1.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
Malaysian Journal of Dermatology 2022;48(Jun 2022):17-24
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.
Isotretinoin--therapeutic use
;
Acne Vulgaris-therapy
2.Bringing the Treatment of Atopic Eczema Into a New Era with Janus Kinase Inhibitors: A Position Statement By the Persatuan Dermatologi Malaysia
Noor Zalmy Azizan ; Adawiyah Jamil ; Chang Choong Chor ; Dawn Ambrose ; Henry Foong Boon Bee ; How Kang Nien ; Rajalingam Ramalingam ; Sabeera Begum Bt Kader Ibrahim ; Sharifah Rosniza Binti Syed Nong Chek ; Tan Wooi Chiang ; Wong Hoi Ling
Malaysian Journal of Dermatology 2022;49(Dec 2022):2-11
Abstract
Atopic eczema (AE) is a complex, chronic and recurrent inflammatory pruritic skin condition that
impacts the quality of life and exerts an economic toll on patients and their families. One of the factors
contributing to AE is the immune dysregulation of the Janus kinase-signal transducers and activators
of transcription (JAK-STAT) inflammatory pathway. This has prompted the conduct of various large
clinical trial programs to evaluate the efficacy and safety of Janus kinase inhibitors (JAK-i) for AE.
The overall and significant benefit of these drugs from clinical studies resulted in regulatory approvals
for JAK-i to treat moderate-to-severe atopic eczema. The objective of this position paper was to
evaluate the safety, efficacy and role of upadacitinib, baricitinib and abrocitinib in managing AE and
update the current recommended treatment algorithm within the 2018 Malaysian Clinical Practice
Guidelines for the Management of Atopic Eczema. The Persatuan Dermatologi Malaysia recommends
that these JAK-i can be considered as an option for systemic therapy in severe AE.
Dermatitis, Atopic--therapy
;
Janus Kinase Inhibitors