Creatine Phosphokinase Values during Low Starting Dose Isotretinoin Therapy

Marco Manfredini; Vincenzo Bettoli; Riccardo Forconi; Lucrezia Pacetti; Francesca Farnetani; Monica Corazza; Giovanni Pellacani

doi:10.1159/000507455

Creatine Phosphokinase Values during Low Starting Dose Isotretinoin Therapy

Skin Appendage Disord. 2020 Jun;6(3):142-146. doi: 10.1159/000507455. Epub 2020 May 5.

Authors

Marco Manfredini^{1

2}, Vincenzo Bettoli², Riccardo Forconi², Lucrezia Pacetti², Francesca Farnetani¹, Monica Corazza², Giovanni Pellacani¹

Affiliations

¹ Department of Surgical, Medical, Dental & Morphological Sciences with Interest Transplant, Oncological & Regenerative Medicine, Dermatology Unit, University of Modena & Reggio Emilia, Modena, Italy.
² Department of Medical Sciences, Section of Dermatology, University of Ferrara, Ferrara, Italy.

Abstract

Background: The value of creatine phosphokinase (CPK) monitoring during isotretinoin therapy is still a matter of debate because of the rarity of muscular and kidney damage in this setting. The aim of the study was to investigate the incidence of CPK elevation during a low starting dose isotretinoin regimen and to discuss the clinical approach to patients with increased CPK.

Methods: We reviewed the records of the acne patients from 2015 to 2018 at the University of Ferrara and at the University of Modena and Reggio Emilia. Routine clinical and laboratory follow-up was analyzed.

Results: The records of 328 patients were included in the study. Abnormal CPK levels were observed in 5.5% of cases. Revised Leeds acne scores and visual assessment scale (VAS) measurements decreased significantly after isotretinoin therapy.

Discussion: The adoption of the low starting dose isotretinoin regimen is associated with low incidence of CPK elevation. The finding of CPK over the conventional value of 5 times above the limit was rarely observed and was never associated with kidney damage. Therefore, it should be interpreted as a relatively benign phenomenon that does not require the interruption of isotretinoin therapy and that should be managed mainly through the reassurance of the patient.

Keywords: Acne; Creatine phosphokinase; Isotretinoin; Laboratory values; Muscle enzymes; Rhabdomyolysis.