isotretinoin and Myalgia

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

Consanguinity is known to be associated with an increase in the prevalence of autosomal recessive disorders such as autosomal recessive congenital ichthyosis (ARCI). ARCI often responds well to retinoid treatment. We describe a patient with ARCI who improved under isotretinoin treatment. The patient subsequently developed elevated levels of serum creatinine phosphokinase (CPK), which led to the diagnosis of a second autosomal recessive disorder, dysferlinopathy, a rare myopathy characterized by muscle weakness, decreased tendon reflexes and marked elevation of CPK levels. This report demonstrates the need for physicians to remain alert to the possible coexistence of rare and mutually relevant disorders in populations with a high rate of consanguinity.

Topics: Adolescent; Alanine Transaminase; Arabs; Aspartate Aminotransferases; Consanguinity; Creatine Kinase; Female; Genes, Recessive; Humans; Ichthyosiform Erythroderma, Congenital; Ichthyosis, Lamellar; Isotretinoin; Keratoderma, Palmoplantar; Muscular Dystrophies, Limb-Girdle; Myalgia