Timothy J Hansen1, SaraMarian Lucking2, Jeffrey J Miller1, Joslyn S Kirby1, Diane M Thiboutot1, Andrea L Zaenglein3. 1. Department of Dermatology, Pennsylvania State/Hershey Medical Center, Hershey, Pennsylvania. 2. Pennsylvania State College of Medicine, Hershey, Pennsylvania. 3. Department of Dermatology, Pennsylvania State/Hershey Medical Center, Hershey, Pennsylvania; Department of Pediatrics, Pennsylvania State/Hershey Medical Center, Hershey, Pennsylvania. Electronic address: azaenglein@hmc.psu.edu.
Abstract
BACKGROUND: Laboratory monitoring for adverse effects to isotretinoin occurs with variability. Standardization of laboratory monitoring practices represents an opportunity to improve quality of care. OBJECTIVE: We sought to develop an evidence-based approach to laboratory monitoring of patients receiving isotretinoin therapy for acne. METHODS: We reviewed laboratory data from 515 patients with acne undergoing 574 courses of isotretinoin from March 2003 to July 2011. Frequency, timing, and severity of abnormalities were determined. RESULTS: Clinically insignificant leukopenia or thrombocytopenia occurred in 1.4% and 0.9% of patients, respectively. Elevated liver transaminases were detected infrequently and not significantly increased compared with baseline detection rates (1.9% vs 1.6% at baseline). Significant elevations occurred with triglyceride (19.3%) and cholesterol (22.8%) levels. The most severe abnormalities were grade 2 (moderate). Mean duration of treatment before abnormalities were detected was 56.3 days for hypertriglyceridemia, 61.9 days for alanine transaminitis, and 50.1 days for hypercholesterolemia. LIMITATIONS: This was a single-center experience examining variable isotretinoin laboratory monitoring practices. CONCLUSIONS: In healthy patients with normal baseline lipid panel and liver function test results, repeated studies should be performed after 2 months of isotretinoin therapy. If findings are normal, no further testing may be required. Routine complete blood cell count monitoring is not recommended.
BACKGROUND: Laboratory monitoring for adverse effects to isotretinoin occurs with variability. Standardization of laboratory monitoring practices represents an opportunity to improve quality of care. OBJECTIVE: We sought to develop an evidence-based approach to laboratory monitoring of patients receiving isotretinoin therapy for acne. METHODS: We reviewed laboratory data from 515 patients with acne undergoing 574 courses of isotretinoin from March 2003 to July 2011. Frequency, timing, and severity of abnormalities were determined. RESULTS: Clinically insignificant leukopenia or thrombocytopenia occurred in 1.4% and 0.9% of patients, respectively. Elevated liver transaminases were detected infrequently and not significantly increased compared with baseline detection rates (1.9% vs 1.6% at baseline). Significant elevations occurred with triglyceride (19.3%) and cholesterol (22.8%) levels. The most severe abnormalities were grade 2 (moderate). Mean duration of treatment before abnormalities were detected was 56.3 days for hypertriglyceridemia, 61.9 days for alanine transaminitis, and 50.1 days for hypercholesterolemia. LIMITATIONS: This was a single-center experience examining variable isotretinoin laboratory monitoring practices. CONCLUSIONS: In healthy patients with normal baseline lipid panel and liver function test results, repeated studies should be performed after 2 months of isotretinoin therapy. If findings are normal, no further testing may be required. Routine complete blood cell count monitoring is not recommended.
Authors: John S Barbieri; Daniel B Shin; Shiyu Wang; David J Margolis; Junko Takeshita Journal: J Am Acad Dermatol Date: 2019-06-19 Impact factor: 11.527
Authors: Maria Cecilia Rivitti Machado; Edileia Bagatin; Thais Helena Proença de Freitas; Maria Cecília Rivitti-Machado; Beatriz Medeiros Ribeiro; Samanta Nunes; Marco Alexandre Dias da Rocha Journal: An Bras Dermatol Date: 2019 Jan-Feb Impact factor: 1.896