Safety and Monitoring Update on Isotretinoin
Résumé
Canadian dermatologists frequently encounter fear and misconceptions of isotretinoin among patients and the general public. In contrast, few medications in dermatology have been as transformative: since its introduction, isotretinoin has dramatically changed the treatment of acne through its potential for providing long-term remission (Figure 1). Initial consultations in which isotretinoin is proposed are often lengthy and emotionally charged, with substantial discussion devoted to drug safety, treatment monitoring, and risk-mitigation strategies. This article provides an evidence-based update on select safety concerns surrounding isotretinoin, including well‑established and serious risks, concerns that have been confidently refuted, and some less common issues frequently raised by patients based on their own research.
Références
Tan JK, Shear N. Oral isotretinoin: ensuring safe use while not limiting access to those who need it. CMAJ. 2017;189(13):E510. doi:10.1503/cmaj.732920
Zhu Y, Anand P, Sarpatwari A, Hernández-Díaz S, Bykov K, Kesselheim AS, et al. Isotretinoin risk evaluation and mitigation strategy and pregnancy incidence. JAMA Intern Med. 2025;185(10):1289-1291. doi:10.1001/jamainternmed.2025.3168
Khan A, Khan C, Ahmed S. The history, development and current status of isotretinoin: a review article. Clin Exp Dermatol. 2026;51(6):939-950. doi:10.1093/ced/llaf523
Tan J, Boyal S, Desai K, Knezevic S. Oral isotretinoin: new developments relevant to clinical practice. Dermatol Clin. 2016;34(2):175-184. doi:10.1016/j.det.2015.11.002
Gupta N, Ray M, Shayya A, McGinnis S, Marson J, Jagdeo J. Isotretinoin does not increase the risk of inflammatory bowel disease: a TriNetX retrospective cohort analysis. J Drugs Dermatol. 2025;24(12):1168-1172. doi:10.36849/JDD.9168
Henderson D, Turner PJ, Hourihane JO. Isotretinoin and peanut allergy: evidence of safety is staring us in the face. Br J Dermatol. 2025;193(2):324-325. doi:10.1093/bjd/ljaf137
Xu KK, Aghazadeh N, Tebben P, Todd A, Tollefson M, Barbieri JS. The effect of isotretinoin treatment for acne vulgaris on height in adolescents: a retrospective cohort study using the Rochester Epidemiology Project. J Am Acad Dermatol. 2025;93(6):1464-1470. doi: 10.1016/j.jaad.2025.08.009
Parikh AK, Lipner SR. Challenges of acne management in aviation careers. J Am Acad Dermatol. Published online February 5, 2026. doi:10.1016/j.jaad.2026.01.081
Lee YH, Scharnitz TP, Muscat J, Chen A, Gupta-Elera G, et al. Laboratory monitoring during isotretinoin therapy for acne: a systematic review and meta-analysis. JAMA Dermatol. 2016;152(1):35-44. doi:10.1001/jamadermatol.2015.3091
Hansen TJ, Lucking S, Miller JJ, Kirby JS, Thiboutot DM, Zaenglein AL. Standardized laboratory monitoring with use of isotretinoin in acne. J Am Acad Dermatol. 2016;75(2):323-328. doi:10.1016/j.jaad.2016.03.019
Gan WK, Fong G, Ravenscroft J, Burden-Teh E, Wood D, Tang TS. O07 To test or not to test? Isotretinoin blood test monitoring in children and adolescents in a teaching hospital over 2 years. Br J Dermatol. 2025;193(Suppl 3):ljaf465.007. doi:10.1093/bjd/ljaf465.007
Cartron AM, Cohrs A, Zaenglein AL. Isotretinoin laboratory monitoring varies by sex for patients with acne vulgaris. J Am Acad Dermatol. 2025;93(1):237-238. doi:10.1016/j.jaad.2025.02.064
Ershadi S, Barbieri JS. Rates of missed windows and premature treatment discontinuation for those treated with isotretinoin via telemedicine. J Am Acad Dermatol. 2026;94(4):1254-1255. doi:10.1016/j.jaad.2025.12.011
Soysal MÇ. Performance of artificial intelligence large language models (LLMs) in answering frequently asked questions about isotretinoin. Cutan Ocul Toxicol. 2026;45(1):58-63. doi:10.1080/15569527.2025.2601639