The Latest Updates in Isotretinoin With Emmy Graber, MD
Dermatology Times® spoke with Emmy Graber, MD, MBA, the Founder and President of the Dermatology Institute of Boston, about her recent session at SCALE 2023, “Isotretinoin Update: What’s Changed in the Last 2 Years.” During her session, Graber covered isotretinoin- Topics include recommended dosage, isotretinoin laboratory monitoring guidelines, and the use of over-the-counter antihistamines in conjunction with isotretinoin to improve acne and reduce adverse events.
transcript
digger: My name is Dr. Emmy Graber and I live in private practice at the Dermatology Institute of Boston in Boston, Massachusetts. I am also a Clinical Associate at Northeastern University.
Dermatology Times: What are the key highlights of your session “Isotretinoin Updates: What Has Changed in the Last 2 Years?”
digger: Today I talked about isotretinoin updates and what has changed in the last two years and I covered a few different topics. First I talked about isotretinoin and dosing and what is the correct endpoint for dosing isotretinoin? How long should a course be? Should we move to a specific cumulative dose? Or is there perhaps new evidence that suggests we should wait two months after a patient has cleared acne lesions before stopping isotretinoin? I’ve talked not only about dosing and the endpoint of therapy, but also about labs because I think we all monitor labs differently in patients taking isotretinoin. And there’s a new Delphi consensus paper that came out recently in the last few years and they asked a group of acne experts how they check labs and they agreed on some guidelines for lab monitoring. It was agreed that LT should be reviewed at baseline and after reaching the maximum daily dose. The same applies to triglycerides at baseline and after reaching the maximum daily dose, but not necessarily monthly and not necessarily at the end of treatment. There was no consensus on creatine kinase monitoring or cholesterol monitoring and some other labs. And in my talk today I may have talked about a suggestion that we should check creatine kinase to prevent or detect rhabdomyolysis in some patients who are at risk of rhabdomyolysis. I also talked about a recent study looking at using over-the-counter antihistamines in conjunction with isotretinoin for better acne improvement, reducing some side effects, and also preventing the initial flare-up. I also reviewed a recent study on alopecia and isotretinoin which suggests that alopecia may be slightly more common with some of the higher doses, typically around 5% of patients taking isotretinoin. So that was my overview of isotretinoin and the updates in the literature.
Dermatology Times: What do you like about SCALE 2023 so far?
digger: What I really like about SCALE is the speed. And that it goes quickly from one speaker to the next. And these really are some of the world’s most important opinion leaders on their various topics in dermatology, whether it’s cosmetic dermatology or general dermatology. It’s great to hear from some of the leading leaders in this field.
[Transcript edited for clarity]