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Isotretinoin and Inflammatory Bowel Disease Revisited

Isotretinoin therapy in the previous 12 months significantly raised the risk for ulcerative colitis but not for Crohn disease.

An association between isotretinoin use and inflammatory bowel disease (IBD) has been suggested. In November 2009, we covered a study by Bernstein and colleagues, which demonstrated no more than a chance association between isotretinoin use and any type of IBD, and a review by Crockett and colleagues, which concluded that a causal association between isotretinoin and IBD had yet to be established. To further evaluate a possible association, some authors of the latter review used a large U.S. database to perform a case-control study comparing isotretinoin use in 8189 patients with incident IBD and 21,832 controls matched for age, sex, and geographic region. The period assessed for pre-IBD diagnosis isotretinoin use was 12 months.

Of the IBD patients, 3664 had Crohn disease (CD), 4428 had ulcerative colitis (UC), and 97 had IBD that could not be classified. Sixty subjects had received isotretinoin (24 cases and 36 controls). Isotretinoin use was strongly associated with UC (odds ratio, 4.36) but not with CD. In addition, higher doses and longer durations of isotretinoin treatment increased the risk for UC. When the authors extended the period examined for previous isotretinoin use from 12 to 24 months, the association between isotretinoin and UC was weaker but still statistically significant. Methodological differences between this study and the Bernstein study may explain the differences in findings.

Comment: This study needs replication, but its results suggest that risk for UC might be increased in isotretinoin recipients. Therefore, we should warn patients of this rare but potentially real risk and, if bowel symptoms develop, consider stopping isotretinoin until the patient is examined and cleared by a gastroenterologist for further therapy.

— Jeffrey P. Callen, MD

Published in Journal Watch Dermatology May 21, 2010

Citation(s):

Crockett SD et al. Isotretinoin use and the risk of inflammatory bowel disease: A case–control study. Am J Gastroenterol 2010 Mar 30; [e-pub ahead of print]. (http://dx.doi.org/10.1038/ajg.2010.124)

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• Isotretinoin
  Robert L Jackson, Private Practice, Memphis,Tennessee, 25 May 2010 2:48 PM EST
  I cannot believe that such a good medicine is being destroyed by things like this. I have been treating patients... [more]

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