Abstract
Oral isotretinoin remains the most effective treatment for acne. The aim of this retrospective single-center cohort study was to estimate the prevalence of adverse events with the different oral isotretinoin brands used in acne treatment. The population consisted of all patients who consulted for acne between January 2015 and January 2020. The inclusion criterion was the initiation of treatment with oral isotretinoin. The exclusion criteria were the use of two or more brands during the same course of treatment and previous treatment with oral isotretinoin. Statistical analysis was carried out using Chi-square and Mann–Whitney tests. We analyzed 468 patients of whom 68.6% were female. The median age was 21 years. The median weight was 65 kg. The treatment was Roaccutane®, Curacné®, Acnotren®, Isosupra®, Contracné®, or Acnogen® in 44.2%, 28%, 14.5%, 10.5%, 1.7% and 0.4% of cases, respectively. Xerosis was the most frequently reported side effect regardless of the brand. The highest frequencies of hypercholesterolemia (25.6%) and eczema (13%) were noted with Roaccutane®; hypertriglyceridemia (16.8%), epistaxis (9.9%) and fatigue (3.1%) with Curacné®; excessive sweating (4.1%) and headache (4.1%) with Isosupra®; and abnormal liver function tests (11%) with Acnotren®. We found a significant correlation mainly between abnormal ASAT and Acnotren® (p = 0.009), hypercholesterolemia and Roaccutane® [OR = 1.652 (95% CI 1.056–2.585)], hypertriglyceridemia and higher body weight (p = 0.004). Factors related to the drug brand and to characteristics of acne patients could explain the variability in the prevalence of some adverse events.
Similar content being viewed by others
Availability of data and material
Available upon request.
Code availability
Not applicable.
References
Zaenglein AL, Pathy AL, Schlosser BJ, Alikhan A, Baldwin HE, Berson DS, Bowe WP, Graber EM, Harper JC, Kang S, Keri JE, Leyden JJ, Reynolds RV, Silverberg NB, Stein Gold LF, Tollefson MM, Weiss JS, Dolan NC, Sagan AA, Stern M, Boyer KM, Bhushan R (2016) Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol 74:945–973
Agamia NF, Hussein OM, Abdelmaksoud RE, Abdalla DM, Talaat IM, Zaki EI, El Tawdy A, Melnik BC (2018) Effect of oral isotretinoin on the nucleo-cytoplasmic distribution of FoxO1 and FoxO3 proteins in sebaceous glands of patients with acne vulgaris. Exp Dermatol 27:1344–1351
Nelson AM, Gilliland KL, Cong Z, Thiboutot DM (2006) 13-cis Retinoic acid induces apoptosis and cell cycle arrest in human SEB-1 sebocytes. J Investig Dermatol 126:2178–2189
On SC, Zeichner J (2013) Isotretinoin updates. Dermatol Ther 26:377–389
Vallerand IA, Lewinson RT, Farris MS, Sibley CD, Ramien ML, Bulloch AGM, Patten SB (2018) Efficacy and adverse events of oral isotretinoin for acne: a systematic review. Br J Dermatol 178:76–85
Brzezinski P, Borowska K, Chiriac A, Smigielski J (2017) Adverse effects of isotretinoin: a large, retrospective review. Dermatol Ther 30(4):e12483. https://doi.org/10.1111/dth.12483
Chelliah P, Glass D (2020) Comprehensive review of reports of menstrual irregularities associated with isotretinoin. Int J Womens Dermatol 6:365–367
Crockett SD, Gulati A, Sandler RS, Kappelman MD (2009) A causal association between isotretinoin and inflammatory bowel disease has yet to be established. Am J Gastroenterol 104:2387–2393
Huang YC, Cheng YC (2017) Isotretinoin treatment for acne and risk of depression: a systematic review and meta-analysis. J Am Acad Dermatol 76:1068-1076.e9
Margolis DJ, Attie M, Leyden JJ (1996) Effects of isotretinoin on bone mineralization during routine therapy with isotretinoin for acne vulgaris. Arch Dermatol 132:769–774
Costa CS, Bagatin E, Martimbianco ALC, da Silva EM, Lúcio MM, Magin P, Riera R (2018) Oral isotretinoin for acne. Cochrane Database Syst Rev 11:CD009435
Strauss JS, Leyden JJ, Lucky AW, Lookingbill DP, Drake LA, Hanifin JM, Lowe NJ, Jones TM, Stewart DM, Jarratt MT, Katz I, Pariser DM, Pariser RJ, Tschen E, Chalker DK, Rafal ES, Savin RP, Roth HL, Chang LK, Baginski DJ, Kempers S, McLane J, Eberhardt D, Leach EE, Bryce G, Hong J (2001) Safety of a new micronized formulation of isotretinoin in patients with severe recalcitrant nodular acne: a randomized trial comparing micronized isotretinoin with standard isotretinoin. J Am Acad Dermatol 45:196–207
Webster GF, Leyden JJ, Gross JA (2014) Results of a phase III, double-blind, randomized, parallel-group, non-inferiority study evaluating the safety and efficacy of isotretinoin-Lidose in patients with severe recalcitrant nodular acne. J Drugs Dermatol 13:665–670
Taylor PW, Keenan MHJ (2006) Pharmaceutical quality of generic isotretinoin products, compared with Roaccutane. Curr Med Res Opin 22:603–615
Rademaker M (2010) Adverse effects of isotretinoin: a retrospective review of 1743 patients started on isotretinoin. Australas J Dermatol 51:248–253
Blasiak RC, Stamey CR, Burkhart CN, Lugo-Somolinos A, Morrell DS (2013) High-dose isotretinoin treatment and the rate of retrial, relapse, and adverse effects in patients with acne vulgaris. JAMA Dermatol 149:1392
Thiboutot DM, Dréno B, Abanmi A, Alexis AF, Araviiskaia E, Barona Cabal MI, Bettoli V, Casintahan F, Chow S, da Costa A, El Ouazzani T, Goh CL, Gollnick HPM, Gomez M, Hayashi N, Herane MI, Honeyman J, Kang S, Kemeny L, Kubba R, Lambert J, Layton AM, Leyden JJ, López-Estebaranz JL, Noppakun N, Ochsendorf F, Oprica C, Orozco B, Perez M, Piquero-Martin J, See JA, Suh DH, Tan J, Lozada VT, Troielli P, Xiang LF (2018) Practical management of acne for clinicians: an international consensus from the global alliance to improve outcomes in acne. J Am Acad Dermatol 78:S1–S23
Landis MN (2020) Optimizing isotretinoin treatment of acne: update on current recommendations for monitoring, dosing, safety, adverse effects, compliance, and outcomes. Am J Clin Dermatol 21:411–419
Tan J, Knezevic S, Boyal S, Waterman B, Janik T (2016) Evaluation of evidence for acne remission with oral isotretinoin cumulative dosing of 120–150 mg/kg. J Cutan Med Surg 20:13–20
Lee YH, Scharnitz TP, Muscat J, Chen A, Gupta-Elera G, Kirby JS (2016) Laboratory monitoring during isotretinoin therapy for acne: a systematic review and meta-analysis. JAMA Dermatol 152:35–44
Barbieri JS, Shin DB, Wang S, Margolis DJ, Takeshita J (2020) The clinical utility of laboratory monitoring during isotretinoin therapy for acne and changes to monitoring practices over time. J Am Acad Dermatol 82:72–79
Xia E, Han J, Faletsky A, Baldwin H, Beleznay K, Bettoli V, Dréno B, Goh CL, Stein Gold L, Gollnick H, Herane MI, Kang S, Kircik L, Mann J, Nast A, Oon HH, See JA, Tollefson M, Webster G, Zip C, Tan J, Tapper EB, Thiboutot D, Zaenglein A, Barbieri J, Mostaghimi A (2022) Isotretinoin laboratory monitoring in acne treatment: a Delphi Consensus study. JAMA Dermatol 158:942–948
Funding
None.
Author information
Authors and Affiliations
Contributions
BS and JS wrote the manuscript text and prepared the tables. BS and JH developed the concept and design. All authors contributed to data acquisition. BS and JS analyzed and interpreted the data with the remunerated assistance of a statistics specialist. All authors critically revised the manuscript for important intellectual content and had full access to all of the data in the study. They all take responsibility for the integrity of the data and the accuracy of the data analysis.
Corresponding author
Ethics declarations
Conflict of interest
The authors have stated explicitly that there are no conflicts of interest in connection with this article.
Ethics approval
The study protocol was approved by the institution’s IRB committee (Reference Number: Tfem/2022/78).
Consent to participate
Not applicable.
Consent for publication
No photos of patients included.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Soutou, B., Sleiman, J., Tomb, R. et al. Prevalence of adverse events varies with the different oral isotretinoin brands in acne treatment: a retrospective observational study. Arch Dermatol Res 315, 1533–1539 (2023). https://doi.org/10.1007/s00403-023-02532-6
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00403-023-02532-6