title: Isotretinoin use and celiac disease: a population-based cross-sectional study.
abstract: OBJECTIVE
  Isotretinoin, a vitamin A analogue, can promote a pro-inflammatory milieu in the small intestine in response to dietary antigens. We hypothesized that oral isotretinoin exposure would increase the risk of celiac disease (CD).
  
  
  METHODS
  We contacted all 28 pathology departments in Sweden, and through biopsy reports identified 26,739 individuals with CD. We then compared the prevalence of ever using oral isotretinoin to the prevalence in 134,277 matched controls through conditional logistic regression. Data on isotretinoin exposure were obtained from the national Swedish Prescribed Drug Registry. As the only indication for isotretinoin use in Sweden is acne, we also examined its relationship to CD. Data on acne were obtained from the Swedish Patient Registry.
  
  
  RESULTS
  Ninety-three individuals with CD (0.35 %) and 378 matched controls (0.28 %) had a prescription of isotretinoin. This corresponded to an odds ratio (OR) of 1.22 [95 % confidence interval (CI) 0.97-1.54]. Risk estimates were similar in men and women, and when we restricted our data to individuals diagnosed after the start of the Prescribed Drug Registry. Restricting our analyses to individuals diagnosed aged 12-45 years did not influence the risk estimates (OR 1.38, 95 % CI 0.97-1.97). Meanwhile, having a diagnosis of acne was positively associated with CD (OR 1.34, 95 % CI 1.20-1.51).
  
  
  CONCLUSIONS
  This study found no association between isotretinoin use and CD, but a small excess risk of CD in patients with a diagnosis of acne.
authors.affiliation: Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Lebwohl
authors.forename: Anders
authors.initials: A
authors.lastname: Sundström
authors.forename: Bana
authors.initials: B
authors.lastname: Jabri
authors.forename: Sonia S
authors.initials: SS
authors.lastname: Kupfer
authors.forename: Peter H R
authors.initials: PH
authors.lastname: Green
authors.forename: Jonas F
authors.initials: JF
authors.lastname: Ludvigsson
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D002446:Celiac Disease / Q000453:epidemiology* / Q000209:etiology; D002648:Child; D003430:Cross-Sectional Studies; D003879:Dermatologic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015474:Isotretinoin / Q000008:administration & dosage / Q000009:adverse effects*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012042:Registries; D012306:Risk; D013548:Sweden; D055815:Young Adult
chemical_list: D003879:Dermatologic Agents; D015474:Isotretinoin