Isotretinoin Laboratory Monitoring in Acne Treatment: A Delphi Consensus Study

Eric Xia, Jane Han, Adam Faletsky, Hilary Baldwin, Katie Beleznay, Vincenzo Bettoli, Brigitte Dréno, Chee Leok Goh, Linda Stein Gold, Harald Gollnick, Maria Isabel Herane, Sewon Kang, Leon Kircik, Julianne Mann, Alexander Nast, Hazel H. Oon, Jo Ann See, Megha Tollefson, Guy Webster, Catherine ZipJerry Tan, Elliot B. Tapper, Diane Thiboutot, Andrea Zaenglein, John Barbieri, Arash Mostaghimi

Research output: Contribution to journalArticlepeer-review


Importance: Although isotretinoin may rarely be associated with laboratory abnormalities such as hypertriglyceridemia, the optimal approach to laboratory monitoring is uncertain, and there is wide variation in clinical practice. Objective: To establish a consensus for isotretinoin laboratory monitoring among a diverse, international cohort of clinical and research experts in acne. Design, Setting, and Participants: Using a modified electronic Delphi process, 4 rounds of anonymous electronic surveys were administered from 2021 to 2022. For laboratory tests reaching consensus (≥70% agreement) for inclusion, questions regarding more time-specific monitoring throughout isotretinoin therapy were asked in subsequent rounds. The participants were international board-certified dermatologist acne experts who were selected on a voluntary basis based on involvement in acne-related professional organizations and research. Main Outcomes and Measures: The primary outcome measured was whether participants could reach consensus on key isotretinoin laboratory monitoring parameters. Results: The 22 participants from 5 continents had a mean (SD) time in practice of 23.7 (11.6) years and represented a variety of practice settings. Throughout the 4-round study, participation rates ranged from 90% to 100%. Consensus was achieved for the following: check alanine aminotransferase within a month prior to initiation (89.5%) and at peak dose (89.5%) but not monthly (76.2%) or after treatment completion (73.7%); check triglycerides within a month prior to initiation (89.5%) and at peak dose (78.9%) but not monthly (84.2%) or after treatment completion (73.7%); do not check complete blood cell count or basic metabolic panel parameters at any point during isotretinoin treatment (all >70%); do not check gamma-glutamyl transferase (78.9%), bilirubin (81.0%), albumin (72.7%), total protein (72.7%), low-density lipoprotein (73.7%), high-density lipoprotein (73.7%), or C-reactive protein (77.3%). Conclusions and Relevance: This Delphi study identified a core set of laboratory tests that should be evaluated prior to and during treatment with isotretinoin. These results provide valuable data to guide clinical practice and clinical guideline development to optimize laboratory monitoring in patients treated with isotretinoin.

Original languageEnglish (US)
Pages (from-to)942-948
Number of pages7
JournalJAMA Dermatology
Issue number8
StatePublished - Aug 2022

ASJC Scopus subject areas

  • Dermatology


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