A Prospective Cohort Study of Laboratory Abnormalities During  Isotretinoin Treatment For Acne Vulgaris

Kanimoli Rathakrishnan; Lay Kim Tan; Sharifah Rosniza Binti Syed Nong Chek; Che Hassan Zuraida; Dyoi E Low

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A Prospective Cohort Study of Laboratory Abnormalities During Isotretinoin Treatment For Acne Vulgaris

Author: Kanimoli Rathakrishnan ¹ ; Lay Kim Tan ² ; Sharifah Rosniza Binti Syed Nong Chek ¹ ; Che Hassan Zuraida ² ; Dyoi E Low ³
Author Information

1. Department of Dermatology, Hospital Kuala Lumpur, Wilayah Persekutuan, Malaysia
2. Sector for Biostatistics and Data Repository, Office of NIH Manager, National Institute of Health, Ministry of Health Malaysia, Selangor, Malaysia
3. Dermatology Unit, Hospital Serdang, Selangor, Malaysia
Publication Type:Journal Article
Keywords: Acne vulgaris; Isotretinoin; Lipid profile; liver transaminases
MeSH: Isotretinoin--therapeutic use; Acne Vulgaris-therapy
From:Malaysian Journal of Dermatology 2022;48(Jun 2022):17-24
CountryMalaysia
Language:English
Abstract: Background:Acne vulgaris is a chronic inflammatory condition of the pilosebaceous unit. Isotretinoin is used to treat moderate to severe acne that is resistant to antibiotics and topical agents. However, it may cause alterations in lipids and liver enzymes.
Methods:A total of 129 patients with acne vulgaris (moderate to severe facial acne) treated with isotretinoin were recruited between May 2020 and July 2021 from the dermatology clinics at Hospital Serdang and Hospital Kuala Lumpur. Of these, 120 patients with complete data of lipid panel (total cholesterol, low density lipoprotein cholesterol [LDL], triglycerides [TG], and high density lipoprotein cholesterol [HDL]) and hepatic panel (alanine transaminase [ALT] and aspartate transaminase [AST]) levels at baseline, and in three subsequent follow-up visits (i.e., one, three, and six months) were included in the analyses. Abnormalities were graded according to standard laboratory values and their severity according to the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE)grading system.
Results:Of the 120 study participants, 83% were female and 37% were male between the ages of 15 and 36 years. We observed a significant increase in median values at baseline and at the six-month follow-up for total cholesterol (p<0.0001), triglycerides (p<0.0001), LDL (p<0.0001), ALT (p<0.0001), and AST (p<0.0001). We observed a significant correlation between body mass index and the HDL (r2 =- 0.26, p=0.01) and ALT (r2 =0.383, p=7.9x10-06) levels. Based on the CTCAE grading system, almost all study participants with abnormal results had grade 1 abnormalities. Only one patient had a grade 2 abnormality in ALT, which required treatment discontinuation.
Conclusion:Low dose isotretinoin therapy for acne vulgaris may cause mild and non-progressive elevation of LDL, total cholesterol, and liver transaminases which do not require treatment withdrawal in most cases.
Full text:15.2022my0002.pdf