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Effect of a single course of isotretinoin therapy on bone mineral density in adolescent patients with severe, recalcitrant, nodular acne.

DiGiovanna JJ, Langman CB, Tschen EH, Jones T, Menter A, Lowe NJ, Eichenfield L, Hebert AA, Pariser D, Savin RP, Smith SR, Jarratt M, Rodriguez D, Chalker DK, Kempers S, Ling M, Rafal ES, Sullivan S, Kang S, Shah LP, Wu E, Newhouse J, Pak J, Eberhardt DR, Bryce GF, McLane JA, Ondovik M, Chin C, Khoo KC, Rich P

Division of Dermatopharmacology, Department of Dermatology, Brown Medical School/Rhode Island Hospital, Providence, RI 02903, USA. John_DiGiovanna_MD@Brown.edu

BACKGROUND: Adverse changes in bone have been reported for patients undergoing high-dose, long-term (several years) isotretinoin therapy for disorders of cornification. The effect of short-term (4-5 months) therapy at the lower dose recommended for acne on bone development in younger, growing adolescent (12-17 years) patients has not been well studied. OBJECTIVE: The purpose of the study was to evaluate the effect of a standard, single course of isotretinoin (Accutane) therapy on bone mineral density (BMD) of the lumbar spine and hip in adolescents ages 12 to 17 years with severe, recalcitrant, nodular acne. METHODS: In this open-label, multicenter study, 217 adolescents (81 girls) with severe, recalcitrant, nodular acne were enrolled and treated with isotretinoin twice daily with food at the recommended total dose of approximately 1 mg/kg for 16 to 20 weeks. BMD in the lumbar spine and hip was measured at baseline and at the end of therapy by dual energy radiograph absorptiometry. RESULTS: There was no clinically significant mean change in BMD measured at the lumbar spine (+1.4%, range: -4.9% to +12.3%) or total hip (-0.26%, range: -11.3% to +15.0%). Hyperostosis was not observed in any patient. Typical efficacy expected in the treatment of acne was observed. CONCLUSIONS: A 16- to 20-week course of isotretinoin treatment at the recommended dose for severe acne has no clinically significant effect on lumbar spine and total hip BMD in the adolescent (12-17 years) population.

Published 3 November 2004 in J Am Acad Dermatol, 51(5): 709-17.
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