Laboratory Monitoring During Isotretinoin Therapy for Acne: Too Much, Too Often?

Oral isotretinoin is uniquely effective for nodulocystic acne. Adverse effects include teratogenicity, hyperlipidemia, leukopenia, thrombocytopenia, and elevated liver function levels. Monitoring for pregnancy in females is standardized, mandated by the iPledge system, but specific guidance for other surveillance is lacking. Physician practice varies widely, and limited data inform the usefulness of laboratory monitoring.

A comprehensive review of the 1960–2013 literature was done to evaluate laboratory changes associated with isotretinoin therapy. Included trials had to assess acne vulgaris treatment with oral isotretinoin at doses of 40 mg/day or more in at least 10 participants aged 9 to 35 years for at least 4 weeks. Excluded were trials…