Isotretinoin treatment was associated with significant changes in laboratory values of patients with acne reflective of liver function, renal function, blood abnormalities, and oxidative stress, according to findings from a study published in the Journal of Cosmetic Dermatology.
Investigators treated adolescents with moderate to severe acne with isotretinoin 0.5 mg/kg daily in 2 divided doses for 6 months. Blood samples were obtained to measure LDL, triglycerides, hemoglobin, ESR, total bilirubin, total albumin, globulin, BUN, serum ferritin, serum uric acid, serum creatinine, CRP, ceruloplasmin, ALT, AST, RBC count, WBC count, and platelets. Investigators conducted follow-up visits every 2 months to assess isotretinoin adherence, and repeat laboratory values were taken 6 months from the beginning of treatment. A paired t test or Wilcoxon test were performed to measure changes in laboratory values from baseline until 6 months of treatment.
There were 53 patients included in the study. All were women, the mean age was about 22 years and the majority (49) had severe acne, according to the International Consensus Conference on Acne Classification System.
After 6 months of treatment, there was a significant increase in LDL (P <.0001), triglycerides (P <.0001), AST and ALT levels (P <.0001), total albumin (P <.0012), total globulin (P <.0001), serum uric acid (P <.0001), ESR (P <.0001), CRP (P <.0001), hemoglobin (P <.0002), and serum ferritin (P <.0001). BUN increased significantly (P <.01) but was still within normal range.
There was a significant decrease in albumin level, albumin/globulin ratio, copper (P <.0001), ceruloplasmin (P <.0001), WBC count (P <.0001), platelets (P <.0001), and neutrophil/lymphocyte ratio (P <.0001).
The study was limited by the lack of control participants for comparison, the investigators acknowledged.
The study authors wrote that in addition to routine bloodwork for follow-up in patients with acne prescribed isotretinoin therapy, clinicians should add uric acid and renal function tests based on their results. They also noted that “the findings in the present work could be an alarm for the augmented oxidative stress induced by isotretinoin” based on the elevated ferritin and uric acid and decreased ceruloplasmin they saw in the study.
Hareedy MS, Tawfik KM. Systemic isotretinoin has an impact on hemoglobin, ferritin, urea, ceruloplasmin, albumin, uric acid levels and neutrophil to lymphocyte ratio in acne patients. J Cosmet Dermatol. Published online June 29, 2022. doi:10.1111/jocd.15199