الفهرس 
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Abstract
Acne vulgaris is one of the most common skin disorders which mainly affect females at the adolescence age. It is a multifactorial chronic inflammatory disease which is considered as one of the top three most prevalent skin conditions. Many different options are availablefor acne treatment but oral isotretinoin is considered to be the best choice.
Isotretinoin counteracts all the pathogenic factors leading to acne development by reducing the sebaceous gland size, reducing the comedogenesis and making a dramatical reduction in sebum excretion rateso it produces complete clearing of acne.
Isotretinoin affects the entire body systematically causing mucocuteanous dryness in skin, lips and eyes, mood changes, musculoskeletal effect and abnormal lab investigations including elevation in serum liver enzymes and cholesterol. It has numerous drug interactions with food and other drugs as it has a lipophilic structure. This drug is contraindicated in pregnancy as it causes malformations for the fetus.Although isotretinoin has many adverse effects, it is considered a very effective drug in acne treatment.
The current study was conducted tostudy oral isotretinoin and its associationwith liver function and cholesterol serum level among acne patients, estimate the proportion of elevated liver enzymes and elevated cholesterol in patients treated with the drug, identify the factors associated with elevated liver enzymes and cholesterol in patients treated with the drug and explore other side effects of oral isotretinoin.
The study was conducted using a cross sectional design. It included 285 patients taking the drug for 1 month or more with a baseline laboratory investigation (liver enzymes and cholesterol) before starting treatment. Patients having history of hypercholesterolemia or any disease affecting the liver or discontinued the drug or those who have already started the drug without making the baseline laboratory investigations were excluded.
A structured interviewing questionnaire was used to collect data from patients including their personal data, pattern of use of the drug, associated diseases, history of drugs intake before starting the isotretinoinand a present history of patients. Also, patients Health Questionnaire-9 was used to assess the severity of depression following the intake of the drug.
Liver enzymes and cholesterol serum level were assessed in acne patients before and afterusing the drug and patients were classified using the United State National Cancer Institute classification.
The study revealed the following main results:
• More than two thirds (68.4%) of the acne patients were females and themean age was 20.84±3.4 years. Three quarters of them were eating chocolates,the same percent were eating oily and fatty foods and 69.8% of cases were eating junk foods and more than half (57.9%) of them were having a family history of acne.
• Regarding the pattern of using the drug, more than one third (36.8%) of cases were taking 80mg/day and nearly the same percent (37.2%) of cases were taking 40 mg/day. Nearly onefifth (20.4%) of the cases were taking it for 2 months, about one third (30.2%) of the cases were taking it for 3 months and 36.5% of the cases were taking the drug for 4-6 months.All cases suffered from adverse effects of the drug, most of them suffered from chelitis,increased acne, dry eyes and muscle aches.Those who suffered from mild depression constituted 16.8%.
• Half of the females were asked to make pregnancy tests, 88.8% of the doctors discussed the instructions of using the drug.
• Almost 30% of the cases had elevation in ALT level, 23.2% had elevation in AST level and 21.1% of the cases had elevation in cholesterol level.
• Nearly two fifths(39%) of those taking 80 mg/day of the drug, half of those taking the drug for 4-6 months and more than two thirds of those eating junk, chocolates and fatty food had elevation in ALT level.
• More than third (37%) of cases taking 80 mg/day of the drug, half (52%) of those taking the drug for 4-6 months and more than three quarters of those eating junk food and chocolates had elevation in AST level.
• While nearly third(33.3%) of those taking 80 mg/day of the drug, 46.2% of those taking the drug for 4-6 months and nearly three quarters of those eating fatty, junk and chocolates had elevation in cholesterol level.
It was concluded from the present study that:
• Acne is more prevalent among females in adolescent age, patients eating chocolates, junk, oily and fatty foods.
• Isotretinoin has a numerous side effects. There was a significant difference in level of liver enzymes and serum cholesterol level before and after using the drug.
• Physicians have informed their patients about the drug usage, dose and duration.
• The dose, duration of taking the drug and the daily diet (chocolates, oily, fatty and junk food) are the factors most commonly affecting the elevation of the serum liver enzymes and cholesterol level.
• There was a weak positive correlation between the dose of the drug, the duration of taking the drug and the elevation in the serum liver enzymes and cholesterol level.
The most important recommendations of the study were:
• Baseline liver enzymes and serum cholesterol level tests should be done before starting treatment and follow up should be done during treatment period.
• Pregnancy test should be done before starting treatment and contraception should be used during treatment.
• Patients should inform their physician about any side effect they feel during taking the drug.
• The physician should monitor the dose, the duration of the drug and the daily meals given to their patients.
• Further liver and lipids tests should be done to check the effect of the drug on different body systems.
• Adverse effects of the drug should be discussed with the patients.