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Ferreira MF, Botazzo Delbem AC, Ervolino E, de Abreu Costa L, Antoniali Silva C, Prando dos Santos JR, de Mendonça MR. Therapeutic dosage of isotretinoin in rats may influence orthodontic tooth movement. Bone Rep 2024; 21:101775. [PMID: 38812839 PMCID: PMC11133493 DOI: 10.1016/j.bonr.2024.101775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 05/16/2024] [Indexed: 05/31/2024] Open
Abstract
Objective Isotretinoin, also known as 13-cis-retinoic acid, is an isomer of tretinoin, the oxidized form of Vitamin A. Orthodontic tooth movement (OTM) is the result of a cascade of inflammatory responses stimulated by a physical element that is the force generated by orthodontic appliances. Isotretinoin is mainly used among adolescents and young adults, and coincidentally it is this age group that also undergoes orthodontic treatment. Materials and Methods Fifty-five animals were used, and they were randomly divided into 11 groups, containing 5 animals in each group. Group 1: Control; Group 2: OTM for 7 days; Group 3: OTM for 14 days; Group 4: Treated with isotretinoin for 14 days with a dosage of 7.5 mg/kg/day; Group 5: Treated with isotretinoin for 14 days with a dosage of 1.0 mg/kg/day; Group 6: Treated with isotretinoin for 21 days with a dosage of 7.5 mg/kg/day; Group 7: Treated with isotretinoin for 21 days with a dosage of 1.0 mg/kg/day; Group 8: Treated with isotretinoin for 14 days with a dosage of 7.5 mg/kg/day and undergoing OTM for 7 days; Group 9: Treated with isotretinoin for 14 days with a dosage of 1.0 mg/kg/day and undergoing OTM for 7 days; Group 10: Treated with isotretinoin for 21 days with a dosage of 7.5 mg/kg/day and undergoing OTM for 14 days; Group 11: Treated with isotretinoin for 21 days with a dosage of 1.0 mg/kg/day and undergoing OTM for 14 days. In Groups 8, 9, 10 and 11, the animals were treated with isotretinoin for 7 days before OTM and maintained during the movement period in the respective groups. Results There was a significant difference in microtomographic parameters, including Trabecular Volume (BV/TV), Trabecular Thickness (Tb.Th), Number of Trabeculae (Tb.N), and Trabecular Separation (Tb.Sp), between the groups. The group that received orthodontic force in conjunction with isotretinoin treatment at a dosage of 7.5 mg/kg/day exhibited lower tooth displacement over a period of 21 days and 14 days. Conclusion Isotretinoin caused a reduction in tooth displacement during OTM when administered at a dose of 7.5 mg/kg/day and isotretinoin did change the microtomographic parameters of treated animals.
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Affiliation(s)
| | | | - Edilson Ervolino
- São Paulo State University (UNESP), School of Dentistry, Araçatuba, São Paulo, Brazil
| | - Luy de Abreu Costa
- São Paulo State University (UNESP), School of Dentistry, Araçatuba, São Paulo, Brazil
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Pignolo RJ, Hsiao EC, Al Mukaddam M, Baujat G, Berglund SK, Brown MA, Cheung AM, De Cunto C, Delai P, Haga N, Kannu P, Keen R, Le Quan Sang KH, Mancilla EE, Marino R, Strahs A, Kaplan FS. Reduction of New Heterotopic Ossification (HO) in the Open-Label, Phase 3 MOVE Trial of Palovarotene for Fibrodysplasia Ossificans Progressiva (FOP). J Bone Miner Res 2023; 38:381-394. [PMID: 36583535 DOI: 10.1002/jbmr.4762] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 12/22/2022] [Accepted: 12/28/2022] [Indexed: 12/31/2022]
Abstract
Fibrodysplasia ossificans progressiva (FOP) is an ultra-rare, severely disabling genetic disorder of progressive heterotopic ossification (HO). The single-arm, open-label, phase 3 MOVE trial (NCT03312634) assessed efficacy and safety of palovarotene, a selective retinoic acid receptor gamma agonist, in patients with FOP. Findings were compared with FOP natural history study (NHS; NCT02322255) participants untreated beyond standard of care. Patients aged ≥4 years received palovarotene once daily (chronic: 5 mg; flare-up: 20 mg for 4 weeks, then 10 mg for ≥8 weeks; weight-adjusted if skeletally immature). The primary endpoint was annualized change in new HO volume versus NHS participants (by low-dose whole-body computed tomography [WBCT]), analyzed using a Bayesian compound Poisson model (BcPM) with square-root transformation. Twelve-month interim analyses met futility criteria; dosing was paused. An independent Data Monitoring Committee recommended trial continuation. Post hoc 18-month interim analyses utilized BcPM with square-root transformation and HO data collapsed to equalize MOVE and NHS visit schedules, BcPM without transformation, and weighted linear mixed-effects (wLME) models, alongside prespecified analysis. Safety was assessed throughout. Eighteen-month interim analyses included 97 MOVE and 101 NHS individuals with post-baseline WBCT. BcPM analyses without transformation showed 99.4% probability of any reduction in new HO with palovarotene versus NHS participants (with transformation: 65.4%). Mean annualized new HO volume was 60% lower in MOVE versus the NHS. wLME results were similar (54% reduction fitted; nominal p = 0.039). All palovarotene-treated patients reported ≥1 adverse event (AE); 97.0% reported ≥1 retinoid-associated AE; 29.3% reported ≥1 serious AE, including premature physeal closure (PPC)/epiphyseal disorder in 21/57 (36.8%) patients aged <14 years. Post hoc computational analyses using WBCT showed decreased vertebral bone mineral density, content, and strength, and increased vertebral fracture risk in palovarotene-treated patients. Thus, post hoc analyses showed evidence for efficacy of palovarotene in reducing new HO in FOP, but high risk of PPC in skeletally immature patients. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
| | - Edward C Hsiao
- Division of Endocrinology and Metabolism, the UCSF Metabolic Bone Clinic, the Eli and Edythe Broad Institute for Regeneration Medicine, and the Institute of Human Genetics, Department of Medicine, and the UCSF Program in Craniofacial Biology, University of California-San Francisco, San Francisco, CA, USA
| | - Mona Al Mukaddam
- Departments of Orthopaedic Surgery & Medicine, The Center for Research in FOP and Related Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Geneviève Baujat
- Département de Génétique, Institut IMAGINE and Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - Staffan K Berglund
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Matthew A Brown
- Faculty of Life Sciences and Medicine, King's College London, London, UK
- Genomics England Ltd, London, UK
| | - Angela M Cheung
- Department of Medicine and Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Carmen De Cunto
- Pediatric Rheumatology Section, Department of Pediatrics, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Patricia Delai
- Centro de Pesquisa Clinica, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Nobuhiko Haga
- Department of Rehabilitation Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Peter Kannu
- Hospital for Sick Children, Toronto, ON, Canada
| | - Richard Keen
- Centre for Metabolic Bone Disease, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Kim-Hanh Le Quan Sang
- Département de Génétique, Institut IMAGINE and Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - Edna E Mancilla
- Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Frederick S Kaplan
- Departments of Orthopaedic Surgery & Medicine, The Center for Research in FOP and Related Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Kapała J, Lewandowska J, Placek W, Owczarczyk-Saczonek A. Adverse Events in Isotretinoin Therapy: A Single-Arm Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116463. [PMID: 35682048 PMCID: PMC9180136 DOI: 10.3390/ijerph19116463] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/19/2022] [Accepted: 05/24/2022] [Indexed: 11/16/2022]
Abstract
Isotretinoin (ISO) is an oral prescription-only retinoid, well known for its acne-treating effect. However, it affects a substantial number of human cell types, causing a broad spectrum of adverse effects. The purpose of this study is to establish the isotretinoin therapy adverse events among human clinical trials and their prevalence. Two authors (J.K., J.L.) systematically performed the literature review and assessment from December 2021-February 2022. Three databases (PubMed, ClinicalTrials, and Cochrane Library) were searched using the following terms: "isotretinoin acne vulgaris" for published studies in English from 1980-2021. Finally, 25 randomized controlled clinical trials (RCTs) and five open-label clinical trials provided 3274 acne vulgaris suffering patients. Isotretinoin therapy affects almost all of the systems in the human body, causing numerous adverse events. However, they mainly concern mild mucocutaneous conditions (severe cases are rare) and represent individual responses to a drug. In addition, all adverse events are reversible and can be avoided by specific preparations.
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Affiliation(s)
- Jan Kapała
- Medical Faculty, University of Warmia and Mazury in Olsztyn, 10-719 Olsztyn, Poland;
- Correspondence:
| | - Julia Lewandowska
- Medical Faculty, University of Warmia and Mazury in Olsztyn, 10-719 Olsztyn, Poland;
| | - Waldemar Placek
- Department of Dermatology Sexually Transmitted Diseases and Clinical Immunology, University of Warmia and Mazury in Olsztyn, 10-719 Olsztyn, Poland; (W.P.); (A.O.-S.)
| | - Agnieszka Owczarczyk-Saczonek
- Department of Dermatology Sexually Transmitted Diseases and Clinical Immunology, University of Warmia and Mazury in Olsztyn, 10-719 Olsztyn, Poland; (W.P.); (A.O.-S.)
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Hasamoh Y, Thadanipon K, Juntongjin P. Association between Vitamin D Level and Acne, and Correlation with Disease Severity: A Meta-Analysis. Dermatology 2021; 238:404-411. [PMID: 34348293 DOI: 10.1159/000517514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/29/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Vitamin D deficiency is frequently associated with several medical conditions. However, a comprehensive meta-analysis assessing the association between vitamin D level and acne is lacking. OBJECTIVE To determine the relationship between vitamin D level and acne, and to assess the association between vitamin D level and acne severity. METHODS This meta-analysis was assessed by using the PubMed, EMBASE, Cochrane, and Scopus databases following the PRISMA guidelines. Serum/plasma 25-hydroxyvitamin D (25[OH]D) level, vitamin D deficiency, and the severity association between acne patients and healthy controls (HCs) were evaluated. The quality assessment was performed by using the Newcastle-Ottawa Scale. RESULTS Thirteen articles with a total of 1,362 acne patients and 1,081 HCs were included. The circulating 25(OH)D levels were significantly lower in patients with acne than in HCs (pooled MD = -9.02 ng/mL, 95% CI = -13.22 to -4.81, p < 0.0001). Vitamin D deficiency was more prevalent in acne patients than in HCs (pooled OR = 2.97, 95% CI = 1.68-5.23, I2 = 72%). Also, vitamin D levels were negatively correlated with acne severity. CONCLUSION This meta-analysis demonstrated the significantly low vitamin D levels in acne patients. Also, there was evidence of an inverse association between vitamin D levels and acne severity. Therefore, vitamin D might be involved in the pathogenesis of acne.
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Affiliation(s)
- Yusuf Hasamoh
- Division of Dermatology, Chulabhorn International College of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Kunlawat Thadanipon
- Department of Clinical Epidemiology and Biostatistics, and Division of Dermatology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Premjit Juntongjin
- Division of Dermatology, Chulabhorn International College of Medicine, Thammasat University, Pathum Thani, Thailand
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Effect of isotretinoin on induced tooth movement in rats. Am J Orthod Dentofacial Orthop 2021; 159:193-201. [PMID: 33388196 DOI: 10.1016/j.ajodo.2019.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 12/01/2019] [Accepted: 12/01/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION This study was performed to evaluate the effect of isotretinoin on tooth displacement and tissues related to induced tooth movement (ITM) in rats. METHODS Wistar rats were randomly divided into 4 groups: vegetable oil (O; n = 40), 7.5 mg/kg isotretinoin (I; n = 40), vegetable oil + ITM (OM; n = 44), and 7.5 mg/kg isotretinoin and ITM (IM; n = 39). After the daily application of the solutions for 30 days, an orthodontic appliance was installed to mesially displace the maxillary first right molar (30 cN) of rats in the OM and IM groups. The animals were killed 2, 7, 14, or 21 days after placement of the devices. The animals in the O and I groups did not undergo ITM but were killed simultaneously. The animals were examined for tooth displacement, the neoformation of mature collagen, bone and root resorption, the presence of hyalinized areas, and trabecular bone modeling by microcomputed tomography. RESULTS There was no difference in tooth displacement, the number of osteoclasts, the presence of hyalinized areas, or trabecular bone among the O, I, OM, and IM groups across the periods tested (P >0.05). A lower percentage of mature collagen was found in the IM group than in the OM group on day 7 (P <0.05). A lower frequency of root resorption was found in the IM group than in the OM group on days 2 and 21 (P <0.05). CONCLUSIONS Isotretinoin at 7.5 mg/kg decreased root resorption in rats subjected to ITM.
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Zaenglein AL, Levy ML, Stefanko NS, Benjamin LT, Bruckner AL, Choate K, Craiglow BG, DiGiovanna JJ, Eichenfield LF, Elias P, Fleckman P, Lawley LP, Lewis RA, Lucky AW, Mathes EF, Milstone LM, Paller AS, Patel SS, Siegel DH, Teng J, Tanumihardjo SA, Thaxton L, Williams ML. Consensus recommendations for the use of retinoids in ichthyosis and other disorders of cornification in children and adolescents. Pediatr Dermatol 2021; 38:164-180. [PMID: 33169909 PMCID: PMC7984068 DOI: 10.1111/pde.14408] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Topical and systemic retinoids have long been used in the treatment of ichthyoses and other disorders of cornification. Due to the need for long-term use of retinoids for these disorders, often beginning in childhood, numerous clinical concerns must be considered. Systemic retinoids have known side effects involving bone and eye. Additionally, potential psychiatric and cardiovascular effects need to be considered. Contraceptive concerns, as well as the additive cardiovascular and bone effects of systemic retinoid use with hormonal contraception must also be deliberated for patients of childbearing potential. The Pediatric Dermatology Research Alliance (PeDRA) Use of Retinoids in Ichthyosis Work Group was formed to address these issues and to establish best practices regarding the use of retinoids in ichthyoses based on available evidence and expert opinion.
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Affiliation(s)
- Andrea L Zaenglein
- Departments of Dermatology and Pediatrics, Penn State/Hershey Medical Center and Penn State Children's Hospital, Hershey, PA, USA
| | - Moise L Levy
- Departments of Pediatrics and Medicine, Division of Dermatology, Dell Medical School, University of Texas at Austin and Dell Children's Medical Center, Austin, TX, USA
| | - Nicole S Stefanko
- Division of Dermatology, Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | - Latanya T Benjamin
- Department of Integrated Medical Science, Florida Atlantic University, Boca Raton, FL, USA
| | - Anna L Bruckner
- Department of Dermatology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Keith Choate
- Department of Dermatology, Yale University, New Haven, CT, USA
| | | | - John J DiGiovanna
- Laboratory of Cancer Biology and Genetics, National Cancer Institute, National Institutes of Health, National Institutes of Health, Bethesda, MD, USA
| | - Lawrence F Eichenfield
- Departments of Dermatology and Pediatrics, University of California San Diego and Rady Children's Hospital, San Diego, CA, USA
| | - Peter Elias
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Philip Fleckman
- Department of Medicine, Division of Dermatology, University of Washington, Seattle, WA, USA
| | - Leslie P Lawley
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA, USA
| | - Richard A Lewis
- Departments of Ophthalmology, Molecular and Human Genetics, Medicine and Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Anne W Lucky
- Department of Pediatrics, Division of Dermatology, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Erin F Mathes
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA.,Departments of Dermatology and Pediatrics, University of California, San Francisco, San Francisco, CA, USA
| | | | - Amy S Paller
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sonali S Patel
- Department of Pediatrics, Section of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Dawn H Siegel
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Joyce Teng
- Department of Dermatology, Stanford University, Stanford, CA, USA
| | | | - Lauren Thaxton
- Department of Women's Health, University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Mary L Williams
- Departments of Dermatology and Pediatrics, University of California, San Francisco, San Francisco, CA, USA
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Bulut M, Korkmaz YN, Erimsah S. Effects of isotretinoin on new bone formation after maxillary sutural expansion. J Orofac Orthop 2020; 81:440-446. [PMID: 31965210 DOI: 10.1007/s00056-019-00209-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 11/26/2019] [Indexed: 01/20/2023]
Abstract
PURPOSE The aim of this study was to examine the effects of isotretinoin on new bone formation after maxillary sutural expansion in rats. MATERIALS AND METHODS A total of 32 male Wistar rats were selected and randomly divided into four groups. The isotretinoin group was treated with 7.5 mg/kg isotretinoin, and the soybean group was treated with 2 ml/kg soybean oil for 57 days. The substances were applied via oral gavage. The expansion-only and the control groups were not treated with any substance. In the experiment groups, expansion springs were applied on day 41 of the experiment, and after day 5 of expansion, a 12-day retention period was established. At the end of the experiment, all the animals were sacrificed, and their maxillae were dissected for histological evaluation. The numbers of osteoclasts, osteoblasts and formation of new bone and capillaries were evaluated on slides centered around the suture. RESULTS The statistical analysis showed significant differences between the groups for the number of osteoblasts and osteoclasts (p < 0.001). In the experiment groups, higher numbers of osteoblasts and osteoclasts were detected in comparison to the control group (p < 0.001), while there was no significant difference between the experiment groups. Capillary formation and new bone formation in the isotretinoin group were found to be on a higher level than in the other groups (p < 0.001). CONCLUSION Isotretinoin had no negative effects on bone formation following the expansion of the maxillary suture in rats.
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Affiliation(s)
- Musa Bulut
- Faculty of Dentistry, Department of Orthodontics, Bolu Abant Izzet Baysal University, Gölköy Yerleşkesi, Bolu, 14030, Turkey.
| | - Yasemin Nur Korkmaz
- Faculty of Dentistry, Department of Orthodontics, Bolu Abant Izzet Baysal University, Gölköy Yerleşkesi, Bolu, 14030, Turkey
| | - Sevilay Erimsah
- Faculty of Medicine, Department of Histology and Embryology, Bolu Abant Izzet Baysal University, Bolu, Turkey
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The safety of isotretinoin treatment in patients with bone fractures. Postepy Dermatol Alergol 2019; 36:18-24. [PMID: 30858774 PMCID: PMC6409881 DOI: 10.5114/ada.2019.82822] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 02/05/2018] [Indexed: 01/09/2023] Open
Abstract
Isotretinoin is widely applicable in dermatology, although it may develop severe side effects in the skeletal system. An intention of this review was to establish the safety of oral isotretinoin in patients with bone fractures. Both MEDLINE/Pubmed and SCOPUS databases were searched to investigate the influence of isotretinoin on the skeletal system. The drug shows a strong osteoporotic activity in rats whereas this effect is milder in humans. Biochemical markers of bone turnover remain unchanged except for serum calcium in patients receiving a high dose of isotretinoin. An excessive intake of vitamin A may impair functioning of vitamin D especially in people with a vitamin D deficiency, therefore a similar side effect may also occur in patients on isotretinoin treatment. We suggest reducing the use of isotretinoin after bone injury or continuing the treatment at low dosing with a concomitant correction of vitamin D and calcium status.
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Tan AU, Schlosser BJ, Paller AS. A review of diagnosis and treatment of acne in adult female patients. Int J Womens Dermatol 2017; 4:56-71. [PMID: 29872679 PMCID: PMC5986265 DOI: 10.1016/j.ijwd.2017.10.006] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 10/11/2017] [Accepted: 10/11/2017] [Indexed: 01/19/2023] Open
Abstract
This review focuses on the treatment options for adult female patients with acne. Acne in adult female patients may start during adolescence and persist or have an onset in adulthood. Acne has various psychosocial effects that impact patients’ quality of life. Treatment of acne in adult women specifically has its challenges due to the considerations of patient preferences, pregnancy, and lactation. Treatments vary widely and treatment should be tailored specifically for each individual woman. We review conventional therapies with high levels of evidence, additional treatments with support from cohort studies and case reports, complementary and/or alternative therapies, and new agents under development for the treatment of patients with acne.
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Affiliation(s)
- A U Tan
- Northwestern University, Department of Dermatology, Chicago, IL
| | - B J Schlosser
- Northwestern University, Department of Dermatology, Chicago, IL
| | - A S Paller
- Northwestern University, Department of Dermatology, Chicago, IL
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10
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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. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol 2016; 74:945-73.e33. [PMID: 26897386 DOI: 10.1016/j.jaad.2015.12.037] [Citation(s) in RCA: 720] [Impact Index Per Article: 90.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 12/15/2015] [Indexed: 02/06/2023]
Abstract
Acne is one of the most common disorders treated by dermatologists and other health care providers. While it most often affects adolescents, it is not uncommon in adults and can also be seen in children. This evidence-based guideline addresses important clinical questions that arise in its management. Issues from grading of acne to the topical and systemic management of the disease are reviewed. Suggestions on use are provided based on available evidence.
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Affiliation(s)
| | | | | | | | | | - Diane S Berson
- Weill Cornell Medical College, New York, New York; New York Presbyterian Hospital, New York, New York
| | - Whitney P Bowe
- SUNY Down State Medical Center-Brooklyn, New York, New York
| | - Emmy M Graber
- Boston University School of Medicine, Boston, Massachusetts; Boston Medical Center, Boston, Massachusetts
| | | | - Sewon Kang
- Johns Hopkins Medicine, Baltimore, Maryland
| | - Jonette E Keri
- University of Miami Health System, Miami, Florida; Miami VA Hospital, Miami, Florida
| | | | - Rachel V Reynolds
- Harvard Medical Faculty Physicians, Boston, Massachusetts; Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Nanette B Silverberg
- Mount Sinai Health System-Beth Israel, New York, New York; St. Lukes-Roosevelt, New York, New York
| | | | | | | | | | | | | | - Kevin M Boyer
- American Academy of Dermatology, Schaumburg, Illinois
| | - Reva Bhushan
- American Academy of Dermatology, Schaumburg, Illinois.
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Safety Considerations and Monitoring in Patients Treated with Systemic Medications for Acne. Dermatol Clin 2016; 34:185-93. [PMID: 27015778 DOI: 10.1016/j.det.2015.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Acne vulgaris, a disorder of the pilosebaceous unit, is one of the most commonly encountered conditions in dermatology practice. Effective treatment of acne vulgaris is important in that it can prevent psychosocial distress and physical scarring. Systemic therapeutic options are available for moderate to severe acne. It is imperative that the safe and effective treatment revolves around the health care provider's familiarity of side effects of various treatments. In this article, the side effects and monitoring guide for the most commonly prescribed systemic agents for acne vulgaris are reviewed.
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12
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Hoover KB, Miller CG, Galante NC, Langman CB. A double-blind, randomized, Phase III, multicenter study in 358 pediatric subjects receiving isotretinoin therapy demonstrates no effect on pediatric bone mineral density. Osteoporos Int 2015; 26:2441-7. [PMID: 25956286 DOI: 10.1007/s00198-015-3158-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 04/27/2015] [Indexed: 10/23/2022]
Abstract
UNLABELLED This study compared the effects of pediatric acne treatment with two isotretinoin formulations on bone mineral density. We demonstrated no difference in the effect of the two formulations. No effect on pediatric bone mineral density was identified for either formulation. INTRODUCTION Isotretinoin (13-cis-retinoic acid) is a treatment for recalcitrant nodular acne with a purported effect on bone mineral density (BMD). The side effects of isotretinoin on vertebral bone were evaluated to assess the safety of a new FDA-approved isotretinoin formulation: Lidose-isotretinoin (Cip-Iso). METHODS This double-blind, randomized, phase III, active control, parallel-group, multicenter study compared the safety, efficacy, and non-inferiority of CIP-Iso to a marketed reference product, Accutane®, in severe recalcitrant nodular acne subjects. Three hundred fifty-eight pediatric male and female subjects aged between 12 and 17 years underwent 20 weeks of treatment with PA lumbar spine dual X-ray absorptiometry (DXA) measurements obtained for bone mineral density (BMD) and Z-scores, 5.5 months apart on visits 1 and 8. One hundred sixty-eight of 358 subjects had height adjusted Z-scores (HAZ) calculated. RESULTS There was no difference in the least squares (LS) mean Z-score or HAZ of the two drugs at visit 1 or 8. The mean and LS mean Z-score and HAZ were greater than zero at visits 1 and 8 for both drugs. The change in the LS mean spine Z-score, but not HAZ, between visits, was statistically significant for both drugs. There was a mean increase in BMD (g/cm(2)) for both products between visits. CONCLUSIONS There is no difference in the effect of two formulations of isotretinoin on spine bone density after 6 months of treatment. BMD increased and the small change in spine Z-score over treatment disappeared after height adjustment. Mean positive Z-scores and HAZ in the study were likely due to the exclusion of low and inclusion of high Z-score subjects.
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Affiliation(s)
- K B Hoover
- Department of Radiology, Virginia Commonwealth University Health Systems, P.O. 980615, Richmond, VA, 23298-0615, USA.
| | - C G Miller
- Alacrita LLC, 1 Broadway, Cambridge, MA, 02142, USA.
| | - N C Galante
- Shepherd Analytics, 641 Longwood Rd, Collegeville, PA, 19426, USA.
| | - C B Langman
- Feinberg School of Medicine, Northwestern University, 225 E. Chicago Avenue, #37, Chicago, IL, 60611, USA.
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Abstract
Acne vulgaris is a chronic inflammatory disease of pilosebaceous follicles commonly affecting adolescents and young adults. This disease has a profound psychological impact on affected individuals and treatment has been shown to significantly improve both self-esteem and quality of life. Isotretinoin is an effective medication used primarily in severe cystic acne patients. Over the past 30 years, this medication has revolutionized the treatment of acne. However, despite its popularity there are numerous side effects associated with its use. Most of its side effects are predictable and dose dependent, which has led to the development of variable dose regimens. Unfortunately, rare but significant side effects (e.g., depression, inflammatory bowel disease) do occur and necessitate careful monitoring to improve clinical outcomes and minimize potential adverse events.
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Affiliation(s)
- Shelbi C Jim On
- Department of Dermatology, The Mount Sinai School of Medicine, New York, New York, USA
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Hauck Pinto BC, Avelar JC, Vilela EM, Fraga MR, Tanaka OM, da Silva Campos MJ, Vitral RWF. Mandibular hyperostosis in a patient receiving orthodontic treatment while on isotretinoin for acne. J World Fed Orthod 2014. [DOI: 10.1016/j.ejwf.2014.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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de Oliveira HT, Bergoli RD, Hirsch WD, Chagas OL, Heitz C, Silva DN. Isotretinoin effect on the repair of bone defects – A study in rat calvaria. J Craniomaxillofac Surg 2013; 41:581-5. [DOI: 10.1016/j.jcms.2012.11.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 11/26/2012] [Accepted: 11/26/2012] [Indexed: 11/28/2022] Open
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Chapman MS. Vitamin a: history, current uses, and controversies. ACTA ACUST UNITED AC 2013; 31:11-6. [PMID: 22361284 DOI: 10.1016/j.sder.2011.11.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Revised: 11/28/2011] [Accepted: 11/30/2011] [Indexed: 10/28/2022]
Abstract
Vitamin A is required for the proper functioning of many important metabolic and physiologic activities, including vision, gene transcription, the immune system and skin cell differentiation. Both excessive and deficient levels of vitamin A lead to poor functioning of many human systems. The biologically active form, retinoic acid, binds to nuclear receptors that facilitate transcription that ultimately leads to it's physiological effects. Retinoids are derivatives of vitamin A that are medications used to treat acne vulgaris, psoriasis, ichthyosis (and other disorders of keratinization), skin cancer prevention as well as several bone marrow derived neoplasias. Systemic retinoids are teratogenic and have to be prescribed with caution and close oversight. Other potential adverse events are controversial. These include the relationship of retinoid derivatives in sunscreens, their effects on bone mineral density, depression and suicidal ideation and inflammatory bowel disease. These controversies will be discussed in detail.
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Affiliation(s)
- M Shane Chapman
- Section of Dermatology, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA.
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Melnik BC. Isotretinoin and FoxO1: A scientific hypothesis. DERMATO-ENDOCRINOLOGY 2011; 3:141-65. [PMID: 22110774 PMCID: PMC3219165 DOI: 10.4161/derm.3.3.15331] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Revised: 02/21/2011] [Accepted: 02/24/2011] [Indexed: 12/13/2022]
Abstract
Oral isotretinoin (13-cis retinoic acid) is the most effective drug in the treatment of acne and restores all major pathogenetic factors of acne vulgaris. isotretinoin is regarded as a prodrug which after isomerizisation to all-trans-retinoic acid (ATRA) induces apoptosis in cells cultured from human sebaceous glands, meibomian glands, neuroblastoma cells, hypothalamic cells, hippocampus cells, Dalton's lymphoma ascites cells, B16F-10 melanoma cells, and neuronal crest cells and others. By means of translational research this paper provides substantial indirect evidence for isotretinoin's mode of action by upregulation of forkhead box class O (FoxO) transcription factors. FoxOs play a pivotal role in the regulation of androgen receptor transactivation, insulin/insulin like growth factor-1 (IGF-1)-signaling, peroxisome proliferator-activated receptor-γ (PPArγ)- and liver X receptor-α (LXrα)-mediated lipogenesis, β-catenin signaling, cell proliferation, apoptosis, reactive oxygene homeostasis, innate and acquired immunity, stem cell homeostasis, as well as anti-cancer effects. An accumulating body of evidence suggests that the therapeutic, adverse, teratogenic and chemopreventive effecs of isotretinoin are all mediated by upregulation of FoxO-mediated gene transcription. These FoxO-driven transcriptional changes of the second response of retinoic acid receptor (RAR)-mediated signaling counterbalance gene expression of acne due to increased growth factor signaling with downregulated nuclear FoxO proteins. The proposed isotretinoin→ATRA→RAR→FoxO interaction offers intriguing new insights into the mode of isotretinoin action and explains most therapeutic, adverse and teratogenic effects of isotretinoin in the treatment of acne by a common mode of FoxO-mediated transcriptional regulation.
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Affiliation(s)
- Bodo C Melnik
- Department of Dermatology; Environmental Medicine and Health Theory; University of Osnabrück; Osnabrück, Germany
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Bergoli RD, Chagas Junior OL, de Souza CECP, Vogt BF, de Oliveira HTR, Etges A, Silva DN. Isotretinoin effect on alveolar repair after exodontia--a study in rats. Oral Maxillofac Surg 2011; 15:85-92. [PMID: 20658349 DOI: 10.1007/s10006-010-0235-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Accepted: 06/01/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVES To evaluate isotretinoin effect on alveolar repair after tooth extraction of maxillary incisor and serum calcium levels in rats. STUDY DESIGN Wistar rats (60-day-old) were assigned to control (CG, n = 12) and experimental (EG, n = 20) groups. EG received daily isotretinoin (7.5 mg/kg) for 30 days before surgery and until euthanasia, 7, 21, 28, or 90 days after tooth extraction. Blood was collected in the EG to analyze serum calcium levels before isotretinoin administration and at euthanasia. Right hemimaxillae underwent histological examination, and the slides were stained with HE and analyzed by descriptive light microscopy. RESULTS There was acceleration in the process of alveolar repair in the EG at all time points when compared to controls. Serum calcium levels showed a statistically significant decrease between first and second blood collection at days 21, 28, and 90. CONCLUSIONS Daily isotretinoin in a dose corresponding to the treatment of cystic acne accelerated alveolar repair.
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Affiliation(s)
- Roberta Dalmolin Bergoli
- Department of Oral and Maxillofacial Surgery and Maxillofacial Prosthodontics, School of Dentistry, Universidade Federal de Pelotas, Rua Gonçalves Chaves, 3.657/401 B, Pelotas, Rio Grande do Sul, Brazil.
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Ertugrul DT, Karadag AS, Tutal E, Akin KO. Therapeutic hotline. Does isotretinoin have effect on vitamin D physiology and bone metabolism in acne patients? Dermatol Ther 2011; 24:291-5. [PMID: 21410620 DOI: 10.1111/j.1529-8019.2011.01406.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Isotretinoin is an effective therapy for severe nodulocystic acne. Several experimental studies suggest that it may have an effect on vitamin D physiology. In the present study, the authors aimed to investigate the effect of isotretinoin treatment on the metabolism of vitamin D in acne patients. A prospective analysis of 50 consecutive acne patients who were treated with isotretinoin for 3 months was done. Before and after 3 months of treatment, 25 hydroxy vitamin D, 1,25 dihydroxy vitamin D, and bone alkaline phosphatase, calcium, phosphate, and parathormone levels were measured. The 25 hydroxy vitamin D and serum calcium levels decreased significantly (p < 0.0001, p < 0.05, respectively), whereas 1,25 dihydroxy vitamin D, parathormone, and bone alkaline phosphatase levels increased significantly after 3 months of isotretinoin treatment (p < 0.005, p < 0.005, p < 0.0001, respectively). Aspartate aminotransferase, total cholesterol, low-density lipoprotein cholesterol, and triglyceride levels also increased significantly after isotretinoin treatment. This prospective clinical study showed that isotretinoin has an effect on vitamin D metabolism. Further clinical studies with longer periods of follow-up are needed to understand the effect of isotretinoin on vitamin D and bone metabolism.
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Affiliation(s)
- Derun Taner Ertugrul
- Department of Internal Medicine, Ankara Kecioren Research and Training Hospital, Ankara, Turkey.
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Brito MDFDM, Sant'Anna IP, Galindo JCS, Rosendo LHPDM, Santos JBD. Avaliação dos efeitos adversos clínicos e alterações laboratoriais em pacientes com acne vulgar tratados com isotretinoína oral. An Bras Dermatol 2010; 85:331-7. [DOI: 10.1590/s0365-05962010000300006] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2007] [Accepted: 07/03/2009] [Indexed: 11/22/2022] Open
Abstract
FUNDAMENTOS: A isotretinoína oral revolucionou o manejo da acne. Os efeitos adversos observados, durante o tratamento, são divididos em dois grupos: mucocutâneos e sistêmicos. Anormalidades laboratoriais, principalmente, as dislipidemias e aumento das enzimas hepáticas são relatados. OBJETIVO: Avaliar a tolerabilidade da isotretinoína oral, com atenção, no metabolismo lipídico, função hepática e reações adversas clínicas. MÉTODOS: Foram incluídos 150 pacientes com diagnóstico clínico de acne submetidos a tratamento com isotretinoína oral. Avaliações clínicas e laboratoriais foram feitas, após um mês e a cada três meses, até completar o tratamento. RESULTADOS: Dos 150 pacientes 48% eram do sexo feminino e 52% do sexo masculino. A idade variou de 15 a 32 anos. Quanto aos efeitos adversos cutâneos e mucosos da isotretinoína, queilite foi o mais frequente, ocorrendo em 94% pacientes. Efeitos clínicos sistêmicos foram bem menos comuns. Os níveis de colesterol, triglicerídeos, transaminases, foram avaliados e não mostraram alterações significativas, ao longo do tratamento. CONCLUSÃO: Os pacientes apresentaram efeitos adversos, compatíveis com os da literatura, e, em sua maioria, controlados com medicações sintomáticas. Podemos concluir que a isotretinoína é uma droga segura, em relação a seus efeitos adversos, tanto clínicos como laboratoriais.
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Tekin NS, Ozdolap S, Sarikaya S, Keskin SI. Bone mineral density and bone turnover markers in patients receiving a single course of isotretinoin for nodulocystic acne. Int J Dermatol 2008; 47:622-5. [PMID: 18477161 DOI: 10.1111/j.1365-4632.2008.03534.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND High-dose isotretinoin has been reported to have adverse effects on bone mineral density (BMD); however, studies evaluating changes in BMD with isotretinoin therapy at different dosages and with varying treatment durations have produced conflicting results. OBJECTIVE To investigate the effect of a standard, single course of isotretinoin therapy on BMD and bone turnover markers in patients with nodulocystic acne. METHODS Thirty-six patients (15 male, 21 female) with severe, recalcitrant, nodulocystic acne and 36 healthy controls (16 male, 20 female) were enrolled in the study. Patients received isotretinoin treatment for 4-6 months until a cumulative dose of 120 mg/kg had been achieved. BMD in the lumbar spine and femur was measured at baseline and at the end of therapy by dual-energy X-ray absorptiometry. Serum calcium, phosphate, parathormone, total alkaline phosphatase, osteocalcin, free deoxypyridinoline, and urinary calcium were also measured before and at the end of treatment. RESULTS No significant differences were found in lumbar spine and femoral BMD between the patient and control groups at the beginning of the study (P > 0.05), and no statistically significant difference was observed between the BMD values in patients at the beginning vs. the end of treatment (P > 0.05). No statistically significant difference in bone turnover markers was found between patients and controls at the beginning of the study (P > 0.05), and no statistically significant changes in bone turnover markers were observed in patients at the beginning vs. the end of treatment (P > 0.05). CONCLUSION A single course of isotretinoin therapy has no clinically significant effect on bone metabolism.
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Affiliation(s)
- Nilgun Solak Tekin
- Department of Dermatology, Faculty of Medicine, Zonguldak Karaelmas University, Zonguldak, Turkey.
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Strauss JS, Krowchuk DP, Leyden JJ, Lucky AW, Shalita AR, Siegfried EC, Thiboutot DM, Van Voorhees AS, Beutner KA, Sieck CK, Bhushan R. Guidelines of care for acne vulgaris management. J Am Acad Dermatol 2007; 56:651-63. [PMID: 17276540 DOI: 10.1016/j.jaad.2006.08.048] [Citation(s) in RCA: 268] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2006] [Revised: 08/17/2006] [Accepted: 08/19/2006] [Indexed: 11/16/2022]
Abstract
DISCLAIMER Adherence to these guidelines will not ensure successful treatment in every situation. Furthermore, these guidelines should not be deemed inclusive of all proper methods of care or exclusive of other methods of care reasonably directed to obtaining the same results. The ultimate judgment regarding the propriety of any specific therapy must be made by the physician and the patient in light of all the circumstances presented by the individual patient.
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Affiliation(s)
- John S Strauss
- Department of Dermatology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, USA
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Halverstam CP, Zeichner J, Lebwohl M. Lack of significant skeletal changes after long-term, low-dose retinoid therapy: case report and review of the literature. J Cutan Med Surg 2007; 10:291-9. [PMID: 17241599 DOI: 10.2310/7750.2006.00065] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Long-term systemic retinoid therapy has been associated with skeletal side effects. There have been reports of diffuse idiopathic skeletal hyperostosis (DISH) syndrome, calcification of ligaments, and osteoporosis, as well as premature fusion of epiphyses and modeling abnormalities of long bones, occurring in patients on chronic high-dose isotretinoin, etretinate, and acitretin therapy. Low-dose acitretin has been used for many years as monotherapy or in combination with other systemic therapies for psoriasis. Evidence to date suggests that the frequency of symptomatic bony effects is quite low in these patients. OBJECTIVE To present the radiologic findings of a patient on long-term, low-dose acitretin and etretinate and to review the literature on the radiologic evidence of skeletal side effects during retinoid therapy. METHODS Case report and literature search. RESULTS A patient on low-dose acitretin had no significant radiologic abnormalities associated with retinoid use after 9 years of treatment. A review of the literature revealed conflicting reports on the incidence of radiologic abnormalities in patients on retinoid treatment. CONCLUSION The evidence to date does not substantiate a clear link between radiologic skeletal abnormalities and long-term, low-dose acitretin or etretinate therapy.
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Affiliation(s)
- Caroline P Halverstam
- Department of Dermatology, Mount Sinai School of Medicine, New York, NY 10029-6574, USA.
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Erdogan BS, Yüksel D, Aktan S, Ergin S, Kiraç FS. The effects of isotretinoin treatment on bone mineral density in patients with nodulocystic acne. J Eur Acad Dermatol Venereol 2006; 20:1006-7. [PMID: 16922957 DOI: 10.1111/j.1468-3083.2006.01598.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ingen-Housz-Oro S, Boudou P, Bergot C, Ibrahim F, Souberbielle JC, Dubertret L, Blanchet-Bardon C. Evidence of a marked 25-hydroxyvitamin D deficiency in patients with congenital ichthyosis. J Eur Acad Dermatol Venereol 2006; 20:947-52. [PMID: 16922943 DOI: 10.1111/j.1468-3083.2006.01689.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Vitamin D is essential for bone mineralization, and its deficiency may be the cause of skeletal fractures and osteomalacia. Geographical or ethnic factors may modulate the cutaneous synthesis of vitamin D. We hypothesized that major changes in keratinization may similarly alter the cutaneous synthesis of vitamin D. OBJECTIVES To explore calciotrophic hormones, parameters of bone remodelling and bone mineral density (BMD) in nine patients with non-bullous congenital ichthyosis. PATIENTS AND METHODS Six patients were European, three were North African. Four had received acitretin over a long period of time. A complete biological investigation, including serum and urinary calcium and phosphorus, calciotrophic hormones [intact parathyroid hormone (iPTH), 25-hydroxyvitamin D (25-(OH)D) and 1,25-dihydroxyvitamin D (1,25-(OH)2D)], bone formation and resorption markers, was performed on all patients during the winter season and repeated among four patients after summer. BMD was measured in all patients. RESULTS All patients had a marked 25-(OH)D deficiency, clearly below the deficiency threshold of 25 nmol/L. Patients from North Africa had a greater deficiency than European patients, perhaps because of the difference in skin pigmentation. iPTH remained normal in European patients but was elevated among the North Africans. After sun exposure, an improvement in vitamin status was visible in only one patient. Bone formation and resorption markers remained normal. Femoral neck osteodensitometry indicated values near the osteopaenic threshold in two young North African females. No deleterious effect of retinoids on vitamin D metabolism was observed. CONCLUSION Patients, and in particular pigmented patients, with congenital ichthyosis present a severe deficiency in vitamin D. Care provided to protect the skeletal future of these patients involves measuring BMD and prescribing supplementation.
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Ozyemisci-Taskiran O, Bölükbasi N, Gögüs F. A hidradenitis suppurativa related SAPHO case associated with features resembling spondylarthropathy and proteinuria. Clin Rheumatol 2006; 26:789-91. [PMID: 16680392 DOI: 10.1007/s10067-005-0199-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2005] [Accepted: 05/21/2005] [Indexed: 10/24/2022]
Abstract
We present a 53-year-old man with synovitis-acne-palmoplantar pustulosis-hyperosteosis-osteitis (SAPHO) syndrome who is HLA-B27 positive with a history of uveitis and complicated by proteinuria and osteoporosis. Interesting, yet unreported features of SAPHO syndrome and the etiology of proteinuria are further discussed.
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Affiliation(s)
- Ozden Ozyemisci-Taskiran
- Physical Medicine and Rehabilitation, Gazi University, 9. Sokak 27/6, Besevler, 06490 Ankara, Turkey.
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Milstone LM, Insogna KL, Leachman SA. Isotretinoin does have an adverse effect on bone mineral density. J Am Acad Dermatol 2005; 53:181; author reply 182-3. [PMID: 15965453 DOI: 10.1016/j.jaad.2005.03.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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DiGiovanna JJ, Langman CB, Tschen EH, Jones T, Menter A, Lowe NJ, Eichenfield L, Hebert AA, Pariser D, Savin RP, Smith SR, Jarratt M, Rodriguez D, Chalker DK, Kempers S, Ling M, Rafal ES, Sullivan S, Kang S, Shah LP, Wu E, Newhouse J, Pak J, Eberhardt DR, Bryce GF, McLane JA, Ondovik M, Chin C, Khoo KC, Rich P. Effect of a single course of isotretinoin therapy on bone mineral density in adolescent patients with severe, recalcitrant, nodular acne. J Am Acad Dermatol 2004; 51:709-17. [PMID: 15523348 DOI: 10.1016/j.jaad.2004.04.032] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Adverse changes in bone have been reported for patients undergoing high-dose, long-term (several years) isotretinoin therapy for disorders of cornification. The effect of short-term (4-5 months) therapy at the lower dose recommended for acne on bone development in younger, growing adolescent (12-17 years) patients has not been well studied. OBJECTIVE The purpose of the study was to evaluate the effect of a standard, single course of isotretinoin (Accutane) therapy on bone mineral density (BMD) of the lumbar spine and hip in adolescents ages 12 to 17 years with severe, recalcitrant, nodular acne. METHODS In this open-label, multicenter study, 217 adolescents (81 girls) with severe, recalcitrant, nodular acne were enrolled and treated with isotretinoin twice daily with food at the recommended total dose of approximately 1 mg/kg for 16 to 20 weeks. BMD in the lumbar spine and hip was measured at baseline and at the end of therapy by dual energy radiograph absorptiometry. RESULTS There was no clinically significant mean change in BMD measured at the lumbar spine (+1.4%, range: -4.9% to +12.3%) or total hip (-0.26%, range: -11.3% to +15.0%). Hyperostosis was not observed in any patient. Typical efficacy expected in the treatment of acne was observed. CONCLUSIONS A 16- to 20-week course of isotretinoin treatment at the recommended dose for severe acne has no clinically significant effect on lumbar spine and total hip BMD in the adolescent (12-17 years) population.
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Affiliation(s)
- John J DiGiovanna
- Division of Dermatopharmacology, Department of Dermatology, Brown Medical School/Rhode Island Hospital, Providence, RI 02903, USA.
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Atalay A, Altaykan A, Ergin G, Kutsal YG. Reversible sclerotic changes of lumbar spine and femur due to long-term oral isotretinoin therapy. Rheumatol Int 2003; 24:297-300. [PMID: 13680140 DOI: 10.1007/s00296-003-0391-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2003] [Accepted: 08/07/2003] [Indexed: 11/28/2022]
Abstract
We present a rare case of retinoid-induced sclerotic changes of lumbar spine and femur demonstrated by dual energy x-ray absorptiometrie (DEXA). The patient had flowing ossification along thoracic spine resembling diffuse idiopathic skeletal hyperostosis (DISH), but there was no ligament calcification in the lumbar spine or pelvis. After discontinuation of the treatment, gradual decline of bone mineral density at lumbar and femoral sites was detected with serial DEXA measurements. To the best of our knowledge, although various abnormalities of bone due to retinoids have been described before, reversible sclerotic changes have not been reported.
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Affiliation(s)
- Ayçe Atalay
- Department of Physical Medicine and Rehabilitation, Hacettepe University Faculty of Medicine, Sihhiye, Ankara, Turkey.
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Brecher AR, Orlow SJ. Oral retinoid therapy for dermatologic conditions in children and adolescents. J Am Acad Dermatol 2003; 49:171-82; quiz 183-6. [PMID: 12894062 DOI: 10.1067/s0190-9622(03)01564-0] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The efficacy of systemic retinoid therapy in a number of dermatologic diseases is well established; however, concerns about potential side effects limit their use, especially in children. We review the efficacy and toxicity of oral retinoids in the pediatric population. The acute mucocutaneous toxicities commonly observed are typically well tolerated, readily treatable, and reversible. Systemic toxicities include teratogenicity and effects on the musculoskeletal, neurologic, and gastrointestinal systems. Children, like adults, generally tolerate short-term retinoid therapy without major complications. Concerns regarding serious systemic side effects are greater for those on high doses of oral synthetic retinoids for longer periods of time. Close patient monitoring and patient education can minimize the occurrence of complications. (J Am Acad Dermatol 2003;49:171-82.)Learning objective At the conclusion of this learning activity, participants should be familiar with use of oral retinoids for childhood dermatologic conditions such as psoriasis, acne, and ichthyoses as well as safety and risks associated with oral retinoid use in children and adolescents.
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Affiliation(s)
- Alexandra R Brecher
- Department of Dermatology, New York University School of Medicine, New York, New York, USA
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Gollnick H, Cunliffe W, Berson D, Dreno B, Finlay A, Leyden JJ, Shalita AR, Thiboutot D. Management of acne: a report from a Global Alliance to Improve Outcomes in Acne. J Am Acad Dermatol 2003; 49:S1-37. [PMID: 12833004 DOI: 10.1067/mjd.2003.618] [Citation(s) in RCA: 413] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Sadick NS. A Practitioner's 10-Year Experience with Isotretinoin and Side Effect Profiles. ACTA ACUST UNITED AC 2002. [DOI: 10.1089/153082002760331072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Hanson N, Leachman S. Safety issues in isotretinoin therapy. SEMINARS IN CUTANEOUS MEDICINE AND SURGERY 2001; 20:166-83. [PMID: 11594672 DOI: 10.1053/sder.2001.28209] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Isotretinoin (Accutane, Roche Laboratories Inc, Nutley, NJ) is an important drug, not only for the treatment of severe acne, but also for other diagnoses and in chemoprevention settings. Because the use of isotretinoin is increasing, it is important for physicians to be aware of the adverse events, toxicities, and management issues related to its use. The most important issue is that of congenital defects, which has resulted in new pregnancy prevention policies and programs implemented by the manufacturer. A relatively new concern is that of depression associated with isotretinoin use, also resulting in new policies placed by the manufacturer and the FDA. The most common adverse effects observed during treatment are mucocutaneous and ocular in nature, but laboratory abnormalities and effects in the nervous, musculoskeletal, gastrointestinal, pulmonary, hematologic, and other systems are also described. Additionally, potential drug interactions, follow-up, and toxicity prevention measures are discussed.
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Affiliation(s)
- N Hanson
- Department of Dermatology and Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City 84112, USA
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