Almuzaini Hanan Ibrahim, Alamri Ali Saeed, Almuzaini Razan Ibrahim
From the General and Specialized Surgery Department (Almuzaini), Head and Neck Surgery, College of Medicine, Taibah University, Al Madina Al Munawwarah; from the Department of Dermatology and Venereology (Alamri), Security Forces Hospital; and from Alhaya Medical Company (Almuzaini), Riyadh, Kingdom of Saudi Arabia.
Saudi Med J. 2024 Dec;45(12):1347-1354. doi: 10.15537/smj.2024.45.12.20240791.
To assess the prevalence and risk factors of isotretinoin-related epistaxis, among patients of acne vulgaris.
A retrospective cohort of 230 Saudi patients who received isotretinoin for treatment of acne vulgaris, was included in the study. An online questionnaire was used to collect data regarding demographics and treatment-related adverse events.
The prevalence of isotretinoin-induced epistaxis was found to be 45.2%, which was a 5-fold increase in epistaxis, versus baseline. Epistaxis was reported by 90% patients who had a prior history of nasal bleeding. Patients with 'obstructed nose', reported a prevalence of 68.8%. The large majority of patients had a mild form of epistaxis, while nearly one-fourth reported moderate severity. A small subgroup of patients reported severe epistaxis warranting emergency room (ER) visits and blood transfusion. A staggering 93.5% and 61.3% patients were not advised by their dermatologists, regarding the importance of an ear-nose-throat (ENT) specialist consultation and nasal moisturization respectively, while taking isotretinoin.
The prevalence of isotretinoin-induced epistaxis is significantly high among Saudi patients; the complication can affect nearly half of the patients receiving this drug. Key risk factors include a prior history of nasal bleeding, nasal obstruction, poor awareness regarding the nasal adverse effects of epistaxis and its preventive measures. Isotretinoin should be prescribed judiciously by dermatologists, in consultation with ENT specialists, and with adequate patient education regarding its potential nasal adverse effects and steps to mitigate the same.
评估寻常痤疮患者中异维A酸相关鼻出血的患病率及危险因素。
本研究纳入了230名接受异维A酸治疗寻常痤疮的沙特患者的回顾性队列。通过在线问卷收集有关人口统计学和治疗相关不良事件的数据。
发现异维A酸引起的鼻出血患病率为45.2%，与基线相比，鼻出血增加了5倍。有鼻出血既往史的患者中有90%报告了鼻出血。“鼻塞”患者的患病率为68.8%。绝大多数患者为轻度鼻出血，而近四分之一的患者报告为中度严重程度。一小部分患者报告了严重鼻出血，需要前往急诊室就诊并输血。令人震惊的是，分别有93.5%和61.3%的患者在服用异维A酸时，皮肤科医生未就耳鼻喉科（ENT）专科会诊的重要性和鼻腔保湿向他们提供建议。
在沙特患者中，异维A酸引起的鼻出血患病率显著较高；这种并发症几乎会影响近一半接受该药物治疗的患者。关键危险因素包括鼻出血既往史、鼻塞、对鼻出血的鼻腔不良反应及其预防措施认识不足。皮肤科医生应在与耳鼻喉科专家协商后谨慎开具异维A酸处方，并对患者进行充分的教育，告知其潜在的鼻腔不良反应以及减轻这些反应的措施。
