The association between low serum vitamin-B12 levels and hyperpigmentation in patients who use isotretinonin

Year 2021, , 19 - 24, 30.04.2021

Sevim Baysak , Ebru Karagün , Havva Hilal Ayvaz

https://doi.org/10.26900/hsq.1.1.04

Abstract

Oral isotretinoin is the most effective agent in the treatment of acne vulgaris. The risk of pigmentation due to the systemic isotretinoin may be associated with decrease in serum levels of vitamin B12. The study aims to contribute to the literature by defining the association between the increase in pigmentation caused by oral isotretinoin (O-ISO) use and low vitamin B12 level (vit-B12). In our study we evaluated 144 patients who have facial acnes at medium degree according to FDA Acne Score and take O-ISO treatment with the dose 0.5 mg/ kg/ day for six months. The mean vit-B12 levels of the patients at the admission and 6th month and the existence of pigmentation at 6th month, the skin type and the skin layer at which the pigmentation occurs were evaluated. Association of vit-B12 level on admission and six months post drug use with the presence of pigmentation at six months, the type of skin and the skin layer in which pigmentation occurs were evaluated. In the patient group with pigmentation, the mean vit-B12 level after six months of drug use was statistically lower than the mean vit-B12 level on admission (p<0.001). In patients without pigmentation, difference between the mean levels of vit-B12 levels was not statistically significant (p = 0,255). As a result, it was determined that the mean vit-B12 level decreased due to O-ISO use and the association of hyperpigmentation and low vit-B12 level was statistically significant. Vit-B12 monitoring and supplementation, if necessary, can help us to prevent hyperpigmentation that may occur during the treatment

Keywords

sotretinonin, hyperpigmentation, vitamin-B12, side effect

References

• ARONI, KYRIAKI, ANAGNOSTOPOULOU, KONSTANTINA, TSAGRONI, EUGENIA, & IOANNIDIS, ELEFTHERIOS. (2008). Skin hyperpigmentation and increased angiogenesis secondary to vitamin B12 deficiency in a young vegetarian woman. Acta Derm. Venereol., 88(2), 191-192.
• BOEN, MONICA, BROWNELL, JOSHUA, PATEL, PRIYANKA, & TSOUKAS, MARIA M. (2017). The role of photodynamic therapy in acne: an evidence-based review. Am J Clin Dermatol, 18(3), 311-321.
• CÜRE, KÜBRA, KOCATÜRK, EMEK, & KIZILTAÇ, UTKAN. (2016). Fasiyal hiperpigmentasyonlar ve tedavisi. Eur Arch Med Res, 32, 211-218.
• DEMIR, BETÜL, ÇIÇEK, DEMET, BILIK, LEYLA, AYDOĞDU, EBRU GÜLER, ARTAŞ, HAKAN, DEMIRPOLAT, NIDA, & ERGIN, CAN. (2017). Oral Isotretinoin Induced Pigmentation Disorder: A Case Report. Firat Tip Derg., 22(3).
• DEREURE, OLIVIER. (2001). Drug-induced skin pigmentation. Am J Clin Dermatol, 2(4), 253-262.
• GERBER, PETER ARNE, KUKOVA, GABRIELA, BÖLKE, EDWIN, HOMEY, BERNHARD, & DIEDRICHSON, EVELYN. (2014). Severe hyperpigmentation and scarring following glycolic acid peel treatment in combination with low-dose isotretinoin. Eur J Med Res., 19(1), 60.
• GILLBRO, JM, & OLSSON, MJ. (2011). The melanogenesis and mechanisms of skin‐lightening agents–existing and new approaches. Int J Cosmet Sci, 33(3), 210-221.
• GÖKALP, HILAL. (2012). Are the Should Side Effects of Isotretinoin Limit its Use in State Hospital? Turkiye Klinikleri J Dermatol, 22(1), 1.
• GÖKALP, HILAL, BULUR, I, & GÜRER, MA. (2014). Decreased vitamin B12 and folic Acid concentrations in acne patients after isotretinoin therapy: a controlled study. Indian J Dermatol, 59(6), 630.
• HAY, RODERICK J, JOHNS, NICOLE E, WILLIAMS, HYWEL C, BOLLIGER, IAN W, DELLAVALLE, ROBERT P, MARGOLIS, DAVID J, . . . WULF, SARAH K. (2014). The global burden of skin disease in 2010: an analysis of the prevalence and impact of skin conditions. J Invest Dermatol, 134(6), 1527-1534.
• HONG, JONG SOO, JUNG, JAE YOON, YOON, JI YOUNG, & SUH, DAE HUN. (2013). Acne treatment by methyl aminolevulinate photodynamic therapy with red light vs. intense pulsed light. Int J Dermatol, 52(5), 614-619.
• KALIL, CÉLIA LUIZA PETERSEN VITELLO, FACHINELLO, FERNANDA ZATTI, LAMB, FLÁVIA MARIA, & COMUNELLO, LUCIANE NARDI. (2008). Use of oral isotretinoin in photoaging therapy. Skinmed, 7(1), 10-14.
• KAMAL, MUHAMMAD, & POLAT, MUHTEREM. (2015). Effect of different doses of isotretinoin treatment on the levels of serum homocysteine, vitamin B 12 and folic acid in patients with acne vulgaris: A prospective controlled study. J Pak Med Assoc., 9, 12.
• KAR, BIKASH RANJAN, TRIPATHY, SANJITA, & PANDA, MAITREYEE. (2013). Comparative study of oral isotretinoin versus oral isotretinoin+ 20% salicylic acid peel in the treatment of active acne. J Cutan Aesthet Surg, 6(4), 204.
• KARADAG, AYSE SERAP, TUTAL, EMRE, ERTUGRUL, DERUN TANER, & AKIN, KADIR OKHAN. (2011). Effect of isotretinoin treatment on plasma holotranscobalamin, vitamin B12, folic acid, and homocysteine levels: non‐controlled study. Int J Dermatol, 50(12), 1564-1569.
• KARADAĞ, AYŞE SERAP, ÇALKA, ÖMER, & AKDENIZ, NECMETTIN. (2011). Evaluation of side effects of isotretinoin in 150 patients with acne vulgaris. Turkderm Arch Turk D, 45(1), 37-42.
• KROEPFL, LUCIJA, & EMER, JASON J. (2016). Combination Therapy for Acne Scarring: Personal Experience and Clinical Suggestions. J Drugs Dermatol, 15(11), 1413-1419.
• MAHADEVAPPA, OMPRAKASH HEGGADAHALLI, MYSORE, VENKATARAM, VISWANATH, VISHALAKSHI, THURAKKAL, SALIM, MAJID, IMRAN, TALWAR, SURESH, . . . BARUA, SHYAMANTA. (2016). Surgical outcome in patients taking concomitant or recent intake of oral isotretinoin: a multicentric study-ISO-AIMS study. J Cutan Aesthet Surg, 9(2), 106.
• MEI, XINGYU, SHI, WEIMIN, & PIAO, YINGLAN. (2013). Effectiveness of photodynamic therapy with topical 5‐aminolevulinic acid and intense pulsed light in Chinese acne vulgaris patients. Photodermatol Photoimmunol Photomed, 29(2), 90-96.
• PADHI, SOMANATH, SARANGI, RAJLAXMI, RAMDAS, ANITA, RAVICHANDRAN, KANDASAMY, VARGHESE, RENU G’BOY, ALEXANDER, THOMAS, . . . MOOKKAPPAN, SUDHAGAR. (2016). Cutaneous hyperpigmentation in megaloblastic anemia: a five year retrospective review. Mediterr J Hematol Infect Dis., 8(1).
• RABELLO‐FONSECA, RM, AZULAY, DR, LUIZ, RR, MANDARIM‐DE‐LACERDA, CA, CUZZI, T, & MANELA‐AZULAY, M. (2009). Oral isotretinoin in photoaging: clinical and histopathological evidence of efficacy of an off‐label indication. J Eur Acad Dermatol Venereol, 23(2), 115-123.
• RADEMAKER, MARIUS. (2010). Adverse effects of isotretinoin: a retrospective review of 1743 patients started on isotretinoin. Australas J Dermatol, 51(4), 248-253.
• RICHTER, CLAUDIA. (2017). Akne vulgaris: Therapie und Quantifizierung in klinischen Studien.
• ŠIMIĆ, DUBRAVKA, PENAVIĆ, JASNA ZELJKO, BABIĆ, DRAGAN, & GUNARIĆ, ANITA. (2017). Pyschological status and quality of life in acne patients treated with oral isotretinoin. Psychiatr Danub, 29(suppl 2), 104-110.
• SPEECKAERT, REINHART, VAN GELE, MIREILLE, SPEECKAERT, MARIJN M, LAMBERT, JO, & VAN GEEL, NANJA. (2014). The biology of hyperpigmentation syndromes. Pigment Cell Melanoma Res, 27(4), 512-524.
• TERZI, ERDINC, TURSEN, BELMA, & TURSEN, UMIT. (2017). Comparison of the intermittent and standard isotretinoin treatment in moderate and severe acne vulgaris cases. Romanian Journal of Clinical and Experimental Dermatology, 4(2).
• TOMITA, YASUSHI, MAEDA, KAZUHISA, & TAGAMI, HACHIRO. (1992). Melanocyte‐stimulating properties of arachidonic acid metabolites: possible role in postinflammatory pigmentation. Pigment Cell Res., 5(5), 357-361.
• YAPAR, EVREN ALĞIN. (2017). Cilt Beyazlatıcılara Genel Bakış. Marmara Pharm J, 21(1), 48-53.