여드름 환자에서 경구 Isotretinoin이 입술 피부장벽에 미치는 영향과 이에 대한 보습제의 예방 효과에 대한 연구

최재은 ( Jae Eun Choi ),서수홍 ( Soo Hong Seo ),손상욱 ( Sang Wook Son ),김일환 ( Il Hwan Kim ) 대한피부과학회 2008 대한피부과학회지 Vol.46 No.10

Background: Oral isotretinoin is an effective treatment for acne patients, and this agent may cause variable side effects. Among them, cheilitis is the most common symptom that occurs in virtually all these patients. Objective: We wanted to assess the functional changes of the lips of acne patients who were treated with oral isotretinoin by measuring the transepidermal water loss (TEWL), and we evaluated the benefit of using a moisturizing cream as an adjunctive treatment to oral isotretinoin. Methods: We measured the TEWL of the lips and cheeks in 17 acne patients who were treated with oral isotretinoin for 6 weeks. Then we compared the changes of the patients and the differences of the TEWL of the lip according to the dose of isotretinoin. In addition, we compared the TEWL change of the lips between 10 patients who were treated with oral isotretinoin and moisturizer cream (PHYSIOGEL(R) A.I. Cream) with that of 10 patients who received only isotretinoin. Results: The TEWL of the lip increased significantly during isotretinoin treatment while the TEWL of the cheek showed no noticeable increase. The increase of the TEWL of the lip was more definite in the 20 mg isotretinoin group than that of the 10 mg isotretinoin group. However, the TEWL of the lip remained stable in the patients treated with oral isotretinoin and moisturizer cream. Conclusion: The lips are vulnerable to the mechanism of isotretinoin due to the poor barrier function of the parakeratotic mucosal epithelium with incomplete corneocyte formation. Therefore, regular use of moisturizer on the lips is recommended as an adjunctive treatment along with oral isotretinoin. (Korean J Dermatol 2008;46(10):1353∼1356)

Isotretinoin exposure in pregnant women in Korea

( Nae Ry Kim ),( So Ra Yoon ),( June Seek Choi ),( Hyun Kyong Ahn ),( So-young Lee ),( Dal Soo Hong ),( Jeong Sup Yun ),( Seong Yeon Hong ),( Yoon Ha Kim ),( Jung Yeol Han ) 대한산부인과학회 2018 Obstetrics & Gynecology Science Vol.61 No.6

Objective Isotretinoin is a notorious teratogen otherwise used for the treatment of acne vulgaris. Some countries, including those in North America and the European Union, implemented the pregnancy prevention program (PPP); however, no PPP has yet been established in South Korea. So the aim of this study was to evaluate the rate of pregnant women exposed to isotretinoin among the callers of the Korean Mother Safe Counseling Center. Methods This is a prospective cohort study. We evaluated the demographic characteristics, obstetric history, and isotretinoin exposure of pregnant women based on the mother safe registry from April 2010 to July 2016. Results Among 22,374 callers, 650 (2.9%) pregnant women were exposed to isotretinoin. The mean age was 29.0±4.4 years in the isotretinoin-exposed group and 32.0±4.2 years in the unexposed group (P<0.001). Moreover, the incidence of pregnancies within 30 days after isotretinoin discontinuation or during isotretinoin intake was 78.9% (513/650). The median duration of isotretinoin exposure was 18 (1-4,231) days. Furthermore, from 2011 to 2015, the incidence of isotretinoin exposure was 2.9±1.2 pregnancies per 10,000 births in South Korea. Conclusion Approximately 80% of pregnant women are exposed to isotretinoin within the recommended 30 days of contraception or during pregnancy. Therefore, the PPP has to be established in South Korea.

The Efficacy of Topical Tacrolimus Ointment on Cheilitis Induced by Isotretinoin Treatment in Acne Vulgaris Patients

( Chang Hwa Song ),( You Jin Jung ),( Dong Seok Shin ),( Ki Yeon Kim ),( Jeong Eun Kim ),( Joo Yeon Ko ),( Young Suck Ro ) 대한피부과학회 2021 대한피부과학회지 Vol.59 No.6

Background: Isotretinoin is a gold standard treatment for moderate to severe acne vulgaris but is associated with cheilitis. Though moisturizing agents or petrolatum have been suggested, uncomfortable isotretinoin-induced cheilitis can disrupt treatment of acne patients. Topical tacrolimus has been used in atopic dermatitis with good safety and efficacy; however, there is no study of application of topical tacrolimus in cheilitis induced by isotretinoin. Objective: In this study, we aimed to describe the efficacy of topical tacrolimus 0.1% ointment on cheilitis associated with isotretinoin therapy using isotretinoin cheilitis grading scale (ICGS), investigator global assessment (IGA), and patient global assessment (PGA). We also observed the side effects of topical tacrolimus ointment. Methods: Fifty acne vulgaris patients with isotretinoin-induced cheilitis were randomly allocated to either topical tacrolimus or petrolatum treatment using permuted-block randomization. Patients were followed-up at 4 and 8 weeks, at which cheilitis lesions were photographed and evaluated with ICGS, IGA, and PGA. Results: Compared to petrolatum group, tacrolimus group had greater responses to treatment as measured by mean values of ICGS, IGA, PGA at follow-up visits. Also, the ICGS decrease was larger in the tacrolimus group compared with the petrolatum group even according to isotretinoin dose. Conclusion: Topical tacrolimus ointment had superior efficacy in treating cheilitis induced by isotretinoin compared to petrolatum. Erythema, fissures, scales, and commissures all showed better response to tacrolimus ointment. Topical tacrolimus ointment can be administered as an effective strategy in treatment of cheilitis as a complication of isotretinoin therapy and can improve compliance of acne patients. (Korean J Dermatol 2021;59(6):468∼473)

P101 : Effect of antihistamine as an adjuvant treatment of isotretinoin in acne: a randomized, controlled comparative study

( Hae Eul Lee ),( Young Lee ),( Chang Deok Kim ),( Young Joon Seo ),( Jeung Hoon Lee ),( Myung Im ) 대한피부과학회 2013 대한피부과학회 학술발표대회집 Vol.65 No.2

Background: Isotretinoin has been frequently used for acne therapy. However, it has limitation in acceptance because of its adverse effects. Although antihistamine is an effective anti-inflammatory drug and recently revealed to decrease the lipogenensis, evidence is lacking regarding the clinical relevance of antihistamine in the treatment of acne. Objectives: To evaluate the clinical efficacy and tolerability of antihistamine as an adjuvant treatment of isotretinoin. Methods: Forty patients with moderate acne were included in this randomized, controlled comparative study. Twenty patients were treated with isotretinoin and twenty patients were treated with additional antihistamine, desloratadine. Assessment was made at baseline, after 2, 4, 8 and 12 weeks of treatment. Results: At week 12, compared with isotretinoin only group, isotretinoin with additional antihistamine group showed more significant decrease in acne lesion counts. Significant decrease was also observed in the score of global acne grading systemand the measured value of sebum and erythema. Moreover, acne flare during the treatment occurred less frequently and adverse events of isotretinoin were more tolerable in additional antihistamine group. Conclusion: This results provide early evidence that antihistamine has a synergic effect with minimizing the side effect of isotretinoin, and may be used as an adjuvant treatment of moderate acne.

한국인에서 경도 및 중등도의 여드름에 대한 경구 Isotretinoin의 유효성 및 안전성 평가

성경제(Kyung Jeh Sung),최응호(Eung Ho Choi),황상민(Sang Min Hwang),서대헌(Dae Hun Suh),이승헌(Seung Hun Lee) 대한피부과학회 2000 대한피부과학회지 Vol.38 No.10

Background:Oral isotretinoin has been widely used in severe acne patients and is known as a very effective drug. Recently it is being used in any grades and any types of acne. However we have few reports of clinical study about oral isotretinoin in our country. Objective:To investigate clinical efficacy, factors influencing the result and side effects of oral isotretinoin in mild to moderate acne patients in Korea, prospectively. Materials and methods:The patients with mild to moderate acne visiting out-patient dermatology clinics of four university hospitals have taken oral isotretinoin 0.3-1.0mg/kg/day over 16 weeks. The clinical improvement was assessed by the scores using photographs before treatment and at 8 weeks, 12 weeks, 16 weeks, 20 weeks after treatment, and by the satisfaction of patients and physicians at the end of treatment. The side effects were recorded and SGOT, SGPT, cholesterol and triglyceride were checked at regular intervals. Results:The grade of acne was much improved proportional to the duration of treatment. The factors showing better results were dosage and duration of oral isotretinoin, older age, more severe acne and severe acne in the past. About 90% of patients and physicians were satisfied with the result at the end of treatment. The side effects, mainly mucocutaneous symptoms were expectable and tolerable in the most cases. The values of SGOT, SGPT, cholesterol and triglyceride were increased after treatment but within normal reference range. Conclusion:Oral isotretinoin is a very effective agent in Korean patients with mild to moderate acne. We expect the better result in patients having high dose and long duration of oral isotretinoin, old ages and more severe acne. If we understand it's side effects enough, we can use it very safely. (Korean J Dermatol 2000;38(10):1309~1314)

The Effect of Evening Primrose Oil for the Prevention of Xerotic Cheilitis in Acne Patients Being Treated with Isotretinoin: A Pilot Study

( Kui Young Park ),( Eun Jung Ko ),( In Su Kim ),( Kap Sok Li ),( Beom Joon Kim ),( Seong Jun Seo ),( Myeung Nam Kim ),( Chang Kwun Hong ) 대한피부과학회 2014 Annals of Dermatology Vol.26 No.6

Background: The most common adverse effects of oral isotretinoin are cheilitis, skin dryness, dry eyes, and conjunctivitis, whereas evening primrose oil (EPO) is known to improve skin moisture and transepidermal water loss (TEWL) in healthy adults and atopic patients. Objective: To evaluate the clinical efficacy and safety of EPO in preventing xerotic cheilitis in acne patients being treated with oral isotretinoin. Methods: Forty Korean volunteers of Fitzpatrick skin types III and IV, having moderate acne, were enrolled and randomized to receive either isotretinoin with or without EPO for 8 weeks. The efficacy of treatment was evaluated on the basis of global acne grading system scores, number of inflammatory and noninflammatory lesions, TEWL, corneometry, physician’s global assessment, and patient satisfaction. Results: The results after 8 weeks of treatment showed that the TEWL of the lip increased significantly during isotretinoin treatment, whereas the TEWL of the hand dorsum showed no significant change. The increase of the TEWL of the lip was more definite in the control group than in the experimental group. The number of acne lesions decreased significantly in both groups, and there were no differences between them. Conclusion: Our study suggests that the addition of EPO improved xerotic cheilitis in acne patients being treated with oral isotretinoin. However, besides TEWL and corneometry assessments, additional studies are required for a complete understanding of the role of EPO in xerotic cheilitis in acne patients being treated with oral isotretinoin. (Ann Dermatol 26(6) 706∼712, 2014)

The rates of major malformations after gestational exposure to isotretinoin: a systematic review and meta-analysis

( Eun Jeong Choi ),( NaeRy Kim ),( Ho-Seok Kwak ),( Hae Ji Han ),( Kyoung-Chul Chun ),( Young-Ah Kim ),( Jae-Whoan Koh ),( Jung Yeol Han ),( Sung Hong Joo ),( Ji Sung Lee ),( Gideon Koren ) 대한산부인과학회 2021 Obstetrics & Gynecology Science Vol.64 No.4

Objective Isotretinoin is among the most notorious human teratogens, documented originally as causing up to 30% of malformations. This systematic review and meta-analysis aimed to evaluate the rates of major malformation (MM) among isotretinoin-exposed pregnant women over the years through a systematic review and meta-analysis. Methods Eligible studies were searched and identified using various databases. Single-arm meta-analysis and meta-analysis of odd ratios among controlled studies were performed using Review Manager version 5.3. Results Ten eligible studies that combined 2,783 isotretinoin-exposed women were included in our study. The rate of MM weighted for the sample size was 15%. Three studies that included an unexposed comparison group were eligible for the meta-analysis. The pooled odds ratio of MM for isotretinoin-exposed women was 3.76. After 2006, the pooled odds ratio of MM for isotretinoin exposure was significantly lower at 1.04. Conclusion The current rate of MM in isotretinoin-exposed women was substantially lower after 2006.

A Case of Suspected Isotretinoin-Induced Malformation in a Baby of a Mother Who Became Pregnant One Month after Discontinuation of the Drug

이순민,He Min Kim,Jun Seok Lee,윤춘식,박민수,박국인,남궁란,이철 연세대학교의과대학 2009 Yonsei medical journal Vol.50 No.3

Isotretinoin is a known human teratogen that can cause multiple malformations. At present, women who conceive one cycle after discontinuing isotretinoin are told that their teratogenic risk is not higher than baseline. We present a case of both ear malformation in a newborn whose mother had taken isotretinoin for 2 years until one month prior to the time when she became pregnant. We suggest that further studies of pharmacokinetics and malformation of isotreinoin are needed. Isotretinoin is a known human teratogen that can cause multiple malformations. At present, women who conceive one cycle after discontinuing isotretinoin are told that their teratogenic risk is not higher than baseline. We present a case of both ear malformation in a newborn whose mother had taken isotretinoin for 2 years until one month prior to the time when she became pregnant. We suggest that further studies of pharmacokinetics and malformation of isotreinoin are needed.

Evaluation of YouTube videos about isotretinoin as treatment of acne vulgaris

( Byeong Chang Ko ),( Su Min Lee ),( Jae Hong Oh ),( Hee Jae Park ),( Mira Choi ),( Hai-jin Park ),( Sik Haw ) 대한피부과학회 2020 대한피부과학회 학술발표대회집 Vol.72 No.1

Background: YouTube is the popular video-sharing websites in Korea. But, there is no proper regulation on incorrect or biased information. Acne is common in adolescent familiar with YouTube. Thus, misleading information about isotretinoin in YouTube videos could have a bad impact on clinical setting. Objectives: We evaluate the contents quality of information about isotretinoin in YouTube videos. Methods: The following keywords were searched on YouTube Korea on July 1st, 2020: ‘isotretinoin’, ‘roaccutane,’ and ‘isotinone’. DISCERN tool was used to evaluate the reliability and quality of information and 8 items were used to evaluate scientific accuracy and comprehensiveness: mechanism, indications, dose regimen, contraindications, side effects, blood tests, drug interactions, and pregnancy issue. Results: Excluding duplicate or inappropriate videos, total 164 videos were analyzed. Mean overall quality score was 2.24 in DISCERN tool (5-point scale from 1 to 5). Mean score in 8-issue-criteria (3-point scale from 0 to 2) was 0.61. Especially, indications, blood tests, and drug interactions were poorly addressed in videos. Health care providers offer better quality of video than non-health care providers. The quality score was not correlated with the popularity of video. Conclusion: YouTube videos covering isotretinoin show overall poor quality. Incorrect information could be propagated in YouTube. So, dermatologists should try to provide more accurate information about isotretinoin.

P084 : A comparison of isotretinoin alone versus isotretinoin with gamma-linolenic acid for the treatment of patients with acne vulgaris

( Seong Hun Moon ),( Hyung Il Kwon ),( Jeong Ho Hong ),( Myeong Gil Jeong ),( Jeong Eun Kim ),( Joo Yeon Ko ),( Young Suck Ro ) 대한피부과학회 2013 대한피부과학회 학술발표대회집 Vol.65 No.2

Background: Oral isotretinoin is well-known effective drug for acne vulgaris, but it commonly causes dryness of skin and mucous membrane. Gamma-linolenic acid (GLA) is known for improving moisturizing effect and reducing transepidermal water loss (TEWL). Objectives: To investigate the clinical efficacy of GLA in the prevention of dryness of skin and mucous membrane and in the efficacy of improvement of acne lesions when concomitantly administered with isotretionin in patients with acne vulgaris. Methods: 89 Korean acne patients between Korean acne grading system (KAGS) grade 2 and 6 were enrolled and randomized to receive isotretinoin (20 mg/day) either with or without GLA (320 mg/day) for 12 weeks. Results: The decrease of the skin hydration and increase of the TEWL of the lip and cheek were less distinct in the combination (experimental) group than in alone (control) group. VAS score for dryness was lower in combination group (p=0.017). The acne lesions (papules, comedos, pustules) were reduced in both groups. In particular, only the numbers of papules were significant between two groups (p=0.043). The decrease of the KAGS and increase of the patient satisfaction for the treatment were more definite in the experimental group. Conclusion: We found that GLA could be effectively used to reduce xerosis in acne patients treated with isotretinoin. The improvements in acne lesions, especially papules, were better treated in combination group.