ADVERTISEMENT

Effects of Oral Isotretinoin on Lipids and Liver Enzymes in Acne Patients

Cutis. 2014 November;94(5):234-238
November 6, 2014|Dermatology
Okan Kızılyel, MD;Mahmut Sami Metin, MD;ömer Faruk Elmas, MD;Yasemin Çayır, MD;Akın Aktas, MD
Author and Disclosure Information

 

Okan Kızılyel, MD; Mahmut Sami Metin, MD; Ömer Faruk Elmas, MD; Yasemin Çayır, MD; Akın Aktaş, MD

From the Faculty of Medicine, Atatürk University, Erzurum, Turkey. Drs. Kızılyel, Metin, Elmas, and Aktas are from the Department of Dermatology. Dr. Çayır is from the Department of Family Medicine.

The authors report no conflict of interest.

Correspondence: Okan Kızılyel, MD, Department of Dermatology, Faculty of Medicine, Atatürk University, 25000 Erzurum, Turkey (erester.34@hotmail.com).

Isotretinoin has been used to treat severe inflammatory acne that is resistant to antibiotics or topical agents; however, it also may cause alterations in lipids and liver enzymes. In this retrospective study, we evaluated changes in lipids and liver enzymes in 322 acne patients who had been treated with oral isotretinoin at our institution over a 3-year period. Each patient’s medical records were evaluated to determine baseline triglyceride (TG), low-density lipoprotein (LDL), high-density lipoprotein (HDL), aspartate aminotransferase (AST), and alanine aminotransferase (ALT) levels compared to levels recorded at 3 and 6 months following initiation of treatment with oral isotretinoin. Overall, statistically significant increases in TG and LDL levels were noted following treatment with isotretinoin (P<.001, respectively), while HDL levels were shown to decrease (P=.016). Although ALT levels also increased, the changes were not statistically significant increases in AST levels also were noted (P=.72). In our study, isotretinoin appeared to have a greater effect on lipids than liver enzymes. Dermatologists should not avoid isotretinoin use for appropriate indications, but close follow-up is important.

     Practice Points

 

  • ­Isotretinoin is recommended for treatment of severe inflammatory acne and for cases resistant to prior treatment with antibiotics or topical agents; however, it may cause alterations in lipids and liver enzymes.
  • In our study, liver enzymes were less affected than lipids in patients who were treated with isotretinoin.
  • ­Use caution when administering isotretinoin in patients with a history of abnormal findings.

Aspartate Aminotransferase Analysis

Aspartate aminotransferase levels were classified as normal and high. At baseline, mean (SD) AST levels were 20.2 (6.6) U/L, with normal levels in 311 (96.6%) patients and high in 7 (2.2%) patients. At 3-month follow-up, mean (SD) AST levels were 20.7 (5.2) U/L, with normal levels in 270 (83.9%) patients and high levels in 3 (0.9%) patients. At 6-month follow-up, mean (SD) AST levels were 21.3 (5.7) U/L, with normal levels in 209 (64.9%) patients and high levels in 4 (1.2%) patients. Aspartate aminotransferase levels increased at 3- and 6-month follow-up compared to baseline. Differences between AST levels were statistically significant (F2,416=4.2, P=.016). Differences between AST levels at baseline and 3-month follow-up were not statistically significant (P=.3). Differences between AST levels at 3- and 6-month follow-up were not statistically significant (P=.4). Differences between AST levels at baseline and 6-month follow-up were statistically significant (P=.07). Differences between AST classifications at the 3 time points were not statistically significant (F2,416=0.44, P=.64). Overall, the results indicated that AST levels increased over time in patients treated with isotretinoin, but the increase was not above the normal range and was not statistically significant.

Alanine Aminotransferase Analysis

Alanine aminotransferase levels were classified as normal or high. At baseline, mean (SD) ALT levels were 16.8 (11.2) U/L, with normal levels in 303 (94.1%) patients and high in 19 (5.9%) patients. At 3-month follow-up, mean (SD) ALT levels were 16.2 (9.3) U/L, with normal levels in 263 (81.7%) patients and high in 11 (3.4%) patients. At 6-month follow-up, mean (SD) ALT levels were 17.0 (11.3) U/L, with normal levels in 201 (62.4%) patients and high in 11 (3.4%) patients. Alanine aminotransferase levels at 3-month follow-up were lower than baseline but higher at 6-month follow-up compared to baseline and 3-month follow-up. Overall, ALT levels increased with time, but the differences between baseline and 3- and 6-month follow-up were not statistically significant (F2,416=0.32, P=.72). Differences between ALT classifications at each time point were not statistically significant (F2,418=0.21, P=.54). Overall, the results indicated that ALT levels increased over time in patients treated with isotretinoin, but the increase was not statistically significant.

Triglycerides Analysis

Triglyceride levels were classified as normal, borderline high, high, and very high. At baseline, mean (SD) TG levels were 107 (71) mg/dL, with normal levels in 270 (83.9%) patients, borderline high in 30 (9.3%) patients, high in 20 (6.2%) patients, and very high in 2 (0.6%) patients. At 3-month follow-up, mean (SD) TG levels were 117 (60) mg/dL, with normal levels in 197 (61.2%) patients, borderline high in 38 (11.8%) patients, high in 22 (6.8%) patients, and very high in 1 (0.3%) patient. At 6-month follow-up, mean (SD) TG levels were 122 (65) mg/dL, with normal levels in 145 (45%) patients, borderline high in 36 (11.2%) patients, high in 16 (5%) patients, and very high in 0 (0%) patients. Triglyceride levels increased and differences between TG levels at baseline and 3- and 6-month follow-up were statistically significant (F2,384=17, P<.001). Baseline TG levels compared to 3-month follow-up were statistically signif-icant (P<.001). Differences in TG levels at 6-month follow-up versus baseline were statistically significant (P<.001). However, changes in TG levels from 3- to 6-month follow-up were not statistically significant (P=.21). Differences between TG classifications at each time point were statistically significant (F2,386=6.9, P=.001). Overall, TG levels increased from baseline during isotretinoin treatment at 3- and 6-month follow-up, and these increases were above normal range; however, there was no statistically significant increase from 3- to 6-month follow-up.

Low-Density Lipoprotein Analysis

Low-density lipoprotein levels were classified as optimal, above optimal, borderline high, high, and very high. At baseline, mean (SD) LDL levels were 102 (28) mg/dL, with optimal levels in 162 (50.3%) patients, above optimal in 95 (29.5%) patients, borderline high in 32 (9.9%) patients, high in 11 (3.4%) patients, and very high in 3 (0.9%) patients. At 3-month follow-up, mean (SD) LDL levels were 113 (30) mg/dL, with optimal levels in 89 (27.6%) patients, above optimal in 98 (30.4%) patients, borderline high in 54 (16.8%) patients, high in 12 (3.7%) patients, and very high in 5 (1.6%) patients. At 6-month follow-up, mean (SD) LDL levels were 113 (27) mg/dL, with optimal levels in 60 (18.6%) patients, above optimal in 84 (26.1%) patients, borderline high in 44 (13.7%) patients, high in 8 (2.5%) patients, and very high in 1 (0.3%) patient. Overall, there were statistically significant increases in LDL levels at 3- and 6-month follow-up (F2,382<75, P<.001). Differences between baseline LDL levels and 3-month follow-up were statistically significant (P<.001). Differences between baseline LDL levels and 6-month follow-up were statistically significant (P<.001). However, differences in LDL levels at 3- and 6-month follow-up were not statistically significant (P=.74). Differences between LDL classifications at each time point were statistically significant (F2,382=51.2, P<.001). Overall, statistically significant increases in LDL levels from baseline were noted during isotretinoin treatment and this increase was above normal range; however, LDL levels did not significantly increase from 3- to 6-month follow-up.

ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT