THE MUSCULOSKELETAL SIDE EFFECTS OF ORAL ISOTRETINOIN: A NARRATIVE REVIEW

Year 2025, Volume: 6 Issue: 3, 255 - 261, 25.11.2025

İbrahim Uludoğan , Murat Birtane

Abstract

Introduction: This narrative review aims to summarize the current literature on the musculoskeletal adverse effects of oral isotretinoin, discuss potential mechanisms and clinical implications, and highlight key considerations for clinicians in patient monitoring.

Method: Publications between January 1983 and August 2025 were reviewed through PubMed, Google Scholar, and ScienceDirect. The keywords “isotretinoin”, “retinoids”, “musculoskeletal system,” “sacroiliitis,” “spondylarthropathies,” “arthritis,” “hyperostosis,” “osteoporosis,” “hypercalcemia,” “myalgia,” “creatine kinase” and “rhabdomyolysis” were used. Only English-language publications were included. No formal methodological quality scale was applied; instead, study relevance, sample quality, and clinical contribution were considered. Systematic reviews, clinical studies, case series, and case reports were included. The findings were summarized in a narrative manner and evaluated in terms of clinical practice.

Results: Musculoskeletal adverse effects of isotretinoin include axial like symptoms (e.g., inflammatory back pain, sacroiliitis, enthesitis), peripheral arthritis, hyperostosis, premature epiphyseal closure, osteoporosis, hypercalcemia, myalgia, and elevated creatine kinase levels. Back pain, arthralgia, and myalgia are the most common side effects, typically emerging within the first three months of treatment. Sacroiliitis is usually acute, HLA-B27-negative, and resolves after drug discontinuation. Bone effects are primarily observed with prolonged, high cumulative doses, whereas vitamin D metabolism may be affected even in short courses. Muscle involvement is generally mild but may rarely lead to rhabdomyolysis with intensive exercise.

Conclusion: Musculoskeletal side effects of isotretinoin are generally mild and reversible but may mimic spondyloarthropathies or other rheumatologic disorders. Awareness, baseline risk assessment (including vitamin D status), and early recognition are essential to avoid misdiagnosis and unnecessary interventions. Collaboration between dermatology and musculoskeletal specialists is recommended for optimal management.

Keywords

isotretinoin , musculoskeletal system , side effect , sacroiliitis , hyperostosis , rhabdomyolysis.

Ethical Statement

Ethical approval: This study did not involve human or animal subjects; therefore, obtaining approval from an ethics committee was deemed unnecessary.

Supporting Institution

none

ORAL İZOTRETİNOİNİN KAS-İSKELET SİSTEMİ YAN ETKİLERİ: ANLATISAL BİR DERLEME

Abstract

Giriş: Bu anlatısal derlemenin amacı, oral izotretinoinin kas-iskelet sistemi üzerindeki advers etkilerine ilişkin güncel literatürü özetlemek, olası mekanizmaları ve klinik yansımaları tartışmak ve klinisyenler için izlemde dikkat edilmesi gereken temel noktaları vurgulamaktır

Yöntem: Ocak 1983–Ağustos 2025 arasında yayımlanmış literatür PubMed, Google Scholar ve ScienceDirect veri tabanlarında taranmıştır. Aramalarda “isotretinoin,” “retinoids,” “musculoskeletal system,” “sacroiliitis,” “spondylarthropathies,” “arthritis,” “hyperostosis,” “osteoporosis,” “hypercalcemia,” “myalgia,” “creatine kinase” ve “rhabdomyolysis” anahtar kelimeleri kullanılmıştır. Tarama sürecinde yalnızca İngilizce yayımlanmış makaleler değerlendirmeye alınmıştır. Çalışmaların metodolojik kalitesini değerlendirmek için resmi bir ölçek kullanılmamış; bunun yerine çalışmanın konuya uygunluğu, örneklem kalitesi ve klinik katkısı dikkate alınmıştır. Sistematik derlemeler, klinik çalışmalar, olgu serileri ve olgu sunumları dahil edilmiştir. Bulgular önceden belirlenen alt başlıklar altında anlatımsal biçimde sentezlenmiştir.

Bulgular: İzotretinoinin kas-iskelet sistemi üzerindeki yan etkileri: aksiyel spondiloartrit benzeri bulgular (inflamatuvar bel ağrısı, sakroiliit, entezit), periferik artrit, hiperostoz, erken epifiz kapanması, osteoporoz, hiperkalsemi, miyalji ve kreatin kinaz yüksekliği şeklinde ortaya çıkmaktadır. Bel ağrısı, artralji ve miyalji en sık görülen yan etkilerdir ve genellikle tedavinin ilk üç ayında ortaya çıkar. Sakroiliit olguları çoğunlukla akut, HLA-B27 negatif olup ilaç kesilmesiyle düzelir. Kemik etkileri genellikle uzun süreli, yüksek kümülatif dozlarla ilişkilidir; kısa süreli tedavilerde ise D vitamini metabolizması etkilenebilmektedir. Kas tutulumu çoğunlukla hafif seyirli olmakla birlikte yoğun egzersizle nadiren rabdomiyolize yol açabilir.

Sonuç: İzotretinoinin kas-iskelet sistemi üzerindeki yan etkileri genellikle hafif ve geri dönüşümlüdür; ancak spondiloartrit veya diğer romatolojik hastalıkları taklit edebilir. Yan etkilerin farkında olunması, D vitamini durumu dahil olmak üzere başlangıç risk değerlendirmesinin yapılması ve erken tanı, yanlış tanı ve gereksiz girişimlerin önlenmesi açısından kritik önemdedir. Dermatoloji ile kas-iskelet sistemi uzmanlarının iş birliği, hasta yönetimini optimize eder.
Anahtar kelimeler: izotretinoin; kas-iskelet sistemi; sakroiliit; spondiloartrit; hiperostoz; rabdomiyoliz.

Keywords

izotretinoin , kas-iskelet sistemi , yan etki , sakroiliit , hiperostoz , rabdomiyoliz

Ethical Statement

Etik onay: Bu çalışma insan veya hayvan deneklerini içermedi; bu nedenle, bir etik komitesinden onay almak gereksiz kabul edildi.

Supporting Institution

yok

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