Severe generalised rhabdomyolysis with fatal outcome associated with isotretinoin

Hartung, Benno; Huckenbeck, W.; Daldrup, Thomas; Neuen-Jacob, Eva; Ritz‐Timme, Stefanie

doi:10.1007/s00414-012-0750-2

Cited by 28 publications

(25 citation statements)

References 19 publications

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“…The risk of rhabdomyolysis has been known for 30 years and is small, but every patient should be warned not to engage in overstrenuous sports or activity at work, as a single, lethal case has shown …”

Section: Further Side‐effects and Adverse Eventsmentioning

confidence: 99%

Management of severe acne

Zouboulis

Bettoli

2015

Br J Dermatol

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SummaryAcne is the most common skin disease, affecting up to 95% of adolescents. Severe episodes of acne can cause considerable physical and psychological scarring, and overexpression of transforming growth factor-b can lead to formation of hypertrophic scars and keloids. The severity of acne in adolescence is associated with a positive history of severe acne in first-degree relatives, especially the mother. In most cases acne is a chronic disease, and it is often a component of systemic diseases or syndromes. All forms of severe acne require systemic treatment. The available options include oral antibiotics, hormonal antiandrogens for female patients and oral isotretinoin, as well as other combination treatments. Oral isotretinoin is the only drug available that affects all four pathogenic factors of acne. However, due to possible serious side-effects, a European directive states that oral isotretinoin should be used only as a second-line therapy in cases of severe, nodular and conglobate acne. The pharmaceutical quality of generic isotretinoin products and the obtainability of isotretinoin through e-pharmacies without prescription raise new therapeutic problems. New anti-inflammatory compounds, such as the 5-lipoxygenase inhibitor zileuton, may replace systemic antibiotics in the future, especially under the scope of antibiotic resistance prevention. This review looks into the various options and latest approaches, and factors to consider, when combating severe acne.

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Section: Further Side‐effects and Adverse Eventsmentioning

confidence: 99%

Management of severe acne

Zouboulis

Bettoli

2015

Br J Dermatol

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“…Between 1983 and 2016, there were seven reported cases of symptomatic elevations in CK on isotretinoin, five of which resulted in rhabdomyolysis . Six of these cases had a notable additional factor (five precipitated by weight lifting; one had an autosomal recessive myopathy) . These individuals had a max serum CK 801–66,000 IU/l and developed fatigue, generalized muscle pain, and weakness while two additionally had myoglobinuria .…”

Section: Introductionmentioning

confidence: 99%

The creatine kinase conundrum: a reappraisal of the association of isotretinoin, creatine kinase, and rhabdomyolysis

Marson

Baldwin

2019

Int J Dermatology

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Background Isotretinoin has been reported to elevate creatine kinase, which may lead to fatal rhabdomyolysis.Objective To review the literature and propose practice guidelines for management of elevated creatine kinase during isotretinoin therapy.Findings Patients have intrinsic and extrinsic qualities that may synergistically work with isotretinoin to elevate serum creatine kinase. Darker skin types and males on isotretinoin are more likely to have elevated creatine kinase. Isotretinoin may induce oxidative stress within muscle tissue, thereby leading to elevations in serum creatine kinase.Conclusion Evidence supports a tenuous correlation between isotretinoin, elevated creatine kinase, and exercise. Physicians should consider obtaining baseline creatine kinase on elite athletes and counseling patients on risk factors that may elevate creatine kinase. However, the potential for elevated CK is not a contraindication for isotretinoin therapy. Capsule Summary• Since 1982 there have been multiple reports of patients who had elevated creatine kinase levels during their course of isotretinoin, mostly with concurrent exercise.• Physicians should consider obtaining baseline creatine kinase in elite athletes and counseling patients that vigorous exercise and male gender are associated with elevated creatine kinase.

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“…This has largely been interpreted as a benign phenomenon, but a fatal generalised rhabdomyolysis in a young male has been recently reported. [50] Association of isotretinoin with inflammatory bowel disease is a subject of controversy with no study yet demonstrating a causal association. [51] ORAL ANTIBIOTICS…”

Section: Synergistic Topical Combinationsmentioning

confidence: 99%