Changes in Plasma Lipids and Lipoproteins during Isotretinoin Therapy for Acne

Susan Bershad, Ardon Rubinstein, James R. Paterniti, Ngoc Anh le, Susana C. Poliak, Bruce Heller, Henry N. Ginsberg, Raul Fleischmajer, W. Virgil Brown

Research output: Contribution to journalArticlepeer-review


Abnormalities in plasma lipids are a recognized side effect of isotretinoin therapy for nodulocystic acne. We studied 60 patients during 20 weeks of isotretinoin therapy, to measure changes in plasma lipids and lipoproteins, to compare plasma lipid responses in men and women, and to determine whether there are alterations in levels of lipoprotein lipase or hepatic triglyceride lipase that could explain the development of isotretinoin-induced hypertriglyceridemia. Mean triglyceride levels rose in men and women, with maximum mean increases of 46.3 mg per deciliter (P<0.0001) and 52.3 mg per deciliter (P<0.002), respectively. The maximum level was reached by 4 weeks of therapy in men but not until the 12th week in women. Nine of 53 patients (17 per cent) completing 20 weeks of isotretinoin therapy acquired hypertriglyceridemia, with values of 200 to 600 mg per deciliter. Both men and women had significant increases in mean plasma levels of cholesterol and low-density-lipoprotein cholesterol and decreases in mean levels of high-density-lipoprotein cholesterol. There were no significant changes in mean levels of lipoprotein lipase or hepatic triglyceride lipase. Plasma lipid and lipoprotein levels returned to base line by eight weeks after discontinuation of the drug. If sustained over a long period, the change in the ratio of low-density-lipoprotein cholesterol to high-density-lipoprotein cholesterol that we observed, from 2.4 to 3.0 (P<0.0001), would predict an increased risk of cardiovascular disease. (N Engl J Med 1985; 313: 981–5.).

Original languageEnglish
Pages (from-to)981-985
Number of pages5
JournalNew England Journal of Medicine
Issue number16
StatePublished - 17 Oct 1985
Externally publishedYes


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