The correlation of age, gender and drug dose with side effects of isotretinoin in patients with acne vulgaris

Background and Design: Acne vulgaris is a chronic inflammatory disease of pilosebaceous unit. Oral isotretinoin is the most effective agent that has been used for many years in acne treatment. The purpose of our study was to determine the side effects of the isotretinoin and to examine the correlation between these side effects, and age, gender and drug dose.
Materials and Methods: One hundred forty nine patients with moderate or severe acne vulgaris (age between: 14-34 years) using isotretinoin were included. Eight patients discontinued treatment for various reasons. Daily isotretinoin dose was started as less than 0.5 mg/kg/day. A cumulative dose of at least 120 mg/kg was targeted in all patients. The patients were assessed in terms of side effects on a monthly basis.
Results: Of the 141 patients who have completed the treatment, 106 (75.2%) were female and 35 (24.8%) were male. Cheilitis was seen in 100%, xeroderma in 66%, photophobia in 44.7%, mild epistaxis in 42.6%, and xerophthalmia in 36.9% of the patients. Lumbar pain was seen in 41.1%, myalgia in 29.1%, arthralgia in 19.1%, headache in 13.5% of the patients. Serum lipid levels increased in 20.6% of the patients, while liver enzyme levels increased in 7.8% of the patients. Myalgia and lumbar pain was more common in females (p=0.045, p=0.019, respectively). Patients who received higher than 0.5 mg/kg/day dose had more xerosis, myalgia and triggering acne complaints (p=0.004, p=0.001, p=0.012, respectively). Myalgia were found to be more common in patients who were older than 20 years old (p=0.003).
Conclusion: Because the use of isotretinoin is a long-lasting treatment method, patient compliance is of paramount importance. Knowing how frequent side effects will occur in different patients groups and informing the patients beforehand will increase patients’ confidence towards to physician and minimize the compliance problems.

Keywords: Acne vulgaris, isotretinoin, side effects, myalgia, epistaxis

Akne vulgaris nedeniyle isotretinoin kullanan hastalarda ilaç yan etkilerinin ya?, cinsiyet ve ilaç dozu ile ili?kisi

Amaç: Akne vulgaris, pilosebase ünitenin kronik enflamatuvar bir hastal???d?r. Oral izotretinoin akne tedavisinde uzun y?llard?r kullan?lan en etkili tedavi ajan?d?r. Çal??mam?zda ilac?n yan etkilerini tespit etmeyi ve bunlar?n ya?, cinsiyet ve ilaç dozu ile ba?lant?s?n? ara?t?rmay? amaçlad?k.
Gereç ve Yöntem: Çal??mam?zda, ya?lar? 14-34 aras?nda de?i?en, izotretinoin kullanan, 149 orta veya ?iddetli akne vulgarisli hasta yer ald?. Sekiz hasta çe?itli sebeplerle tedaviye devam etmedi. Günlük izotretinoin dozu 0,5 mg/kg’nin alt?nda ba?land?. Tüm hastalarda en az 120 mg/ kg kümülatif doz hedeflendi. Hastalar yan etkiler aç?s?ndan ayl?k olarak de?erlendirildi.
Bulgular: Tedaviyi tamamlayan 141 hastan?n 106’s? (%75,2) kad?n, 35’i (%24,8) erkekti. Hastalar?n %100’ünde keilitis, %66’s?nda kseroderma, %44,7’sinde fotofobi, %42,6’s?nda hafif burun kanamas?, %36,9’unda göz kurulu?u görüldü. Bel a?r?s? hastalar?n %41,1’inde, kas a?r?s? %29,1’inde, eklem a?r?s? %19,1’inde ve ba? a?r?s? %13,5’inde görüldü. Serum lipit düzeyleri hastalar?n %20,6’s?nda, karaci?er enzim düzeyleri ise hastalar?n %7,8’inde yüksekti. Kas a?r?s? ve bel a?r?s? kad?n hastalarda daha yüksekti (s?ras?yla; p=0,045, p=0,019). ?laç dozu 0,5 mg/ kg/günün üzerinde olan hastalarda kseroderma, kas a?r?s? ve akne tetiklenmesi daha fazlayd? (s?ras?yla; p=0,004, p=0,001, p=0,012). Yirmi ya??ndan büyük hastalarda kas a?r?s? daha fazlayd? (p=0,003).
Sonuç: ?zotretinoin tedavisi uzun süreli bir tedavi oldu?u için hasta uyumu önem arz etmektedir. Hangi hasta grubunda hangi yan etkilerin ne s?kl?kta oldu?unu iyi bilmek ve hastalar? önceden bu konuda bilgilendirmek hastan?n hekime olan güvenini artt?racakt?r ve uyum problemini minimuma indirecektir.

Anahtar Kelimeler: Akne vulgaris, izotretinoin, yan etkiler, kas a?r?s?, epistaksis