Inflammatory bowel disease isotretinoin

Most patients with cystic acne respond to 1-2 mg/kg, given 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... 

Although three other cases of inflammatory bowel disease during isotretinoin therapy have been reported (70-72), there have also been reports of the safe use of isotretinoin in patents with a history of inflammatory bowel disease (that is without exacerbation of the inflammatory bowel disease) (70,73,74). Since retinoids are being increasingly used to treat moderately severe acne, larger studies are needed to elucidate the relation between retinoid use and inflammatory bowel disease. 

Reniers DE, Howard JM. Isotretinoin-induced inflammatory bowel disease in an adolescent. Ann Pharmacother 2001 35(10) 1214-16. 

Godfrey KM, James MP. Treatment of severe acne with isotretinoin in patients with inflammatory bowel disease. Br J Dermatol 1990 123(5) 653-5. 

Brodin MB. Inflammatory bowel disease and isotretinoin. J Am Acad Dermatol 1986 14(5 Pt 1) 843. 

Schleicher SM. Oral isotretinoin and inflammatory bowel disease. J Am Acad Dermatol 1985 13(5 Pt l) 834-5. 

Adverse/Toxic Inflammatory bowel disease and pseudotumor cerebri (benign intracranial hypertension) have been associated with isotretinoin therapy. 

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. 

Crockett SD, Gulati A, Sandler RS, Kappelman MD. A causal association between isotretinoin and inflammatory bowel disease has yet to be established. Am J Gastroenterol 2009 104 2387-93. 

Etminan M, Bird ST, Delaney JA, Bressler B, Brophy JM. Isotretinoin and risk for inflammatory bowel disease a nested case-control study and meta-analysis of published and unpublished data. JAMA Derm 2013 149(2) 216-20. 

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