In this letter, we discuss the topic of necessity of routine laboratory monitoring during isotretinoin treatment for acne. According to Park and colleagues, it is advisable to monitor the levels of triglycerides, alanine aminotransferase, and aspartate aminotransferase every 5 to 6 months. Additionally, the levels of total cholesterol and low-density lipoprotein should be checked within the first two months of treatment. Isotretinoin is a commonly prescribed agent mainly used to treat acne. Despite its high effectiveness, it necessitates regular monitoring of laboratory parameters due to its side effect profile. Currently, there remains a lack of consensus on the appropriate frequency for monitoring these parameters during treatment with isotretinoin. This letter will provide insight into this complex and controversial topic. Based on existing literature, we concluded that the incidence of changes in lipid and liver aminotransferase levels during isotretinoin treatment for acne was low and likely clinically insignificant. For generally healthy people, we recommend testing lipid and liver profiles once at baseline and a second time at the peak dosage. However, frequent testing might still be beneficial in certain populations of patients.

Background Isotretinoin therapy is a commonly prescribed medication by dermatologists for the treatment of acne. Regular laboratory assessments are recommended throughout the treatment period to detect any potential complications. Objectives This study aims to present the alterations in laboratory parameters throughout the course of isotretinoin therapy and identify required diagnostic testing. Methods This study involved 136 patients undergoing isotretinoin treatment at doses of 0.3-0.5 mg/kg/day, with ages ranging from 18 to 41 years. A retrospective evaluation was conducted on biomarkers including aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transpeptidase (GGT), creatine kinase (CK), triglycerides, total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), hemoglobin, white blood cells, and thrombocytes. Levels of these parameters were analyzed prior to treatment and at the third month of treatment from the records of patients and the data were compared statistically. Moreover, the parameters of ALT, AST, CK, and GGT were graded objectively, and any alterations were noted in the patients. Results The levels of ALT, AST and GGT, along with triglycerides, total cholesterol, LDL-C, and thrombocyte levels showed significant elevation (p=0.001, p<0.001, p<0.001, p=0.001, p<0.001, p<0.001, and p=0.003, respectively). A significant decrease in HDL-C with hemoglobin was also noted (p=0.022, p=0.006, respectively). One patient (0.73%) exhibited grade 1 elevations in ALT, AST, and CK. One patient (0.73%) displayed grade 1 elevations in ALT and AST. One patient (0.73%) exhibited grade 1 elevations in AST and CK, while another patient (0.73%) had grade 1 elevation in AST and grade 3 elevation in CK. Furthermore, one patient (0.73%) had a grade 1 elevation exclusively in ALT, two patients (1.47%) had a grade 1 elevation exclusively in AST, and six patients (4.41%) exhibited a grade 1 elevation in CK only. No grade changes were observed in the GGT levels in the patients. Conclusion During isotretinoin treatment, changes in ALT and AST levels were more frequently associated with the muscle enzyme CK, while GGT levels remained unaffected. Therefore, GGT can be considered a reliable parameter for evaluating liver function in patients undergoing isotretinoin treatment.

Acne is a chronic inflammatory skin disease with a high prevalence in Saudi Arabia. Isotretinoin is used to treat severe, resistant nodulocystic acne. Side effects include joint discomfort, headache, mucosal dryness, and nose bleeds. Elevated lipids and liver enzymes have also been recorded. The study goal is to identify the prevalence of increased lipid levels during and after isotretinoin use.

This retrospective study was conducted in the dermatology polyclinic at King Faisal University, Al-Ahsa, Saudi Arabia. It included adults of different age groups diagnosed with acne vulgaris and treated with oral isotretinoin between January 2021 and December 2022. Parameters included baseline laboratory tests and follow-up laboratory results of cholesterol and triglycerides.

Among 88 patients, 48.9% were aged 21-23 years, with females dominating. In total, 47.7% of patients started using isotretinoin at age 20 years or less, with starting doses ranging from 10 to 20 mg. Fifty percent of the patients had five months or more of treatment duration and only 6.8% of the patients had previously used isotretinoin. For the cholesterol and triglycerides, 87.5% of patients had normal pre-treatment with cholesterol and 90.9% with triglycerides, followed by 81.8% and 95.5% in the second reading, respectively. In the last reading, results were 77.3% for cholesterol and 94.3% for triglycerides.

The study found that most acne patients treated with isotretinoin had normal cholesterol and triglyceride levels at baseline, second, and last readings. The incidence of higher laboratory alterations was low, with 12.5% and 4.5% for cholesterol and triglycerides at baseline, and 18.2% and 3.4% at second, and 22.7% and 5.7% at last readings. Overall, age, gender, age of start of isotretinoin, isotretinoin dose, and previous use of isotretinoin are factors that could affect laboratory readings.