Isotretinoin-induced epistaxis among acne vulgaris patients

Objectives: To assess the prevalence and risk factors of isotretinoin-related epistaxis, among patients of acne vulgaris. Methods: A retrospective cohort of 230 Saudi patients who received isotretinoin for treatment of acne vulgaris, was included in the study. An online questionnaire was used to collect data regarding demographics and treatment-related adverse events. Results: The prevalence of isotretinoin-induced epistaxis was found to be 45.2%, which was a 5-fold increase in epistaxis, versus baseline. Epistaxis was reported by 90% patients who had a prior history of nasal bleeding. Patients with 'obstructed nose', reported a prevalence of 68.8%. The large majority of patients had a mild form of epistaxis, while nearly one-fourth reported moderate severity. A small subgroup of patients reported severe epistaxis warranting emergency room (ER) visits and blood transfusion. A staggering 93.5% and 61.3% patients were not advised by their dermatologists, regarding the importance of an ear-nose-throat (ENT) specialist consultation and nasal moisturization respectively, while taking isotretinoin. Conclusion: The prevalence of isotretinoin-induced epistaxis is significantly high among Saudi patients; the complication can affect nearly half of the patients receiving this drug. Key risk factors include a prior history of nasal bleeding, nasal obstruction, poor awareness regarding the nasal adverse effects of epistaxis and its preventive measures. Isotretinoin should be prescribed judiciously by dermatologists, in consultation with ENT specialists, and with adequate patient education regarding its potential nasal adverse effects and steps to mitigate the same.