Sibi Krishna Thiyagarajan, Kaur Ravneet, Malhotra Vani, Fatima Zaineb, Mustajab Manahil, Singh Tarundeep, Iqbal Mahrukh, Kesavan Trisha, Ajeya S P, Mathew S Grace, Singh Mansi
Department of Medicine, University of Perpetual Help System Dalta, Rizal, Philipines.
Department of Medicine, Lady Hardinge Medical College, New Delhi, India.
Ann Med Surg (Lond). 2025 May 20;87(7):4395-4403. doi: 10.1097/MS9.0000000000003366. eCollection 2025 Jul.
Isotretinoin, or 13-cis retinoic acid, is prescribed to treat moderate to severe recalcitrant nodulocystic acne that remains untreated with other drugs, such as antibiotics. The adverse effect profile of isotretinoin has raised concerns since studies have reported a substantial elevation in the low-density lipoprotein (LDL)/high-density lipoprotein (HDL) ratio, indicating the risk of cardiovascular diseases after a long-term course of isotretinoin. Assessing the impact of isotretinoin on lipid profile markers in acne patients was the aim of this systematic review.
Various databases, such as PubMed, Google Scholar, SCOPUS, Embase, and Web of Science, were comprehensively searched to identify relevant clinical studies. Ten articles out of 256 were selected based on the inclusion and exclusion criteria by two independent reviewers. Each review was thoroughly evaluated using Assessment of the Methodological Quality of Systematic Reviews and the Newcastle-Ottawa Scale.
A decrease in HDL was observed, whereas total cholesterol, triglyceride, and LDL levels were notably elevated. However, most changes in lipid profile parameters are non-progressive, and their clinical significance is poorly understood. Liver enzyme levels, including aspartate transaminase and alanine transaminase, were altered to a lesser degree.
Long-term use of isotretinoin is associated with mild alterations in the lipid profile, resulting in increased total cholesterol, triglyceride, and LDL levels. However, since lipid alterations vary depending on factors such as the population studied, dosage, and duration of isotretinoin treatment, regular monitoring of the lipid profile along with low density lipoprotein is recommended to avoid potential risk factors of isotretinoin on lipid metabolism and, thereafter, on the cardiovascular system, but is not deemed paramount.
异维A酸，即13 - 顺式维甲酸，被用于治疗中度至重度难治性结节囊肿性痤疮，这类痤疮用其他药物（如抗生素）治疗无效。自研究报告长期服用异维A酸后低密度脂蛋白（LDL）/高密度脂蛋白（HDL）比值大幅升高，提示有心血管疾病风险以来，异维A酸的不良反应情况引发了关注。本系统评价的目的是评估异维A酸对痤疮患者血脂指标的影响。
全面检索了多个数据库，如PubMed、谷歌学术、Scopus、Embase和科学网，以识别相关临床研究。由两名独立评审员根据纳入和排除标准从256篇文章中筛选出10篇。每项综述都使用系统评价方法学质量评估和纽卡斯尔 - 渥太华量表进行了全面评估。
观察到HDL降低，而总胆固醇、甘油三酯和LDL水平显著升高。然而，血脂参数的大多数变化是非进行性的，其临床意义尚不清楚。包括天冬氨酸转氨酶和丙氨酸转氨酶在内的肝酶水平变化较小。
长期使用异维A酸与血脂的轻度改变有关，导致总胆固醇、甘油三酯和LDL水平升高。然而，由于血脂改变因所研究人群、剂量和异维A酸治疗持续时间等因素而异，建议定期监测血脂及低密度脂蛋白，以避免异维A酸对脂质代谢以及随后对心血管系统产生潜在风险因素，但这并非至关重要。
