Adverse effects of systemic acne therapy: A strategy of never giving up
https://doi.org/10.21518/ms2026-101
Abstract
The management of acne patients treated with isotretinoin has evolved quite markedly over the last years: from simply reporting elevated transaminase levels and lipids to a deeper insight into the mechanisms of these changes, development of effective correction methods, and to more clarity on patient selection criteria. Comorbid conditions that can affect safety and tolerability of systemic retinoids require special consideration. This article presents a clinical case of a 15-year-old female patient with severe, extensive, and treatment-resistant acne (IGA 4). The patient had been suffering from rashes over her face, chest, and back for three years. Her comorbidities included class I obesity (BMI 31.2), insulin resistance, hyperprolactinemia, and functional menstrual cycle disorders. The patient had a history of apathy and depressive episodes (she was emotionally stable at the time of therapy). The previous therapy with antiseptics and topical antibiotics has proved to be ineffective. Given the resistance and severity of the disease, isotretinoin was prescribed at a starting dose of 30 mg/day (0.36 mg/kg/day). After one month, improvements were noted: a decrease in sebum secretion and the number of inflammatory lesions. At 2.5 month of therapy, acute abdominal pain syndrome developed due to dietary inconsistency. Laboratory tests showed elevated transaminase levels (ALT, AST), and the abdominal ultrasound examination revealed signs of cholelithiasis. The acute condition was resolved. The isotretinoin dosage was temporally tapered to 10 mg/day, and a diet was recommended. After laboratory parameters and clinical status returned to normal, the dosage was gradually increased to 20 mg/day, and then to the initial therapeutic dose (30 mg/day). At the time of this writing, the patient was completing a course of isotretinoin therapy; the skin process regressed with development of stable clinical remission. The presented case demonstrates the potential to safely continue isotretinoin therapy with transient transaminase elevations, including in patients with comorbidities. Isotretinoin tapering, dietary therapy, and follow-up laboratory monitoring allow to maintain commitment to the treatment and achieve the target cumulative dose without discontinuation of the drug therapy.
About the Authors
O. А. Katkhanova
Klinika Mir-O-Med;
Klinika Ekaterininskaya
Russian Federation
Russian Federation
Olga A. Katkhanova, Dr. Sci. (Med.), Dermatovenerologist, Cosmetologist; Dermatovenerologist, Cosmetologist
132, Rashpilevskaya St., Krasnodar, 350000;
37/1, Kubanskaya Naberezhnaya St., Krasnodar, 350063
M. Yu. Martynova
Kuban State Medical University
Russian Federation
Russian Federation
Margarita Yu. Martynova, Student
4, Mitrofan Sedin St., Krasnodar, 350063
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For citations:
Katkhanova OА, Martynova MY. Adverse effects of systemic acne therapy: A strategy of never giving up. Meditsinskiy sovet = Medical Council. 2026;(2):116-124. (In Russ.) https://doi.org/10.21518/ms2026-101
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