Effect of systemic Retinoids on Lipid Profile in patients with dermatological diseases.
Journal Title: International Journal of Medical Science and Innovative Research (IJMSIR) - Year 2019, Vol 4, Issue 1
Abstract
Many drugs besides lipid-lowering drugs affect serum lipid levels in either a potentially harmful or beneficial way, and may therefore increase or decrease the risk of vascular disease. Oral retinoids like isotretinoin and acitretin are among the drugs of choice for treating dermatological diseases and long term usage may cause common side effects such as serum lipid alterations, hepatotoxicity, pancreatitis, and skeletal deformities. In several cases of retinoid therapy, drug induced hypertriglyceridaemia have been reported. To investigate the effect of systemic retinoids usage and response in changes occur in the lipid profile after treatment, we conducted an open clinical intervention study on eighty dermatological patients admitted to our outpatient department. At the end of treatment at 12th week, 9 patients (11.25%) showed increase in Serum triglyceride levels, 5 patients (6.25%) with elevated serum cholesterol levels. 3 patients (3.75%) had decrease in HDL levels. Triglycerides were more often and elevated earlier than cholesterol 14 (17.5%) Vs 9 (11.25%). Our study concludes that alteration in lipid levels is not significant while on treatment with retinoid therapy. Only such people who had predisposing factors >3 should be carefully monitored with lipid levels and if drug use is expected to be long term, the existing guidelines for the management of dyslipidaemia has to be followed. In cases of extreme hyperlipidaemia, medication use should be reassessed. Introduction Retinoids are synthetic and natural analogues of vitamin A involved in diverse biological activities and mediated by their ability to bind to complex groups of intra nuclear receptors- retinoic acid A receptors (RARs) and retinoic acid X receptors (RXRs).1 The introduction of retinoids has virtually revolutionized medical therapy in dermatology. Retinoids regulate various biologic functions, cell proliferation and differentiation, alter cell cohesiveness and possess antikeratinization properties. They exhibit anti-acne and anti-seborrheic effects, have immunologic, anti-inflammatory and anti-proliferative functions and are involved in the induction of apoptosis, tumor prevention, and affect extracellular matrix.2 Systemic retinoids are classified into three generations. Tretinoin and Isotretinoin are considered as first generation retinoids; the aromatic retinoids Etretinate, and its active metabolite Acitretin as second generation retinoids. Bexarotene and Alitretinoin are the third generation retinoid.3 Isotretinoin inhibits sebaceous gland activity and promotes normalization of epidermal differentiation. Additionally it also has anti-inflammatory and antibacterial effects. It is FDA-approved, and considered as a gold standard in the treatment of severe nodular, recalcitrant acne and acne scarring.4 The Indications for using isotretinoin in acne has expanded.5 Therefore it can be concluded that the usage of isotretinoin will become more common in future. The use of Acitretin in dermatology has been approved by FDA in conditions like Psoriasis vulgaris and Mycosis fungoides. Other off label indications includes Follicular disorders, Keratinization disorders, inflammatory disorders and chemoprevention of certain malignancies. Retinoids are associated with a spectrum of idiosyncratic and dose dependent side effects.The most common laboratory abnormality observed in patients taking systemic retinoids is elevation in serum lipids, especially triglyceride levels. Alteration in lipid levels have been grouped as a very common side effect (occurring in >1/10 patients).6 Isotretinoin, Etretinate and Acitretin elevate triglycerides in 50% of patients and cholesterol in 30%. Bexarotene elevates these levels in 79% of patients.7 Hyperlipidemia is proportional to the dose of retinoids and usually reverses within 4–8 weeks after discontinuation. In addition, HDL levels have been found to be decreased in about 40% of patients taking Acitretin. The LDL ⁄HDL ratio (atherogenic index) has been directly correlated to the risk of developing cardiovascular disease, and therefore fasting lipids should be regularly checked in all patients receiving treatment with Acitretin. These variations are more likely to occur in patients with predisposing factors such as Diabetes mellitus, Obesity, increased alcohol intake, or a family history of these conditions. Guidelines have been framed on the use of retinoids and to monitor for the lipid levels while on retinoids.8,9 There has been much debate as to whether Liver function tests and lipids should be monitored while on therapy. There is a paucity of literature especially involving the Indian population where the prevalence of hyperlipidemia and Metabolic Syndrome is significantly high in the general population. The objective of this study is to evaluate the Lipid profile changes in patients who are on treatment with Tab Isotretinoin and Tab Acitretin.
Authors and Affiliations
Dr. Bhanu Prakash
Keywords
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