Abnormalities in Those Taking Accutane - How Serious Are They?

Lee T. Zane; Wendy A. Leyden; Ann L. Marqueling; M. Michele Manos
A Population-Based Analysis of Laboratory Abnormalities During Isotretinoin Therapy for Acne Vulgaris.
Arch Dermatol. 2006;142 (8):1016-1022.

The purpose of this study was to determine the incidence of abnormal laboratory test results among isotretinoin users. Although oral isotretinoin is currently the most effective treatment for moderate to severe acne, it’s use has been restricted due to numerous possible systemic side effects such as; elevations in total cholesterol and serum triglyceride levels; decreases in white blood cell triglycerides and platelet counts; and chemically induced liver damage. This has led to frequent laboratory monitoring of patients receiving isotretinoin therapy.

This was a retrospective, population based, cohort study that included 13,772 patients, aged 13 to 50 years, who had received oral isotretinoin treatment for acne between 1995 and 2002. The patients were mostly young (average age 19), and males and females were equally represented.

The researchers analyzed the medical records of each patient before, during and following treatment with isotretinoin and evaluated laboratory values for serum triglyceride, total cholesterol, hemoglobin, and liver transaminase levels; white blood cell and platelet count; and frequency of abnormal laboratory results by severity.

The study found statistically significant increases in triglyceride (44%), total cholesterol (31%), and liver enzyme (11%) levels during treatment, in patients who had normal pretreatment levels. No significant changes were seen in hemoglobin levels, white blood cell or platelet counts. Lipid and enzyme levels returned to normal for most patients within three months of completing treatment. The researchers also noted the physicians are generally doing a good job of monitoring patients on this drug.

The researchers concluded that the incidence of abnormally high serum lipid levels during isotretinoin treatment may be greater than previously estimated. Normal baseline values of serum lipid and liver enzyme levels do not preclude the development of new abnormalities during isotretinoin treatment. Routine monitoring of hemoglobin level, white blood cell and platelet count during isotretinoin therapy may not be necessary unless there is clinical suspicion of an abnormality. Further study is required to determine if there are long term risks for cardiovascular and liver disease associated with the use of isotretinoin.

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