Isotretinoin Does Not Increase Liver Enzyme Elevations in Patients With Severe Acne

Acne patients receiving isotretinoin may not need continued testing when experiencing low-grade liver enzyme abnormalities, as most mild elevations do not worsen.

Although treatment with isotretinoin for severe acne is often associated with mild elevations in liver enzymes aspartate transaminase (AST) and alanine aminotransferase (ALT), these elevations do not appear to worsen and tend to normalize when healthcare providers maintain the initial treatment dose, according to study data published in the Journal of Dermatological Treatment.

Researchers from the dermatology department at Wake Forest University, Winston-Salem, North Carolina, retrospectively reviewed health records of patients with acne vulgaris who had elevated AST and ALT levels after treatment with isotretinoin (age range, 12-64 years). The researchers investigated the time it took between treatment and normalization of abnormal AST and ALT levels. In the final cohort, a total of 79 patients with severe acne and abnormal liver enzymes were receiving 80 mg isotretinoin, and 23 patients were receiving 40 mg isotretinoin.

Median AST levels in this cohort were 50, and patients with grade 1 AST had a mean of 6 weeks for AST levels to completely normalize after maintaining their isotretinoin dose. During dose maintenance, in the grade 1 AST elevations, 40 patients normalized, 38 patients remained elevated, and 1 patient elevated further into grade 2. Median levels of ALT were 67, and it took an average of 7 weeks for grade 1 elevations of ALT to normalize when managed by maintaining the isotretinoin dose. In the grade 1 ALT elevations, a total of 31 patients had normalized enzyme levels and 38 patients had levels that remained elevated.

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Limitations of the study were the inclusion of only patients with acne vulgaris, the loss to follow-up of some of the patients, and the single-center design.

The researchers concluded that “low-grade alterations of AST and ALT may not benefit from the continued testing” in acne vulgaris patients who are treated with isotretinoin.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

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Pona A, Cardenas-de la Garza JA, Haidari W, et al. Abnormal liver function tests in acne patients receiving isotretinoin [published online September 9, 2019]. J Dermatolog Treat. doi:10.1080/09546634.2019.1662882