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

Ghanshani, Serena; Chen, Cheng; Lin, Bryan; Zhou, Hui; Lee, Ming‐Sum

doi:10.1007/s40257-020-00568-2

Cited by 5 publications

(4 citation statements)

References 29 publications

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“…Theoretically, the increased prevalence of AF in male Xp22.31 deletion carriers might have been due to the administration of retinoid-derived medications sometimes used to treat severe skin scaling which can have extensive side-effect profiles 27 28. However, <5% of male Xp22.31 deletion carriers within UK Biobank reported being formally diagnosed with ichthyosis, AHRs are not typically reported as a side effect of acitretin/(iso)tretinoin administration,27 29 and no male deletion carriers within the UK Biobank sample self-reported receiving acitretin or (iso)tretinoin treatment. Therefore, it is likely that the Xp22.31 deletion somehow confers a biological predisposition to AF.…”

Section: Discussionmentioning

confidence: 99%

Characterising heart rhythm abnormalities associated with Xp22.31 deletion

et al. 2022

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BackgroundGenetic deletions at Xp22.31 are associated with the skin condition X linked ichthyosis (XLI), and with a substantially increased risk of atrial fibrillation/flutter (AF), in males. AF is associated with elevated thrombosis, heart failure, stroke and dementia risk.MethodsThrough: (a) examining deletion carriers with a diagnosis of AF in UK Biobank, (b) undertaking an online survey regarding abnormal heart rhythms (AHRs) in men/boys with XLI and female carriers of XLI-associated deletions and (c) screening for association between common genetic variants within Xp22.31 and idiopathic AF-related conditions in UK Biobank, we have investigated how AHRs manifest in deletion carriers, and have identified associated risk factors/comorbidities and candidate gene(s). Finally, we examined attitudes towards heart screening in deletion carriers.ResultsWe show that AHRs may affect up to 35% of deletion carriers (compared with <20% of age-matched non-carriers), show no consistent pattern of onset but may be precipitated by stress, and typically resolve quickly and respond well to intervention. Gastrointestinal (GI) conditions and asthma/anaemia were the most strongly associated comorbidities in male and female deletion carriers with AHR, respectively. Genetic analysis indicated significant enrichment of common AF risk variants aroundSTS(7 065 298–7 272 682 bp in GRCh37/hg19 genome build) in males, and of common GI disorder and asthma/anaemia risk variants aroundPNPLA4(7 866 804–7 895 780 bp) in males and females, respectively. Deletion carriers were overwhelmingly in favour of cardiac screening implementation.ConclusionOur data suggest AHRs are frequently associated with Xp22.31 deletion, and highlight subgroups of deletion carriers that may be prioritised for screening. Examining cardiac function further in deletion carriers, and in model systems lacking steroid sulfatase, may clarify AF pathophysiology.

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Section: Discussionmentioning

confidence: 99%

Characterising heart rhythm abnormalities associated with Xp22.31 deletion

et al. 2022

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“…4) and other articles (Tab. 5) may indicate a potential cardiovascular risk, an overall correlation between isotretinoin and cardiovascular disorders has not been proven in large population-based studies [26]. This is important in the context of assessing the risks and benefits of using isotretinoin to treat acne.…”

Section: Commentsmentioning

confidence: 99%

The effect of isotretinoin therapy on the circulatory system

Banderowicz,

Roszyk,

Wierzbowska

et al. 2024

Forum Dermatologicum

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Isotretinoin is a drug belonging to the group of retinoids, which is mainly used in dermatology. Through its mechanism of action, it leads to a reduction in sebum production, which effectively inhibits the formation of acne. Unfortunately, this drug exhibits numerous side effects. This study aimed to review the literature in terms of clinical cases and articles on the side effects of isotretinoin in the context of the cardiovascular system. It has been proven that isotretinoin can harm the circulatory system, causing changes in the structure of the heart walls, thromboembolic episodes, coronary events and lipid metabolism disorders. Further clinical trials are needed to better understand these side effects.

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“…To the best of our knowledge, this is the first described case of renal thromboembolism and severe DCM leading to implantable cardioverter-defibrillator (ICD) implantation occurring during isotretinoin treatment. adverse effects of isotretinoin are cheilitis, teratogenicity, myalgia, and arthritis; conversely, cardiac toxicity is not acknowledged as common [3][4][5][6]. During hospital stay, isotretinoin was stopped, and recommended heart failure therapy was set up.…”

mentioning

confidence: 99%

“…Liver dysfunction is not infrequently observed in patients treated with RA and can affect the function of cystathionine-b-synthase, an enzyme involved in homocysteine metabolism, causing hyperhomocysteinemia [1,2]. Other common adverse effects of isotretinoin are cheilitis, teratogenicity, myalgia, and arthritis; conversely, cardiac toxicity is not acknowledged as common [3][4][5][6]. During hospital stay, isotretinoin was stopped, and recommended heart failure therapy was set up.…”

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confidence: 99%

A Young Patient Presenting with Dilated Cardiomyopathy and Renal Infarction during Treatment with Isotretinoin: Mere Coincidence or Serious Side Effect of a Drug Commonly Used in Adolescence?

et al. 2023

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Isotretinoin or 13-cis-retinoic acid (RA) is one of the most effective and widely used drugs for the treatment of severe acne vulgaris. Despite being deemed safe, no definite consensus has been reached on the cardiovascular risk of RA derivatives. We report a case of heart failure due to dilated cardiomyopathy (DCM) and concomitant renal infarction occurring after 5 months of isotretinoin use in a previously healthy 18-year-old male. The patient, with a history of acne vulgaris, presented to our emergency department with left iliac fossa pain and effort dyspnea. A trans-thoracic echocardiogram showed DCM and severely reduced left ventricle ejection fraction (LVEF: 29%). During hospitalization, a total body computed tomography (CT) showed an ischemic lesion in the left kidney. Ischemic, autoimmune, infective, and heritable causes of DCM were ruled out. Cardiac magnetic resonance (CMR) evidenced LV circumferential mid-wall late gadolinium enhancement. Heart failure therapy was promptly started and up-titrated, but only poor LVEF improvement was detected overtime. Our case aims to raise awareness on rare life-threatening cardiovascular events possibly associated with isotretinoin use. To the best of our knowledge, this is the first described case of renal thromboembolism and severe DCM leading to implantable cardioverter-defibrillator (ICD) implantation occurring during isotretinoin treatment.

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

Cited by 5 publications

References 29 publications

Characterising heart rhythm abnormalities associated with Xp22.31 deletion

Characterising heart rhythm abnormalities associated with Xp22.31 deletion

The effect of isotretinoin therapy on the circulatory system

A Young Patient Presenting with Dilated Cardiomyopathy and Renal Infarction during Treatment with Isotretinoin: Mere Coincidence or Serious Side Effect of a Drug Commonly Used in Adolescence?

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