Impact of oral isotretinoin therapy on musculoskeletal system and physical activity in patients with acne
Keywordsacne, isotretinoin, adverse effects, physical activity, musculoskeletal disorders
Introduction and purpose: Isotretinoin, the vitamin A derivative, has been commonly used
in treatment of acne vulgaris for years. Despite its unquestionable efficacy, chronic oral isotretinoin treatment leads to multiple side effects. The aim of study is analysis of musculoskeletal symptoms prevalence during oral isotretinoin treatment and their impact on physical activity.
Material and methods: The study was conducted using the original survey questionnaire shared online among members of Polish group of patients treated for acne. Total of 196 responses were analyzed and compared with up-to-date literature related to the topic.
Results: 86,7% of respondents reported at least one of the musculoskeletal symptoms. The most common were back pain (82,7%), fatigue and lethargy (70,4%), myalgia (55,1%) and arthalgia (32,1%). In 97,6% cases adverse effects were developed within the first 6 months of treatment. In 64,2% they persisted during the whole therapy, sometimes even beyond. Due to musculoskeletal side effects, in 2,4% cases dose reduction was necessary, 1,8% of respondents had to stop treatment and 48% had to limit or stop physical activity. 71,4% of repondents reported that lower back pain occurred or escalated during isotretinoin treatment.
Conclusions: Prevalence of reported musculoskeletal symptoms is very high and totals 86,7%. They result in prolonged limiting or stopping of physical activity in almost 50% of people. Although musculoskeletal symptoms are typically benign, possibility of severe disorders and potential permanent effects must be taken into consideration.
Wolkenstein P, Machovcová A, Szepietowski JC, Tennstedt D, Veraldi S, Delarue A. Acne prevalence and associations with lifestyle: a cross-sectional online survey of adolescents/young adults in 7 European countries. J Eur Acad Dermatol Venereol JEADV. 2018;32:298–306.
Costa CS, Bagatin E, Martimbianco ALC, da Silva EM, Lúcio MM, Magin P, et al. Oral isotretinoin for acne. Cochrane Database Syst Rev [Internet]. 2018 [cited 2020 Jul 22];2018. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6383843/
Katsambas AD, Stefanaki C, Cunliffe WJ. Guidelines for treating acne. Clin Dermatol. 2004;22:439–44.
Barnes LE, Levender MM, Fleischer AB, Feldman SR. Quality of life measures for acne patients. Dermatol Clin. 2012;30:293–300, ix.
Tan J, Boyal S, Desai K, Knezevic S. Oral Isotretinoin. Dermatol Clin. 2016;34:175–84.
Rademaker M. Isotretinoin: dose, duration and relapse. What does 30 years of usage tell us? Australas J Dermatol. 2013;54:157–62.
Melnik BC. Apoptosis May Explain the Pharmacological Mode of Action and Adverse Effects of Isotretinoin, Including Teratogenicity. Acta Derm Venereol. 2017;97:173–81.
Vallerand IA, Lewinson RT, Farris MS, Sibley CD, Ramien ML, Bulloch AGM, et al. Efficacy and adverse events of oral isotretinoin for acne: a systematic review. Br J Dermatol. 2018;178:76–85.
Layton A. The use of isotretinoin in acne. Dermatoendocrinol. Taylor & Francis; 2009;1:162–9.
Borghi A, Mantovani L, Minghetti S, Giari S, Virgili A, Bettoli V. Low-cumulative dose isotretinoin treatment in mild-to-moderate acne: efficacy in achieving stable remission. J Eur Acad Dermatol Venereol JEADV. 2011;25:1094–8.
Brzezinski P, Borowska K, Chiriac A, Smigielski J. Adverse effects of isotretinoin: A large, retrospective review. Dermatol Ther. 2017;30:e12483.
Chroni E, Monastirli A, Tsambaos D. Neuromuscular adverse effects associated with systemic retinoid dermatotherapy: monitoring and treatment algorithm for clinicians. Drug Saf. 2010;33:25–34.
Baykal Selçuk L, Aksu Arıca D, Baykal Şahin H, Yaylı S, Bahadır S. The prevalence of sacroiliitis in patients with acne vulgaris using isotretinoin. Cutan Ocul Toxicol. 2017;36:176–9.
Verhoeven F, Tordi N, Prati C, Demougeot C, Mougin F, Wendling D. Physical activity in patients with rheumatoid arthritis. Joint Bone Spine. 2016;83:265–70.
Kaymak Y. Creatine phosphokinase values during isotretinoin treatment for acne. Int J Dermatol. 2008;47:398–401.
Marson JW, Baldwin HE. The creatine kinase conundrum: a reappraisal of the association of isotretinoin, creatine kinase, and rhabdomyolysis. Int J Dermatol. 2020;59:279–83.
Tasdelen OY, Yurdakul FG, Duran S, Bodur H. Isotretinoin-induced arthritis mimicking both rheumatoid arthritis and axial spondyloarthritis. Int J Rheum Dis. 2015;18:466–9.
Alkan S, Kayiran N, Zengin O, Kalem A, Kimyon G, Kilinc EO, et al. Isotretinoin-induced Spondyloarthropathy-related Symptoms: A Prospective Study. J Rheumatol. The Journal of Rheumatology; 2015;42:2106–9.
Kaplan G, Haettich B. Rheumatological symptoms due to retinoids. Baillieres Clin Rheumatol. 1991;5:77–97.
Barbareschi M, Paresce E, Chiaratti A, Ferla Lodigiani A, Clerici G, Greppi F. Unilateral sacroiliitis associated with systemic isotretinoin treatment. Int J Dermatol. 2010;49:331–3.
Aydog E, Ozturk G, Comert A, Tasdelen N, Akin O, Kulcu DG. Sacroiliitis during isotretinoin treatment: Causal association or coincidence? North Clin Istanb. 2018;6:75–80.
Zesztywniające zapalenie stawów kręgosłupa (ZZSK) [Internet]. [cited 2020 Jul 24]. Available from: http://www.mp.pl/social/chapter/B16.II.16.12.1.
Geller ASB, Alagia RFN. Sacroiliitis after use of oral isotretinoin - association with acne fulminans or adverse effect? An Bras Dermatol. 2013;88:193–6.
Schett G. Resolution of inflammation in arthritis. Semin Immunopathol. 2019;41:675–9.
How to Cite
The periodical offers access to content in the Open Access system under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0
Number of views and downloads: 1084
Number of citations: 0