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Dermatology Online Journal

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Laboratory tests in patients treated with isotretinoin: occurrence of liver and muscle abnormalities and failure of AST and ALT to predict liver abnormality


Current laboratory monitoring may not be optimal.A retrospective chart review was performed on thelaboratory results of 246 patients who were treatedwith isotretinoin for acne over a 9-year period. Testsobtained were CBC, lipid panel, AST, ALT, CK, GGT,and C-reactive protein. Thirty-five patients had anelevated AST and 35 of these had an elevated CK; 32had an elevated ALT and 11 of these had an elevatedCK. Thirteen patients had an elevated GGT; in 5 thiswas the only abnormality, whereas 8 had a GGTelevation accompanied by an elevated AST or ALT.Two had an elevated GGT and an elevated CK withnormal AST and ALT. Fifty-two patients had a singleepisode of elevated CK, of which 22 were female.However, 57 had multiple CK elevations and only onewas female. Thirty-five patients had CK elevations <2 times normal; 38 had levels between 2 and 3 timesnormal, 18 had levels between 3 and 4 times normal,and 18 had levels greater than 4 times normal. Wesuggest that ALT and AST are not useful for monitoringisotretinoin therapy and that GGT and CK may be ofgreater value in managing patients.

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