Ocular surface changes in the treatment of rosacea: comparison between low-dose oral isotretinoin and doxycycline / Alterações da superfície ocular no tratamento da Rosácea: comparação entre isotretinoína oral em baixa dosagem e doxiciclina

ABSTRACT Purpose: To compare the impact of ocular changes between systemic treatment with doxycycline and low-dose oral isotretinoin in patients with moderate-to-severe papulopustular rosacea. Methods: Patients were randomized to receive either isotretinoin 0.3-0.4 mg/kg (group A) or doxycycline 100 mg/day (group B) for 16 weeks. Ocular symptoms were searched and evaluated, including best-corrected visual acuity (BCVA), Schirmer test, breakup time, rose bengal staining score, and meibomian gland dysfunction grading. The patients were retested at the end of treatment. Results: The present study included 39 patients (30 females and 9 males). Best-corrected visual acuity was > 20/30 in >90% of patients in both groups and did not change after treatment. After treatment, improvement in ocular symptoms and meibomian gland dysfunction was more pronounced in group B (p<0.05); the other parameters did not reach statistical significance. Conclusion: Doxycycline improved meibomian gland dysfunction, ocular symptoms, and ocular surface in patients with rosacea. Even though some patients experienced worsening meibomian gland dysfunction and symptoms, no subject experienced any serious complications after administration of low-dose isotretinoin.

RESUMO Objetivos: Comparar o impacto das alterações oculares entre o tratamento sistêmico de doxiciclina e isotretinoína em baixa dosagem em pacientes com rosácea papulopustulosa moderada a grave. Métodos: Os pacientes form randomizados para receber isotretinoína 0,3 a 0,4 mg/kg (grupo A) ou doxiciclina 100mg/dia (grupo B) por 16 semanas. Os sintomas oculares foram pesquisados e avaliados, incluindo melhor acuidade visual corrigida, teste de Schirmer, tempo de ruptura do filme lacrimal, coloração de rosa bengala e graduação da disfunção de glândula de Meibomius. Os pacientes foram novamente testados no final do tratamento. Resultados: O presente estudo incluiu 39 pacientes (30 mulheres e 9 homens). A melhor acuidade visual corrigida foi >20/30 em >90% dos pacientes em ambos os grupos e não se alterou após o tratamento. A melhora dos sintomas oculares e da disfunção de glândula de Meibomius foi mais pronunciada no grupo B (p<0,05) após o tratamento; as demais variáveis não atingiram significância estatística. Conclusão: A doxiciclina melhorou a disfunção de glândula de Meibomius, os sintomas oculares e a superfície ocular de pa cientes com rosácea. Mesmo que alguns pacientes tenham piorado a disfunção e os sintomas da glândula de Meibomius, nenhum indivíduo apresentou complicações graves após a admi nistração de baixas doses de isotretinoína.

Use of oral isotretinoin to treat acne in the public system: a hospital-based retrospective cohort

ABSTRACT BACKGROUND: Acne needs to be treated early to prevent negative psychosocial impacts. In severe or moderate forms, which tend to leave scars, oral isotretinoin is the first-line therapy. However, concern about its adverse events, especially in developed countries, delays effective treatment. In contrast, isotretinoin is widely prescribed in Brazilian private clinics. OBJECTIVES: To describe the use of isotretinoin for treating acne in a Brazilian public hospital, and to analyze whether its prescription is effective or belated. DESIGN AND SETTING: Retrospective cohort study in a public hospital. METHODS: Clinical and therapeutic data were obtained from the medical records of patients who were undergoing or had undergone acne treatment with isotretinoin in this hospital's general dermatology outpatient clinic over the last seven years, up to April 2018. RESULTS: 1526 medical records from patients with acne were analyzed. Isotretinoin was prescribed for 279 patients (18.28%) with mild (1.19%), moderate (57.37%), severe (35.85%) or conglobata (5.57%) forms of acne vulgaris. Sequelae of acne were present at the start of most of these patients' treatment. An initial daily dose of 20 mg was usually prescribed. The average initial dose/weight ratio was 0.33 mg/kg/day. The average total dose/weight ratio was 127.61 mg/kg. There were only a few cases of laboratory abnormalities. CONCLUSION: Sequelae of acne at the onset of treatment reveal delayed indication of isotretinoin, which can have negative psychosocial impacts on quality of life. Isotretinoin should be indicated early to prevent this. Its use is supported by its lack of laboratory alterations and controllable adverse events.

Oral isotretinoin in photoaging: objective histological evidence of efficacy and durability

AbstractBACKGROUND:The off-label use of oral isotretinoin in photoaging is a therapeutic tool that has been used by dermatologists. There are few studies to corroborate its effectiveness and durability.OBJECTIVES:To assess, both clinically and histologically, the changes caused by the use of oral isotretinoin in skin photoaging as well as the duration of the effects.METHODS:20 female patients, aged 45-50 years, with phototypes II-VI, none of whom had experienced menopause, were treated with 20mg oral isotretinoin, 3 days a week, for 12 weeks. They underwent clinical analysis and skin biopsies in the pre-auricular region, while histologic cuts enabled assessment of the solar elastosis level and morphologic analysis.RESULTS:Clinically, patients, as well as the researching and the assessor physicians, noticed improvement in skin quality. One patient presented severe solar elastosis, 11 manifested the moderate form, while 8 presented the discreet type. According to histological analysis, 65% of the patients revealed alteration in the distribution and thickness of the elastic fibers, which can be interpreted as a histological improvement, while 60% showed an increase in collagen density. We observed an increase in collagen density, from 51.2% to 57.4%, (p=0.004). At the end of the 12-week follow-up period, this density decreased to 54.7% (p=0.050). There was an increase in the density of elastic fibers, from 26.5% to 31.3%, (p=0.02), which had dropped to 27.5% at the end of the 12-week follow-up period.CONCLUSIONS:The study confirmed the role of oral isotretinoin in remodeling the extracellular matrix against photoaging, as well as its durability after 12 weeks, especially when we consider collagen fibers.

Pseudo-acne fulminans associated with oral isotretinoin

Acne fulminans is a rare and serious condition characterized by the sudden onset of nodular and ulcerative acne lesions associated with systemic symptoms. It has been recognized a subset of patients with a sudden worsening of acne, often during treatment with oral isotretinoin, but without the strong presence of systemic involvement. Recognized by some authors as "pseudo-acne fulminans" or " acne fulminans sine fulminans," we report a case with these features in order to draw attention to the recognition and early management of this manifestation.

Actualización: uso de isotretinoína oral en rosácea / Update: use of oral isotretinoin in rosacea

La rosácea es una dermatosis facial inflamatoria crónica caracterizada por periodos intermitentes de exacerbación y remisión. La etiología es desconocida y factores genéticos y ambientales están involucrados en su desarrollo. El tratamiento tópico y sistémico controla la rosácea en forma parcial. La Isotretinoína oral es útil por sus propiedades antiinflamatorias,inmunomoduladoras y de reducción del flujo sanguíneo.

Rosacea is a chronic facial inflammatory dermatoses characterized by intermittent periods of clinical exacerbation and remission. The etiology is unkown. Genetic and external factors are involved in the pathogenesis. Topical and oral treatments partially control the disease. Oral Isotretinoin can be useful because of the antiinflammatory, inmumodulating actions and because it reduce the blood flow.

The effect of isotretinoin on triglycerides and liver aminotransferases / Influência da isotretinoína nas transaminases hepáticas e triglicerídeos

BACKGROUND: Isotretinoin has been used to treat the most severe cases of acne; however, it may provoke adverse events in mucocutaneous and hepatic tissues, lead to alterations in lipid levels and cause teratogenicity. OBJECTIVE: The objective of this study was to evaluate the profile of changes in alanine aminotransferase (ALT), aspartate aminotransferase (AST) and triglyceride levels in patients who had been treated with oral isotretinoin dispensed by the São Mateus/ES pharmacy for special drugs. METHODS: A retrospective, observational, longitudinal study was conducted by carrying out a secondary analysis of each patient's data. RESULTS: Of the 130 patients who received isotretinoin between January and December 2009, only 70 were actually treated for 3 months or more and handed in the results of their laboratory tests. Of these 70 patients, 39 (55.7%) were female. The mean age of the women (23.9 years) was higher than the mean age of the men (20.1 years). There was a statistically significant increase in the levels of triglycerides (87.01 ± 48.25 versus 105.32 ± 48.76 mg/dL), AST (20.44 ± 6.26 versus 24.38 ± 11.92 U/L) and ALT (18.24 ± 8.31 versus 23.34 ± 20.03 U/L) performed prior to and 3 months or more after oral isotretinoin treatment. After treatment with oral isotretinoin, triglyceride levels had increased beyond the normal range in 11% of the patients, while 8.6% had elevated AST levels and 7.3% had increased ALT levels. CONCLUSION: The results in this population show that the use of oral isotretinoin for the treatment of acne may result in altered triglyceride, AST and ALT levels. These findings are in accordance with data published previously in the scientific literature, confirming the need to monitor these patients.

FUNDAMENTOS: A isotretinoína tem sido usada no tratamento dos casos mais graves de acne, embora possa induzir reações adversas nos tecidos mucocutâneos e hepáticos, alterações nos níveis lipídicos e teratogenicidade. OBJETIVOS: Este estudo avaliou o perfil de alterações nas concentrações de Alanina Aminotransferrase, Aspartato Aminotransferrase e triglicerídeos em pacientes que fizeram uso de isotretinoína oral fornecida pelo serviço Farmácia de Medicamentos Excepcionais de São Mateus/ES. MÉTODOS: Foi realizado estudo observacional longitudinal exploratório retrospectivo, utilizando coleta de dados secundários de cada paciente. RESULTADOS: Dos 130 pacientes que receberam isotretinoína no período de janeiro a dezembro de 2009, somente 70 realizaram o tratamento por 3 meses ou mais e apresentaram os resultados dos exames. Desses 70 pacientes, 39 (55,7%) eram do sexo feminino. A média de idade das mulheres (23,9 anos) foi maior do que a média de idade dos homens (20,1 anos). Houve aumento estatisticamente significante nas dosagens de triglicerídeos (87,01±48,25 versus 105,32 ± 48,76), Aspartato Aminotransferrase (20,44 ± 6,26 versus 24,38 ± 11,92) e Alanina Aminotransferrase (18,24 ± 8,31 versus 23,34 ± 20,03), realizadas antes e após 3 meses ou mais de tratamento com isotretinoína oral. Após o tratamento com isotretinoína oral, 11% dos pacientes apresentaram elevação de triglicerídeos acima dos valores normais, 8,6% apresentaram elevação da Aspartato Aminotransferrase e 7,3% tiveram elevação da Alanina Aminotransferrase. CONCLUSÃO: Os resultados mostraram que o uso de isotretinoína oral para o tratamento da acne, na população estudada, pode levar a alterações nas dosagens de triglicerídeos, Alanina Aminotransferrase e Aspartato Aminotransferrase, como mostrado pela literatura científica, confirmando a necessidade de monitoramento.

Avaliação laboratorial do perfil lipídico e testes de lesão hepatocelular em pacientes com acne vulgar sob uso de isotretinoína oral / Laboratory evaluation of lipid profile and tests of liver injury in patients with acne vulgaris using oral isotretinoin

JUSTIFICATIVA E OBJETIVOS: Este estudo visa à investigação dos efeitos do tratamento com isotretinoína oral sobre o perfil lipídico e de lesão hepatocelular em pacientes com acne vulgar na população de Alagoas, de modo a comparar com os índices de alterações da população de outros países, pois não existe qualquer estudo na população brasileira, comprovando sua segurança quando usada de forma racional. MÉTODO: Através de estudo transversal, avaliaram-se dados de prontuários de pacientes que fizeram uso de isotretinoína oral, por intermédio da Farmácia de Medicamentos Excepcionais (FARMEX), sendo enquadrados no estudo os resultados referentes às dosagens de colesterol total e frações (HDL e LDL), triglicerídeos e enzimas hepáticas (ALT e AST). A amostra compreendeu aqueles que realizaram tratamento entre os anos de 2002 a 2009, perfazendo um total de 721 pacientes. RESULTADOS: Dos 721 pacientes; 15,27% apresentaram elevação sérica dos triglicerídeos; com aumento médio de 30,6% em seus níveis; 19,95% desenvolveram hipercolesterolemia, com elevação média de 7,5% em suas taxas; 12,55% apresentaram elevação da ALT e 3,26% evoluíram com aumento da AST, visto que, mostraram incremento sérico médio de 8,3% e 9,5%, respectivamente. Apenas 1,66% obtiveram algum valor laboratorial que exigisse a cessação da terapia. CONCLUSÃO: Pequeno número de pacientes desenvolveu níveis sanguíneos de quaisquer variáveis compatíveis com a descontinuidade do tratamento ou mesmo diminuição da dose administrada, corroborando a segurança da terapia com a isotretinoína oral.

BACKGROUND AND OBJECTIVES: This study aims to research of the effects of treatment with oral isotretinoin on lipid profile and tests of hepatocellular damage in patients with acne vulgaris in the population of Alagoas, in order to compare the rates of changes in the population of other countries, since there is no study in the Brazilian population, demonstrating its safety when used in a rational. METHOD: Through sectional study, data were evaluated from medical records of patients who used oral isotretinoin, by the Exceptional Drug Pharmacy - FARMEX, being framed in the study results concerning to total cholesterol and fractions (HDL and LDL), triglycerides and liver enzymes (ALT and AST). The sample included those who underwent treatment between the years 2002 to 2009, a total of 721 patients. RESULTS: Of the 721 patients, 15.27% had high serum triglycerides, with an average increase of 30.6% in levels, 19.95% developed hypercholesterolemia, with an average increase of 7.5% in their rates, 12.55% had addition of ALT and 3.26% developed increased AST, so that showed a serum increase of 8.3% and 9.5%, respectively. Only 1.66% had a laboratory value that required cessation of therapy. CONCLUSION: Small number of patients developed blood levels of any variables consistent with the discontinuation of treatment or dose reduction, confirming the safety of therapy with oral isotretinoin.

Acne fulminans e isotretinoína: relato de caso / Acne fulminans and isotretinoin: case report

A acne fulminans é afecção rara e a forma mais grave de todo o espectro clínico da acne. Caracterizase pelo aparecimento súbito de nódulos inflamatórios dolorosos que ulceram, concomitantemente, a manifestações sistêmicas. Pode ser induzida pela isotretinoína e alguns autores acreditam que a ocorrência do quadro seja dose dependente. O tratamento é controverso, não havendo padronização até o momento. Apresenta-se caso desta rara doença, desenvolvida durante o uso de isotretinoína em baixas doses.

Acne fulminans (AF) is a rare disorder, the most severe form of the entire clinical spectrum of acne. It is characterized by emergence of painful inflammatory nodules that turn into ulcers, concomitant with systemic manifestations. It can be induced by isotretinoin and some authors believe that the occurrence of this condition is dose dependent. The treatment is controversial and there is no consensus up to this time. A case of this rare disease, developed during use of isotretinoin in low doses, is presented.

Recidiva de acne após tratamento com isotretinoína oral: seguimento de cinco anos / Acne recurrence after treatment with oral isotretinoin: 5-years follow-up

Introdução: A isotretinoína foi inicialmente utilizada no tratamento da acne inflamatória grave, sendo atualmente bem reconhecida como tratamento de sucesso para acne vulgar. Muitos são os fatores associados com a recorrência da doença, que varia entre 5,6% e 65,4%. Há muita controvérsia sobre a importância e a contribuição de cada um desses fatores. Objetivos: Determinar a taxa de recidiva dos pacientes que receberam tratamento completo com isotretinoína oral (dose entre 120 e 150mg/kg) e fatores associados ao risco. Métodos: Estudo retrospectivo a partir de dados de 276 pacientes tratados com isotretinoína. Após período mínimo de 30 meses a contar do término do tratamento realizou-se a aná-lise. Considerou-se recidiva o surgimento de lesões ativas que necessitassem de retratamento. Resultados: Houve 25,53% de recidiva nos pacientes que fizeram dose completa, e 81,03% nos que receberam dose incompleta. Os demais fatores estudados não demonstraram signifi-cância estatística. Conclusão: A isotretinoína oral é tratamento efetivo em produzir redução significativa e de longa duração da acne. No entanto, deve ser reforçado o fato de que recidivas ocorrem com frequência significativa principalmente quando não se atingem as doses preconizadas.

Enfermedad de Darier-White tratada con isotretinoína oral / Darier-White disease treated with oral isotretinoin

La enfermedad de Darier-White (EDW) es un trastorno autosómico dominante; descrita por Darier y White en 1889, se caracteriza por alteraciones de la queratinización de la epidermis, uñas y mucosas. Presentamos el caso de un paciente masculino de 16 años con lesiones cutáneas e histológicas características de la EDW, que realizó tratamiento con isotretinoína oral a una dosis de 0,7 mg/kg/día por seis meses, con respuesta favorable. Se plantea una alternativa terapéutica con retinoides orales para las lesiones fjas, resistentes, crónicas y pruriginosas.

Darier-White Disease (DWD) is an autosomal dominant disorder, described by Darier and White in 1889, characterized by abnormal keratinization in the epidermis, nails and mucosae. We present the case of a 16-year-old, male patient, with clinically and histologically confrmed DWD treated with oral isotretinoin (0.7 mg/kg/day) for six months, with good response. We recommend an optional therapeutic treatment for chronic, itchy, recalcitrant lesions with oral retinoids.

Avaliação dos efeitos adversos clínicos e alterações laboratoriais em pacientes com acne vulgar tratados com isotretinoína oral / Evaluation of clinical adverse effects and laboratory alterations in patients with acne vulgaris treated with oral isotretinoin

FUNDAMENTOS: A isotretinoína oral revolucionou o manejo da acne. Os efeitos adversos observados, durante o tratamento, são divididos em dois grupos: mucocutâneos e sistêmicos. Anormalidades laboratoriais, principalmente, as dislipidemias e aumento das enzimas hepáticas são relatados. OBJETIVO: Avaliar a tolerabilidade da isotretinoína oral, com atenção, no metabolismo lipídico, função hepática e reações adversas clínicas. MÉTODOS: Foram incluídos 150 pacientes com diagnóstico clínico de acne submetidos a tratamento com isotretinoína oral. Avaliações clínicas e laboratoriais foram feitas, após um mês e a cada três meses, até completar o tratamento. RESULTADOS: Dos 150 pacientes 48 por cento eram do sexo feminino e 52 por cento do sexo masculino. A idade variou de 15 a 32 anos. Quanto aos efeitos adversos cutâneos e mucosos da isotretinoína, queilite foi o mais frequente, ocorrendo em 94 por cento pacientes. Efeitos clínicos sistêmicos foram bem menos comuns. Os níveis de colesterol, triglicerídeos, transaminases, foram avaliados e não mostraram alterações significativas, ao longo do tratamento. CONCLUSÃO: Os pacientes apresentaram efeitos adversos, compatíveis com os da literatura, e, em sua maioria, controlados com medicações sintomáticas. Podemos concluir que a isotretinoína é uma droga segura, em relação a seus efeitos adversos, tanto clínicos como laboratoriais.

BACKGROUND: Oral isotretinoin therapy has completely changed the treatment of acne. The clinical adverse effects of isotretinoin are classified into two groups: mucocutaneous and systemic toxic. Laboratory alterations such as dyslipidemia and increase of hepatic enzymes are reported. OBJECTIVES: To evaluate the tolerability of oral isotretinoin with special attention to lipid metabolism, hepatic function, and clinical adverse reactions. METHODS: 150 patients clinically diagnosed with acne being treated with oral isotretinoin were included in the study. Clinical and laboratory evaluations were conducted before the start of therapy, one month after, and every three months thereafter until the completion of treatment. RESULTS: Of the 150 patients evaluated, 48 percent were female and 52 percent, male. They were aged from 15 to 32 years. The most prevalent mucocutaneous adverse reaction associated with isotretinoin therapy was cheilitis, reported by 94 percent of the patients. Systemic clinical effects were much less common. Cholesterol, triglyceride, and transaminase levels were assessed and significant changes were not observed during treatment. CONCLUSION: Patients showed adverse effects compatible to those described in the literature, which are mostly controlled with symptomatic medication. Isotretinoin is a safe drug and adverse and laboratory effects are well tolerated.

Oral isotretinoin is as effective as a combination of oral isotretinoin and topical anti-acne agents in nodulocystic acne.

BACKGROUND: Due to the late introduction of oral isotretinoin, there is only a single report of the use of this drug from India. AIMS: To evaluate the efficacy, acceptability and side effects of oral isotretinoin in Indian conditions and to compare the efficacy of oral isotretinoin monotherapy with that of a combination of oral isotretinoin and topical anti-acne agents. METHODS: Sixty clinically diagnosed patients of nodulocystic acne were divided into two groups of 30 each. Patients in group A were administered oral isotretinoin 20 mg twice a day along with topical clindamycin (1%) and adapalene (0.1%) for 24 weeks. Patients in group B were given only oral isotretinoin. An objective clinical scoring was repeated every four weeks and patients were followed up for six months on completion of treatment. RESULTS: Out of the 60 patients, 50 completed the treatment and 35 completed the follow-up at six months. The mean pretreatment score in group A came down from 12.8 to 1.24 and in group B from 12.4 to 1.48, thus showing a 90.55% and 88% reduction in pretreatment scores respectively. There was no statistical difference in the results obtained from the two groups. Side effects were common but minor in nature. CONCLUSION: Isotretinoin produces gratifying results in patients of nodulocystic acne in Indian conditions. Addition of topical antiacne agents does not alter the final outcome. This addition is well tolerated but requires careful monitoring.

Combinational Treatment with Retinoic Acid Derivatives in Non-small Cell Lung Carcinoma In Vitro

The growth inhibitory effects of four retinoic acid (RA) derivatives, 9-cis RA, 13-cis RA, N-(4-hydroxyphenyl) retinamide (4-HPR), and all-trans retinoic acid (ATRA) were compared. In addition, the effects of various combinations of these four agents were examined on non-small cell lung carcinoma (NSCLC) cell-lines, and on the expressions of retinoic acid receptors (RARs) and retinoid X receptors (RXRs) on these cells. At the clinically achievable concentration of 1 micrometer, only 4-HPR inhibited the growths of H1299 and H460 cells-lines. However, retinoic acid receptor beta(RAR beta) expression was up-regulated on H460 and H1299 cells treated with 1 micrometer of ATRA, 13-cis RA, or 9-cis RA. All NSCLC cell lines showed growth inhibition when exposed sequentially to 1 micrometer ATRA and 0.1 micrometer 4-HPR. In particular, sequential treatment with 1 micrometer ATRA or 13-cis RA and 4-HPR markedly inhibited H1703 cell growth; these cells exhibited no basal RAR beta expression and were refractory to 4-HPR. However, in NSCLC cell lines that expressed RAR beta, the expressional levels of RAR beta were up-regulated by ATRA alone and by sequential treatment with ATRA and 4-HPR. 4-HPR was found to be the most active of the four agents in terms of NSCLC growth-inhibition. Moreover, sequential treatments with ATRA or 13-cis RA followed by 4-HPR were found to have synergistic growth-inhibitory effects and to regulate RAR expression.

Evaluation of the efficacy of intermittent isotretinoin doses in acne patients

Oral isotretinoin is the only treatment that has an effect on all the major etiological factors involved in acne [increased sebum production, alterations in microbial flora, hyperkeratinization of pilosebaceous duct, and inflammation]. Considering complications and relative expense, several treatment regimens have been suggested. The objective of this study was to evaluate the efficacy of intermittent doses of isotretinoin in acne patients. We made a quasi-experimental clinical trial in the acne patients without nodular and cystic lesions that were recalcitrant to conventional therapy. Therapeutic regimen included 0.5 mg/kg isotretinoin per day for a week every month; so we use 21 mg/kg as total dosage. Acne severity decreased in entire patients at the end of treatment course. After six months follow up recurrence rate was 19.3% and partially recurrence rate was 44%. It seems that intermittent isotretinoin treatment with a total dose of 21 mg/kg has led to good therpeutic results in patients without nodulocystic lesions

Adverse effects of systemic isotretinoin therapy: a study of 78 patients

Isotretinoin is an effective treatment for severe forms of acne refractory to other therapies, but it is a teratogen and can cause serious side effects. The side effects, in addition to the constitutional features are related to skin, mucosae, eyes, sexual organs, central nervous system, respiratory system and gastrointestinal tract. Deranged biochemical profile may also be seen in few patients. The current study was aimed to determine the frequency of side effects of systemic isotretinoin therapy in patients treated for acne, thereby assessing its safety. During the calendar year 2004, all the acne patients attending the outpatient department of dermatology, Ziauddin Medical University, KDLB campus, Karachi, fulfilling the inclusion criteria, managed on systemic isotretinoin were enrolled. All were taking isotretinoin at a dose of 0.5mg/kg body weight daily. Baseline investigations were performed in all the patients i.e. liver function tests, lipid profile, complete blood picture and renal function tests. They were followed up for any side effects and clinical improvement. The baseline investigations were repeated monthly to see any biochemical and hematological derangements. 78 patients, 42 females [53.8%] and 36 males [46.2%], with ages ranging from 18 to 24 years, were enrolled. 72 patients [92.2%, p<0.001] developed side effects with a variable frequency of at least one feature in each of these subjects. The side effects, in addition to the constitutional features, observed were related to skin [87.2%], mucosae [10.3%], central nervous system [5.2%], eyes [3.8%], reproductive organs [2.6%], respiratory system [1.3%] and gastrointestinal tract [1.3%]. Deranged biochemical profile was also a feature in few patients [6.3%]. The majority of the patients on systemic isotretinoin have side effects, the most common being cutaneous and mucosal but are trivial. Side effects pertaining to the other systems are less frequent