key: cord-0926215-ta4slrh4 authors: Demirel Öğüt, Neslihan; Kutlu, Ömer; Erbağcı, Ece title: Oral isotretinoin treatment in patients with acne vulgaris during the COVID‐19 pandemic: A retrospective cohort study in a tertiary care hospital date: 2021-04-29 journal: J Cosmet Dermatol DOI: 10.1111/jocd.14168 sha: 60cea6208f803d7c34a7fbfbf2f525cb16b8f851 doc_id: 926215 cord_uid: ta4slrh4 BACKGROUND: Patients with acne vulgaris continue to present increasingly in dermatology outpatient clinics and seek treatment during the COVID‐19 pandemic. As far as we know, the effect of isotretinoin on COVID‐19 has not been studied before. AIM: We aimed to evaluate whether patients receiving oral isotretinoin are at increased risk of COVID‐19 infection by comparing them with patients on topical treatment for acne vulgaris. METHODS: The data were collected retrospectively from a cohort of 267 acne vulgaris patients, who were under follow‐up for acne vulgaris treatment during the pandemic period. RESULTS: Total of 227 patients (141 receiving isotretinoin treatment and 86 receiving topical treatment) were included of whom 29 patients had COVID‐19 infection during acne vulgaris treatment. Fifteen (10.6%) patients were receiving oral isotretinoin and 14 (16.3%) were receiving topical acne treatment at the time of COVID‐19 infection. The mean cumulative dose was 2340 ± 1988 mg at the time of COVID‐19 infection. The mean elapsed time between the onset of isotretinoin treatment and positive PCR result for COVID‐19 was 13.3 ± 10.3 weeks. Nine patients (64.3%) receiving isotretinoin treatment and 9 patients (60%) under topical treatment had loss of taste and smell during COVID‐19 infection. Isotretinoin treatment was not found to be associated with a significant increased risk of getting COVID‐19 (odds ratio, 0.671; 95% confidence interval, 0.247–1.823; P = 0.434). CONCLUSION: As a conclusion, the results of this study encourage dermatologists and acne vulgaris patients to initiate oral isotretinoin treatment safely during the pandemic period. by January 15 th , 2021. 4 The patient presentations to dermatology outpatient clinics have significantly reduced in Turkey and all around the world during COVID-19 pandemic. [5] [6] [7] The pandemic has negatively affected dermatology patients especially those on systemic treatment due to interruption of follow-up in dermatology clinics and inability to perform monitoring laboratory tests. 8 The pattern of the diseases presenting in dermatology outpatient clinics has changed 9 ; however, acne vulgaris has constituted one of the most common dermatologic disorders during the pandemic period as before the pandemic. 10 Since isotretinoin treatment has an important role in the treatment of moderate to severe acne vulgaris, 11 British Association of Dermatologists (BAD) and American Academy of Dermatology (AAD) have published guidelines and recommendations regarding the management of isotretinoin treatment in acne vulgaris during the current pandemic. Scheduled telemedicine appointments for side effect monitoring and blood monitoring and home-pregnancy testing for female patients have been advised to reduce face-to-face consultations during the pandemic. It has been speculated that drying effect of isotretinoin on the mucous membranes may pose a theoretically increased risk of COVID-19 viral load in patients on isotretinoin. 12, 13 Therefore, the aim of this study was to compare the prevalence of COVID-19 in the acne vulgaris patients receiving oral isotretinoin treatment with the acne patients on topical treatment in order to provide an evidence for the management of acne vulgaris patients during the COVID-19 pandemic. This study was conducted as a retrospective cohort study of acne vulgaris patients presented to the dermatology outpatient clinics in Uşak Training and Research Hospital. Uşak University Training and Research Hospital is a tertiary care teaching hospital located in Uşak in which has a population over 370 thousand. After the first COVID-19 case was seen in Turkey, our dermatology outpatient clinic has limited the scheduled appointments to every 15 min in order to prevent overcrowding and the spread of the virus among the patients who applied to our clinic. The patients diagnosed with acne vulgaris have been started to topical treatment or systemic treatment (isotretinoin or systemic antibiotics) regarding the severity of the disease, and have been monitored according to acne vulgaris guidelines before pandemic. 11 Isotretinoin was started with low doses (0.3-0.5 mg/kg per day), continued with low doses, and sustained till the threshold dose, 120-150 mg/kg. The patients were recommended to stop taking isotretinoin for five to ten days if they tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and/or prescribed hydroxychloroquine or favipiravir treatment. After the ethical approval of our local ethics committee (1.12.2020/602.03.99), 267 acne vulgaris patients who were under follow-up for acne vulgaris treatment after March 15, 2020, were evaluated within one and a half months period between December 1, 2020, and January 15, 2021. Patients older than 12 years of age who did not use any other treatment due to a dermatologic or systemic disorder were included in the study. 37 patients who were under systemic antibiotic treatment such as azithromycin or doxy- The data were analyzed with the IBM SPSS v18.0 (SPSS Inc.) statistical package program. Descriptive categorical data were presented as frequencies and percentages, and continuous data were presented as mean ± standard deviation. Shapiro-Wilk test for normality was used to check the distribution of continuous data. Independent samples t test was used to analyze normally distributed data. Pearson's Chi-squared test or Fisher's exact test was performed in order to compare differences between patients receiving oral isotretinoin treatment and topical acne treatment for categorical variables. Odds ratios (ORs) and 95% confidence intervals (CIs) were reported as parameters of association. Adjusted logistic regression analyses (in which age, gender, body mass index (BMI), and acne severity were considered) were performed taking COVID-19 prevalence and olfactory and/or gustatory dysfunction as dependent variables. p-values below 0.05 were considered statistically significant. Table 2 . There were no significant differences in terms of gender, age, BMI, acne severity, length of isotretinoin treatment, and total cumulative doses between the acne vulgaris patients who had COVID-19 infection and the patients who did not ( Table 3) ies are needed in order to provide additional support for these results. In conclusion, low-dose oral isotretinoin treatment was not associated with an increased risk of developing COVID-19 infection. The result of our study encourages dermatologists and acne vulgaris patients to initiate oral isotretinoin treatment safely during the pandemic period. We believe that our results are important to inform acne vulgaris patients to continue the follow-up and to provide treatment compliance. No funding to declare. The authors report no conflict of interest. Approved by local ethics committee with the date/the number: 1.12.2020/602.03.99. The data that support the findings of this study are available from the corresponding author upon reasonable request. 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