isotretinoin and Low-Back-Pain

Hidradenitis suppurativa (HS) is a chronic, suppurative skin disease characterized by painful nodules, particularly in the axillae and groin. Isotretinoin can be used in the treatment of HS; however, it may paradoxically lead to skin lesions or worsen the existing lesions. Isotretinoin, which is commonly used in the treatment of severe acne, is associated with several side effects, including rheumatic side effects and rarely sacroiliitis. In this study, we discussed two cases who presented with low back pain after isotretinoin was used for the treatment of acne vulgaris. The patients did not have low back pain before isotretinoin use and did not have enthesitis, dactylitis, uveitis, psoriasis, recent infection, trauma, and family history spondylitis. HLA-B27 was negative. Bone-marrow edema was detected at the sacroiliac joint on magnetic resonance imaging. Because of these findings, sacroiliitis related to the drug was considered in our patients and isotretinoin treatments were discontinued. Because the patients' low back pain continued when they administered non-steroidal anti-inflammatory drugs, biological drug treatments were started. Both cases presented had a simultaneous HS lesion. After the treatment, both low back pain and HS lesions regressed. Patients with isotretinoin therapy should be alerted for inflammatory low back pain and HS lesions that may develop. We should note that biologic agents should be considered in the treatment of resistant cases.

Topics: Acne Vulgaris; Adult; Dermatologic Agents; Female; Hidradenitis Suppurativa; Humans; Isotretinoin; Low Back Pain; Male; Sacroiliitis; Young Adult

Isotretinoin (ISO) is a drug which is used for the treatment of severe and refractory acne vulgaris (AV), over the last few decades. The drug has various musculoskeletal side effects. The aim of this study was to investigate relationship between serum 25 hydroxy (OH) vitamin D levels and the ISO-induced musculoskeletal side effects in patients with AV. We included 87 patients receiving ISO and had musculoskeletal symptoms as adverse effect (AE) group. Another 90 patients receiving ISO for AV and had any musculoskeletal complaints were recruited as control (C) group. Locomotor system examination of the patients was performed by the same clinician. Serum 25 OH vitamin D levels of the all participants were measured. Patients in the AE group were divided into three subgroups by serum 25 OH vitamin D levels. Patients with serum 25 OH vitamin D level lower than 10 ng/ml was classified as Group I, the ones between 10-20 ng/ml as Group II and those higher than 20 ng/ml were classified as Group III. AE and C groups were similar in terms of age and sex (p > 0.05). There was no statistically significant difference in the mean serum vitamin D levels between two groups (p = 0.17). Also, there was no significant difference in number of arthralgia (p = 0.30), myalgia (p = 0.29), low back pain (p = 0.10) and sacroiliitis (p = 0.17) between three subgroups in AE group. In addition, we found no statistically significant correlation between the serum vitamin D levels and age, cumulative dose of ISO, arthralgia, myalgia and sacroiliitis parameters in AE group (p > 0.05). Serum 25 OH vitamin D levels between the AE and C groups were similar. We also found that no significant difference in musculoskeletal adverse events between AE subgroups. Therefore, it can be concluded that vitamin D deficiency has no effect on the musculoskeletal adverse events in patients receiving ISO.

Topics: Acne Vulgaris; Adolescent; Adult; Arthralgia; Cross-Sectional Studies; Female; Humans; Isotretinoin; Low Back Pain; Male; Myalgia; Sacroiliitis; Vitamin D; Vitamin D Deficiency; Young Adult

Isotretinoin (ISO) is a synthetic vitamin A derivative which has been used for treatment-resistant acne vulgaris. Although most musculoskeletal side effects of ISO are common, including myalgia, arthralgia, and back pain, sacroiliitis is one of the uncommon side effects. ISO-induced sacroiliitis usually completely resolves within a few months by the cessation of the drug.. In this paper, we present a 26-year-old female patient with chronic sacroiliitis that was probably induced by ISO and not resolved by the discontinuation of the drug.. In this patient, sacroiliitis was overlooked for three years. Therefore, ISO usage should be considered in the differential diagnosis of sacroiliitis and low back pain.

Topics: Acne Vulgaris; Adult; Anti-Inflammatory Agents, Non-Steroidal; Arthralgia; Chronic Disease; Dermatologic Agents; Diagnosis, Differential; Female; Follow-Up Studies; Humans; Indomethacin; Isotretinoin; Low Back Pain; Myalgia; Sacroiliitis; Treatment Outcome

Acne vulgaris is a chronic inflammatory disease affecting the pilosebaceous unit in the skin. Isotretinoin is a synthetic vitamin A derivative regarded as the most effective agent in the treatment of acne. There have recently been increasing reports of adverse effects of isotretinoin on the skeletal system. Our aim in this study was to evaluate the rheumatic side-effects triggered by this drug, and particularly the prevalence of sacroiliitis.. A total of 73 patients receiving isotretinoin due to moderate or severe acne vulgaris were included. All patients were questioned about inflammatory low back pain and musculoskeletal pains during the treatment process. Inflammatory low back pain was evaluated using Assessment of Spondyloarthritis International Society (ASAS) criteria. Patients meeting ASAS criteria were evaluated with radiography and when necessary with sacroiliac magnetic resonance.. The dose range for isotretinoin was between 0.4 and 0.8 mg/kg/day (mean 0.53 mg/kg/day). Treatment lasted for 6-8 months (mean 6.8 months). Lethargy was determined in 37 (50.7%) patients, myalgia in 31 (42.5%) and low back pain in 36 (49.3%). Mechanical low back pain symptoms were present in 20 of the patients describing low back pain and inflammatory low back pain in 16. Acute sacroiliitis was determined in six patients (8.2%) following a sacroiliac magnetic resonance imaging (MRI). Five (83.3%) of the patients with sacroiliitis were female and one (16.7%) was male. No statistically significant difference was determined between male and female patients in terms of prevalence of sacroiliitis (p = 0.392).. The incidence of sacroiliitis in patients using isotretinoin is quite high. Patients using isotretinoin must be questioned about sacroiliitis findings and must be subjected to advanced assessment when necessary. Further studies regarding the development of sacroiliitis under isotretinoin therapy are now needed.

Topics: Acne Vulgaris; Administration, Oral; Adolescent; Adult; Dermatologic Agents; Female; Humans; Incidence; Isotretinoin; Low Back Pain; Magnetic Resonance Imaging; Male; Pain Measurement; Prevalence; Prospective Studies; Radiography; Sacroiliitis; Severity of Illness Index; Young Adult

We report a case of acute sacroiliitis with severe disability after only 3 weeks of isotretinoin therapy with graduate reduction of pain, limitation and muscle incompetence after discontinuation of the drug and ACTH-depo injection and Ethodolac therapy. Naranjo probability scale indicated a probable relationship between isotretinoin therapy and bilateral sacroiliitis. We discussed possible mechanisms of sacroiliitis and disability due to isotretinoin treatment.

Topics: Acne Vulgaris; Adrenocorticotropic Hormone; Adult; Anti-Inflammatory Agents, Non-Steroidal; Arthralgia; Arthritis; Dermatologic Agents; Disability Evaluation; Edema; Etodolac; Humans; Iatrogenic Disease; Isotretinoin; Low Back Pain; Magnetic Resonance Imaging; Male; Muscle Weakness; Radiography; Sacroiliac Joint; Treatment Outcome; Whole Body Imaging