American Journal of Clinical Dermatology

, Volume 15, Issue 6, pp 537–542

Isotretinoin Use and Celiac Disease: A Population-Based Cross-Sectional Study

  • Benjamin Lebwohl
  • Anders Sundström
  • Bana Jabri
  • Sonia S. Kupfer
  • Peter H. R. Green
  • Jonas F. Ludvigsson
Original Research Article

DOI: 10.1007/s40257-014-0090-8

Cite this article as:
Lebwohl, B., Sundström, A., Jabri, B. et al. Am J Clin Dermatol (2014) 15: 537. doi:10.1007/s40257-014-0090-8

Abstract

Background and aim

Isotretinoin, a vitamin A analogue, can promote a pro-inflammatory milieu in the small intestine in response to dietary antigens. We hypothesized that oral isotretinoin exposure would increase the risk of celiac disease (CD).

Methods

We contacted all 28 pathology departments in Sweden, and through biopsy reports identified 26,739 individuals with CD. We then compared the prevalence of ever using oral isotretinoin to the prevalence in 134,277 matched controls through conditional logistic regression. Data on isotretinoin exposure were obtained from the national Swedish Prescribed Drug Registry. As the only indication for isotretinoin use in Sweden is acne, we also examined its relationship to CD. Data on acne were obtained from the Swedish Patient Registry.

Results

Ninety-three individuals with CD (0.35 %) and 378 matched controls (0.28 %) had a prescription of isotretinoin. This corresponded to an odds ratio (OR) of 1.22 [95 % confidence interval (CI) 0.97–1.54]. Risk estimates were similar in men and women, and when we restricted our data to individuals diagnosed after the start of the Prescribed Drug Registry. Restricting our analyses to individuals diagnosed aged 12–45 years did not influence the risk estimates (OR 1.38, 95 % CI 0.97–1.97). Meanwhile, having a diagnosis of acne was positively associated with CD (OR 1.34, 95 % CI 1.20–1.51).

Conclusions

This study found no association between isotretinoin use and CD, but a small excess risk of CD in patients with a diagnosis of acne.

Supplementary material

40257_2014_90_MOESM1_ESM.doc (84 kb)
Supplementary material 1 (DOC 84 kb)

Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  • Benjamin Lebwohl
    • 1
    • 2
  • Anders Sundström
    • 3
  • Bana Jabri
    • 4
  • Sonia S. Kupfer
    • 4
  • Peter H. R. Green
    • 1
  • Jonas F. Ludvigsson
    • 2
    • 5
  1. 1.Celiac Disease Center, Department of MedicineColumbia University College of Physicians and SurgeonsNew YorkUSA
  2. 2.Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
  3. 3.Clinical Epidemiology UnitKarolinska InstitutetStockholmSweden
  4. 4.Celiac Disease CenterUniversity of ChicagoChicagoUSA
  5. 5.Department of PaediatricsÖrebro University HospitalÖrebroSweden