Background Isotretinoin,13-cis-retinoic asid, is used for treatment of severe nodular, cystic acne. Dry skin, hyperlipidemia, hepatotoxicity, arthralgia, myalgia, skeletal hyperosteosis and calcification of tendons are well known side effects (1). Sacroiliitis due to isotretinoin usage is a rare adverse effect.
Objectives The aim of this study was to underline an uncommon side effect of isotretinoin treatment.
Methods Five cases with sacroiliitis related with isotretinoin usage is reported. Hospital files of the patients were retrospectively evaluated and clinical and laboratory characteristics were recorded.
Results Clinical and laboratory features of patients are summerised in Table 1.
Conclusions Isotretinoin is a widely used drug for treatment of acne vulgaris. Apart from other well-known side effects, sacroiliitis is a rare adverse effect of isotretinoin. The mechanisms underlying the induction of sacroiliitis by isotretinoin are not currently known. Isotretinoin may stimulate matrix metallopretinase-2 activity and consequent membrane degradation in joints or detergent-like properties of isotretinoin may cause joints to be more susceptible to degenerative processes (2).
All of the patients were HLA B27 negative, acute phase response reactants were within normal limits except one, they all received indomethacin treatment and achieved partial response. After interrupting isotretinoin therapy all symptoms of the patients completely resolved. In young patients receiving isotretinoin who have back pain without typical signs of spondyloartropathy, isotretinoin must be considered as aetiological factor. Patients may be re-evaluated for resolution of sacroiliitis with radiologic imaging.after interrupting isotretinoin administration
Brelsford M, Beute TC. Preventing and managing the side effects of isotretinoin. Semin Cutan Med Surg. 2008;27(3):197-206.
Levinson M, Gibson A, Stephenson G. Sacroiliitis secondary to isotretinoin. Australas J Dermatol. 2012;53(4):298-300
Disclosure of Interest None declared