Original Research Article

American Journal of Clinical Dermatology

, Volume 15, Issue 6, pp 537-542

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

  • Benjamin LebwohlAffiliated withCeliac Disease Center, Department of Medicine, Columbia University College of Physicians and SurgeonsDepartment of Medical Epidemiology and Biostatistics, Karolinska Institutet
  • , Anders SundströmAffiliated withClinical Epidemiology Unit, Karolinska Institutet
  • , Bana JabriAffiliated withCeliac Disease Center, University of Chicago
  • , Sonia S. KupferAffiliated withCeliac Disease Center, University of Chicago
  • , Peter H. R. GreenAffiliated withCeliac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons
  • , Jonas F. LudvigssonAffiliated withDepartment of Medical Epidemiology and Biostatistics, Karolinska InstitutetDepartment of Paediatrics, Örebro University Hospital Email author 

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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.