title: Isotretinoin: controversies, facts, and recommendations.
abstract: Since it was introduced to the market by Hoffman-La Roche (Roche) in 1982, isotretinoin has remained the most effective treatment for severe and recalcitrant acne. However, it has also been surrounded by controversy due to its teratogenicity and inconsistent associations with depression, suicidality, inflammatory bowel disease, increases in lipid levels, and elevated transaminases. Areas covered: In this article, we reviewed data regarding safety of isotretinoin and its association with these conditions. A thorough and comprehensive search on the topics was performed using pubmed and google scholar. Expert commentary: Despite common misperceptions, there is weak evidence for increased incidence of depression, suicidality, or inflammatory bowel disease with isotretinoin use. Furthermore, data indicates that transient increases in transaminases and lipid levels do not typically necessitate discontinuation of therapy. We hope to provide clinicians with information necessary to have meaningful discussions with patients regarding the safety and efficacy of isotretinoin.
authors.affiliation: a University of Missouri School of Medicine , Columbia , MO , USA.
authors.forename: Lindsey B
authors.identifier: http://orcid.org/0000-0001-5520-7242
authors.initials: LB
authors.lastname: Bauer
authors.affiliation: b School of Medicine , University of California-Davis , Sacramento , CA , USA.
authors.forename: Jennifer N
authors.initials: JN
authors.lastname: Ornelas
authors.affiliation: c Department of Dermatology , Medical University of South Carolina , Charleston , SC , USA.
authors.forename: Dirk M
authors.initials: DM
authors.lastname: Elston
authors.affiliation: d Department of Dermatology , University of Cincinnati College of Medicine , Cincinnati , OH , USA.
authors.forename: Ali
authors.identifier: http://orcid.org/0000-0003-0821-2502
authors.initials: A
authors.lastname: Alikhan
mesh_terms: D000152:Acne Vulgaris / Q000188:drug therapy* / Q000473:pathology; D003863:Depression / Q000139:chemically induced / Q000453:epidemiology; D003879:Dermatologic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000139:chemically induced / Q000453:epidemiology; D015474:Isotretinoin / Q000008:administration & dosage* / Q000009:adverse effects; D012720:Severity of Illness Index; D013405:Suicide / Q000706:statistics & numerical data; D013723:Teratogens / Q000633:toxicity
chemical_list: D003879:Dermatologic Agents; D013723:Teratogens; D015474:Isotretinoin
keywords: Acne; accutane; depression; hypertriglyceridemia; iPLEDGE; inflammatory bowel disease; isotretinoin; transaminitis