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Demirci Saadet E, Sahin U. Evaluation of hematological parameters in patients using systemic isotretinoin with diagnosis of acne vulgaris. J Cosmet Dermatol 2023; 22:1077-1082. [PMID: 36437707 DOI: 10.1111/jocd.15532] [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: 10/07/2022] [Accepted: 11/14/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Oral isotretinoin is the most effective treatment option in patients with acne. However, it can cause various hematologic and biochemical abnormalities. This study aimed to evaluate hematologic abnormalities during oral isotretinoin treatment in patients with acne. MATERIAL AND METHODS In this cross-sectional study, the hematologic and inflammatory parameters of 138 patients with acne using 0.3-1 mg/kg/day oral isotretinoin for at least 6 months were retrospectively analyzed. RESULTS In the study, the female-to-male ratio was 2.83, and the mean age of the patients was 23.1 ± 5.8 years. At the third and sixth months of isotretinoin treatment, there was a statistically significant decrease in the neutrophil count compared to the pre-treatment values (p = 0.003 and p = 0.032, respectively). The platelet count showed the most statistically significant increase (p < 0.001) at the first month of treatment. The most statistically significant decrease in the neutrophil-to-lymphocyte ratio (NLR) was observed at the third month of treatment (p < 0.001). No significant changes were observed in hemoglobin, hematocrit, white blood cell count, mean corpuscular volume, and mean platelet volume. CONCLUSIONS There was a decrease in neutrophils and NLR and an increase in platelets during isotretinoin treatment, and these changes were usually mild. However, it would be appropriate to monitor blood counts during treatment in patients with neutropenia or thrombocytosis.
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Affiliation(s)
- Elif Demirci Saadet
- Department of Dermatology, Atilim University, School of Medicine, Medicana International Ankara Hospital, Ankara, Turkey
| | - Ugur Sahin
- Department of Hematology, Atilim University, Vocational School of Health Services, Medicana International Ankara Hospital, Ankara, Turkey
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Affleck A, Jackson D, Williams HC, Chavez P, Albrecht J. Is routine laboratory testing in healthy young patients taking isotretinoin necessary: a critically appraised topic. Br J Dermatol 2022; 187:857-865. [PMID: 35986616 DOI: 10.1111/bjd.21840] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 08/15/2022] [Accepted: 08/18/2022] [Indexed: 12/24/2022]
Abstract
CLINICAL QUESTION Is monitoring of liver function, lipids and full blood count necessary in healthy people taking isotretinoin? BACKGROUND Routine blood testing was recommended in the original licence for Roaccutane™ (isotretinoin) in 1983. In recent years, less frequent monitoring has been suggested by various authors. DATA SOURCES We performed four individual systematic searches of the MEDLINE database, via PubMed, from origin to 2 May 2021, supplemented by a hand search of all references in the identified papers. STUDY SELECTION Inclusion criteria were any description of clinical symptoms, laboratory abnormalities and/or physical findings, and any paper that explicitly described the patients as asymptomatic, during treatment with oral isotretinoin. DATA EXTRACTION Two independent reviewers (J.A. and D.J.) assessed articles for eligibility of inclusion. Evaluation of the data was done also by two of the authors (A.A., D.J. and J.A.) for each section, with the aim to use the presented evidence including guidelines, databases, case series, case reports, cohort studies and randomized clinical trials to delineate the clinical presentation and frequency of adverse events that might be amenable to laboratory monitoring. RESULTS We identified 407 papers in our searches and reviewed 125 papers in four sections. Overall, reported adverse events were very rare (< 1 in 10 000) and were either idiosyncratic or not preventable by monitoring, accompanied by symptoms, or seen in identifiable predisposed individuals who might benefit from monitoring because of pre-existing conditions. RECOMMENDATION FOR CLINICAL CARE We could not find evidence to support the benefit of monitoring to detect adverse events. We suggest that in healthy young people laboratory monitoring for oral isotretinoin is unnecessary and risks detecting nonserious biochemical abnormalities. However, we recognize that new information about adverse events may change that recommendation.
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Affiliation(s)
| | - David Jackson
- Walsall Healthcare NHS Trust, Moat Rd, Walsall, West Midlands, WS2 9PS, UK
| | | | | | - Joerg Albrecht
- Division of Dermatology, Department of Medicine, J.H. Stroger Hospital of Cook County, Chicago, IL, USA.,Department of Otolaryngology, Division of Dermatology, Rush Medical College, Chicago, IL, USA
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Effect of systemic isotretinoin use on neutrophil/lymphocyte ratio in acne patients: A retrospective study. JOURNAL OF CONTEMPORARY MEDICINE 2022. [DOI: 10.16899/jcm.1158798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Objective: Acne vulgaris (AV) describes a chronic inflammatory condition that occurs in the pilosebaceous unit, which is common in the community. Increase in sebum production, abnormal follicular keratinization, Propionibacterium acnes (P.acnes) colonization and inflammation play a role in acne development. ISO, comedolytic, is the only agent that has an effect on all four conditions that determine the pathogenesis of acne, such as a large reduction in sebaceous gland size, suppression of sebum production and reduction in inflammation. In this study, it was aimed to compare the N/L ratio values at the beginning of the treatment and at the 4th month of the treatment in acne vulgaris patients receiving systemic ISO treatment. Material and Method 50 patients with acne vulgaris who applied to the dermatology outpatient clinics of Karaman Training and Research Hospital between October 2020 and February 2021, had moderate and severe acne vulgaris and were started on oral isotretinoin were included in the study. The medical records of the patients were reviewed retrospectively. The neutrophil/lymphocyte (N/L) ratio values of the patients at the beginning of Isotretinoin treatment and after four months were recorded. Results The mean age of the patients was 23.1±6.23, 52.0% (26 persons) were male. There was a significant decrease in the N/L ratio in total and in both genders with isotretinoin use (p
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Mohamed AA, Hassnine A, Elsayed A, Montaser M, Ismail Y, El-Demery A, Sultan E, Abdel Aziz RS, Eldemiry E, Hagag R, El-Kholy AA, Salah E. Isotretinoin Induced Hyperlipidemia and Impact of Leptin Gene rs 7799039 Polymorphism in Safety of Acne Patients. Pharmgenomics Pers Med 2022; 14:1679-1687. [PMID: 34992430 PMCID: PMC8714009 DOI: 10.2147/pgpm.s341723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 11/23/2021] [Indexed: 11/23/2022] Open
Abstract
Background Acne vulgaris (AV) is a chronic inflammatory disease that affects the pilosebaceous unit. Leptin (LEP) gene polymorphisms is associated with higher risk of multiple disorders. Insulin-like growth factor-1 (IGF-1) exerts comedogenic effect by stimulating the sebaceous glands. Isotretinoin is an effective oral therapy for AV with many side effects including hyperlipidemia and increased serum levels of liver enzymes. Purpose To evaluate the impact of LEP gene rs7799039 polymorphism in acne patients' clinical response lipid profile and liver enzymes following 6 months oral isotretinoin therapy in Egyptian AV patients. Methods One hundred eligible AV patients received 0.5 mg/kg oral isotretinoin for 6 months. Patients' demographics and clinical data were obtained. Body mass index (BMI), lipid profile, liver enzymes and IGF-1 were measured at baseline and after 6 months of therapy. Genotyping was done for LEP gene rs 7799039. Results Six month administration of oral isotretinoin in Egyptian AV patients is associated with significantly elevated aspartate transaminase (AST) in CC and AC genotypes (P<0.001). Significant alanine aminotransferase (ALT) elevation was observed in CC, AC and AA genotypes (P <0.001, 0.004, 0.002, respectively). Total cholesterol (TC), triglycerides (TG) and low density lipoprotein (LDL) were elevated significantly P<0.001) in the three genotypes. IGF-1 was decreased significantly in CC and AC genotypes (P<0.001). CC genotype is associated with highest response (P<0.001). Conclusion LEP rs7799039 gene had an impact on the clinical response, lipid profile and liver enzymes in AV patients treated with oral isotretinoin. LEP rs7799039 CC genotype is predicted to be the treatment candidate for 6 month oral isotretinoin.
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Affiliation(s)
- Amal A Mohamed
- Biochemistry and Molecular Biology Department, National Hepatology & Tropical Medicine Research Institute, Cairo, Egypt
| | - Alshymaa Hassnine
- Gastroenterology and Tropical Medicine Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Amr Elsayed
- Gastroenterology and Tropical Medicine Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Mahmoud Montaser
- Department of Dermatology, Andrology and STDs, Faculty of Medicine, Minia University, Minia, Egypt
| | - Yasmeen Ismail
- Clinical Pharmacology Department, Faculty of Medicine, Benha University, Benha, Egypt
| | - Ahmed El-Demery
- Biochemistry Department, Faculty of Medicine, October 6 University, 6th of October City, Egypt
| | - Eman Sultan
- Clinical Nutrition Department, National Nutrition Institute, Cairo, Egypt
| | - Rania S Abdel Aziz
- Clinical and Chemical Pathology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Eman Eldemiry
- Faculty of Pharmacy, Fellow of Clinical Pharmacology, Cairo University Hospitals, Giza, Egypt
| | - Radwa Hagag
- Pharmacy Practice and Clinical Pharmacy Department, Faculty of Pharmacy, Egyptian Russian University, Badr City, Egypt
| | - Amal A El-Kholy
- Clinical Pharmacy Department, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - Eman Salah
- Department of Dermatology, Andrology, Sexual Medicine and STDs, Faculty of Medicine, Helwan University, Cairo, Egypt
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Önder S, Ozturk M. Can monocyte/HDL show inflammatory activity of isotretinoin treatment in acne patients? Cutan Ocul Toxicol 2020; 39:111-114. [DOI: 10.1080/15569527.2020.1734815] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Sevda Önder
- Department of Dermatology, Ordu University Medical Faculty, Ordu, Turkey
| | - Murat Ozturk
- Department of Dermatology, Health Sciences University, Van Training and Research Hospital, Van, Turkey
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Kutlu Ö. Effect of isotretinoin treatment on the inflammatory markers in patients with acne vulgaris: can monocyte/HDL be a new indicator for inflammatory activity of isotretinoin treatment? Cutan Ocul Toxicol 2019; 39:67-70. [DOI: 10.1080/15569527.2019.1701485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Ömer Kutlu
- Department of Dermatology and Venereology, Kayseri Develi State Hospital, Kayseri, Turkey
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Tamer F, Yuksel ME, Avcı E. Is mean platelet volume an inflammatory marker in acne patients treated with isotretinoin? ACTA DERMATOVENEROLOGICA ALPINA PANNONICA ET ADRIATICA 2019. [DOI: 10.15570/actaapa.2019.17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Yaldız M, çetinkaya R, solak B. Sistemik İsotretionin Tedavisi Alan Akne Vulgarisli Hastalarda Hematolojik ve İnflamatuar Parametrilerin Değerlendirilmesi. MUSTAFA KEMAL ÜNIVERSITESI TIP DERGISI 2018. [DOI: 10.17944/mkutfd.421437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Seçkin HY, Baş Y, Takçı Z, Kalkan G. Effects of isotretinoin on the inflammatory markers and the platelet counts in patients with acne vulgaris. Cutan Ocul Toxicol 2015; 35:89-91. [PMID: 25853176 DOI: 10.3109/15569527.2015.1021927] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Oral isotretinoin is an efficient treatment used commonly in treating the moderate and severe acne. It has various side effects that affect many systems in the body. In this study, we are planning to examine the possible effects of the oral isotretinoin on platelet density, mean platelet volume, neutrophil lymphocyte rate, platelet lymphocyte rate, and red-blood-cell distribution width level. METHODS Twenty-eight males and 84 females, 112 patients in total, diagnosed with acne vulgaris and receiving oral isotretinoin treatment were examined retrospectively. The full blood parameters of the patients before the treatment and in the third month of the treatment were recorded. RESULTS A statistically meaningful increase was observed in the platelet density, hemoglobin levels. And a statistically significant decrease has been determined in the red-blood-cell distribution width level while no meaningful differences were detected in the mean platelet volume, neutrophil lymphocyte rate, platelet lymphocyte rate, and white blood cell count. CONCLUSIONS The oral isotretinoin treatment has been demonstrated as having increased the platelet density, hemoglobin levels and having decreased red-blood-cell distribution width level significantly.
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Affiliation(s)
- Havva Yıldız Seçkin
- a Department of Dermatology , School of Medicine, Gaziosmanpasa University , Tokat , Turkey and
| | - Yalçın Baş
- a Department of Dermatology , School of Medicine, Gaziosmanpasa University , Tokat , Turkey and
| | - Zennure Takçı
- a Department of Dermatology , School of Medicine, Gaziosmanpasa University , Tokat , Turkey and
| | - Göknur Kalkan
- b Faculty of Medicine, Department of Dermatology , Yıldırım Beyazıt University , Ankara , Turkey
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Effects of isotretinoin on the platelet counts and the mean platelet volume in patients with acne vulgaris. ScientificWorldJournal 2014; 2014:156464. [PMID: 24605049 PMCID: PMC3925551 DOI: 10.1155/2014/156464] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 12/16/2013] [Indexed: 12/22/2022] Open
Abstract
Aim. The aim of this study was to evaluate the platelet counts and the mean platelet volume in patients who received isotretinoin for the treatment of acne vulgaris. Method. A total of 110 patients were included in this retrospective study. Complete blood count parameters were recorded prior to and three-months following the treatment. Results. Both platelet counts and the mean platelet volume were significantly decreased following the treatment. No significant differences were noted on the levels of hemoglobin, hematocrit, and white blood cell count. Conclusion. Platelet counts and mean platelet volume significantly decreased following isotretinoin treatment. Since the decrease of platelet counts and the mean platelet volume was seen concomitantly, it is concluded that the effect of isotretinoin was through the suppression of bone marrow.
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