Dr. Del Rosso added: "Oral isotretinoin can significantly reduce night vision. I am actually more concerned about that that is something that will happen to everyone. I document telling them they should not drive at night."
Inhibition of bone growth and an increased likelihood of depression are other major fears of patients and parents regarding isotretinoin that are not fully supported by evidence in the literature.
With respect to bone growth, Dr. Harper said: "There is not a lot of data out there." On the basis of a report of three cases, Dr. Harper said that premature closure of the epiphyses might be possible with a long duration of high doses of isotretinoin (JAAD 2001:45:S176-82).
"I have one [adolescent] patient who is very tall, a star basketball player, who could benefit from isotretinoin. His mom and dad heard about this [risk] and will not let him take it," Dr. Harper said.
Regarding isotretinoin and depression, Dr. Harper said, "Most of what we have out there are case reports, ‘n’s of 1 or small series." One notable exception is a large, population-based study where researchers assessed risk for depression and suicidality among 21,911 people prescribed isotretinoin or an antibiotic for acne (Arch. Dermatol. 2000;136:1231-6). "In summary, there was no difference between isotretinoin and minocycline [with respect to] development of depression," Dr. Harper said.
"When it comes to isotretinoin and depression, evidence is weak, but we have to be vigilant," Dr. Harper said. "Most of us have seen some cases where there is a change in mood – I’m not sure it’s depression – but it’s a small number [of patients]."
Dr. Harper and Dr. Del Rosso are consultants for and receive honoraria from Ranbaxy, which makes a generic form of isotretinoin. Dr. Thiers has supported Hoffman-La Roche in lawsuits concerning isotretinoin.