What is it about?

Doctors have been checking various blood items routinely in people taking oral isotretinoin for acne for the last 40 years since it came on the market. These tests are always normal or just show small changes in liver function or slight increases in lipids (fats). Many dermatologists have questioned the need for doing these tests as they do not appear to be clinically significant ie - do not cause any harm. We wanted to examine all the existing evidence from scientific publications to see if indeed there was any reports or studies to support this long term practice.

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Why is it important?

Doing routine blood tests we thought was "an elephant in the room" as the benefit was questionable - dermatologists generally have kept doing these tests even though many do not really believe they are necessary. We were keen to set the record straight and we thought the only way to do this was to look in great detail at all the evidence to support or refute doing routine blood tests. We could not find evidence to support the benefit of monitoring to detect adverse events. We suggest that in healthy young people laboratory monitoring for oral isotretinoin is unnecessary and risks detecting non-serious biochemical abnormalities.

Perspectives

I am an advocate of so called "realistic medicine". Over the last 30 years, doctors are doing more and more tests often with questionable benefit, no benefit or that are causing harm. Defensive-based practice has gradually over-taken evidence-based practice. Generally it is easier for doctor to do a test - to "exclude" something or to tick a box in a protocol. It is healthy to challenge existing medical practice that has become ingrained aka dogma and unless this is done then existing practice will not change. I am proud that I initiated this study and would like to thank myco-authors for all their hard work on it over the last 2 years. We met some resistance along the way but persevered. I believe it was worth the effort and we hope our paper will be game changer.

Andrew Affleck
NHS Providers

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This page is a summary of: Is routine laboratory testing in healthy young patients taking isotretinoin necessary: a critically appraised topic, British Journal of Dermatology, September 2022, Wiley, DOI: 10.1111/bjd.21840.
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