The effect of isotretinoin treatment on plasma homocysteine levels in acne vulgaris.

Isotretinoin has revolutionized the treatment of acne by improving the cosmetic outcome and decreasing the psychological damage. However, use of isotretinoin is associated with significant side-effects such as mucocutaneous involvement, dyslipidaemia and liver dysfunction, as indicated by increases in liver enzymes. The responsible enzyme for homocysteine metabolism, cystathionine-beta-synthase, might also be affected by isotretinoin-induced liver dysfunction, which leads to hyperhomocysteinaemia, an independent risk factor for thrombovascular diseases. The aim of this study was to evaluate homocysteine levels and the responsible vitamins for its metabolism in patients with moderate to severe acne vulgaris on isotretinoin treatment, before and after treatment. We found increased level of homocysteine in patients after 2 months of taking isotretinoin. Our findings suggest that isotretinoin may increase the risk of cardiovascular disorders by causing hyperhomocysteinaemia.

Efficacy of oral naltrexone on pruritus in atopic eczema: a double-blind, placebo-controlled study.

AIM: The intent of our study was to determine the efficacy of oral naltrexone, an opioid antagonist, in the treatment of pruritus in patients with chronic eczema. METHODS: This double-blind, placebo-controlled study recruited 38 patients with eczema complaining from pruritus. Pruritus scores were evaluated. Patients were given placebo (n = 20) or naltrexone 50 mg (n = 18) for 2 weeks period. During the study, pruritus scores based on visual analogue scale system (VAS) were assessed three times: at the start of study, after 1 week, and after 2 weeks. RESULTS: In both groups, decreased VAS scores were observed, but naltrexone showed to be significantly more effective than placebo in decreasing VAS score after 1 week (P < 0.005) and 2 weeks (P < 0.001). CONCLUSION: Naltrexone is more effective than placebo in the treatment of pruritus in patient with eczema. Naltrexone might be considered as an adjunct treatment in the treatment of pruritus. However, further studies in this aspect are highly fostered.