Inflammatory bowel disease clinical presentation

Most cystic acne patients respond to 1-2 mg/kg, given orally in two divided doses daily for 4-5 months. If severe cystic acne persists following this initial treatment, after a period of 2 months, a second course of therapy may be initiated. Common adverse effects resemble hypervitaminosis A and include dryness and itching of the skin and mucous membranes. Less common side effects are headache, corneal opacities, pseudotumor cerebri, inflammatory bowel disease, anorexia, alopecia, and muscle and joint pains. These effects are all reversible on discontinuance of therapy. Skeletal hyperostosis has been observed in patients receiving isotretinoin with premature closure of epiphyses noted in children treated with this medication. Lipid abnormalities (triglycerides, HDL) are frequent their clinical relevance is unknown at present. 

Gastrointestinal A systematic search for case reports, case series, and clinical studies of the association between isotretinoin and inflammatory bowel disease yielded 12 case reports and one case series of such an association, to which the Bradford Hill guidelines to evaluate causality [36 ] were applied [37 ]. The cases occurred in seven countries over 23 years and differed with respect to isotretinoin dose, duration of treatment before development of the disease, whether the disease developed on or off medication, and the clinical presentation. There have been no prospective or retrospective studies. An estimated 59 coincident cases of inflammatory bowel disease would be expected in isotretinoin users each year, assuming no increased risk. The current evidence is insufficient to confirm or refute a causal association. 

Phospholipidosis presents an alternative but rather benign effect of macrolides. Although it is reported in chronic macrolide therapy, there are no obvious negative effects and there is a possibility that it contributes to beneficial effects, notably in inflammatory bowel and eye diseases where additional phospholipids correct surfactant deficiencies. Various studies show that phospholipidosis resolves on discontinuation of macrolide therapy and there are no clinical reports of negative outcomes associated with it. Thus phospholipidosis is probably mechanistically linked to effects in immune cells and it seems to present therapeutic opportunities in phospholipid deficiencies rather than any obvious adverse effects in clinical practice. 

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