects in the nervous, musculoskeletal, gastrointestinal, pulmonary and other systems have been described.

Fate of retinoic acid–activated embryonic cell lineages

“…Further studies of specific organ systems, using combined labelings to trace at the single cell level the RA-responsive populations with respect to the cell lineages contributing to the organ may prove informative, for instance in the case of the developing lymphoid system, the exocrine vs. endocrine pancreas, or the fetal gonad considering the implication of RA signaling in the control of meiosis. Further applications may also be found in experiments reproducing the teratogenic effects of retinoic acid (Lammer et al, 1985;Hanson and Leachman, 2001;Charakida et al, 2004). Tracing of the cell populations stimulated by exogenous RA in RARE-Cre mice may help understand how the human malformations manifest.…”

“…This would provide important information with respect to various developing systems, including the brain (Dupe et al, 1999;Smith et al, 2001;Sirbu et al, 2005;Ribes et al, 2006;Molotkova et al, 2007), sensory organs Matt et al, 2005;Molotkov et al, 2006;Romand et al, 2006), cranial neural crest cells and branchial arch derivatives (Wendling et al, 2000;Niederreither et al, 2003;Mark et al, 2004), and heart (Merki et al, 2005;Ryckebusch et al, 2008;Sirbu et al, 2008). Retinoids are also potent teratogenic compounds in human (Lammer et al, 1985;Hanson and Leachman, 2001;Charakida et al, 2004, and references therein), and excess RA administration affects many morphogenetic processes in mice (e.g., Kessel and Gruss, 1991;Marshall et al, 1992;Shum et al, 1999;Matt et al, 2003). Thus, it is equally important to be able to identify and trace the fate of cells that have not been in contact with RA, to clarify whether teratogenesis mediated by RA results from ectopic signaling in tissues that are normally devoid of retinoids.…”

Acne fulminans in the course of oral isotretinoin treatment. Presentation of cases

“…Acne fulminans in the course of treatment with oral isotretinoin is a very severe systemic disease and its course is difficult to foresee [20]. Currently, as isotretinoin therapy is a golden standard in treatment of severe acne vulgaris, we can expect an increased incidence of AF in the future.…”

Evaluation of Side Effects of Isotretinoin in 150 Patients with Acne Vulgaris

“…Hastalar›n %50' sinden az›nda belirgin kserozise yol açar ve pruritus oluflabilir. Bu durum atopisi olan kiflilerde daha fazla görülür 1,13 . Önceki çal›fl-malarda deri kurulu¤u oran› %74,4-85 aras›nda bildirilmifltir [10][11][12] .…”

“…Çal›flmam›zda deri kurulu¤u %56,3 oran›nda görüldü. Avuç içi ve ayak taban›nda peeling görülebilir 1,13 . Hastalar›m›zda özellikle el ve kolda dermatit tablosu görüldü, iki hastam›zda da palmar peeling geliflti.…”