isotretinoin and Musculoskeletal-Diseases

Isotretinoin (Accutane, Roche Laboratories Inc, Nutley, NJ) is an important drug, not only for the treatment of severe acne, but also for other diagnoses and in chemoprevention settings. Because the use of isotretinoin is increasing, it is important for physicians to be aware of the adverse events, toxicities, and management issues related to its use. The most important issue is that of congenital defects, which has resulted in new pregnancy prevention policies and programs implemented by the manufacturer. A relatively new concern is that of depression associated with isotretinoin use, also resulting in new policies placed by the manufacturer and the FDA. The most common adverse effects observed during treatment are mucocutaneous and ocular in nature, but laboratory abnormalities and effects in the nervous, musculoskeletal, gastrointestinal, pulmonary, hematologic, and other systems are also described. Additionally, potential drug interactions, follow-up, and toxicity prevention measures are discussed.

Topics: Abnormalities, Drug-Induced; Acne Vulgaris; Cheilitis; Dermatologic Agents; Drug Interactions; Eye Diseases; Humans; Isotretinoin; Liver Function Tests; Mental Disorders; Mouth Mucosa; Musculoskeletal Diseases

Although the efficacy of isotretinoin in the treatment of acne is unquestioned, improvement of patient tolerance and acceptance of the drug are desirable. Furthermore, no data on acne-induced scarring during isotretinoin treatment are available.. In the present study, we have evaluated the efficacy and tolerability of an initial stepwise incremental (n = 83) or an initial high dose (n = 11) and a subsequent medium maintenance dosing of isotretinoin in outpatients treated for acne over a 7 year period.. Ninety-four patients with moderate to severe acne were treated for a mean duration of 8.3 months, at a mean daily dose of 31.4 mg. Follow-up and final evaluation were done during outpatient visits and with a standardized patient questionnaire.. Response to treatment was very good in 62.8% and good in 31.9% of patients, with only one treatment failure. Of the patients, 21.3% required retreatment after a mean interval of 7.7 months. Four patients refused or dropped out from treatment, 27% noted initial mild worsening of their acne, and none experienced severe adverse effects. Scars were present in 89.4% of patients, with improvement occurring in 67.9% during treatment.. The altogether good to excellent clinical response of acne lesions and acne scars, with a low side effect profile, warrants further study of this simple, modified treatment regimen in patients with acne and acne-induced scarring.

Topics: Acne Vulgaris; Adolescent; Adult; Child; Dose-Response Relationship, Drug; Facial Dermatoses; Female; Follow-Up Studies; Humans; Isotretinoin; Keratolytic Agents; Lipids; Male; Middle Aged; Musculoskeletal Diseases; Pain; Patient Compliance; Patient Satisfaction; Recurrence; Skin; Treatment Outcome

Acne can be associated with severe musculoskeletal and constitutional symptoms. This is a case history of a 15 year-old boy with severe acne, treated with isotretinoin, who was admitted because of high fever and weight loss of 3 weeks duration. His complaints were of severe chest and back pain, and inability to walk. His laboratory results revealed elevated erythrocyte sedimentation rate and C-reactive protein. On a pelvic radiograph bilateral sacroiliitis was noticed. Radionuclide bone scan revealed increased uptake in the right sacroiliac joint, in small vertebral bodies and sternum. A diagnosis of acne-associated musculoskeletal syndrome was made and the patient was treated with high dose steroids. His symptoms resolved and his acne improved. This case report sheds light on the relationship between acne and associated musculoskeletal syndromes. Physicians should be aware of this association in order to provide prompt and efficient treatment.

Topics: Acne Vulgaris; Adolescent; Blood Sedimentation; C-Reactive Protein; Dermatologic Agents; Humans; Isotretinoin; Male; Musculoskeletal Diseases; Syndrome

Topics: Acne Vulgaris; Adolescent; Disease Progression; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Eruptions; Family Practice; Follow-Up Studies; Humans; Isotretinoin; Musculoskeletal Diseases; Pain; Prednisone; Risk Assessment; Severity of Illness Index; Skin Diseases, Vesiculobullous; Treatment Outcome