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Role of Oral Nutraceuticals as Adjunctive Therapy to Reduce Side Effects of Treatment With Isotretinoin
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- This systematic review evaluated evidence regarding the role of oral nutraceuticals as adjunctive therapy in patients with acne undergoing treatment with isotretinoin. The results from two randomized controlled trials indicated that the use of omega-3 fatty acids reduced rates of cheilitis and xerosis. The results from two other randomized controlled trials showed that the use of primrose oil, which contains omega-6 fatty acids, is associated with reduced transepidermal water loss, improved skin hydration, and improvement in xerotic cheilitis. Furthermore, the results from one trial showed that zinc 1 mg/kg/day reduced overall treatment-related side effects and cheilitis.
- Omega-3 fatty acids, primrose oil, and zinc may all reduce mucocutaneous side effects of isotretinoin.
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersAlthough isotretinoin is a highly efficacious acne treatment associated with durable remission, adverse events such as mucocutaneous side effects are common and can result in treatment discontinuation. Since patients may be interested in natural and complementary therapies to alleviate these side effects, this review sought to evaluate the evidence regarding the role of oral nutraceuticals as adjunctive therapy with isotretinoin.
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The role of oral nutraceuticals as adjunctive therapy to reduce side effects from isotretinoin: A systematic review
J Am Acad Dermatol 2023 Oct 21;[EPub Ahead of Print], A Shields, S Ly, B Wafae, YF Chang, P Manjaly, M Archila, C Heinrich, L Drake, A Mostaghimi, J BarbieriFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
There is something about this article that makes me a bit uneasy. Isotretinoin is an amazing drug for acne that we have been using with great success for over 40 years. With time, we have become more comfortable with the safety of the drug, which requires less laboratory monitoring, for our patients and have questioned the potential links between isotretinoin and depression and inflammatory bowel disease. These cosmic shifts in the way that we prescribe and monitor isotretinoin are supported by mounds and mounds of data. I guess when it comes to this drug, I like mounds and mounds of data.
Mucocutaneous side effects are the most common side effects that we see with isotretinoin. I wonder whether they correlate with outcomes or they are just an annoyance that should become their own target for treatment. These are reasonable questions, and I applaud those who will move us toward answering these questions. But, I would also caution us against making sweeping recommendations to our isotretinoin prescribing habits based on very small studies, all of poor to fair quality. Out of the five studies of “fair” quality (vs “poor”), three were double-blind, two were with omega-3, and one was with evening primrose oil. These three studies enrolled fewer than 250 subjects combined. To be fair, these “fair” studies did show statistically significant reductions in mucocutaneous side effects.
It is unlikely that we will do harm with the addition of omega-3s to our patients using isotretinoin. Omega-3s can also decrease triglycerides, the most common laboratory abnormality in isotretinoin patients. But, is the difference worth it? Are there risks that we do not know about? Does it add unnecessary cost and complexity? Does it alter the outcome of treatment overall? Mounds and mounds of data do not happen overnight; maybe this is a start. But, I hope that we show some restraint and hold these nutraceuticals to the high standards that we expect and that our patients deserve.