The Latest Updates in Isotretinoin With Emmy Graber, MD

Graber discusses isotretinoin dosing and monitoring pearls at SCALE 2023.

Dermatology Times® spoke with Emmy Graber, MD, MBA, the founder and president of the Dermatology Institute of Boston, on her recent session at SCALE 2023, “Isotretinoin Update: What Has Changed Over the Last 2 Years.” During her session, Graber covered isotretinoin topics including recommended dosing, isotretinoin lab monitoring guidelines, and the use of over-the-counter antihistamines in conjunction with isotretinoin for improved acne and reduced adverse events.


Graber: My name is Dr. Emmy Graber, and I am in private practice at the Dermatology Institute of Boston in Boston, Massachusetts. And I am also an affiliate clinical instructor at Northeastern University.

Dermatology Times: What are the key highlights from your session, "Isotretinoin Updates: What Has Changed Over the Last 2 Years?"

Graber: So today I talked about isotretinoin updates and what has changed in the last 2 years and I covered a few different topics. First, I talked about isotretinoin and dosing and what is the right endpoint for dosing isotretinoin? How long should a course be? Should we go to a certain cumulative dose? Or perhaps there's some new evidence that suggests that we may want to go 2 months after a patient is clear of acne lesions before stopping their isotretinoin? In addition to talking about dosing and the endpoint of therapy, I also talked about labs because I think we all monitor laboratory values differently in patients on isotretinoin. And there's a new Delphi consensus paper that was recently published within the last couple of years, and they asked a group of acne experts how they check labs and they came to an agreement on some lab monitoring guidelines. The agreements were that an LT should be checked at baseline and once the maximum daily dose is reached. Similarly, for triglycerides at baseline, and once the maximum daily dose is reached, but not necessarily monthly and not necessarily at the end of treatment. There was no consensus for monitoring creatine kinase, or monitoring cholesterol and some other labs. And in my talk today, I talked about perhaps a suggestion that we may want to check creatine kinase to prevent or check for rhabdomyolysis in some patients who may be at risk for that. I also talked about a newer study that looks at the use of over-the-counter antihistamines using those in conjunction with isotretinoin to get better improvement in the acne, reduction of some of the side effects, and also prevention of the initial flare. I also reviewed a recent study looking at alopecia and isotretinoin that suggests that perhaps at some of the higher doses, alopecia is slightly more common, usually around 5% of patients on isotretinoin. And so that was my review of isotretinoin and what are the updates in the literature.

Dermatology Times: What are you enjoying so far about SCALE 2023?

Graber: What I really like about SCALE is how fast-paced it is. And that it quickly goes from one speaker to the next. And these are really some of the world's key opinion leaders on their various subject matters in dermatology, whether it's cosmetic dermatology related or general dermatology related. It's great to hear from some of the foremost leaders in the field.

[Transcript edited for clarity]

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