Isotretinoin: controversies, facts, and recommendations

ABSTRACT

Introduction: Since it was introduced to the market by Hoffman-La Roche (Roche) in 1982, isotretinoin has remained the most effective treatment for severe and recalcitrant acne. However, it has also been surrounded by controversy due to its teratogenicity and inconsistent associations with depression, suicidality, inflammatory bowel disease, increases in lipid levels, and elevated transaminases.

Areas covered: In this article, we reviewed data regarding safety of isotretinoin and its association with these conditions. A thorough and comprehensive search on the topics was performed using pubmed and google scholar.

Expert commentary: Despite common misperceptions, there is weak evidence for increased incidence of depression, suicidality, or inflammatory bowel disease with isotretinoin use. Furthermore, data indicates that transient increases in transaminases and lipid levels do not typically necessitate discontinuation of therapy. We hope to provide clinicians with information necessary to have meaningful discussions with patients regarding the safety and efficacy of isotretinoin.

KEYWORDS:

• Acne
• isotretinoin
• accutane
• inflammatory bowel disease
• depression
• hypertriglyceridemia
• iPLEDGE
• transaminitis

Declaration of interest

A Alikhan has no relevant conflicts of interest pertaining to the submitted work. He does disclose relevant financial activities outside the submitted work including personal fees from Valeant Pharmaceuticals and Prasco Pharmaceuticals. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This paper was not funded.