Prevalence of Isotretinoin Therapy in Adolescents and Young Adults With and Without Atopic Dermatitis: A Nationwide Prescription-based Population Study
DOI:
https://doi.org/10.2340/actadv.v103.9424Keywords:
Acne, Dermatitis, Atopic, Dermatologic Agents, Eczema, Isotretinoin, Pharmacoepidemiology, Topical acne treatment, Topical calcineurin inhibitor, Topical corticosteroidsAbstract
Although isotretinoin has anti-inflammatory and immunomodulatory properties, it can exacerbate atopic dermatitis. National estimates of the extent to which patients with atopic dermatitis are affected by severe acne and isotretinoin tolerability are lacking. The aim of this study is to investigate isotretinoin therapy in patients with atopic dermatitis and to compare the nationwide prevalence with individuals without atopic dermatitis. All Norwegian residents were followed for 17 years until age 20–22 years in 2020. Approximately 28% of patients with atopic dermatitis had been treated for acne, and 8% had received isotretinoin before age 23 years. In those over 17 years old, significantly more patients with atopic dermatitis were treated with isotretinoin than those without. At age 22 years, 2.21% (95% confidence interval 1.92–2.49) of patients with atopic dermatitis were treated with isotretinoin, compared with 1.55% (95% confidence interval 1.44–1.65) of those without, representing 42.8% (1.43; 95% confidence interval 1.24–1.65) higher use in patients with atopic dermatitis. Patients who received long-term treatment (probable severe atopic dermatitis) tolerated isotretinoin similarly to patients who received short-term treatment (probable mild atopic dermatitis). There was significantly higher use of topical corticosteroids during isotretinoin therapy in patients with atopic dermatitis. Conclusively, severe acne (isotretinoin therapy) was associated with atopic dermatitis at the population level in young adults.
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References
Langan SM, Irvine AD, Weidinger S. Atopic dermatitis. Lancet 2020; 396: 345-360.
https://doi.org/10.1016/S0140-6736(20)31286-1 DOI: https://doi.org/10.1016/S0140-6736(20)31286-1
Yamamoto A, Takenouchi K, Ito M. Impaired water barrier function in acne vulgaris. Arch Dermatol Res 1995; 287: 214-218.
https://doi.org/10.1007/BF01262335 DOI: https://doi.org/10.1007/BF01262335
Stewart ME, Grahek MO, Cambier LS, Wertz PW, Downing DT. Dilutional effect of increased sebaceous gland activity on the proportion of linoleic acid in sebaceous wax esters and in epidermal acylceramides. J Invest Dermatol 1986; 87: 733-736.
https://doi.org/10.1111/1523-1747.ep12456856 DOI: https://doi.org/10.1111/1523-1747.ep12456856
Agrawal K, Hassoun LA, Foolad N, Borkowski K, Pedersen TL, Sivamani RK, et al. Effects of atopic dermatitis and gender on sebum lipid mediator and fatty acid profiles. Prostaglandins Leukot Essent Fatty Acids 2018; 134: 7-16.
https://doi.org/10.1016/j.plefa.2018.05.001 DOI: https://doi.org/10.1016/j.plefa.2018.05.001
Ottaviani M, Camera E, Picardo M. Lipid mediators in acne. Mediators Inflamm 2010; 2010.
https://doi.org/10.1155/2010/858176 DOI: https://doi.org/10.1155/2010/858176
Choi CW, Choi JW, Park KC, Youn SW. Facial sebum affects the development of acne, especially the distribution of inflammatory acne. J Eur Acad Dermatol Venereol 2013; 27: 301-306.
https://doi.org/10.1111/j.1468-3083.2011.04384.x DOI: https://doi.org/10.1111/j.1468-3083.2011.04384.x
Danby SG, Andrew PV, Brown K, Chittock J, Kay LJ, Cork MJ. An investigation of the skin barrier restoring effects of a cream and lotion containing ceramides in a multi-vesicular emulsion in people with dry, eczema-prone, skin: the RESTORE study phase 1. Dermatol Ther (Heidelb) 2020; 10: 1031-1041.
https://doi.org/10.1007/s13555-020-00426-3 DOI: https://doi.org/10.1007/s13555-020-00426-3
Li X, He C, Chen Z, Zhou C, Gan Y, Jia Y. A review of the role of sebum in the mechanism of acne pathogenesis. J Cosmet Dermatol 2017; 16: 168-173.
https://doi.org/10.1111/jocd.12345 DOI: https://doi.org/10.1111/jocd.12345
Yin H, Qiu Z, Zhu R, Wang S, Gu C, Yao X, et al. Dysregulated lipidome of sebum in patients with atopic dermatitis. Allergy 2023; 78: 1524-1537.
https://doi.org/10.1111/all.15569 DOI: https://doi.org/10.1111/all.15569
Firooz A, Gorouhi F, Davari P, Atarod M, Hekmat S, Rashighi-Firoozabadi M, et al. Comparison of hydration, sebum and pH values in clinically normal skin of patients with atopic dermatitis and healthy controls. Clin Exp Dermatol 2007; 32: 321-322.
https://doi.org/10.1111/j.1365-2230.2007.02364.x DOI: https://doi.org/10.1111/j.1365-2230.2007.02364.x
Wirth H, Gloor M, Stoika D. Sebaceous glands in uninvolved skin of patients suffering from atopic dermatitis. Arch Dermatol Res 1981; 270: 167-169.
https://doi.org/10.1007/BF00408228 DOI: https://doi.org/10.1007/BF00408228
Abdelmaksoud A, Lotti T, Anadolu R, Goldust M, Ayhan E, Dave DD, et al. Low dose of isotretinoin: a comprehensive review. Dermatol Ther 2020; 33: e13251.
https://doi.org/10.1111/dth.13251 DOI: https://doi.org/10.1111/dth.13251
Colgecen E, Ozyurt K, Ferahbas Kesikoglu A. The effect of systemic isotretinoin treatment on skin biophysicalparameters among patients with acne vulgaris. Turk J Med Sci 2016; 46: 1641-1644.
https://doi.org/10.3906/sag-1507-31 DOI: https://doi.org/10.3906/sag-1507-31
Lee SD, Ahn HJ, Shin MK. A case series of acne following Janus kinase inhibitors in patients with atopic dermatitis. JAAD Case Rep 2022; 30: 11-16.
https://doi.org/10.1016/j.jdcr.2022.09.029 DOI: https://doi.org/10.1016/j.jdcr.2022.09.029
Halling AS, Jemec GBE, Linneberg A, Thyssen JP. No association between atopic dermatitis and acne vulgaris in the general population. J Eur Acad Dermatol Venereol 2021; 35: e276-e278.
https://doi.org/10.1111/jdv.17040 DOI: https://doi.org/10.1111/jdv.17040
Thyssen JP, Nymand LK, Maul JT, Schmid-Grendelmeier P, Wu JJ, Thomsen SF, et al. Incidence, prevalence and risk of acne in adolescent and adult patients with atopic dermatitis: a matched cohort study. J Eur Acad Dermatol Venereol 2022; 36: 890-896.
https://doi.org/10.1111/jdv.18027 DOI: https://doi.org/10.1111/jdv.18027
WHO Collaborating Centre for Drug Statistics Methodology, Guidelines for ATC classification and DDD assignment 2022. [Accessed Mars 10, 2022] Available from: https://www.whocc.no/atc_ddd_index/
World Health Organization (WHO) - I nternational Classification of Primary Care, Second edition (ICPC-2). [Accessed date Mars 10, 2022] Available from: https://www.whocc.no/atc_ddd_index/
Norwegian Government. Statistics Norway (Statistisk Sentralbyrå). [Accessed April 4, 2022] Available from http://www.ssb.no/en.
Helsedirektoratet. Isotretinoin (Vedlegg 1 til § 5-14). [Accessed date November 18, 2022] Available from https://www.helsedirektoratet.no/rundskriv/kapittel-5-stonad-ved-helsetjenester/vedlegg-1-til--5-14-legemiddellisten/virkestoffer/isotretinoin.
Felleskatalogen. [Accessed September 5, 2022] Available from https://www.felleskatalogen.no/medisin/isotretinoin-orifarm-orifarm-generics-560319.
Larsson PA, Lidén S. Prevalence of skin diseases among adolescents 12-16 years of age. Acta Derm Venereol 1980; 60: 415-423.
https://doi.org/10.2340/0001555560415423 DOI: https://doi.org/10.2340/0001555560415423
Roh YS, Huang AH, Sutaria N, Choi U, Wongvibulsin S, Choi J, et al. Real-world comorbidities of atopic dermatitis in the US adult ambulatory population. J Am Acad Dermatol 2022; 86: 835-845.
https://doi.org/10.1016/j.jaad.2021.11.014 DOI: https://doi.org/10.1016/j.jaad.2021.11.014
Sun D, Ong PY. Infectious complications in atopic dermatitis. Immunol Allergy Clin North Am 2017; 37: 75-93.
https://doi.org/10.1016/j.iac.2016.08.015 DOI: https://doi.org/10.1016/j.iac.2016.08.015
Davis DMR, Drucker AM, Alikhan A, Bercovitch L, Cohen DE, Darr JM, et al. American Academy of Dermatology Guidelines: awareness of comorbidities associated with atopic dermatitis in adults. J Am Acad Dermatol 2022; 86: 1335-1336.e1318.
https://doi.org/10.1016/j.jaad.2022.01.009 DOI: https://doi.org/10.1016/j.jaad.2022.01.009
Prevost N, English JC. Isotretinoin: update on controversial issues. J Pediatr Adolesc Gynecol 2013; 26: 290-293.
https://doi.org/10.1016/j.jpag.2013.05.007 DOI: https://doi.org/10.1016/j.jpag.2013.05.007
Alshammari S, Alamari Y, Alazani A, Almuhanna S, Pinjabi L, Alsnadi N. Prevalence and associated risk factors of acne relapse among Saudi acne vulgaris patients using isotretinoin. Saudi Pharm J 2020; 28: 374-379.
https://doi.org/10.1016/j.jsps.2020.01.019 DOI: https://doi.org/10.1016/j.jsps.2020.01.019
Laquieze S, Czernielewski J, Rueda M-J. Beneficial effect of a moisturizing cream as adjunctive treatment to oral isotretinoin or topical tretinoin in the management of acne. J Drugs Dermatol 2006; 5: 985-990.
King T, McKenna J, Alexandroff AB. Alitretinoin for the treatment of severe chronic hand eczema. Patient Prefer Adherence 2014; 8: 1629-1634.
https://doi.org/10.2147/PPA.S38830 DOI: https://doi.org/10.2147/PPA.S38830
Biset N, Lelubre M, Senterre C, Amighi K, Bugnon O, Schneider MP, et al. Assessment of medication adherence and responsible use of isotretinoin and contraception through Belgian community pharmacies by using pharmacy refill data. Patient Prefer Adherence 2018; 12: 153-161.
https://doi.org/10.2147/PPA.S149355 DOI: https://doi.org/10.2147/PPA.S149355
Rademaker M. Isotretinoin: dose, duration and relapse. What does 30 years of usage tell us? Australas J Dermatol 2013; 54: 157-162.
https://doi.org/10.1111/j.1440-0960.2012.00947.x DOI: https://doi.org/10.1111/j.1440-0960.2012.00947.x
Smith Jervelund S, De Montgomery CJ. Nordic registry data: value, validity and future. Scand J Public Health 2020; 48: 1-4.
https://doi.org/10.1177/1403494819898573 DOI: https://doi.org/10.1177/1403494819898573
Norrlid H, Hjalte F, Lundqvist A, Svensson A, Tennvall GR. Cost-effectiveness of maintenance treatment with a barrier-strengthening moisturizing cream in patients with atopic dermatitis in Finland, Norway and Sweden. Acta Derm Venereol 2016; 96: 173-176.
https://doi.org/10.2340/00015555-2221 DOI: https://doi.org/10.2340/00015555-2221
Mulder B, Groenhof F, Kocabas LI, Bos HJ, De Vries TW, Hak E, et al. Identification of Dutch children diagnosed with atopic diseases using prescription data: a validation study. Eur J Clin Pharmacol 2016; 72: 73-82.
https://doi.org/10.1007/s00228-015-1940-x DOI: https://doi.org/10.1007/s00228-015-1940-x
Ortqvist AK, Lundholm C, Wettermark B, Ludvigsson JF, Ye W, Almqvist C. Validation of asthma and eczema in population-based Swedish drug and patient registers. Pharmacoepidemiol Drug Saf 2013; 22: 850-860.
https://doi.org/10.1002/pds.3465 DOI: https://doi.org/10.1002/pds.3465
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