Effective monitoring of isotretinoin safety in a pediatric dermatology population: A novel “patient symptom survey” approach - 13/08/11

Doi : 10.1016/j.jaad.2010.06.040

Chelsea J. Hodgkiss-Harlow, BS ^a, Lawrence F. Eichenfield, MD ^a,^b, Magdalene A. Dohil, MD ^a,^b,^⁎
^a University of California, San Diego School of Medicine, San Diego, California
^b Division of Pediatric and Adolescent Dermatology, Rady Children’s Hospital, San Diego, California

Reprint requests: Magdalene A. Dohil, MD, Division of Pediatric and Adolescent Dermatology, Rady Children’s Hospital, San Diego, and University of California, San Diego School of Medicine, 8010 Frost St, Suite 602, San Diego, CA 92123.

Abstract

Background

Assessment of adverse effects in pediatric patients on oral isotretinoin has not been standardized and the exact incidence is unknown.

Objective

Our goal was to determine the usefulness of an isotretinoin symptom survey as a screening tool for assessment and quantification of adverse effects, including psychiatric symptoms, during isotretinoin treatment in a pediatric population of different age groups.

Methods

We performed a retrospective chart review on a random sample of patients treated with isotretinoin at a tertiary pediatric dermatology clinic where patients completed an isotretinoin symptom survey at each visit. Responses were stratified by age group and psychiatric history.

Results

The charts of 102 patients, representing 123 courses of isotretinoin and 760 treatment-months, were reviewed. A total of 722 (95.0%) symptom surveys were complete and 38 (5.0%) were incomplete/missing. Recorded side effects were similar to published adult data; dry lips/dry skin were reported in 94.25% and 72.13% of treatment-months of isotretinoin, respectively. Psychiatric symptoms were reported in 1.65%, with no statistical difference between patients with or without a mental health history. Patients aged 11 to 15 years had similar side-effect profiles to those aged 16 to 21 years. Impaired night vision, nosebleeds, and dry/bloodshot eyes were more common in the older age group.

Limitations

This was a retrospective chart review, with known limitations. The study was performed at a tertiary referral center for pediatric dermatology, possibly allowing patient selection bias.

Conclusions

The isotretinoin symptom survey appears to be an effective screening tool to standardize monitoring of isotretinoin side effects in the pediatric population.

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Key words : acne, adolescent, depression, isotretinoin, pediatrics, symptom survey