Skeletal Side Effects of Systemic Isotretinoin Treatment: Do They Depend on Age, Gender, Treatment Duration, Daily Dose and Isotretinoin-Naiveness?

Citation: Özkoca D, Caf N, Alacagöz Yılmaz NN, Uzunçakmak TK, Özdil A, Atsü AN. Skeletal Side Effects of Systemic Isotretinoin Treatment: Do They Depend on Age, Gender, Treatment Duration, Daily Dose and Isotretinoin-Naiveness? Dermatol Pract Concept. 2023;13(2):e2023121. DOI: https://doi.org/10.5826/dpc.1302a121

Accepted: November 14, 2022; Published: April 2023

Copyright: ©2023 Özkoca et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited.

Funding: None.

Competing interests: None.

Authorship: All authors have contributed significantly to this publication.

Corresponding author: Defne Özkoca, MD, Zonguldak Atatürk Devlet Hastanesi, Site Ek Binası, Bahçelievler, Zonguldak, Turkey. Phone: 00905366561000 E-mail: defneozkoca@yahoo.com

Abstract

Introduction: Systemic isotretinoin is the most effective treatment modality in acne vulgaris; however, both patients and physicians hesitate to use it due its side effects.

Objectives: The aim of this study is to determine the prevalence of fatigue, myalgia and low back pain during systemic isotretinoin treatment; and to determine their relationship with age, gender, treatment duration, daily isotretinoin dose and isotretinoin-naiveness of the patient.

Methods: This is a cross sectional study including the acne vulgaris patients, aged between 13 to 40 years, who have at least received one month of oral isotretinoin treatment. Patients were questioned for side effects during their follow-up visits; a physical therapy and rehabilitation specialist further evaluated patients complaining of low back pain.

Results: Fatigue was reported by 4.4% of the patients, myalgia by 2.8% and low back pain by 25% of the patients; 2.2% had inflammatory and 22.8% had mechanical low back pain. None of the patients had sacroiliitis. All the side effects that were examined were found to be independent of age, gender, isotretinoin dosage (mg/kg/day), treatment duration and isotretinoin-naiveness.

Conclusions: The side effects are not as common as feared; thus, patients and physicians should not hesitate to use systemic isotretinoin in indicated cases. 

Keywords : acne vulgaris, isotretinoin, side effects, musculoskeltal, low back pain

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

References

1. Layton A. The use of isotretinoin in acne. Dermatoendocrinol. 2009;1(3):162-169. DOI: 10.4161/derm.1.3.9364. PMID: 20436884. PMCID: PMC2835909. 2. Leyden JJ, Del Rosso JQ, Baum EW. The use of isotretinoin in the treatment of acne vulgaris: clinical considerations and future directions. J Clin Aesthet Dermatol. 2014;7(2):S3-S21. PMID: 24688620. PMCID: PMC3970835. 3. Kaplan G, Haettich B. Rheumatological symptoms due to retinoids. Baillieres Clin Rheumatol. 1991;5(1):77–97. DOI: 10.1016/s0950-3579(05)80297-3. PMID: 2070429. 4. Acar EM, Şaş S, Aybala Koçak F. Evaluation of musculoskeletal adverse effects in patients on systemic isotretinoin treatment: A cross-sectional study. Arch Rheumatol. 2022;37(2):223-229. DOI: 10.46497/ArchRheumatol.2022.8645. PMID: 36017204. PMCID: PMC9377170. 5. Civelek U, Baykal L, Aksu Arica D, Capkin E, Yayli S. Isotretinoin‐induced inflammatory back pain and sacroiliitis in patients with moderate to severe acne vulgaris. J Cosmet Dermatol. 2022;21(10):4846-4851. DOI: 10.1111/jocd.14807. PMID: 35092165. 6. Agarwal US, Besarwal RK, Bhola K. Oral isotretinoin in different dose regimens for acne vulgaris: A randomized comparative trial. Indian J Dermatol Venereol Leprol. 2011;77(6):688-694. DOI: 10.4103/0378-6323.86482. PMID: 22016276. 7. Kapała J, Lewandowska J, Placek W, Owczarczyk-Saczonek A. Adverse Events in Isotretinoin Therapy: A Single-Arm Meta-Analysis. Int J Environ Res Public Health. 2022;19(11):6463. DOI: 10.3390/ijerph19116463. PMID: 35682048. PMCID: PMC9180136. 8. Karaosmanoğlu N, Mülkoğlu C. Analysis of musculoskeletal side effects of oral Isotretinoin treatment: a cross-sectional study. BMC Musculoskelet Disord. 2020;21(1):631. DOI: 10.1186/s12891-020-03656-w. PMID: 32977793. PMCID: PMC7519514. 9. Ledford C. Spine Conditions: Mechanical and Inflammatory Low Back Pain. FP Essent. 2017;461:15-20. PMID: 29019640. 10. Aydog E, Ozturk G, Comert A, Tasdelen N, Akin O, Kulcu DG. Sacroiliitis during isotretinoin treatment: Causal association or coincidence? North Clin Istanb. 2018;6(1):75-80. DOI: 10.14744/nci.2018.93798. PMID: 31180372. PMCID: PMC6526982. 11. Taheri A, Sabouhi S, Farazmand F. Incidence of low back pain and sacroiliitis in military families with acne vulgaris under isotretinoin therapy. Am J Clin Exp Immunol. 2020;9(2):6-9. PMID: 32419981. PMCID: PMC7218680. 12. Baykal Selçuk L, Aksu Arıca D, Baykal Şahin H, Yaylı, Bahadır S. The prevalence of sacroiliitis in patients with acne vulgaris using isotretinoin.. Cutan Ocul Toxicol. 2017;36(2):176-179. DOI: 10.1080/15569527.2016.1237521. PMID: 27764978. 13. Bauer L, Ornelas J, Elston D, Alikhan A. Isotretinoin: controversies, facts, and recommendations. Expert Rev Clin Pharmacol. 2016;9(11):1435-1442. DOI: 10.1080/17512433.2016.1213629. PMID: 27414637.