American Journal of Clinical Dermatology

, Volume 15, Issue 6, pp 537–542 | Cite as

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


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).


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.


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).


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



BL was funded by the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant Number UL1 TR000040. JFL was supported by grants from the Swedish Society of Medicine, the Swedish Research Council—Medicine (522-2A09-195), and the Swedish Celiac Society.

Competing interests

Dr. Lebwohl: The author declares that he has no conflict of interest. Dr. Sundström: The author declares that he has no conflict of interest. Dr. Jabri: The author declares that she has no conflict of interest. Dr. Kupfer: The author declares that she has no conflict of interest. Dr. Green: The author declares that he has no conflict of interest. Dr. Ludvigsson: The author declares that he has no conflict of interest.

Details of ethics approval

This project (2006/633-31/4) was approved by the Research Ethics Committee of the Karolinska Institute, Sweden, on June 14, 2006.

Authors’ contributions

International Committee of Medical Journal Editors (ICMJE) criteria for authorship read and met: BL, AS, BJ, SSK, PG, and JFL. Agree with the manuscript’s results and conclusions: BL, AS, BJ, SSK, PG, and JFL. Designed the experiments/the study: BL and JFL. Collected data: JFL. Analyzed the data: BL. Wrote the first draft of the paper: BL and JFL. Contributed to study design, interpretation of data and writing: AS and PG. Interpretation of data; approved the final version of the manuscript: BL, AS, BJ, SSK, PG, and JFL. Responsible for data integrity: JFL. Obtained funding: JFL.

Supplementary material

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


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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

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