Isotretinoin causes low back pain
In a study published this week it was found that 50% of acne sufferers who are on isotretinoin medication (Roaccutance / Accutane) for more than 6 months, suffer from low back pain, with 8% of them suffering from acute inflammation of the sacroiliac joint in the low back/pelvis area.
Muscle pain was also reported in 42% of participants and lethargy (low energy levels) was reported by 50% of participants.
The authors conclude their report by stating that "the incidence of sacroiliitis in patients using isotretinoin is quite high. Patients using isotretinoin must be questioned about sacroiliitis findings and must be subject to advanced assessment when necessary. Further studies regarding the development of sacroiliitis under isotretinoin therapy are now needed."
Acne diet and medication
The most common acne treatments are either isotretinoin or contraceptives, both of which reduce sebum production. Acne and antibiotics also fight the acne-causing bacteria Propionibacterium Acnes.
A diet low in dairy products, saturated fat and sugar, and high in vegetables, fruit and lean protein is also beneficial in acne, and helps maximise the results of medication.
- Paper: The prevalence of sacroiliitis in patients with acne vulgaris using isotretinoin.
- Abstract: BACKGROUND/OBJECTIVE: Acne vulgaris is a chronic inflammatory disease affecting the pilosebaceous unit in the skin. Isotretinoin is a synthetic vitamin A derivative regarded as the most effective agent in the treatment of acne. There have recently been increasing reports of adverse effects of isotretinoin on the skeletal system. Our aim in this study was to evaluate the rheumatic side-effects triggered by this drug, and particularly the prevalence of sacroiliitis. MATERIALS AND METHODS: Seventy-three patients receiving isotretinoin due to moderate or severe acne vulgaris were included. All patients were questioned about inflammatory low back pain and musculoskeletal pains during the treatment process. Inflammatory low back pain was evaluated using Assessment of Spondyloarthritis International Society (ASAS) criteria. Patients meeting ASAS criteria were evaluated with radiography and when necessary with sacroiliac magnetic resonance. RESULTS: The dose range for isotretinoin was between 0.4 and 0.8 mg/kg/day (mean 0.53 mg/kg/day). Treatment lasted for 6-8 months (mean 6.8 months). Lethargy was determined in 37 (50.7%) patients, myalgia in 31 (42.5%) and low back pain in 36 (49.3%). Mechanical low back pain symptoms were present in 20 of the patients describing low back pain and inflammatory low back pain in 16. Acute sacroiliitis was determined in 6 patients (8.2%) following a sacroiliac MRI. Five (83.3%) of the patients with sacroiliitis were female and one (16.7%) was male. No statistically significant difference was determined between male and female patients in terms of prevalence of sacroiliitis (p: 0.392). CONCLUSION: The incidence of sacroiliitis in patients using isotretinoin is quite high. Patients using isotretinoin must be questioned about sacroiliitis findings and must be subject to advanced assessment when necessary. Further studies regarding the development of sacroiliitis under isotretinoin therapy are now needed.