Analysis of clinical efficacy, side effects, and laboratory changes among patients with acne vulgaris receiving single versus twice daily dose of oral isotretinoin

Abstract

Acne vulgaris is a debilitating disorder and requires proper treatment. This work evaluates the clinical efficacy, side effects, and laboratory changes of serum lipids and liver function during oral isotretinoin therapy for acne vulgaris, comparing single versus twice daily dose. Fifty-eight patients with acne vulgaris were included and randomized into group I (26 patients), who received once daily dose, and group II (32 patients), who received twice daily dose of oral isotretinoin. Global acne scoring system was used to evaluate acne severity and post-treatment improvement. Both regimens resulted in highly significant clinical improvement of acne with no significant difference. However, side effects were significantly more common among patients of group I. Both regimens caused mild rise of serum cholesterol, alanine transaminase (ALT), and aspartate aminotransferase (AST) with more prominent rise of triglycerides especially with twice daily dose. Oral isotretinoin is a very effective treatment for acne vulgaris with no statistically significant difference in clinical efficacy between once and twice daily doses. However, dividing dose to twice per day might cause fewer incidence of side effects without reducing clinical efficacy. The drug causes mild clinically insignificant rise of serum cholesterol, triglycerides, AST, and ALT.

Adverse effects of isotretinoin: A large, retrospective review

“…This is confirmed by other researchers (Ahmad, 2015;Blasiak et al, 2013;Rademaker, 2010;Rademaker, 2016;Rao et al, 2014). We followed all cases of exacerbation of adverse events and in of unpleasant adverse reactions for the patient.…”

“…Most recently, the occurrence of hyperuricemia has been reported in patients receiving isotretinoin (Ahmad, 2015). The efficacy of systemic retinoid therapy in a number of dermatologic diseases is well established.…”

“…Rarely it is observed to cause impaired night vision; cataracts; optic neuritis; menstrual disturbances; inflammatory bowel disease; pancreatitis; hepatitis; corneal opacities; papilloedema; idiopathic intracranial hypertension; skeletal hyperostosis; extra osseous calcification (Ahmad, 2015;Charakida et al, 2004;Rademaker, 2010;Rademaker, 2016).…”

“…The levels then stabilize and return to normal within 8 weeks after treatment is stopped. Therapy should be stopped if the triglyceride level exceeds 8.0 mmol/L because of a risk of pancreatitis (Ahmad, 2015). More dramatic increases in the triglyceride level have been observed in patients who were obese, consumed excessive amounts of alcohol, had a family history of hyperlipidemia or other risk factors (Blasiak et al, 2013;Bugdayci, Polat, Oguzman, & Cinpolat, 2016).…”

Effect of systemic isotretinoin treatment on voice

“…[5] Due to the these underlying mechanisms the main mucocutaneous side effects of Iso use in the head and neck region are; dryness of the skin, lips, mouth (xerostomia), nasal mucosa (epistaxis), cheilitis and inflammation and bleeding of the gums. [4,6] Even if it has not occurred yet, it has been postulated that the recognized side effects of Iso on mucosal surfaces and epithelium may emerge in the vocal folds (VF).…”