isotretinoin and Muscular-Diseases

The acne conglobata (AC)-, acne fulminans (AF)-, and isotretinoin-associated musculoskeletal syndromes are three distinct clinical entities. The AC-associated musculoskeletal syndrome occurs primarily in black men over the age of 22, who develop sacroilitis with or without a peripheral arthropathy. In contrast, the AF-associated musculoskeletal syndrome is found almost exclusively in white male teenagers. Fever, weight loss, and arthralgias are prominent components of this syndrome. A unique feature of the AF-associated musculoskeletal syndrome is osteolytic lesions that occur most frequently in the clavicle, sternum, long bones, and ilium. The isotretinoin-associated musculoskeletal syndrome occurs with equal frequency in male and female acne patients. Mild, transient myalgias and arthralgias are very common and do not require discontinuation of isotretinoin therapy. Asymptomatic, small, hyperostotic lesions of the spine occur in approximately 10% of acne patients with the isotretinoin-associated musculoskeletal syndrome.

Topics: Acne Vulgaris; Adolescent; Adult; Bone Diseases; Female; Humans; Isotretinoin; Male; Middle Aged; Muscular Diseases; Syndrome

Isotretinoin (Iso) is currently indicated for the treatment of cystic acne (CA) and is related to marked teratogenicity.. The aim of the study was to evaluate the relationship between total antioxidant status (TAS) and a serum marker of DNA oxidative damage, 8-hydroxy-2-desoxyguanosine (8-OHdG), in patients on Iso treatment.. Patients with CA (n=18) were evaluated before and 45 days after Iso (0.5 mg/kg per day) treatment and non-diseased controls (n=22) were tested only once. Plasma TAS levels and 8-OHdG were measured spectrophotometrically and with an immunoassay, respectively. Liver biochemical parameters and muscle enzymes were measured on a blood chemistry analyzer.. TAS levels were significantly (p<0.0001) lower in patients before treatment (921+/-124 micromol/L) compared with those after treatment (1335+/-93 micromol/L) and in controls (1536+/-126 micromol/L). In contrast, 8-OHdG serum levels were two-fold higher in patients after treatment (0.21+/-0.03 ng/mL) than before treatment (0.11+/-0.02 ng/mL) and three-fold higher than in controls (0.07+/-0.01 ng/mL; p<0.0001). Negative correlations were found between TAS and 8-OHdG (r=-0.754, p<0.0001) in patients before therapy and positive correlations were found between creatine kinase (CK) and 8-OHdG (r=0.488, p<0.001) and liver enzymes after Iso treatment.. High serum levels of 8-OHdG in patients on Iso therapy may be due to a direct effect of Iso on liver, muscle and skin epidermal cells. Regular evaluation of 8-OHdG in sera of patients, especially of women of reproductive age, on Iso treatment could be a sensitive follow-up biomarker of DNA oxidation.

Topics: 8-Hydroxy-2'-Deoxyguanosine; Adolescent; Adult; Antioxidants; Deoxyguanosine; Dermatologic Agents; DNA Damage; Female; Humans; Isotretinoin; Liver; Male; Muscle, Skeletal; Muscular Diseases; Oxidative Stress

Patients with cystic acne (CA) on Isotretinoin (Iso) therapy might present muscular symptoms as side effect of the drug. Myalgia, weakness, hypotension are also some of the main characteristics of carnitine (car) deficiency.. Two hundred and thirty (N = 230) patients with CA were treated with Isotretinoin (0.5 mg/kg per 24 h). All the patients were requested to visit our out-patient department at the onset of muscular symptoms. Laboratory tests including car (total, free, acylcarnitine) were determined in blood and urine before treatment, at the onset of muscular symptoms and after the end of a 45 day study. Fifty percent of the patients with muscular involvement received L-carnitine (100 mg/kg per 24 h per os) (group C) and 50% placebo (group P).. Their laboratory tests showed the well known increases of their liver enzymes and lipids, whereas car blood levels were remarkably decreased at the onset of their muscular symptoms and or at the end of the study. Their supplementation with L-car, in patients of group C (N = 20) without Iso discontinuation or reduction, resulted in the disappearance of their muscular symptoms within 5-6 days and normalisation not only of the increased levels of their liver enzymes but also those of car, at the 45 day of their therapy. Additionally, the patients who received placebo (group P, N = 20) continued complaining for mualgias. The rest of the patients (group A, N = 190) did not experience any muscular symptoms, their laboratory tests showed elevation of liver enzymes and lipids and a decrease in car levels in the blood whereas a remarkable increase of car excretion was determined in their urine.. Iso therapy decreases car blood levels in patients with CA. L-car supplementation might treat liver and muscular side effects of the drug. These hopeful preliminary results need further investigation.

Topics: Acne Vulgaris; Adult; Alanine Transaminase; Alkaline Phosphatase; Aspartate Aminotransferases; Carnitine; Case-Control Studies; Cholesterol; Female; Follow-Up Studies; Humans; Isotretinoin; Keratolytic Agents; Liver; Male; Muscle Weakness; Muscular Diseases; Pain; Placebos; Triglycerides

Topics: Diplopia; Humans; Isotretinoin; Male; Muscular Diseases

Muscle-related complaints and high creatine phosphokinase (CPK) blood levels have been reported in 15-50% of patients with acne treated with isotretinoin. Clinical investigations about CPK levels in isotretinoin therapy were few, and most of them were case reports. The aim of this study was to investigate the incidence, course, and clinical significance of severe hyperphosphokinasemia in isotretinoin therapy for acne.. A total of 89 patients were treated with isotretinoin for moderate or severe acne at our dermatology department. At the initial visit and during the monthly follow-up visits, hemoglobin, hematocrit, leukocytes, thrombocyte, renal function tests (urea and creatinine), direct and indirect bilirubin, liver enzymes [serum glutamate oxaloacetate (SGOT), serum glutamate pyruvate transaminase (SGPT), gamma glutamil transpeptidase (GGT), and alkaline phosphotase (ALP)], lipid profile [total cholesterol, very low density lipoproteins (VLDL), low density lipoproteins (LDL), high density lipoproteins (HDL), and triglycerides], urine analysis, and CPK were requested. We asked all patients about muscle-related complaints, weakness, exercise, and compared CPK levels.. Elevated CPK levels were recorded in only five patients during treatment period. Maximum serum CPK values recorded for each patient ranged between 292 and 569 IU/l. Only one patient out of five had myalgia and four patients were completely asymptomatic.. In conclusion, marked hyperCPKemia with or without muscle-related complaints in isotretinoin-treated patients with acne is a benign phenomenon; therefore, it is logical to reserve measurement of CPK levels as well as renal tests for cases with severe muscle pain.

Topics: Acne Vulgaris; Adolescent; Adult; Creatine Kinase; Dermatologic Agents; Exercise; Female; Humans; Isotretinoin; Male; Muscular Diseases; Pain

The effect of isotretinoin on muscle is considered to be uncommon and benign. We analyzed the files of all our patients given isotretinoin over a 5-year period and determined the incidence and gravity of its effect on muscles.. Sixty treatments with isotretinoin were studied. Myalgia and elevated CPK observed at the pretherapeutic consultation and each month or 2 months thereafter were recorded.. Muscle symptoms were noted in 60 p. 100 of the cases: myalgia in 51 p. 100 and elevated CPK in 41 p. 100. In this group, male sex (H/F = 2.6) and sports activities (70 p. 100) were found more often. In 5 patients, CPK level was 5 times the normal, defining rhabdomyolysis. One patient interrupted treatment because of persistently high CPK levels.. Myalgia and elevated CPK signal skeletal muscle involvement. These signs were more frequent in our series than in reports in the literature, probably because we systematically looked for them. Besides use of isotretinoin, one case of viral infection and sports activities, no other explanatory cause could be found. Isotretinoin could have a potentializing effect on other myotoxicity inducers (drugs, infection, fever, muscular exertion...). The benign nature of the muscle effect appears to be validated although there were some patients who had persistent and/or severe signs.

Topics: Acne Vulgaris; Adolescent; Adult; Creatine Kinase; Drug Monitoring; Female; Humans; Incidence; Isotretinoin; Keratolytic Agents; Male; Muscular Diseases; Pain; Prospective Studies; Rhabdomyolysis; Sex Factors; Sports

Topics: Acne Vulgaris; Acute Disease; Adult; Fatigue; Female; Humans; Isotretinoin; Keratolytic Agents; Male; Muscle Weakness; Muscular Diseases; Pain

A 99mTc-MDP bone scan performed on a 34-yr-old female for suspected osteomyelitis of the proximal tibia revealed focally increased activity in both tibial tuberosities due to enthesopathies secondary to chronic isotretinoin therapy. Physicians should be aware that isotretinoin therapy can cause abnormal bone scans and not mistake these abnormalities for other diseases such as osteomyelitis. Second, bone scans may be helpful in diagnosing and following isotretinoin bone toxicity.

Topics: Adult; Diagnosis, Differential; Female; Humans; Hyperostosis; Isotretinoin; Knee Joint; Muscular Diseases; Osteomyelitis; Radionuclide Imaging; Spinal Diseases; Tendons

An 18-year old male patients with tetracycline-resistant acne vulgaris was prescribed isotretinoin in daily doses of 0.5 mg/kg. Ten days later, he developed an acute episode of acne fulminans which was regressive. Subsequently, two attempts were made at reintroducing isotretinoin; the first one was followed by a new episode of acne fulminans and the second one, by ordinary myalgias, while the patient was still under corticosteroid therapy. A search in the literature yielded 14 cases of acne fulminans that had possibly been induced by isotretinoin. Doses and intervals between medication and acute manifestations varied, and the responsibility of isotretinoin was seldom demonstrated. Associations with erythema nodosum myalgias and arthralgias have been described. This rare adverse effect of isotretinoin therapy must be known. Its course and treatment are not different from those of ordinary acne fulminans.

Topics: Acne Vulgaris; Adolescent; Adrenal Cortex Hormones; Bone Diseases; Humans; Isotretinoin; Joint Diseases; Muscular Diseases; Recurrence; Suppuration

The treatment of scleromyxedema has been largely ineffective. We report improvement of scleromyxedema with myopathy after treatment with isotretinoin, 40 mg twice a day. We review other therapeutic modalities used for this disorder and discuss properties of isotretinoin that may have contributed to the favorable response.

Topics: Adult; Facial Dermatoses; Hand Dermatoses; Humans; Isotretinoin; Male; Muscular Diseases; Myxedema; Skin Diseases

Topics: Adolescent; Adult; Humans; Isotretinoin; Male; Muscles; Muscular Diseases; Tretinoin