Systemic and ocular adverse effects of Isotretinoin: a literature review

Background. Isotretinoin remains one of the most effective therapeutic agents for the management of chronic acne vulgaris; however, its use is associated with a wide spectrum of adverse effects varying in severity and clinical consequences. Internationally, isotretinoin has been widely prescribed for more than 30–40 years, whereas in the Russian Federation its clinical use has historically been limited, with a noticeable increase in prescriptions only in recent decades. Over the past ten years, publications by Russian authors addressing isotretinoin-related adverse effects – particularly ocular complications – have remained scarce. The aim of this review was to analyze and systematize available evidence on the frequency and severity of both ocular and systemic adverse effects associated with isotretinoin therapy, to summarize current concepts and clinical approaches, and to identify unresolved issues requiring further investigation. Materials and methods. A literature search of peer-reviewed publications was conducted using the PubMed and eLibrary.ru (Scientific Electronic Library) databases. The search strategy included the following keywords: isotretinoin, isotretinoin adverse effects, and ocular adverse effects of isotretinoin. A total of 43 articles, published predominantly within the past decade, were included in the final analysis. Results. Dry eye disease may lead to inflammatory disorders of the ocular surface, including blepharitis, conjunctivitis, keratitis, and corneal ulceration. Importantly, the severity of dry eye disease does not consistently correlate with the intensity of patient-reported symptoms. Currently, robust data regarding dose dependency and reversibility of isotretinoin-related adverse effects remain limited. Ocular complications of isotretinoin are insufficiently addressed within routine dermatological practice. Conclusion. This review highlights the need for further well-designed studies to clarify the incidence, severity, dose dependency, and reversibility of both systemic and ocular adverse effects associated with isotretinoin therapy. The findings emphasize the importance of interdisciplinary collaboration between ophthalmologists and dermatologists to ensure timely ocular assessment, appropriate monitoring, and early initiation of targeted therapy when adverse effects develop.

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