Evaluating the utility of frequent laboratory monitoring among acne patients receiving isotretinoin. A two-center study.

Introduction: Acne vulgaris is a common dermatological disorder with significant sociopsychological impacts. Isotretinoin is the mainstay of treatment for severe cases. Adverse effects, such as liver enzyme elevations and lipid profile changes, are linked to this medication. Despite these risks, the need of monthly laboratory monitoring has been questioned, particularly in healthy individuals without comorbidities. Aim: This study investigates the incidence of laboratory abnormalities and evaluates the clinical utility of frequent monitoring in acne patients on isotretinoin therapy in Jeddah, Saudi Arabia. Methods: This retrospective study included 265 patients treated with isotretinoin at King Abdulaziz University Hospital and King Fahad General Hospital. Data collected included patient demographics, isotretinoin doses, and laboratory results for liver enzymes, triglycerides (TG), and total cholesterol (TC). Laboratory results were assessed at baseline, after 3 months of treatment, and at the last visit. Statistical analyses included the aligned rank transform ANOVA and Wilcoxon Signed-Rank tests to assess changes in laboratory values over time and their relationship with treatment doses. Results: Our study group had a median age of 24 years, with 70.9% being female participants. Abnormal lab values increased from 11.7% at baseline to 15.8% during treatment and 14.7% at the last visit. The most common abnormality was high TC levels, rising from 6.8% at baseline to 11.7% at the last visit. Alanine aminotransferase (ALT) abnormalities increased from 3.0% at baseline to 4.9% during treatment but decreased to 2.6% at the last visit. Triglyceride abnormalities showed minimal variation, increasing from 1.1% at baseline to 1.9% at the last visit. Changes in ALT and TG levels were dose-dependent, whereas aspartate aminotransferase and TC levels were not significantly influenced by the starting dose. Conclusion: Our research assessed the importance of monthly monitoring of liver function tests and lipid profiles in patients undergoing isotretinoin therapy. The findings emphasize the significance of a personalized monitoring approach. This approach suggests that monthly laboratory testing may only be necessary for a few patients. However, baseline assessments and patient specific follow-ups remain essential.