Ocular side effects possibly associated with isotretinoin usage

Isotretinoin (13-cis-retinoic acid) is widely used for the treatment of severe acne as well as for disorders of conification, for psoriasis, and for skin cancer prevention. As a member of the retinoid family, it has a wide spectrum of side effects, including reproductive, cutaneous, ocular, neurological, musculoskeletal, and hepatic. As long as patients are able to tolerate these side effects, it can be a very effective treatment option. This article examines both the most common and the most concerning side effects as well as ways in which providers and patients may best manage them to be able to benefit from isotretinoin treatment.

Preventing and managing the side effects of isotretinoin.

Isotretinoin (Accutane, Roche Laboratories Inc, Nutley, NJ) is an important drug, not only for the treatment of severe acne, but also for other diagnoses and in chemoprevention settings. Because the use of isotretinoin is increasing, it is important for physicians to be aware of the adverse events, toxicities, and management issues related to its use. The most important issue is that of congenital defects, which has resulted in new pregnancy prevention policies and programs implemented by the manufacturer. A relatively new concern is that of depression associated with isotretinoin use, also resulting in new policies placed by the manufacturer and the FDA. The most common adverse effects observed during treatment are mucocutaneous and ocular in nature, but laboratory abnormalities and effects in the nervous, musculoskeletal, gastrointestinal, pulmonary, hematologic, and other systems are also described. Additionally, potential drug interactions, follow-up, and toxicity prevention measures are discussed.

Safety issues in isotretinoin therapy.

PurposeTo compare the effects of high- (Group 1) and low-dose (Group 2) isotretinoin treatments for acne vulgaris on lacrimal functions and other ocular complications.MethodsTwenty-six patients rec...

Comparison of dose-related ocular side effects during systemic isotretinoin administration.

https://www.cidjournal.com/article/S0738-081X(11)00230-6/pdf

Isotretinoin systemic therapy and the shadow cast upon dermatology's downtrodden hero.

SIR, we would like to report a case of a 19-year-old trainee RAF navigator who developed abnormal night vision during isotretinoin therapy, given in a dose of 70 mg daily for acne vulgaris. He developed the common side-effects of dry skin and cheilitis, but after 3 weeks of treatment he complained of blurred vision, photophobia and decreased night vision. His visual acuities were reduced to 6/18 in the right eye and 6/12 in the left eye. Refraction showed 1-5 dioptres of myopia in both eyes but appropriate correction of this produced 6/4 vision in both eyes. Blepharoconjunctivitis was noted bilaterally but otherwise ocular examination was unremarkable, and in particular both fundi and optic discs were normal. There was no family history or ophthalmic evidence of retinitis pigmentosa. Isotretinoin therapy was withdrawn immediately and the decreased night vision was investigated using electrophysiology. Visual evoked potentials (VEP) were normal but the scotopic electro-retinogram (ERG) and the electro-oculogram (EOG) were abnormal, suggesting poor retinal function in dark adapted conditions. At 2 weeks followup his unaided vision had returned to normal with no significant refractive error. However, at 3 months follow-up the patient still complained of poor night vision and the ERG and EOG showed little recovery in retinal function. At the last follow-up appointment, 9 months after withdrawal of isotretinoin, the patient subjectively felt that his night vision was still poor.

Abnormal night vision with isotretinoin therapy for acne.

Topical antiseptics are frequently used in dermatological management, yet evidence for the efficacy of traditional generic formulations is often largely anecdotal We tested the in vitro bactericidal activity of four commonly used topical antiseptics against Staphylococcus aureus, using a modified version of the European Standard EN 1276, a quantitative suspension test for evaluation of the bactericidal activity of chemical disinfectants and antiseptics To meet the standard for antiseptic effectiveness of EN 1276, at least a 5 log10 reduction in bacterial count within 5 minutes of exposure is required While 1% benzalkonium chloride and 6% hydrogen peroxide both achieved a 5 log10 reduction in S aureus count, neither 2% aqueous eosin nor 1 : 10 000 potassium permanganate showed significant bactericidal activity compared with control at exposure periods of up to 1 h Aqueous eosin and potassium permanganate may have desirable astringent properties, but these results suggest they lack effective antiseptic activity, at least against S aureus

M. J. Tidman

Papers

Abnormal night vision with isotretinoin therapy for acne.

Quantitative evaluation of dermatological antiseptics.