Abnormal Blood Tests Generally Mild and Reversible During Powerful Acne Treatment

Patients taking the acne medication isotretinoin, commonly marketed as Accutane, may develop elevated cholesterol levels and liver enzyme levels. However, these changes tend to be mild and generally return to normal after patients stop taking the drug, according to a study in the August issue of Archives of Dermatology. According to lead author Lee Zane, MD, MAS, assistant professor of Clinical Dermatology at UCSF and clinical dermatologist at UCSF Medical Center, while isotretinoin is the most effective acne treatment currently available, fears generated by rare isolated cases of severe complications such as pancreatitis, liver toxicity, and low blood counts have prompted the widespread monitoring of certain blood tests. "The potential for laboratory abnormalities in patients during isotretinoin therapy is well known in the medical community and routinely monitored," said Zane. "However, these increases tend to be mild and should not cause concern in patients who are generally healthy." The retrospective study examined the laboratory results of 13,772 patients between 13 and 50 years of age who had undergone isotretinoin treatment for an average of 21 weeks between 1995 and 2002. The researchers compared levels of triglycerides; total cholesterol; liver transaminase (enzymes) levels; white blood cell count; hemoglobin level; and platelet count before, during, and after isotretinoin treatment. Results showed that approximately a third of patients on the acne medication developed abnormal cholesterol levels while about half had higher levels of triglycerides. While this was more common than had been previously reported in other smaller studies, severe abnormalities were notably rare. Even among triglycerides, the test where abnormalities were most commonly seen, severe elevations were only observed in 2 out of nearly 10,000 patients who had normal triglycerides before starting the medication. "Moderate to severe abnormalities in triglyceride, total cholesterol and transaminase levels were generally transient and reversible," said Zane. "Among those subjects with such abnormalities who received post-treatment testing, the proportion returning to normal or only slightly elevated levels by the end of the post-treatment period was 92 percent for transaminase level, 80 percent for triglyceride level and 79 percent for total cholesterol level." Hemoglobin levels, white blood cell counts, and platelet counts were only minimally affected, suggesting that routinely checking these tests may not be required for most patients during treatment. Because the study only examined laboratory test results, patients are cautioned not to assume that abnormal test results will lead to medical complications. "The presence of a laboratory abnormality does not necessarily signal the presence of an adverse clinical outcome," warned Zane, adding that more studies are needed to look at those risks. Zane also recommends patients do not to lose sight of the great benefits of the medication, "Isotretinoin is arguably the most important development in dermatology in the last 30 years and sometimes may be the only effective treatment for cases of very severe acne. It can truly be a life-changing medication." Related Links:

"A Population-Based Analysis of Laboratory Abnormalities During Isotretinoin Therapy for Acne Vulgaris" Lee T. Zane, MD, MAS; Wendy A. Leyden, MPH; Ann L. Marqueling, BA; M. Michele Manos, PhD, MPH, DVM Archives of Dermatology 2006;142:1016-1022 Abstract | Full Text | Full Text (PDF)