The Risks and
Side Effects of Prescription Acne Medications
J Pritchard, R Appleton, R Howard, and R A C Hughes.
Drug Points: Guillain-Barré syndrome seen in users of isotretinoin.
BMJ. 2004 June 26; 328(7455): 1537. doi: 10.1136/bmj.328.7455.1537.
This small case study reported
Guillain-Barré syndrome occurring in
two patients being treated with oral isotretinoin for severe acne.
Guillain-Barré syndrome is a rare autoimmune disorder in which the body's
immune system attacks the peripheral nervous system. The first symptoms of
this disorder include varying degrees of weakness and abnormal sensations in
the extremities which spread to the upper body. These symptoms can increase
in intensity until the patient is almost totally paralyzed.
The first case was a 31 year old man who was treated with 80 mg of oral isotretinoin a day for five weeks. During that time he experienced nosebleeds, dry lips, cough and joint pain before developing tingling and numbness in his feet along with flu-like symptoms. By the following day his extremities were paralyzed, he was no longer able to stand and needed to be put on a ventilator. Within four days he could only blink.
The second case involved a 13 year
old boy who was treated with 50 mg of oral isotretinoin a day for two
months, stopped for one week, and then took 30 mg a day for six weeks. He
experienced nosebleeds, lethargy, and headaches. After stopping isotretinoin
again for 10 days he also developed paralysis and required ventilatory
support.
Both patients had
cerebrospinal fluid and nerve conduction abnormalities. They were
successfully treated with
high-dose immunoglobulin therapy
and were discharged from hospital within three months. Although these cases
are insufficient to establish a causal relationship between Guillain-Barré
syndrome and isotretinoin, further investigation into a possible link is
warranted.
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