The effect of isotretinoin on insulin resistance and adipocytokine levels in acne vulgaris patients

Efficacy and Safety of Adding Low-Dose Isotretinoin to Itraconazole in the Treatment of Chronic Recurrent Dermatophytosis among Sample of Iraqi Patients: An Open-Labelled Therapeutic Clinical Comparative Study

Background

An increasing number of dermatophytosis is seen now in daily clinical practice, with unusual presentations, running a chronic recurrent course and seems to be more resistant to systemic and topical conventional treatments, which necessitate the use of other treatment options that help to cure these challenging clinical conditions such as isotretinoin along with itraconazole.

Objectives and Aim

This is a prospective randomised open-label therapeutic comparative clinical trial to assess the efficacy and safety of low-dose isotretinoin along with itraconazole to treat and reduce the recurrence of this distressing chronic recurrent dermatophytosis.

Methods

Eighty-one patients with chronic recurrent dermatophytosis with positive mycological examination were recruited, all of them received itraconazole for 7 days per month for 2 consecutive months duration; half of them were randomly chosen to receive low-dose isotretinoin every other day for 2 months in addition to itraconazole. All patients were followed up at monthly intervals for 6 months.

Results

The patients who received isotretinoin along with itraconazole showed earlier and complete clearance in 97.5% with a significantly low recurrence rate (12.8%) in comparison with those who received itraconazole alone where the cure rate was relatively slower reported in 53.7% of the patients with a relapse rate of 68.1% with no significant side effects.

Conclusion

Low-dose isotretinoin with itraconazole seems to be safe, effective and promising choice in the treatment of chronic recurrent dermatophytosis as it induced earlier complete cure with a significant reduction of recurrence rate.

Isotretinoin and Risk of Cardiovascular Events in Adults with Acne: A Population-based Retrospective Cohort Study

BACKGROUND

Case reports have suggested isotretinoin exposure may be associated with adverse cardiac events. There are limited data where the cardiovascular safety of isotretinoin is systematically evaluated.

OBJECTIVE

The aim of this study was to determine the strength of association between isotretinoin exposure and adverse cardiovascular events.

METHODS

This was a population-based retrospective cohort study within an integrated healthcare delivery system. Adults ≥ 18 years of age with acne between 2009 and 2018 were included. Exposure to isotretinoin was identified using pharmacy records, and propensity score 1:1 matching was performed. The primary outcome was a composite of cardiovascular outcomes, including acute myocardial infarction, heart failure, and all-cause death.

RESULTS

The cohort consisted of 12,140 adults (10.5%) exposed to isotretinoin and 103,126 adults who were never exposed. Mean follow-up was 7.1 ± 2.9 years. After propensity score 1:1 matching, 23,844 patients were included. The rates of the composite cardiovascular outcomes were 0.47 versus 0.48 per 1000 person-years in the isotretinoin and non-exposed groups, respectively. No significant association was observed between isotretinoin treatment and the composite cardiovascular outcomes (adjusted hazard ratio [HR] 0.99, 95% confidence interval [CI] 0.62-1.58), all-cause mortality (adjusted HR 1.10, 95% CI 0.62-1.95), acute myocardial infarction (adjusted HR 1.00, 95% CI 0.33-3.09), congestive heart failure (adjusted HR 0.45, 95% CI 0.14-1.40), or atrial fibrillation (adjusted HR 0.44, 95% CI 0.12-1.65).

CONCLUSIONS

Among adult patients with acne, no association was found between exposure to isotretinoin and an increased risk of cardiovascular events. Physicians should not be discouraged from prescribing isotretinoin out of concern for cardiovascular effects.

Skin and metabolic syndrome: A review of the possible associations

Metabolic syndrome (MeTS) is a well-known health-related problem with several end-organ damages and the resulted side effects such as rising in the blood glucose and lipid and blood pressure. Although MeTS might show several skin symptoms such as acanthosis nigricans, skin tags, acne, and androgenic alopecia, it could also be implicated in the pathophysiology of numerous dermatologic disorders. Furthermore, some dermatologic drugs might be implicated in the incidence or exacerbation of MeTS. Consequently, MeTS and skin problem could interfere closely with each other and each one could predispose the patient to the other one and vice versa. Remembering these close relationships help us to have better therapeutic choices regarding each inflammatory skin conditions. Moreover, some of the skin symptoms should be followed cautiously to define the underlying MeTS.

The Association between Adiponectin Single Nucleotide Polymorphisms and Side Effects of Isotretinoin in Acne Patients

Background

Acne is a common condition of pilosebaceous follicle especially among young. Clinically, the most used medication in the treatment of moderate to severe acne is oral isotretinoin. However, interindividual variability in therapeutic response to isotretinoin and many side effects such as musculoskeletal pain, headache, and alteration in lipid profile can be seen with this treatment.

Aim

In this study, the effect of genetic polymorphisms, rs2241766 and rs1501299, of the adiponectin gene was investigated in relation to the side effects of isotretinoin-treated young adult acne patients (n = 230).

Methods

Several biochemical parameters were measured at baseline and after treatments with isotretinoin. The ADIPOQ gene SNPs, rs2241766 and rs1501299, were genotyped in 230 patients.

Results

Alterations in lipid profile with a significant increase of ALT (P=0.007) were detected after isotretinoin treatment. Moreover, percentage change in HDL following isotretinoin treatment was significantly associated with rs1501299 (P=0.008). On the other hand, no associations between examined SNPs and side effects of isotretinoin and other lipid parameters (total cholesterol, LDL, and triglycerides) or liver function enzymes (ALT and AST) were detected.

Conclusions

Current findings showed that rs1501299 of the ADIPOQ gene might be associated with changes in HDL level in acne patients following treatment with isotretinoin.