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Accutane is a brand-name version of the drug isotretinoin. The brand is no longer available in the United States. However, the generic version of isotretinoin and other brand-name versions, such as Absorica, are still available. Isotretinoin is used to treat a type of severe acne called nodular acne.

Nodular acne causes red, swollen, tender lumps to form in the skin. If untreated, nodular acne can lead to permanent scarring. While isotretinoin can help treat nodular acne, it can also cause many side effects. Some of these effects can be serious, especially if the drug is taken during pregnancy.

These side effects may go away on their own. The more serious side effects of isotretinoin can have long-term or permanent effects. However, apart from increased cholesterol and joint and muscle problems, these side effects are all quite rare.

Isotretinoin can increase the levels of fats and cholesterol in your blood. During your treatment, your doctor may suggest regular blood tests to check your fat and cholesterol levels. This side effect, if you have it, typically goes away when you finish your treatment with isotretinoin. Learn more: What is metabolic syndrome? Tell your doctor if you plan to do hard physical activity during treatment with isotretinoin. Isotretinoin can cause pain in your bones, joints, muscles, and ligaments.

It can also stunt the growth of long bones in teens, which could have permanent effects. If you have any of the following symptoms, call your doctor right away:. If you break a bone, be sure to tell all of the healthcare providers that care for you that you take isotretinoin. If you have muscle weakness, with or without pain, stop taking isotretinoin and call your doctor right away.

Muscle weakness can be a sign of serious muscle damage and could be a permanent effect. Rarely, isotretinoin can cause increased pressure on the brain. This can lead to permanent loss of eyesight and, in rare cases, death. Stop taking isotretinoin and call your doctor right away if you have any of these symptoms:. Although rare, a rash caused by isotretinoin can be serious.

Stop using isotretinoin and call your doctor right away if you have any of the following symptoms:. Isotretinoin can damage your internal organs. These organs include your liver, pancreas, intestines, and esophagus the tube connecting your mouth and stomach. The damage may not get better even after you stop taking isotretinoin.

This side effect is rare. Still, stop taking isotretinoin and call your doctor right away if you have any of the following symptoms:. Isotretinoin can cause serious hearing problems in rare cases. Stop using isotretinoin and call your doctor right away if your hearing gets worse or if you have ringing in your ears.

Any hearing loss may be permanent. Isotretinoin can cause vision problems such as blurry vision, double vision, and tunnel vision. This drug can also reduce your ability to see in the dark. Vision problems may fix themselves after you stop taking the drug or the damage may be permanent. Isotretinoin can cause your eyes to produce more tears than normal. If you wear contact lenses, you may have trouble wearing them while taking isotretinoin. Like the other vision problems, this problem may go away after your stop treatment or it may be permanent.

All of these vision and eye problems are rare. Nevertheless, stop taking isotretinoin and call your doctor right away if you have problems with your vision, an increased amount of tears, or painful or constant eye dryness. Isotretinoin can cause serious allergic reactions in rare cases. Stop taking isotretinoin and call your doctor if you have a rash, red patches, or bruises on your legs or a fever.

If you have any of the following symptoms, stop taking isotretinoin and call or go to the nearest emergency room:. Isotretinoin may cause blood sugar problems, including diabetes. Call your doctor if you have any of the following symptoms:. Another rare, serious side effect is a decrease in blood cell levels. Low levels of red blood cells can cause problems such as anemia.

Low levels of white blood cells raise your risk of infections. Rarely, isotretinoin can cause serious mental health problems. These include depression, psychosis losing touch with realityand suicidal thoughts or actions.

Taking isotretinoin during pregnancy carries an extremely high risk of severe birth defects. This is true if the drug is used in any amount and even for short periods of time. If you become pregnant during treatment with isotretinoin, stop taking the drug right away. A gynecologist can then give you further evaluation and counseling.

Because of the risks it carries for pregnancies, isotretinoin can be prescribed only under a special restricted distribution program called iPLEDGE. This program is approved by the Food and Drug Administration. Both males and females who take isotretinoin need to discuss this program with their doctor.

Doctors who prescribe isotretinoin and pharmacies that dispense isotretinoin must be registered and activated with the iPLEDGE Program. The second pregnancy test must be done in a lab specified by your doctor. The program also requires females to choose and agree to use two forms of effective birth control at the same time.

This precaution goes along with the third requirement. That is, you must agree not to become pregnant while using isotretinoin and for one month before or after treatment.

At least one of the birth control methods must be a primary form of birth control. Examples of these forms are tubal ligation having your tubes tiedan IUD, and hormonal birth control.

Another approach is for your partner to have a vasectomy. The only exceptions to this requirement are if you have chosen not to have intercourse with a male abstinence or have had a hysterectomy surgery to remove your uterus. As you can see, there are many risks linked with isotretinoin use. If you have more questions about these side effects, talk with your doctor. Questions you may ask include:.

Your doctor can help you decide if isotretinoin is the right drug for you. They can also help you manage any side effects you have. Isotretinoin belongs to a class of drugs called retinoids. Less oil on your skin gives the acne-causing bacteria less to feed on. With fewer clogged pores, bacteria have fewer places to grow. Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. Accutane was the brand name of a drug for severe acne treatment called isotretinoin.

Understanding the risks and knowing the signs of common STDs is crucial for men who are sexually active. Learn how to spot the main symptoms. While some types of acne scarring are best treated by a dermatologist, others may benefit from over-the-counter topical products.

Ice therapy is routinely used for injuries. But can ice facials help reduce puffy eyes and acne? Learn more about its purported benefits and how to…. Nodules, pustules, whiteheads, and more. Here's what you need to care for it all. Differin Gel uses retinoid to clear up acne and scarring.

Here's everything you need to know about the over-the-counter medication. Dairy, chocolate, gluten, and fried foods all get a bad rap for causing acne in adults and teens, but are the claims valid? This article breaks down 5…. Teenagers tend to experience breakouts and acne due to hormonal changes.

There are treatments and skin care habits that can help. What can you do about acne scars? While the AAD suggest things like surgery and laser resurfacing, you might also find relief through less invasive…. While it may be tempting to pop your own pimple, experts recommend that you resist the urge.

How Well Do You Sleep? Skin Care. More common side effects Serious side effects Pregnancy warning Takeaway Introduction Accutane is a brand-name version of the drug isotretinoin.

 


Isotretinoin (Oral Route) Side Effects - Mayo Clinic.



 

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    Hughes RA.

Some of these are original studies, while most of them are sporadic case reports [ 1 , 2 , 9 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ]. The onset of the musculoskeletal symptoms of the patients in these case reports was in the first few months. They have found myalgia in Acute sacroiliitis was determined in 8.

The authors concluded that the incidence of sacroiliitis in patients receiving isotretinoin is quite high [ 1 ]. In our study, the percentages of myalgia and sacroiliitis were similar to this study, however, the frequency of back pain was noticeably higher in isotretinoin group. This was one of the most important results of this study.

Other musculoskeletal side effects were not found to be statistically significantly related with the total cumulative dose of isotretinoin. The patients with low back pain using isotretinoin should be asked about the dosage and duration of their drug, and if necessary, the dose should be reduced.

On the other hand, it is an interesting finding that sacroiliitis is not related with the total cumulative dose of the drug. In their study, Alkan et al. In the isotretinoin group, No inflammatory back pain was observed in tetracycline group 32 patients. They found unilateral sacroiliitis only in one patient in the isotretinoin group that included a total of 42 patients.

They also emphasized that all rheumatologic symptoms of the patients disappeared after the discontinuation of the drug and the complaints were drug related [ 2 ].

In the present study, The total cumulative dose of isotretinoin does not seem to be in relationship with mechanical or inflammatory back pain. In another study, the effect of isotretinoin on Achilles tendinopathy was investigated. The authors divided a total of sixteen rats into two groups and administered isotretinoin for the first group and soy oil for the second group.

In the isotretinoin group, a biomechanical and histopathological negative effect on Achilles tendon was detected. Therefore, the authors recommended asking the patients with tendinopathy about their use of isotretinoin in their medical history [ 9 ]. Enthesitis is a hallmark feature of the spondyloarthropathies. Although rare, enthesitis can be seen due to isotretinoin usage.

Several new MRI and ultrasound scoring systems have been used for diagnosis of enthesitis. The increased thickness of entheses and hypoechogenicity are the specific ultrasonographic findings of the enthesitis [ 22 , 31 ]. In our study, the diagnosis of enthesitis was based on solely clinical examination. Only four patients 4. Since tendinopathy can be seen in patients receiving isotretinoin, such patients should be asked whether they use the drug or not [ 9 ].

The exact pathogenesis of sacroiliitis in isotretinoin use is unclear. This leads to a degeneration process in the synovial cells. Retinol and retinoic acid derivatives such as isotretinoin can also stimulate MMP-2 activity and cause membrane damage in the joints [ 8 , 12 , 32 , 33 ]. It is believed that isotretinoin treatment may render cells susceptible to mild traumas that normally would not cause injury. This theory is supported by studies of the presence of sacroiliitis in athletes treated with isotretinoin [ 8 , 32 , 34 ].

Weber et al. MRI scans were examined by three readers, independently. Bone marrow edema edema and fat metaplasia were observed in both groups but these lesions did not increase after running. They said that these MRI findings could be reflective of mechanical stress injury, vascular signals, anatomic variants, or degenerative joint disease [ 34 ]. The limited extent bone marrow edema of sacroiliac joints is quite unspecific and can occur in various conditions, not related to axial spondyloarthropathy.

Winter et al. In our study, all of the patients were young and physically active. Bone marrow edema consistent with sacroiliitis was observed in It may be an overdiagnosis of sacroiliitis, for this reason, this results should be interpreted with caution. Our patients were symptomatic after using isotretinoin which suggest the hypothesis of drug related sacroiliitis, in addition, MRI follow up to confirm resolution is recommended. Taheri et al. The authors reported that Of the patients with back pain, Sacroiliitis was determined only in 5 patients [ 10 ].

This study have more patients but no control group. In addition, they assessed only the incidence of low back pain and sacroiliitis but not arthralgia, myalgia, tendinopathy or enthesopathy. Similarly to our study, inflammatory back pain without sacroiliitis was found in the majority of the patients. It can be claimed that the drug may cause inflammatory back pain without sacroiliitis in healthy subjects. However in our study, numbers of the patients with mechanical back pain were more higher than inflammatory back pain.

We showed that mechanical low back pain is a common complication in patients receiving isotretinoin. We recommend that young patients with back pain be questioned about their drug usage, and clinicians need to be aware about this complaint may result from isotretinoin.

In healthy control group, only a few of the volunteers had musculoskeletal pain symptoms such as myalgia, arhtralgia and back pain.

None of them had sacroiliitis or tendinopathy. The statistically significant high prevalence of musculoskeletal findings in drug users in the same age group was considered as an important indicator that current symptoms were significantly drug dependent. This study has some limitations. There is a limited number of patients in total, so the results of the study should be interpreted carefully.

Another limitation was that the MRI images of the patients with sacroiliitis were not scored. Furthermore, MRI follow up may be recommended for sacroiliitis positive patients to confirm resolution after drug cessation.

Enthesitis was not evaluated and scored by an imaging method such as ultrasonography or MRI in our study. The diagnosis of enthesitis was depended on solely clinical evaluation. Further randomized controlled studies are needed with wider patient groups in order to elucidate the musculoskeletal side effects of the isotretinoin.

Low back pain is a very common side effect of isotretinoin and it is dose-related. Although sacroiliitis is a rare complication of isotretinoin, inflammatory back pain without sacroiliitis can be seen frequently. The patients suffering from back pain should be asked for drug usage. Considering that musculoskeletal complaints are mostly temporary, they can be often overlooked by clinicians.

For this reason, we recommend the clinicians to perform a more careful and close follow-up in order to carry out the most proper approach to these patients. The prevalence of sacroiliitis in patients with acne vulgaris using isotretinoin.

Cutan Ocul Toxicol. Article Google Scholar. Isotretinoin-induced spondyloarthropathy-related symptoms: a prospective study. J Rheumatol. Clin Dermatol. PubMed Article Google Scholar. Ganceviciene R, Zouboulis CC. Isotretinoin: state of the art treatment for acne vulgaris.

J Dtsch Dermatol Ges. Kaplan G, Haettich B. Rheumatological symptoms due to retinoids. Baillieres Clin Rheumatol. Acute hip monoarthritis in a patient treated with isotretinoin. J Clin Rheumatol. Nesher G, Zuckner J. Rheumatological complications of vitamin a and retinoids. Semin Arthritis Rheum. Hughes RA. Arthritis precipitated by isotretinoin treatment for acne vulgaris. Isotretinoin induced achilles tendinopathy: histopathological and biomechanical evaluation on rats.

Acta Orthop Traumatol Turc. Incidence of low back pain and sacroiliitis in military families with acne vulgaris under isotretinoin therapy. Am J Clin Exp Immunol. Isotretinoin-induced bilateral sacroiliitis. Inflammatory back pain in patients treated with isotretinoin. Bilateral sacroiliitis confirmed with magnetic resonance imaging during isotretinoin treatment: assessment of 11 patients and a review of the literature. There are no adequate studies in women for determining infant risk when using this medication during breastfeeding.

Weigh the potential benefits against the potential risks before taking this medication while breastfeeding. Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary.

When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive. Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases.

If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines. Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Using this medicine with any of the following is usually not recommended, but may be unavoidable in some cases.

If used together, your doctor may change the dose or how often you use this medicine, or give you special instructions about the use of food, alcohol, or tobacco. The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:.

Isotretinoin comes with a patient information form and Medication Guide. It is very important that you read and understand this information. Be sure to carefully follow these instructions and ask your doctor if you have any questions.

Be sure to ask your doctor if you have any questions about this program. It is very important that you understand and follow all of the requirements. You will not get another prescription unless you follow the instructions for the program. Swallow the capsule whole with a full glass 8 ounces of water or other liquid. Do not crush, break, chew, or suck the capsule. It is very important that you take isotretinoin only as directed by your doctor.

Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. To do so may increase the chance of side effects. It is very important that you not share this medicine with anyone else because of the risk of birth defects and other serious side effects. Different brands may not work the same way. If you refill your medicine and it looks different, check with your pharmacist.

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine.

If your dose is different, do not change it unless your doctor tells you to do so. The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule.

Do not double doses. Do not take extra medicine to make up for a missed dose. Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light.

Keep from freezing. It is very important that your doctor check your or your child's progress at regular visits to make sure this medicine is working properly. Blood tests may be needed to check for unwanted effects.

Isotretinoin causes birth defects in humans if taken during pregnancy. If you suspect that you may have become pregnant, check with your doctor right away. Using this medicine while you are pregnant can cause very serious birth defects. Use two forms of effective birth control to keep from getting pregnant 1 month before beginning treatment, while you are using this medicine even if the medicine is temporarily stopped , and for at least 1 month after you stop taking the medicine.

The most effective forms of birth control are hormone birth control pills, patches, shots, vaginal rings, or implants, an IUD, or a vasectomy for men.

One of these forms of birth control should be combined with a condom, a diaphragm, or a cervical cap. Isotretinoin must not be taken by women of reproductive age who may become pregnant unless 2 effective forms of birth control have been used for at least 1 month before the start of treatment.

Contraception must be continued during the period of treatment, which is up to 20 weeks, and for 1 month after isotretinoin is stopped.

Be sure that you have discussed this information with your doctor. If you are a woman who is able to have children, you must have 2 pregnancy tests before beginning treatment with isotretinoin to make sure you are not pregnant.

Rarely, isotretinoin can cause increased pressure on the brain. This can lead to permanent loss of eyesight and, in rare cases, death. Stop taking isotretinoin and call your doctor right away if you have any of these symptoms:. Although rare, a rash caused by isotretinoin can be serious.

Stop using isotretinoin and call your doctor right away if you have any of the following symptoms:. Isotretinoin can damage your internal organs. These organs include your liver, pancreas, intestines, and esophagus the tube connecting your mouth and stomach. The damage may not get better even after you stop taking isotretinoin. This side effect is rare. Still, stop taking isotretinoin and call your doctor right away if you have any of the following symptoms:. Isotretinoin can cause serious hearing problems in rare cases.

Stop using isotretinoin and call your doctor right away if your hearing gets worse or if you have ringing in your ears. Any hearing loss may be permanent. Isotretinoin can cause vision problems such as blurry vision, double vision, and tunnel vision. This drug can also reduce your ability to see in the dark. Vision problems may fix themselves after you stop taking the drug or the damage may be permanent. Isotretinoin can cause your eyes to produce more tears than normal.

If you wear contact lenses, you may have trouble wearing them while taking isotretinoin. Like the other vision problems, this problem may go away after your stop treatment or it may be permanent. All of these vision and eye problems are rare.

Nevertheless, stop taking isotretinoin and call your doctor right away if you have problems with your vision, an increased amount of tears, or painful or constant eye dryness. Isotretinoin can cause serious allergic reactions in rare cases. Stop taking isotretinoin and call your doctor if you have a rash, red patches, or bruises on your legs or a fever. If you have any of the following symptoms, stop taking isotretinoin and call or go to the nearest emergency room:.

Isotretinoin may cause blood sugar problems, including diabetes. Call your doctor if you have any of the following symptoms:. Another rare, serious side effect is a decrease in blood cell levels. Low levels of red blood cells can cause problems such as anemia. Low levels of white blood cells raise your risk of infections.

Rarely, isotretinoin can cause serious mental health problems. These include depression, psychosis losing touch with reality , and suicidal thoughts or actions. Taking isotretinoin during pregnancy carries an extremely high risk of severe birth defects. This is true if the drug is used in any amount and even for short periods of time.

If you become pregnant during treatment with isotretinoin, stop taking the drug right away. A gynecologist can then give you further evaluation and counseling. Because of the risks it carries for pregnancies, isotretinoin can be prescribed only under a special restricted distribution program called iPLEDGE. This program is approved by the Food and Drug Administration. Both males and females who take isotretinoin need to discuss this program with their doctor.

Keywords: Acne, hyperostosis, inflammatory back pain, sacroiliitis, spondyloarthropathy, systemic isotretinoin. Objectives: This study aims to investigate the frequency of musculoskeletal adverse effects in acne vulgaris patients receiving systemic isotretinoin treatment.

Patients and methods: Between January and Decembera total of severe acne patients 22 males, females; mean age: Data including age, sex, body mass index BMIduration of disease, diagnosis, and comorbidities were recorded.

Results: The treatment period was mean 8. The dose of isotretinoin was mean 0. Musculoskeletal side effects were seen in 99 Back pain was reported during the treatment period in 78 The diagnosis was mechanical back pain in 31 Creatine kinase elevation was reported in 18 Conclusion: Low back pain is one of the most common musculoskeletal side effects of isotretinoin treatment that usually resolves with dose reduction. The cumulative dose of isotretinoin does not seem to play a role in the development of back pain, but can determine pain severity.

Pain severity is directly correlated with the increasing age. Evaluation of the patients for musculoskeletal side effects during isotretinoin use is important in clinical practice, as it is a common occurrence. Acne vulgaris is a chronic inflammatory skin disease, particularly affecting the young population. Topical and systemic treatment regimens are used to treat the condition. Isotretinoin is a synthetic vitamin A derivative that is effective on four of the factors that play a role in acne pathogenesis: sebum hypersecretion, follicular hyperkeratinization, Propionibacterium acnes proliferation, and inflammation.

Isotretinoin use is associated with mucocutaneous, ocular, neurological, musculoskeletal, and hepatic side effects. Musculoskeletal side effects are common during systemic isotretinoin treatment and include enthesopathy, arthritis, sacroiliitis, costochondritis, osteoporosis, hyperostosis, extraspinal calcifications, and premature epiphyseal closure in children. Isotretinoin has detergent-like properties and can affect immunomodulation by causing alterations in the cytokine levels.

Catabolic events such as the upregulation of ubiquitin ligases including atrogin-1 and muscle-specific ring finger protein-1 have been also noted in the etiology of muscle pain related to isotretinoin.

The results of the limited number of studies investigating the frequency of isotretinoin-related musculoskeletal effects in the literature have been variable.

Tendinopathy has been reported in 4. The management of the musculoskeletal side effects related to isotretinoin use is important, as these side effects are frequently encountered in clinical practice. In the present study, we aimed to evaluate the frequency and sex distribution of these musculoskeletal side effects and to examine the effect of age, drug dose, and body mass index BMI on isotretinoin treatment.

A total of severe acne patients 22 males, females; mean age: Patients with a history of neuromuscular, rheumatoid, or systemic inflammatory disease were excluded. The patients on isotretinoin were referred to the Physical Medicine and Rehabilitation specialist during their monthly follow-up and the development of any musculoskeletal side effects was evaluated.

The data of these patients were retrospectively analyzed together with the radiology findings. Table 1. Data including age, sex, height, weight, BMI, duration of disease, diagnosis, and comorbidities of the patients were recorded.

The VAS scores of were classified as mild pain, as moderate pain, and as severe pain. The ASAS criteria consist of disease onset under the age of 40 years, insidious onset, relief with exercise, no relief with rest, and nocturnal pain improving with rising. The statistical difference between the groups was analyzed using the Student t-test for mean values. The correlation between the variables was evaluated using the Spearman correlation test. A p value of The treatment period was mean 8.

Seventy-eight Thirty-one patients Table 2. Considering the severity of back pain, 49 Table 3. Dose reduction was used in patients with moderate and severe back pain, constituting The vast majority of these patients responded to dose reduction, while eight Bilateral sacroiliitis was detected in one patient Figure 1. Sacroiliitis regressed 1. The patients diagnosed with sacroiliitis were followed for six months.

Among these patients, two female patients also described low back pain. Creatine kinase CK elevation was observed in 18 The elevated CK values ranged between and IU and returned to normal levels after dose reduction. Figure 1. Bilateral sacroiliitis in pelvic X-ray. Isotretinoin use is associated with neuromuscular side effects, the most common of which are musculoskeletal pains and arthralgia.

They are usually mild and improve with discontinuation of treatment. In the current study, the most common musculoskeletal side effect was back pain. Our results are in line with previous studies, suggesting a high rate of mechanical and inflammatory back pain in patients using isotretinoin.

However, there was a higher percentage of male patients developing back pain in the current study. In contrast, the current study revealed a higher frequency of inflammatory back pain, similar to the study by Taheri et al. Inflammatory low back pain was more common in the female population in our study. Similarly, Elnady et al. In the literature, only a few studies have investigated the predisposing factors for the development of back pain related to isotretinoin use.

In our study, we found no significant difference in terms of the cumulative isotretinoin dose between the patient groups with and without back pain. This finding indicates that the development of back pain may not be dependent on the isotretinoin dose.

There was also no significant correlation between VAS score and the cumulative dose. However, the moderate and severe pain group received a higher cumulative isotretinoin dose than the mild pain group, suggesting that the severity of the back pain could be affected by the cumulative dose. This is also supported by the fact that the pain severity decreases with isotretinoin dose reduction in most patients.

Obesity has been associated with an increased risk of low back pain in some studies. In our study, the correlation between the VAS scores and age suggests that the effect of isotretinoin on the musculoskeletal system increases with age. Musculoskeletal degeneration related to alterations in hormones, cytokines, growth factors, and altered connective tissue biology occurs during the aging process.

Isotretinoin-induced sacroiliitis develops days to weeks after starting the treatment. In the current study, sacroiliitis developed within the first one to six months of isotretinoin treatment. Another study reported that sacroiliitis related to isotretinoin treatment was more frequent in females than males. Previous studies provide insufficient data to assume that sacroiliitis development is dosedependent. The patients developing sacroiliitis in our study were also on a low dose of isotretinoin, supporting the notion that sacroiliitis development is not dose-dependent.

The lower rate of sacroiliitis in the current study can be attributed to the careful selection of patients with no prior history of arthritis or arthralgia, as well as the heterogeneity of the genetic features of the study populations that can determine the susceptibility for the development of sacroiliitis. In our study, symptoms completely regressed with treatment cessation in all patients with sacroiliitis. The main features of CK elevation include darker skin types, male sex, and a history of regular athletic activity.

Elevated CK levels approaching or exceeding 1, to 2, IU during isotretinoin treatment also raise a concern for rhabdomyolysis, which is characterized by generalized muscle damage, acute kidney injury, and myoglobinuria.

Enthesopathy is a reported side effect of isotretinoin and usually develops after long-term isotretinoin use. Tendinitis of the Achilles tendon is a known side effect of isotretinoin and has been reported in 9. Dose reduction and interruption can be considered in patients developing tendinitis. The main limitations of this study include its retrospective nature and the lack of HLA-B27 assessment.

In conclusion, low back pain is one of the most common musculoskeletal side effects of isotretinoin treatment that usually resolves with dose reduction. The cumulative isotretinoin dose and increasing age are the main determinants of the severity of low back pain. Since musculoskeletal side effects are common during isotretinoin use, questioning the patients about such side effects during the treatment is essential.

Evaluation of musculoskeletal adverse effects in patients on systemic isotretinoin treatment: A cross-sectional study. Arch Rheumatol ;37 2 The study was conducted in accordance with the principles of the Declaration of Helsinki. A written informed consent was obtained from each patient. Data Sharing Statement: The data that support the findings of this study are available from the corresponding author upon reasonable request. Design, draft of manuscript: E.

Age, treatment duration, cumulative isotretinoin dosage and BMI of the patients. Isotretinoin related side effects according to sex. Correlation coefficents and significance values of VAS and age, cumulative isotretinoin dosage, treatment duration and BMI.

Figure 2. Enthesitis in right side of lateral foot X-ray.

Low back pain is a very common side effect of isotretinoin and it is dose-related. Although sacroiliitis is a rare complication of isotretinoin. Questions about Accutane and back pain, with answers from board-certified doctors. Get all of your questions answered on RealSelf. Conclusion: Low back pain is one of the most common musculoskeletal side effects of isotretinoin treatment that usually resolves with dose. Accutane can affect any joint in the body. Low back discomfort is seen in about half the people who take it and is transient and usuall resolves in two months. Experts estimate that body aches and pains impact about 20% of people taking isotretinoin. In fact, a small study published in BMC. Acute sacroiliitis was determined in 8. John's wort may cause your birth control pills to not work as well. Isotretinoin can cause pain in your bones, joints, muscles, and ligaments. Isotretinoin-induced skeletal hyperostosis.

Metrics details. Acne vulgaris is a chronic inflammatory disease affecting the pilosebaceous unit. Isotretinoin is an effective treatment option for severe acne. The aim of this study was to evaluate musculoskeletal side effects of systemic isotretinoin treatment. Ninety-four patients with acne vulgaris and sex- and age-matched controls were enrolled in this study. Only the patients who had musculoskeletal symptoms were evaluated in this study. All participants were firstly assessed by a dermatologist.

The patients were asked whether they had any musculoskeletal symptoms after isotretinoin treatment, if so, the feature and duration of the symptoms were recorded. The dosage of the drug, treatment duration, incidence of arthralgia, myalgia, low back pain, sacroiliitis and tendinopathy and laboratory test results were noted.

The severity of pain was assessed by visual analog scale VAS. Of the 94 patients, 71 were female and 23 were male. Bone marrow edema consistent with sacroiliitis was detected by sacroiliac MRI in 11 patients with inflammatory back pain. Low back pain is one of the very common complications of isotretinoin. It can be mostly mechanical or inflammatory. Isotretinoin-induced low back pain is dose-related, and inflammatory back pain without sacroiliitis is also frequent. The clinicians should be aware of the back pain may be a reflective of sacroiliitis during isotretinoin usage.

Peer Review reports. Acne vulgaris is a chronic inflammatory disease affecting the pilosebaceous unit with multifactorial etiology [ 1 ]. Isotretinoin is an effective treatment option for severe acne vulgaris. Isotretinoin has a wide spectrum of side effects, including multiorgan systems such as reproductive, mucocutaneous, ocular, neurological, musculoskeletal and hepatic systems.

It may also cause several musculoskeletal side effects such as arthralgia, myalgia, back pain, spondyloarthropathy-related symptoms and sacroiliitis [ 1 , 2 , 3 ]. Other uncommon musculoskeletal disorders related with isotretinoin are hyperostosis, extraspinal calcifications, enthesitis, arthritis, costochondritis, osteoporosis, growth retardation, premature epiphyseal closure in children and as well as gout [ 3 , 6 , 7 , 8 ].

In the literature, there are only a few original studies investigating the musculoskeletal side effects of isotretinoin [ 1 , 2 , 9 , 10 ].

Furthermore, there are many case reports or case series indicating the musculoskeletal side effects of isotretinoin [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ]. The majority of the recently performed studies are the case studies regarding with isotretinoin-induced sacroiliitis [ 11 , 13 , 16 , 18 , 20 ].

To the best our knowledge, there is no controlled study investigating the presence of isotretinoin-related musculoskeletal side effects with a wide spectrum such as arthralgia, myalgia, low back pain, sacroiliitis, tendinopathy and enthesopathy. In previous studies, the incidence of sacroiliitis and back pain were the most detected parameters [ 1 , 2 , 10 ].

The primary aim of this study was to evaluate and emphasize the musculoskeletal side effects of systemic isotretinoin treatment in patients with acne vulgaris and to compare them with healthy controls.

The second aim was to elucidate clinicians regarding with isotretinoin-induced musculoskeletal symptoms. A total of 94 patients with moderate to severe acne vulgaris treated with systemic isotretinoin and sex- and age-matched controls who were admitted to Ankara Training and Research Hospital, Department of Dermatology, between September and April were enrolled in this cross-sectional study.

The local ethics committee approved the study. All participants were informed about the study and their written consent form was obtained. Isotretinoin group included the patients under isotretinoin treatment for acne vulgaris, but had no history of rheumatologic syndromes. The control group was selected from among health professionals who had received a routine medical checkup in the hospital. Exclusion criteria for this study were the presence of any chronic rheumatological, dermatological diseases or any patients with a history of mechanical back pain, inflammatory back pain, sacroiliitis, enthesitis, before starting isotretinoin, history suggestive of spondyloarthropathies reactive arthritis, ankylosing spondylitis, inflammatory bowel disease, and psoriasis , or systemic autoimmune disorders.

Also, the patients with depression or similar psychiatric diseases, had renal and liver function disorders, those who were pregnant or using any systemic drugs for other diseases, were not included. All participants were firstly evaluated by a dermatologist and questioned carefully about the musculoskeletal symptoms.

Only the patients who had musculoskeletal symptoms such as myalgia, arthralgia, back pain were determined and enrolled in the study. They were referred to the physical medicine and rehabilitation department and examined by a specialist. Sociodemographic information, including age, sex, history of drug use dose and duration , history of chronic diseases were recorded.

A detailed anamnesis was obtained and a careful dermatological and physical examination was performed by both of the specialists. It was queried that whether myalgia, arthralgia and low back pain occurred after starting isotretinoin treatment. Data were recorded on a standardized pre-prepared evaluation form. The pain severity of the participants was evaluated by visual analog scale VAS based on a chart numbered from 0 no symptom to 10 maximum severity. According to GAGS, the body was divided into six regions -forehead, nose, each cheek, chin and back.

In each region, each type of lesion is given a number: zero for no lesion, one for comedones, two for papules, three for pustules and four for nodules.

It was investigated that whether there was a enthesitis by a detailed clinical examination. The following entheses were examined for tenderness and swelling bilaterally: common extensor tendon insertion on the lateral epicondyle of the humerus, quadriceps tendon, patellar tendon, tibial tuberosity, knee medial collateral ligament, Achilles tendon, and plantar fascia insertion on the calcaneus [ 23 ]. If there was a swelling and erythema, it was considered as inflammatory enthesitis.

The absence of swelling or erythema was considered to be mechanical enthesitis. The ASAS criteria consist of commencement under the age of 40, insidious onset, relief with exercise, no relief with rest and nocturnal pain improving with rising up from bed. These 4 items are essential in diagnosing inflammatory low back pain. The various imaging modalities, including conventional radiography, computed tomography CT , magnetic resonance imaging MRI and bone scintigraphy are used for investigation of inflammatory changes at the sacroiliac joints.

In early and acute stages of sacroiliitis the diagnosis can be difficult because conventional radiographs may be normal.

Inflammatory back pain is not a specific indicator of sacroiliitis. Therefore, there is need for valuable imaging methods. Scintigraphy lacks specificity. CT is a very good method for visualization of established bony destruction or ossification.

MRI can identify both inflammation and structural changes, localise different degrees of inflammation and bone marrow edema, and differentiate a possible septic sacroiliitis. MRI is the most sensitive and specific modality for sacroiliitis by directly imaging changes in the synovium, articular cartilage, and subchondral bone [ 26 , 27 , 28 ].

In our study, the patients meeting ASAS criteria for inflammatory back pain were evaluated in detail and requested both sacroiliac radiography and sacroiliac MRI. Sacroiliac MRI was performed on 1. At least 12 slices of coronal oblique T1-weighted turbo spin-echo and short tau inversion recovery STIR sequences of the sacroiliac joints were acquired.

This images were interpreted by the same reader who had received standardized training and were blinded with regard to the study groups. In addition, laboratory blood tests including rheumatoid factor RF , erythrocyte sedimentation rate ESR and c-reactive protein CRP values were requested.

Anti-nuclear antibody ANA was ordered to rule out other connective tissue diseases. Data were analyzed using SPSS software version The normality of the data was tested by Kolmogorov-Smirnov test.

For the comparison of the paired groups, the independent samples t-test normal distribution and the Mann-Whitney U test non-normal distribution were used for the quantitative data. Chi-squared test was used to evaluate whether there was a difference in terms of musculoskeletal symptoms between the study groups. This case-control study included 94 71 women, 23 men patients with acne vulgaris receiving isotretinoin and 74 women, 26 men age- and sex-matched controls.

The age and sex distributions of the study and control groups are presented in Table 1. All of the tendinopathies were mechanical feature, swelling or erythema was not observed. The flow chart of the participants was presented in Fig. The median duration of treatment was 3 min. There was a total of 66 patients The clinical characteristics of both isotretinoin group and healthy controls can be seen in Table 2.

The median duration of treatment was 3 IQR: 3, min. The comparison of the patients who had musculoskeletal symptoms or not in isotretinoin group regarding as total cumulative dose of drug were given in Table 3. The results of linear regression analysis between the age, sex, duration of treatment and cumulative dose of drug with musculoskeletal side effects were shown in Table 4.

The sacroiliac radiography was normal in all of the patients with inflammatory back pain. In sacroiliac MRI, sacroiliitis was observed in 11 Semicoronal short tau inversion recovery STIR images show hyperintense lesions arrows consistent with bone marrow edema in bilateral sacroiliac joints. Semicoronal T1-weighted spin-echo image shows signal loss arrows in sacroiliac joints consistent with sacroiliitis.

The patients who developed rheumatologic symptoms during isotretinoin usage were called to follow-ups by monthly. They were evaluated by a specialist and physical examination was performed at each time they came to control. VAS scores of the patients were also assessed at each follow-up. In addition, routine biochemical blood tests were acquired from all of the patients in isotretinoin group.

The patients who developed musculoskeletal symptoms such as mechanical back pain, arthralgia, myalgia or tendinopathy, except for sacroiliitis were initiated a nonsteroidal antiinflammatory drugs NSAID and continued a lower dose of isotretinoin. In patients who were diagnosed as sacroiliitis, the drug was discontinued immediately and a NSAID was prescribed.

We observed that the complaints of these patients were resolved within a month after cessation of the drug and VAS scores were also decreased dramatically. The symptoms were mostly disappeared by the third month. All the patients with sacroiliitis were completely symptom free at the sixth month of the discontinuation of the drug.

Isotretinoin, or cis retinoic acid, is a vitamin A derivative used for severe recalcitrant acne since Although isotretinoin is a very effective drug, it may have many side effects. It is essential that the clinician should be careful about the various side effects of the drug [ 30 ]. In this study, we focused on the musculoskeletal side effects of isotretinoin. Ninety-four patients treated with isotretinoin suffering from musculoskeletal pain were included.

The patients were then examined in detail.



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