Monitoring Isotretinoin Therapy in Acne: Rational Use of Laboratory Tests

Abstract

Background:

Several recent long-term follow-up studies confirm the relative safety of isotretinoin in acne. Yet, conscientious dermatologists may order more laboratory tests than is strictly necessary.

Objective:

Our goals were to determine which laboratory tests used in monitoring isotretinoin therapy predict significant abnormalities, when such abnormalities are likely to occur, and to establish guidelines for practitioners in ordering these tests.

Methods:

In the Hamilton, Ontario region, 27 dermatologists were surveyed to determine the tests and their frequency requested by practicing dermatologists. We also critically reviewed the literature to establish the frequency and magnitude of laboratory tests in acne patients on isotretinoin and assessed the rationale and cost-effectiveness of the suggested tests.

Results:

Seventeen dermatologists (63%) responded. A wide range of tests were ordered at variable intervals. The literature review suggests that adverse laboratory events are uncommon and that many are clinically insignificant.

Conclusion:

Dermatologists may be requesting more laboratory tests for monitoring isotretinoin therapy than are warranted or cost-effective. We propose a rational laboratory program for monitoring patients on isotretinoin.