Effect of a single course of isotretinoin therapy on bone mineral density in adolescent patients with severe, recalcitrant, nodular acne.
BACKGROUND
Adverse changes in bone have been reported for patients undergoing high-dose, long-term (several years) isotretinoin therapy for disorders of cornification. The effect of short-term (4-5 months) therapy at the lower dose recommended for acne on bone development in younger, growing adolescent (12-17 years) patients has not been well studied.


OBJECTIVE
The purpose of the study was to evaluate the effect of a standard, single course of isotretinoin (Accutane) therapy on bone mineral density (BMD) of the lumbar spine and hip in adolescents ages 12 to 17 years with severe, recalcitrant, nodular acne.


METHODS
In this open-label, multicenter study, 217 adolescents (81 girls) with severe, recalcitrant, nodular acne were enrolled and treated with isotretinoin twice daily with food at the recommended total dose of approximately 1 mg/kg for 16 to 20 weeks. BMD in the lumbar spine and hip was measured at baseline and at the end of therapy by dual energy radiograph absorptiometry.


RESULTS
There was no clinically significant mean change in BMD measured at the lumbar spine (+1.4%, range: -4.9% to +12.3%) or total hip (-0.26%, range: -11.3% to +15.0%). Hyperostosis was not observed in any patient. Typical efficacy expected in the treatment of acne was observed.


CONCLUSIONS
A 16- to 20-week course of isotretinoin treatment at the recommended dose for severe acne has no clinically significant effect on lumbar spine and total hip BMD in the adolescent (12-17 years) population.
DiGiovanna
John J
JJ
Division of Dermatopharmacology, Department of Dermatology, Brown Medical School/Rhode Island Hospital, Providence, RI 02903, USA. John_DiGiovanna_MD@Brown.edu
Langman
Craig B
CB
Tschen
Eduardo H
EH
Jones
Terry
T
Menter
Alan
A
Lowe
Nicholas J
NJ
Eichenfield
Lawrence
L
Hebert
Adelaide A
AA
Pariser
David
D
Savin
Ronald P
RP
Smith
Stacy R
SR
Jarratt
Michael
M
Rodriguez
David
D
Chalker
Dan K
DK
Kempers
Steven
S
Ling
Mark
M
Rafal
Elyse S
ES
Sullivan
Sabra
S
Kang
Sewon
S
Shah
Leena P
LP
Wu
Emily
E
Newhouse
Julie
J
Pak
Jonathan
J
Eberhardt
Douglas R
DR
Bryce
Graeme F
GF
McLane
John A
JA
Ondovik
Michael
M
Chin
Catherine
C
Khoo
Ko-Chin
KC
Rich
Phoebe
P
D000152:Acne Vulgaris / Q000188:drug therapy*; D000293:Adolescent; D015519:Bone Density / Q000187:drug effects*; D002648:Child; D003879:Dermatologic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D004334:Drug Administration Schedule; D005260:Female; D006615:Hip / Q000502:physiology; D006801:Humans; D015576:Hyperostosis / Q000139:chemically induced; D015474:Isotretinoin / Q000008:administration & dosage / Q000009:adverse effects*; D008159:Lumbar Vertebrae / Q000502:physiology; D008297:Male; D011446:Prospective Studies
D003879:Dermatologic Agents; D015474:Isotretinoin