• Users Online: 554
  • Print this page
  • Email this page


 
 
Table of Contents
ORIGINAL ARTICLE
Year : 2021  |  Volume : 25  |  Issue : 1  |  Page : 37-38

Oral isotretinoin therapy and milia formation in patients with acne vulgaris: A prospective study


1 Department of Dermatology, King Saud University, College of Medicine, Riyadh, Saudi Arabia
2 Department of Dermatology, King Saud Medical City, Riyadh, Saudi Arabia
3 Department of Dermatology, King Abdullah Bin Abdulaziz University Hospital, Riyadh, Saudi Arabia

Date of Submission27-Sep-2019
Date of Acceptance26-Nov-2019
Date of Web Publication04-May-2021

Correspondence Address:
Dr. Ahmad AlAmari
King Saud University, Riyadh
Saudi Arabia
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdds.jdds_57_19

Get Permissions

  Abstract 


Background: Isotretinoin (13-cis-retinoic acid) is effective in acne treatment. Isotretinoin can cause hair loss, xerosis, cheilitis, and nail changes. Milia is a reported side effect; however, little is known about the relationship between oral isotretinoin and milia formation. Purpose: The objective was to investigate milia as a potential side effect of oral isotretinoin treatment. Methods: Fifty-one patients (male/female: 21/30) aged 18–25 years with moderate-to-severe acne vulgaris were treated with a standard dose of oral isotretinoin 0.5 mg/kg/day and a cumulative dose of 120–150 mg/kg. Clinical assessments of milia were obtained at 0, 2, 4, 6, and 8 months of treatment. Results: None of the patients who received oral isotretinoin therapy developed milia. Conclusion: We found no association between oral isotretinoin at a standard dose of 0.5 mg/kg/day and milia formation in patients with moderate-to-severe acne vulgaris.

Keywords: Acne vulgaris, isotretinoin, milia


How to cite this article:
AlSaif F, AlDakhil A, AlSyefi N, AlAmari A, AlAmari A, AlSaif F, AlOtaibi H, Balbeesi A, AlBabtain N. Oral isotretinoin therapy and milia formation in patients with acne vulgaris: A prospective study. J Dermatol Dermatol Surg 2021;25:37-8

How to cite this URL:
AlSaif F, AlDakhil A, AlSyefi N, AlAmari A, AlAmari A, AlSaif F, AlOtaibi H, Balbeesi A, AlBabtain N. Oral isotretinoin therapy and milia formation in patients with acne vulgaris: A prospective study. J Dermatol Dermatol Surg [serial online] 2021 [cited 2021 Dec 8];25:37-8. Available from: https://www.jddsjournal.org/text.asp?2021/25/1/37/315330




  Introduction Top


Milia are small cysts caused by keratin retention. They present with white papules of 1–2 mm and are quite common, affecting individuals of all ages and appearing most commonly on the face. They may appear spontaneously or secondary to trauma, ulceration, blistering diseases, or cosmetic procedures.[1] Milia formation has also been reported as a side effect of topical corticosteroids, cyclosporine, sorafenib, penicillamine, and 5-fluorouracil.[2] Although milia is not a serious condition, it can cause emotional distress, particularly in female patients.

Isotretinoin (13-cis-retinoic acid) is a revolutionary medication in dermatology.[3] It targets the main pathophysiological mechanisms of acne vulgaris such as sebum production, follicular keratinization, and leukocytic chemotaxis-induced inflammation. Isotretinoin can be effective for rosacea, hidradenitis suppurativa, and Gram-negative folliculitis.[4]

However, despite the effectiveness and popularity of this unique medication, isotretinoin has been associated with teratogenicity, xerosis, mood change, eczema, cheilitis, nose bleeding, muscle ache, dry eyes, and dyslipidemia.[5] Little is known about the relationship between oral isotretinoin and milia formation.[6] We assessed whether milia develop in patients treated with isotretinoin.


  Methods Top


This was a prospective study conducted over a 1-year period. Patients were recruited from the outpatient dermatology clinic at King Saud University Hospital in Riyadh, Saudi Arabia, by dermatologists. We included young adults (18–25 years old) with moderate-to-severe acne vulgaris requiring oral isotretinoin therapy. Individuals were excluded from the study if they had a past history of blistering diseases or recent history of sunburn, ulceration, laser treatment, or cosmetic procedures in the past 1 month. Participants who applied topical medications such as phenols, hydroquinone, 5-fluorouracil, or corticosteroid creams in the past 1 month were also excluded from the study.

All patients received oral isotretinoin with a standard dose of 0.5 mg/kg/day and a cumulative dose of 120–150 mg/kg. Clinical assessment of milia was obtained by two blinded experienced dermatologists to minimize observer-expectancy bias at baseline and then at the 2nd, 4th, 6th, and 8th months of treatment.


  Results Top


Twenty-one male patients and thirty female patients (total: 51 patients) were enrolled in the study. The mean age of the participants was 20.7 years (range: 18–25 years).

None of the patients who received oral isotretinoin therapy developed eruptive or new milia lesions.


  Discussion Top


In one study of milia as a side effect of oral isotretinoin therapy, milia was observed in 8% of the patients.[7] Eruptive milia occurred over the malar cheeks and inferior eyelids in a patient with severe nodulocystic acne after 4 months of treatment with systemic isotretinoin (dose: 80 mg/day). Three patients developed eruptive milia over the eyelids and periorbital area after receiving low-dose isotretinoin treatment for acne.[8] We found no milia in over fifty prospectively followed isotretinoin-treated acne patients. Milia appear to be at worst an uncommon manifestation of isotretinoin treatment.

Our study had some limitations. First, the sample size was limited. Our study is not informative about milia formation with higher dose isotretinoin.


  Conclusion Top


In conclusion, we found no association between oral isotretinoin at a standard dose of 0.5 mg/kg/day and secondary milia in patients with moderate to severe acne vulgaris. Further studies involving higher doses of oral isotretinoin are required to explore this possible association.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Langley RG, Walsh NM, Ross JB. Multiple eruptive milia: Report of a case, review of the literature, and a classification. J Am Acad Dermatol 1997;37:353-6.  Back to cited text no. 1
    
2.
Berk DR, Bayliss SJ. Milia: A review and classification. J Am Acad Dermatol 2008;59:1050-63.  Back to cited text no. 2
    
3.
Farrell LN, Strauss JS, Stranieri AM. The treatment of severe cystic acne with 13-cis-retinoic acid. Evaluation of sebum production and the clinical response in a multiple-dose trial. J Am Acad Dermatol 1980;3:602-11.  Back to cited text no. 3
    
4.
Layton MA, Stainforth JM, Cunliffe WJ. Ten years' experience of oral isotretinoin for the treatment of acne vulgaris. J Dermatol Treat 1992;4:2-5.  Back to cited text no. 4
    
5.
Rademaker M. Adverse effects of isotretinoin: A retrospective review of 1743 patients started on isotretinoin. Australas J Dermatol 2010;51:248-53.  Back to cited text no. 5
    
6.
Farmer W, Cheng K, Marathe K. Eruptive milia during isotretinoin therapy. Pediatr Dermatol 2017;34:728-9.  Back to cited text no. 6
    
7.
Dhir R, Gehi NP, Agarwal R, More YE. Oral isotretinoin is as effective as a combination of oral isotretinoin and topical anti-acne agents in nodulocystic acne. Indian J Dermatol Venereol Leprol 2008;74:187.  Back to cited text no. 7
  [Full text]  
8.
Altalhab SM, Zainalabidin RA. Eruptive milia associated with isotretinoin. J Dermatol Dermatol Surg 2019;23:44-5.  Back to cited text no. 8
  [Full text]  




 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
Abstract
Introduction
Methods
Results
Discussion
Conclusion
References

 Article Access Statistics
    Viewed1201    
    Printed4    
    Emailed0    
    PDF Downloaded116    
    Comments [Add]    

Recommend this journal