ABSTRACT
Purpose: Acne is a chronic inflammatory skin disease with a high prevalence in Saudi Arabia. Isotretinoin is used to treat severe, resistant nodulocystic acne. Side effects include joint discomfort, headache, mucosal dryness, and nose bleeds. Elevated lipids and liver enzymes have also been recorded. The study goal is to identify the prevalence of increased lipid levels during and after isotretinoin use. Patients and Methods: This retrospective study was conducted in the dermatology polyclinic at King Faisal University, Al-Ahsa, Saudi Arabia. It included adults of different age groups diagnosed with acne vulgaris and treated with oral isotretinoin between January 2021 and December 2022. Parameters included baseline laboratory tests and follow-up laboratory results of cholesterol and triglycerides. Results: Among 88 patients, 48.9% were aged 21-23 years, with females dominating. In total, 47.7% of patients started using isotretinoin at age 20 years or less, with starting doses ranging from 10 to 20 mg. Fifty percent of the patients had five months or more of treatment duration and only 6.8% of the patients had previously used isotretinoin. For the cholesterol and triglycerides, 87.5% of patients had normal pre-treatment with cholesterol and 90.9% with triglycerides, followed by 81.8% and 95.5% in the second reading, respectively. In the last reading, results were 77.3% for cholesterol and 94.3% for triglycerides. Conclusion: The study found that most acne patients treated with isotretinoin had normal cholesterol and triglyceride levels at baseline, second, and last readings. The incidence of higher laboratory alterations was low, with 12.5% and 4.5% for cholesterol and triglycerides at baseline, and 18.2% and 3.4% at second, and 22.7% and 5.7% at last readings. Overall, age, gender, age of start of isotretinoin, isotretinoin dose, and previous use of isotretinoin are factors that could affect laboratory readings.
ABSTRACT
Introduction Isotretinoin is a bioactive retinoic acid variant that is taken orally to treat moderate to severe acne vulgaris. One of the adverse effects of isotretinoin is elevated liver enzymes. This study estimated the prevalence of liver enzyme changes during isotretinoin use among dermatology clinic patients in Al-Ahsa, Kingdom of Saudi Arabia. Methods This study was a retrospective analysis that reviewed the medical data of 97 patients with acne at the King Faisal University Polyclinic who were taking systemic isotretinoin. It determined the baseline, second, and last readings of aspartate aminotransferase (AST) and alanine aminotransferase (ALT). Among the 97 patients, 67 (69.1%) were female and 30 (30.9%) were male. Results Of the patients, 41 (50.6%) weighed 51-70 kg, and 45 (46.4%) were 21-23 years old. The age of acne onset was 20 years or younger. Most patients had a starting isotretinoin dose of 10-20 mg and an ending dose of 30-40 mg over six months. Ninety (92.8%) patients had not used isotretinoin in the past. Before treatment, AST was elevated in three (3.1%) patients, and ALT was elevated in two (2.1%) patients. In the last readings, AST was elevated in eight (8.2%) patients, and ALT was elevated in four (4.1%) patients. Conclusion The result of this study indicates that the incidence of high levels of AST and ALT with oral isotretinoin was low. So frequent laboratory monitoring is not recommended since the elevation was not associated with any morbidity and carries financial and emotional burdens. An exception is patients with higher body weight, males, and those whose acne started at age 16-19, in whom frequent monitoring may be considered for AST more than ALT.
