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Isotretinoin
and Intestinal Damage
(1) Isotretinoin, a vitamin A derivative, is marketed
as an oral treatment for refractory severe acne. It
is known to carry a risk of severe birth defects. The
skin tends to become dry and fragile during isotretinoin
treatment; (2) Some adverse effects of isotretinoin
are caused by damage to the intestinal mucosae. These
effects include bloody and mucousy diarrhoea, colitis,
ileitis (sometimes severe and necessitating surgery),
and aggravation of inflammatory bowel disease such as
Crohn's disease; (3) Isotretinoin can affect all mucous
membranes, causing multiple disorders of varying severity,
affecting: the eyes (conjunctivitis); ear, nose and
throat (epistaxis); respiratory tract; gastrointestinal
tract (colitis); and urinary tract; (4) Patients must
be informed of the risk of mucosal damage and especially
of intestinal disorders associated with isotretinoin
therapy. Isotretinoin should be borne in mind as a possible
cause when a young patient presents with gastrointestinal
disorders, and its withdrawal should be envisaged. Isotretinoin
is an additional risk factor in patients with a personal
or familial history of inflammatory bowel disease.
A
case of suspected isotretinoin-induced malformation
in a baby of a mother who became pregnant one month
after discontinuation of the drug.
Isotretinoin is a known human teratogen that can cause
multiple malformations. At present, women who conceive
one cycle after discontinuing isotretinoin are told
that their teratogenic risk is not higher than baseline.
We present a case of both-ear malformation in a newborn
whose mother had taken isotretinoin for 2 years until
one month prior to the time when she became pregnant.
We suggest that further studies of pharmacokinetics
and malformation of isotretinoin are needed.
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