- Isotretinoin (Oral Route) Precautions - Mayo Clinic

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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.

The second pregnancy test must be taken at least 19 days after the first test and during the first 5 days of the menstrual period immediately before beginning treatment. In addition, you must have a pregnancy test each month while you are using this medicine and 1 month after treatment is completed.

Do not take vitamin A or any vitamin supplement containing vitamin A while using this medicine, unless otherwise directed by your doctor. During the first 3 weeks you are taking isotretinoin, your skin may become irritated.

Also, your acne may seem to get worse before it gets better. Check with your doctor if your skin condition does not improve within 1 to 2 months after starting this medicine or at any time your skin irritation becomes severe. Full improvement continues after you stop using isotretinoin and may take up to 6 months. Your doctor can help you choose the right skin products to reduce skin dryness and irritation. You or your child should not donate blood to a blood bank while using isotretinoin or for 30 days after you stop using it.

This is to prevent a pregnant patient from receiving blood that contains the medicine. In some patients, isotretinoin may cause a decrease in night vision. This problem may occur suddenly. If it does occur, do not drive or do anything else that could be dangerous until you know how this medicine affects you. Also, check with your doctor. Isotretinoin may cause dryness of the eyes. If you or your child wear contact lenses, your eyes may be more sensitive to them during the time you are using isotretinoin and for up to 2 weeks after stopping it.

To help relieve dryness of the eyes, check with your doctor about using a lubricating solution, such as artificial tears. If eye inflammation occurs, check with your doctor right away. Isotretinoin may cause dryness of the mouth and nose. For temporary relief of mouth dryness, use sugarless candy or gum, melt bits of ice in your mouth, or use a saliva substitute.

However, if dry mouth continues for more than 2 weeks, check with your medical doctor or dentist. Continuing dryness of the mouth may increase the chance of dental disease, including tooth decay, gum disease, and fungus infections.

Avoid overexposing your skin to sunlight, wind, or cold weather. Your skin will be more prone to sunburn, dryness, or irritation, especially during the first 2 or 3 weeks of treatment. However, you or your child should not stop using this medicine unless the skin irritation becomes too severe.

Do not use a sunlamp or tanning beds. To help isotretinoin to work properly, use sunscreen or sunblock lotions with a sun protection factor SPF of at least 15 on a regular basis. Also, wear protective clothing and hats. Isotretinoin may cause some people to be agitated, irritable, or display other abnormal behaviors. It may also cause some people to have suicidal thoughts and tendencies or to become more depressed. If you, your child, or your caregiver notice any of these side effects, check with you doctor right away.

This medicine may increase pressure in your head, which may lead to vision loss or serious brain problems. Check with your doctor right away if you have a bad headache, blurred vision, dizziness, nausea, vomiting, or seizures. Serious skin reactions can occur with this medicine.

Check with your doctor right away if you or your child have any of the following symptoms while using this medicine: blistering, peeling, or loosening of the skin, chills, diarrhea, itching, joint or muscle pain, rash, red skin lesions, often with a purple center, sores, ulcers, or white spots in the mouth or on the lips, or unusual tiredness or weakness.

Isotretinoin may cause bone or muscle problems, including joint pain, muscle pain or stiffness, or difficulty moving. You may get hurt more easily during rough sports.

You may also heal more slowly. If this medicine is for your child, tell the doctor if you think your child is not growing properly. It is very important that you or your child not use wax epilation to remove hair while you are taking isotretinoin and for 6 months after stopping it. Isotretinoin can increase your chance of scarring from wax epilation.

It is very important that you or your child not have any cosmetic procedures to smooth your skin eg, dermabrasion, laser while you are using isotretinoin and for 6 months after stopping it. Isotretinoin can increase your chance of scarring from these procedures.

This medicine may affect blood sugar levels. If you or your child are diabetic and notice a change in the results of your blood or urine sugar tests, check with your doctor. Pancreatitis may occur while you are using this medicine. Tell your doctor right away if you or your child have sudden and severe stomach pain, chills, constipation, nausea, vomiting, fever, or lightheadedness. Isotretinoin may cause some people to have hearing problems within a few weeks after they start using it.

Check with your doctor right away if you or your child have hearing loss, a continuing ringing or buzzing, or any other unexplained noise in the ears. Check with your doctor right away if you have pain or tenderness in the upper stomach, pale stools, dark urine, loss of appetite, nausea, unusual tiredness or weakness, or yellow eyes or skin.

These could be symptoms of a serious liver problem. Tell your doctor right away if you or your child have abdominal or stomach pain, rectal bleeding, or severe diarrhea. These may be symptoms of a serious condition called inflammatory bowel disease. This medicine may cause serious allergic reactions, including anaphylaxis, which can be life-threatening and requires immediate medical attention.

Call your doctor right away if you have a rash, itching, redness, soreness, or itching skin, trouble breathing, trouble swallowing, or any swelling of your hands, face, or mouth while you are using this medicine. This reaction is more often seen in people who also have an allergy to aspirin.

This medicine lowers the number of some types of blood cells in your body. Because of this, you or your child may bleed or get infections more easily. To help with these problems, avoid being near people who are sick or have infections. Wash your hands often. Stay away from rough sports or other situations where you could be bruised, cut, or injured. Brush and floss your teeth gently.

Be careful when using sharp objects, including razors and fingernail clippers. Do not take other medicines without checking first with your doctor. This includes vitamins, herbal products, and prescription or nonprescription over-the-counter [OTC] medicines. Some medicines or nutritional supplements eg, St. John's wort may cause your birth control pills to not work as well. Along with its needed effects, a medicine may cause some unwanted effects.

Although not all of these side effects may occur, if they do occur they may need medical attention. Some side effects may occur that usually do not need medical attention.

These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects.

Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:.

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. 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.

Acta Dermatovenereol Croat. Google Scholar. Semira FS. Isotretinoin-induced acute severe myopathy involving pelvic girdle muscles: a case report. Isotretinoin-induced skeletal hyperostosis. Graf Whittle SpringerPlus. Sacroiliitis and polyneuropathy during isotretrinoin treatment. Clin Exp Dermatol. Isotretinoin-induced arthritis mimicking both rheumatoid arthritis and axial spondiloarthritis.

Int J Rheum Dis. Sacroiliitis and severe disability due to isotretinoin therapy. Rheumatol Int. Zhao S, Goodson NJ. Diffuse idiopathic skeletal hyperostosis and isotretinoin in cystic acne. BMJ Case Rep. A patient with chronic sacroiliitis undiagnosed for three years after isotretinoin use.

BMC Musculoskelet Disord. Mease PJ. Arthritis Care Res Hoboken. Koppikar S, Eder L. The management of enthesitis in clinical practice. Curr Opin Rheumatol. Ultrasonographic and clinical assessment of peripheral enthesitis in patients with psoriatic arthritis, psoriasis, and fibromyalgia syndrome - the ULISSE study. Assessment of enthesis in patients with psoriatic arthritis and fibromyalgia using clinical examination and ultrasound. Clin Exp Rheumatol.

PubMed Google Scholar. The assessment of SpondyloArthritis international society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general.

Ann Rheum Dis. Imaging of Sacroiliitis. Clin Rheumatol. Imaging of the sacroiliac joint involvement in seronegative spondylarthropathies. Imaging of the Seronegative Spondyloarthropathies. Curr Rheumatol Rep. Behav Res Methods. Safety and side effects of the acne drug, oral isotretinoin. Expert Opin Drug Saf. Enthesitis and its relationship with disease activity, functional status, and quality of life in psoriatic arthritis: a multi-center study.

Can isotretinoin induce sacroiliitis: three cases. Turk J Rheumatol. Sacroiliitis secondary to isotretinoin. Australas J Dermatol. Arthritis Rheumatol. Magnetic resonance imaging of the sacroiliac joints indicating Sacroiliitis according to the assessment of SpondyloArthritis international society definition in healthy individuals, runners, and women with postpartum Back pain.

Download references. You can also search for this author in PubMed Google Scholar. All of authors have participated equally in this study. NK and CM: Searched the literature and wrote the paper. NK: Selected the participants and designed the study. CM: Examined the patients and analyzed the data.

CM and NK: Supervised, edited and revised the manuscript. All authors have read and approved the final version of the article. Written informed consent was obtained from all the participants for this study. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material.

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Reprints and Permissions. Analysis of musculoskeletal side effects of oral Isotretinoin treatment: a cross-sectional study. BMC Musculoskelet Disord 21 , Download citation. Received : 11 February Accepted : 18 September Published : 25 September Anyone you share the following link with will be able to read this content:.

Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative. Skip to main content. Search all BMC articles Search. Download PDF. Methods Ninety-four patients with acne vulgaris and sex- and age-matched controls were enrolled in this study. Results Of the 94 patients, 71 were female and 23 were male. Conclusion Low back pain is one of the very common complications of isotretinoin.

Background Acne vulgaris is a chronic inflammatory disease affecting the pilosebaceous unit with multifactorial etiology [ 1 ]. Methods 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. Results 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.

Table 1 Demographic features of the participants Full size table. Flow chart of the participants. Full size image.

Table 2 The clinical characteristics of the study groups Full size table.

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    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.

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.

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 tied , an 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…. 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. They were also compared with healthy controls. Isotretinoin has been associated with various musculoskeletal side effects in the recent literature. 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.

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 [ 123 ]. 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 [ 3678 ].

In the literature, there are only a few original studies investigating the musculoskeletal side effects of isotretinoin [ 12910 ]. Furthermore, there are many case reports or case series indicating the musculoskeletal side effects of isotretinoin [ 11121314151617181920 ]. The majority of the recently performed studies are the case studies regarding with isotretinoin-induced sacroiliitis [ 1113161820 ].

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 [ 1210 ]. 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 psoriasisor 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 durationhistory 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 CTmagnetic 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 [ 262728 ]. 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 RFerythrocyte 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.

localhost › journals › fullarticle. We encountered two cases of acute, aseptic arthritis of the knee in male patients receiving isotretinoin, during the third week and third month of therapy. Isotretinoin may cause bone or muscle problems, including joint pain, muscle pain or stiffness, or difficulty moving. You may get hurt more. Isotretinoin may cause bone or muscle problems, including joint pain, muscle pain or stiffness, or difficulty moving. I took accutane for 6 months and had knee and joint pain. I just got off about a week ago and my legs and feet hurt alot almost like a swelling pain. Did. These include depression, psychosis losing touch with realityand suicidal thoughts or actions. Tell your doctor right away if you or your child have abdominal or stomach pain, rectal bleeding, or severe diarrhea. This medicine should be used with caution in teenagers, especially those with bone problems or diseases. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. Sociodemographic information, including age, sex, history of drug use dose and durationhistory of chronic diseases were recorded. Tell your doctor right away if you or your child have sudden and severe stomach pain, chills, constipation, nausea, vomiting, fever, or lightheadedness. The exact pathogenesis of sacroiliitis in isotretinoin use is unclear.

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 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. 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 tied , an 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.



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