The effect of isotretinoin treatment on plasma homocysteine levels in acne vulgaris

Abstract

Isotretinoin has revolutionized the treatment of acne by improving the cosmetic outcome and decreasing the psychological damage. However, use of isotretinoin is associated with significant side-effects such as mucocutaneous involvement, dyslipidaemia and liver dysfunction, as indicated by increases in liver enzymes. The responsible enzyme for homocysteine metabolism, cystathionine-beta-synthase, might also be affected by isotretinoin-induced liver dysfunction, which leads to hyperhomocysteinaemia, an independent risk factor for thrombovascular diseases. The aim of this study was to evaluate homocysteine levels and the responsible vitamins for its metabolism in patients with moderate to severe acne vulgaris on isotretinoin treatment, before and after treatment. We found increased level of homocysteine in patients after 2 months of taking isotretinoin. Our findings suggest that isotretinoin may increase the risk of cardiovascular disorders by causing hyperhomocysteinaemia.

Laboratory Monitoring During Isotretinoin Therapy for Acne

“…The mean value of nonbaseline measurements [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] (Figure 2A) or those made during isotretinoin therapy was 119.98 mg/dL (99% CI, 98.58-141.39 mg/dL). The difference in mean values between baseline and the mean follow-up period (11.3 weeks) ( Figure 2B) was 36.96 mg/dL (99% CI, 22.12-51.79 mg/dL).…”

“…Buckley et al, 13 1990 Ragos et al, 12 1998 105.90 (4.89) 93. 31 Michaëlsson et al, 15 1986 Bershad et al, 16 1985 Hanstad and Thune, 17 1985 Pigatto et al, 18 1986 Melnik et al, 20 1987 Laker et al, 19 1987 Lyons et al, 21 1982 Jones et al, 22 1983 Strauss et al, 23 1984 Ostlere et al, 24 1996 Strauss et al, 25 2001 Ferahbas et al, 26 2004 Altman et al, 7 2002 Polat et al, 28 2008 Koistinen et al, 27 2006 Roodsari et al, 29 Michaëlsson et al, 15 1986 Bershad et al, 16 1985 Hanstad and Thune, 17 1985 Pigatto et al, 18 1986 Melnik et al, 20 1987 Laker et al, 19 1987 Lyons et al, 21 1982 Jones et al, 22 1983 Strauss et al, 23 1984 Ostlere et al, 24 1996 Strauss et al, 25 2001 Koistinen et al, 33 line and the mean follow-up period (9.7 weeks) was 16.08 mg/dL (99% CI, 13.37-18.78 mg/dL) (eFigure 3A and B in the Supplement). Analyses for late effects could not be made because of lack of available data.…”

Character of distribution of immunological indicators in patients with average and severe forms of acne

“…Поражаются представители всех рас и обоего пола. Однако, в силу анатомо-физиологических особенностей кожи, лица мужского пола чаще страдают и имеют более тяжелые проявления заболевания по сравнению с женщинами [7][8]. Заболевание не угрожает жизни, но, поскольку поражает преимущественно открытые участки кожи, приносит пациентам выраженный эстетический дискомфорт [9][10][11].…”

“…Известно, что у пациентов с акне имеется большее количество долек в сальной железе и относительный дефи цит линолевой кислоты в секрете сальных желез в сравнении с лицами, не имеющими предраспо ложенности к угревой болезни, что, скорее всего, обусловлено генетическими фак торами [33]. Низкий уровень линолевой кислоты может индуцировать гиперпролиферацию фолликулярных кератиноцитов и продукцию провоспалительных цитокинов, что усугубляет воспаление [7]. Высокая восприимчивость андрогеновых рецепторов себоцитов к андрогенам и/или повышенное количество самих андрогеновых рецепторов также могут быть генетически детерминированы [34][35].…”

A novel explanation for isotretinoin-induced psychiatric problems and its practical implication

“…In a interesting article published recently in this journal, Roodsari et al. 1 reported that isotretinoin induced hyperhomocysteinaemia and increased the risk of cardiovascular disorders. We would like to mention some related psychopathologies, and we suggest an interesting mechanism for these that has not been suggested previously in the literature, to our knowledge, and might lead to a preventive measure for these important side‐effects of isotretinoin treatment.…”