Isotretinoin and IBD: Debunking Concerns, Embracing Clarity

Original Article: Isotretinoin and the risk of inflammatory bowel disease and irritable bowel syndrome: A large-scale global study

What are the key takeaways of this article?

The risk of developing inflammatory bowel disease (IBD) with the use of isotretinoin has been a long-standing, but unverified, concern. This particular risk has received comparatively less research attention compared to other adverse side effects associated with isotretinoin use. Isotretinoin is a recognized treatment for stubborn cases of acne and is known to carry side effects such as cheilitis, xerosis, photosensitivity, desquamation, and skin fragility. However, the emergence of instances of Crohn's disease (CD) and ulcerative colitis (UC) among patients using isotretinoin has prompted a call for a more comprehensive investigation. The study's data was drawn from the global TriNetX analytics network, which aggregates electronic medical records from across the world.

The authors conducted a retrospective cohort study with 154,010 patients, making it the largest cohort study to date to investigate the risk of IBD in patients on acne therapeutics. The study encompassed two distinct treatment groups: those treated with isotretinoin (without prior exposure to antibiotics) and those treated with antibiotics (including doxycycline, minocycline, tetracycline, roxithromycin, and azithromycin). These groups were monitored to assess for risk of IBD and inflammatory bowel syndrome (IBS).

The study showed that those treated with isotretinoin had a comparable lifetime risk of developing UC and CD as those treated with antibiotics. In patients using isotretinoin, the lifetime risk of UC was only increased in a statistically significant manner in the first 6 months following treatment initiation. However, this elevated risk remained marginal, with only five excessive cases observed in this cohort per every 10,000 patients. Conversely, the lifetime risk of IBS appeared to be reduced in those undergoing isotretinoin treatment in comparison to those utilizing antibiotics.

Although the study identified a slight increase in IBD risk during the initial 6 months of isotretinoin usage, in contrast to those treated with antibiotics, the authors assert that this difference lacks significant clinical significance. While it might be hypothesized that individuals prescribed isotretinoin, a third-line medication, could have more severe acne and subsequently more severe disease, the study's conclusion concerning the safety profile of isotretinoin remains unchanged. In summary, the study underscores that the safety profile of isotretinoin parallels that of antibiotics and their respective associations with IBD and IBS. Ultimately, no substantial elevation in the lifetime risk of IBD or IBS has been demonstrated in relation to the use of isotretinoin.

Publication Date: August 28th, 2023

Reference: Kridin K, Ludwig RJ. Isotretinoin and the risk of inflammatory bowel disease and irritable bowel syndrome: A large-scale global study. J Am Acad Dermatol. 2023 Apr;88(4):824-830. doi: 10.1016/j.jaad.2022.12.015. Epub 2022 Dec 15. PMID: 36529376.

Summary By: McKenzie Van Eaton