Side-effects

Side effects of isotretinoin are dose related and can be minimized by using low doses over longer period of time (1).

Side-effects include:

• mucocutaneous dryness causing:
  • cracked lips
  • nose bleeds
  • colonization of S. aureus leading to complications like abscesses, conjunctivitis, impetigo, cellulitis, and folliculitis (1)
• headaches
• myalgia
• hyperlipidaemia, hypercholesterolaemia and disordered liver function tests:
  • lipid levels and liver function tests are monitored during treatment
• teratogenesis:
  • the rate of fetal abnormality is high so contraception must be reliable and termination is usually recommended if pregnancy did occur
  • ear defects together with CNS defects or cardiovascular defects or both can be seen (1)

Rare side effects:

• photosensitivity
• diffuse alopecia
• changing of hair character
• anaemia
• leucopenia
• benign intracranial hypertension
• psychiatric disorders e.g. depression, suicide
  • neuropsychiatric reactions have been reported in patients taking oral retinoids (3)
    • healthcare professionals are advised to monitor patients for signs of depression or suicidal ideation and refer for appropriate treatment, if necessary; particular care is needed in those with a history of depression. Patients should be advised to speak to their doctor if they experience any changes in mood or behaviour, and encouraged to ask family and friends to look out for any change in mood
• hepatitis (2)

Reference:

• 1. James W.D. Acne. NEJM 2005; 352:1463-1472 2.
• 2. British association of dermatologists 2003. Isotretinoin for Acne
• 3. British National Formulary. Isotretinoin (Accessed July 7th 2021)