Indicators of Isotretinoin-Induced Myopathy: Neutrophil/Lymphocyte Ratio, Cobb Angle of Spine

Yıl 2020, Cilt: 6 Sayı: 3, 299 - 304, 31.12.2020

Densel Araç Rukiye Güner

https://doi.org/10.19127/mbsjohs.776897

Öz

Objective: There are many side effects of isotretinoin on the musculoskeletal system, liver, nervous system and dermatological side effects. To investigate usage and side effects of isotretinoin (13-cis retinoic acid), which is popularly recommended by dermatologists for the treatment of acne vulgaris, on young patients admitted to the hospital with severe low back and neck pains.
Methods: We evaluated 61 patients who, using isotretinoin for the treatment of acne vulgaris for an average of eight months, experienced cervical and lumbar pain between 2017-2019. The age range of patients was between 16 and 38 years, there were 45 female and 16 male patients. These patients used isotretinoin at a dose of 0.5-0.8 mg/kg/day for the treatment of acne vulgaris for about eight months. The patients were questioned about cervical and lower back pain, joint pain, muscle weakness, myoglobinuria, creatine phospo-kinase (CPK), Visual Analog Scale (VAS), inflammation myopathy, neutrophil/lymphocyte ratio (Neu/Lymp ratio), and Cobb angle of the spine during monthly controls.
Results: The VAS and Neu/Lymp ratio, cervical and lumbar Cobb angles of the patients were statistically analyzed and the relationship between them was shown.
Conclusion: The Neu/Lymp ratio and Cobb angle of the cervical and lumbar spine should be considered as an alternative or additional parameter to diagnose drug-induced myopathy.

Anahtar Kelimeler

Neu/Lymp ratio, Myopathy, cob angle, inflamation, pain

Kaynakça

• Aydog E, Ozturk G, Comert A, Tasdelen N, Akin O, Geler Kulcu D. Sacroiliitis during isotretinoin treatment: Causal association or coincidence? North Clin Istanb 2019;6(1):75–80. doi: 10.14744/nci.2018.93798
• Bodo Melnik. Isotretinoin and FoxO1, Dermato-Endocrinology, 2011;3:3, 141-165, DOI: 10.4161/derm.15331
• Cengiz AB, Ozyilmaz C, Tabaru A, Kayabasi S, Ege SS, Ruzgar S et al. Effects of oral ısotretinoin on normal and wounded nasal mucosa: an experimental study. European Archives of Oto-Rhino- Laryngology 2018;275(12), 3025-3031, https://doi.org/10.1007/s00405-018-5190-2
• Dalakas MC. Toxic and drug-induced myopathies. J Neurol Neurosurg Psychiatry. 2009 Aug;80(8):832-8. doi:10.1136/jnnp.2008.168294.
• Dicken CH. Retinoids: a review. J Am Acad Dermatol 1984;11: 541-552. Doi: 10.1016/s0190- 9622(84)70204-0
• DiGiovanna JJ. Isotretinoin effects on bone. J Am Acad Dermatol. 2001;45:S176-S182. Doi:10.1067/mjd.2001.113721
• Dincer U, Cakar E, Kıralp MZ, Dursun H. Can isotretinoin induce sacroiliitis: three cases. Romatizma/Rheumatism 2008;23:157-9. Ebru Karagun. The Effect of Isotretinoin-Induced Myalgia on Daily Quality of Life and Evaluation of Serum Creatine Phosphokinase Levels, Van tıp Derg.2019;26(4):452-455 doi:10.5505/vtd.2019.26918
• Elías LM, Gómez MI, Torrelo A, Boixeda JP, Ledo A. Acnefulminans and bilateral seronegative sacroiliitis triggered by isotretinoin. J Dermatol 1991;18:366-7. doi: 10.1111/j.1346
• Farah Sameem, Semira. Isotretinoin-induced acute severe myopathy involving pelvic girdle muscles: A case report. Indian journal of pharmacology 2016; 48(5), 601. doi: 10.4103/0253-7613.190764
• Fiallo P, Tagliapietra AG. Severe acute myopathy induced by isotretinoin. Arch Dermatol 1996;132:1521-2. doi:10.1001/archderm.132.12.1521
• Heudes AM, Laroche L. [Muscular damage during isotretinoin treatment]. Ann Dermatol Venereol 1998;125: 94-97. PMID: 9747221
• Hodak E, Gadoth N, David M, Sandbank M. Muscle damage induced by isotretinoin. Br Med J (Clin Res Ed) 1986;293: 425-426. DOI: 10.1136/bmj.293.6544.425, doi: 10.1136/bmj.293.6544.425
• Janati A, Naif AG, Ghorbel S, Al-Emadi BA, Al-Shurtan KS,Alghassab AS et al. Pelvic Girdle Myopathy Caused by Isotretinoin: Case Report and Discussion of Pathophysiology. J Clin Exp Pathol 2014;4: 160. doi:10.4172/2161-0681.1000160
• Layton A. The use of isotretinoin in acne. Dermatoendocrinology 2009;1(3):162–169. doi: 10.4161/derm.1.3.93648138.1991.tb03100.x
• Levinson M, Gibson A, Stephenson G. Sacroiliitis secondary to isotretinoin. Australas J Dermatol 2012;53:298–300. doi: 10.1111/j.1440-0960.2011.00841.x.
• McLane J. Analysis of common side effects of isotretinoin. J Am Acad Dermatol 2001;45:S188eS194. doi:10.1067/mjd.2001.113719
• Melnik BC. Apoptosis May Explain the Pharmacological Mode of Action and Adverse Effects of Isotretinoin, Including Teratogenicity. Acta Derm Venereol. 2017 Feb 8;97(2):173-181. doi: 10.2340/00015555-2535
• Nesher G, Zuckner J. Rheumatologic complications of vitamin A and retinoids. Semin Arthritis Rheum 1995;24:291e296.doi:10.1016/s0049-0172(95)80039-5
• Pehlivan Y, Kisacik B, Sayiner ZA, Onat AM. Inflammatory backpain in patients treated with isotretinoin. J Rheumatol 2011;38:2690. doi:10.3899/jrheum.110703
• Penniston KL, Tanumihardjo SA. The acute and chronic toxic effects of vitamin A. Am J Clin Nutr. 2006;83:191-201. DOI: 10.1093/ajcn/83.2.191
• Samet Alkan, Nuriye Kayiran, Orhan Zengin, Ali Kalem, Gezmis Kimyon, Emine Ozkul Kilinc et al. Isotretinoin-induced Spondyloarthropathy-related Symptoms: A Prospective Study.The Journal of Rheumatology November 2015, 42 (11) 2106-2109; doi:https://doi.org/10.3899/jrheum.150013
• Scuderi AJ, Datz FL, Valdivia S, Morton KA. Enthesopathy of the patellar tendon insertion associated with isotretinoin therapy. J Nucl Med 1993;34:455e457. PMID: 8441038
• Valiyil R, Christopher-Stine L. Drug-related myopathies of which the clinician should be aware. Curr Rheumatol Rep. 2010;12:213–20. doi: 10.1007/s11926-010-0104-3.