Acne is a common condition, affecting 83–95% of adolescents.
1 Oral isotretinoin is reserved for severe acne because
of the potential side-effects. We report a case of anaemia
due to B12 and folate deficiency developing 8 weeks after
treatment with isotretinoin for acne.
A 24-year-old woman presented with nodulocystic
scarring acne resistant to antibiotics. She was referred for
isotretinoin treatment. Fasting lipids and liver function test
were within normal limits. Full blood count was not
performed. Dietary history revealed that she did not eat red
meat, but was not a strict vegetarian. Apart from the acne,
she was otherwise well with no clinically evident anaemia.
She was commenced on isotretinoin 45 mg ⁄ day
(0.5 mg ⁄ kg ⁄ day).
On the eighth week of treatment, she started to feel tired
and dizzy. One week later, she felt sick, with epigastric pain,
vomiting and diarrhoea. On admission to hospital she
looked pale, with a pulse rate of 90 beats ⁄ min and normal
blood pressure and temperature. She had extensive crusting
around the mouth with erosions of the lips and redness
of the buccal mucosa. She also had multiple painful
perianal ulceration.
Investigations on admission showed haemoglobin of
7.0 g ⁄ dL and a mean cell volume of 110 fL. Her white
cell count was 8.2 · 10)9 ⁄ L and rapidly dropped to
3.1 · 10)9 ⁄ L in 5 days (neutrophil count 1.44 ·
10)9 ⁄ L). Platelet count, and renal and liver function
were within normal limits apart from an elevated bilirubin
of 22 lmol ⁄ L (reference range 1–17 lmol ⁄ L). Serum
folate was 1.3 mg ⁄ L (normal > 1.8 mg ⁄ L), vitamin B12
was 76 ng ⁄ L (reference range 140–650 ng ⁄ L) and
b-carotene was 0.04 lmol ⁄ L (reference range 0.1–
1 lmol ⁄ L). Anti-intrinsic factor, antiendomysial and antitransglutaminase
antibodies, and iron studies were normal.
...
bla bla
....
We report an interesting association between B12 and
folate deficiency anaemia with isotretinoin treatment for
acne. Our patient was clinically well before isotretinoin
treatment, and her symptoms stopped rapidly after discontinuation
of isotretinoin and initiation of B12 and folate
replacement. The mechanism of her B12 and folate
deficiency is not entirely clear. In this case, anaemia and
neutropenia occurred possibly because of B12 ⁄ folate defi-
ciency or direct drug toxicity. More likely, an accelerated
development of isotretinoin toxicity (with colitis) resulting
in B12 ⁄ folate deficiency anaemia in a marginally deficient
but clinically normal patient led to the development of the
symptoms. To our knowledge, this is the first case showing
this association
tino Beiträge: 2762 Registriert: November 2005 Ort: Europa
Reputation: 17
Power Member *****
Also nichts mit TGF-ß oder so.Hab gerade gelesen was du eingestellt hast,..schaut so aus als hätten die auch keinen Schimmer warum,bzw was genau das Isotretinoin gemacht hat..oder?