John Barbieri, MD, MBA Hospital & Health Care University of Pennsylvania 

Blood Test Abnormalities Rare During Isotretinoin Treatment for Cystic Acne Interview with:

John Barbieri, MD, MBA Hospital & Health Care University of Pennsylvania 

Dr. Barbieri

John Barbieri, MD, MBA
Hospital & Health Care
University of Pennsylvania What is the background for this study? Would you briefly describe the type of acne treated with Isotretinoin?

Response: Isotretinoin is often used to treat moderate to severe acne or acne that has been unresponsive to other treatments. It is also used for patients with scarring acne. While highly effective for acne, due to concerns about medication related side-effects, patients are often monitoring with frequent blood tests, sometimes up to once per month.

However, there have been several studies over the past two decades questioning the value of these frequent blood tests for patients on isotretinoin for acne. The purpose of this study was to examine whether blood test monitoring has been decreasing over time in response to these studies. We also evaluated the frequency of blood test abnormalities for patients being treated with isotretinoin. What are the main findings? 

Response: In our cohort of 1,863 patients, blood test abnormalities were extremely rare, occurring in fewer than 1% of patients screened. Notably, no blood count abnormalities were detected. In addition, we found that blood test monitoring remains common. We conservatively estimated that if we were to reduce the frequency of blood testing as has been suggested, we could decrease costs of isotretinoin monitoring in the United States by approximately $17 million per year. What should readers take away from your report?

Response: These results highlight that there is likely an opportunity to decrease blood test monitoring among patients being treated with isotretinoin. In particular, there may be no value to complete blood count testing, which suggests it should be eliminated completely. Since acne commonly affects younger individuals who may be bothered by frequent needle sticks for blood testing, reducing this monitoring may improve quality of care and decrease costs. Unfortunately, we also found that the use of frequent blood test monitoring has not been decreasing substantially over time. Therefore, it will be important to consider how we can better align clinical practice with the available evidence. Some potential strategies include stronger clinical guideline statements clearly outlining the opportunity to reduce blood test monitoring or other educational initiatives. What recommendations do you have for future research as a result of this work? 

Response: Future studies are needed to evaluate how often blood test abnormalities are meaningful to patient management, as an abnormal test result may not be due to the medication. Particularly liver function testing may be capturing abnormalities unrelated to treatment, as they are just as common before starting the medication as on treatment. In addition, studies are needed regarding how to align clinician behavior with the accumulating evidence that this frequent blood test monitoring may be of low value. 

I have no conflicts of interest to declare 


The Clinical Utility of Laboratory Monitoring During Isotretinoin Therapy for Acne and Changes to Monitoring Practices Over Time
Barbieri, John S. et al.
Journal of the American Academy of Dermatology, Volume 0, Issue 0 

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Last Updated on July 8, 2019 by Marie Benz MD FAAD