Haydar UÇAK, Zeynep Meltem AKKURT, Derya UÇMAK, Bilal SULA, Mustafa ARICA

Akneli hastalarda sistemik isotretinoin tedavisinin laboratuvar değişkenleri üzerine etkisi ve literatürün gözden geçirilmesi

Amaç: İsotretinoin (İSO), bir sentetik retinoid olup konvansiyonel tedavilere yanıt vermeyen şiddetli kistik aknenin tedavisinde tercih edilen bir ilaçtır. Bu çalışmada oral İSO tedavisi başlanan akne hastalarında laboratuvar değerlerinin retrospektif olarak değerlendirilmesi amaç- lanmıştır. Yöntemler: Çalışmaya dermatoloji polikliniğine başvuran ve klinik olarak akne tanısı konularak İSO tedavisi başlanan 40 hasta alındı. Hastaların tedavi öncesi ve tedavinin 3. ayındaki karaciğer fonksiyon testleri (AST, ALT), kan üre ve kreatinin değerleri ile total kolesterol, yüksek dansiteli lipoprotein (HDL), düşük dansiteli lipoprotein (LDL) ve trigliserid (TG) değerleri hasta dosyaları taranarak elde edildi. Bulgular: Hastaların tedavi öncesi ve tedavinin 3. ayındaki laboratuvar sonuçları karşılaştırıldığında total kolesterol, LDL, HDL, TG ve AST değerlerinde istatistiksel olarak anlamlı değişiklikler saptandı (p

Effect of systemic isotretinoin treatment on laboratory variables in patients with acne and a review of the literature

Objective: Isotretinoin (ISO) is a synthetic retinoid that is a preferred drug for unresponsive to conventional therapy in the treatment of severe cystic acne. In this study, to evaluate retrospectively laboratory values in patients with acne using oral ISO treatment was aimed. Methods: 40 patients were enrolled to the study that admitted to the dermatology clinic and clinically diagnosed as acne vulgaris and oral isotretinoin treatment was started. Patients pre-treatment and 3rd month of the teatment values of liver function tests (AST, ALT), blood urea nitrogen and creatinine levels, total cholesterol, high density lipoprotein (HDL), low density lipoprotein (LDL) and triglyceride (TG) levels were obtained by screening of files. Results: Compared to values of patients before and 3rd month of treatment, statistically significant differences was detected for total cholesterol, LDL, HDL, TG and AST values (p<0.001, p<0.001, p= 0.003, p= 0.01, p=0.001 respectively). Conclusion: We think that starting a good diet before treatment would be useful to prevent TG disorder. In addition, we believe it would be useful to do strict laboratory follow in patients with familial hypertriglyceridemia during treatment. We believe that it is more necessary to follow up the blood lipid values rather than liver and kidney function tests. However, we also think that it would be sufficient to follow up once every 2 or 3 months.

PDF

___

1. Dreno B, Poli F. Epidemiology of acne. Dermatology 2003;206:7-10.
2. Layton AM. A review on the treatment of acne vulgaris. J Clin Pract 2006;60:64-72.
3. Brelsford M, Beute TC. Preventing and managing the side effects of isotretinoin. Semin Cutan Med Surg 2008;27:197- 206.
4. Vieira AS, Beijamini V, Melchiors AC. The effect of isotretinoin on triglycerides and liver aminotransferases. An Bras Dermatol 2012;87:382-387.
5. Alcalay J, Landau M, Zucker A. Analysis of laboratory data in acne patients treated with isotretinoin: is there really a need to perform routine laboratory tests? J Dermatolog Treat 2001;12:9-12.
6. Barth JH, Macdonald-Hull SP, Mark J, Jones RG, Cunliffe WJ. Isotretinoin therapy for acne vulgaris: a re-evaluation of the need for measurements of plasma lipids and liver function tests. Br J Dermatol 1993;129:704-707.
7. Doshi A, Zaheer A, Stiller MJ. A comparison of current acne grading systems and proposal of a novel system. Int J Dermatol 1997;36:416-418.
8. Cooper AJ. Treatment of acne with isotretinoin: recommendations based on Australian experience. Astralas J Dermatol 2003;44:97-105.
9. Altman RS, Altman LJ, Altman JS. A proposed set of new guidelines for routine blood tests during isotretinoin therapy for acne vulgaris. Dermatology 2002;204:232-235.
10. Tallab T, Joharji H, Jazei M, Bahamdan K, Ibrahim K, Karkashan. Isotretinoin therapy: any need for laboratory assessment? West Afr J Med 2004;23:273-275.
11. Zane LT, Leyden WA, Marqueling AL, Manos MM. A population-based analysis of laboratory abnormalities during isotretinoin therapy for acne vulgaris. Arch Dermatol 2006;142:1016-1022.
12. De Marchi MA, Maranhao RC, Brandizzi LI, Souza DR. Effects of isotretinoin on the metabolism of triglyceriderich lipoproteins and on the lipid profile in patients with acne. Arch Dermatol Res 2006;297:403-408.
13. Rodondi N, Darioli R, Ramelet AA, et al. High risk for hyperlipidemia and the metabolic syndrome after an episode of hypertriglyceridemia during 13-cis-retinoic acid therapy for acne: A pharmacogenetic study. Ann Intern Med 2002;136:582-589.
14. Mc Lane J. Analysis of common side effects of isotretinoin. J Am Acad Dermatol 2001;45:S188-194.
15. Lestringant GG, Frossard PM, Agarwal M, Galadari IH. Variations in lipid and lipoprotein levels during isotretinoin treatment for acne vulgaris with special emphasis on HDLcholesterol. Int J Dermatol 1997;36:859-862.
16. Bickers DR, Saurat J. Isotretinoin: A state of the art conference. J Am Acad Dermatol 2001;45:125-128.
17. Ataseven A, Öztürk P, Dilek N. Akne vulgaris tedavisi için isotretinoin alan hastalarda laboratuvar parametrelerinin değerlendirilmesi. Turk J Dermatol 2013;7:130-132.
18. Ertam I, Alper S, Unal I. Is it necessary to have routine blood tests in patients treated with isotretinoin? J Dermatolog Treat 2006;17:214-216.
19. Armaly Z, Haj S, Bowirrat A, et al. Acute kidney injury following isotretinoin treatment. Am J Case Rep 2013;14:554- 556.