Isotretinoin Associated Rhabdomyolysis: Monitoring Creatine Kinase and Educating Patients

Folasade F Fayiga; Sophia C Reyes-Hadsall; Ludonir C Sebastiany; Sergey Arutyunyan; Alan Wong; Ana M Duarte

doi:10.1159/000517831

Isotretinoin Associated Rhabdomyolysis: Monitoring Creatine Kinase and Educating Patients

Skin Appendage Disord. 2021 Nov;7(6):493-498. doi: 10.1159/000517831. Epub 2021 Jul 28.

Authors

Folasade F Fayiga^{1

2

3}, Sophia C Reyes-Hadsall⁴, Ludonir C Sebastiany⁵, Sergey Arutyunyan⁶, Alan Wong⁷, Ana M Duarte^{1

2

3

8

9}

Affiliations

¹ Children's Skin Center, Nicklaus Children's Hospital, Miami, Florida, USA.
² Division of Dermatology, Department of Pediatrics, Nicklaus Children's Hospital, Miami, Florida, USA.
³ The Philip Frost Department of Dermatology and Cutaneous Surgery at The University of Miami Miller School of Medicine, Miami, Florida, USA.
⁴ University of Miami Miller School of Medicine, Miami, Florida, USA.
⁵ Community Health of South Florida Inc., Miami, Florida, USA.
⁶ Larkin Community Hospital, Miami, Florida, USA.
⁷ Lake Erie College of Osteopathic Medicine, Bradenton, Florida, USA.
⁸ Department of Dermatology, Florida International University Herbert Wertheim College of Medicine, Miami, Florida, USA.
⁹ Department of Internal Medicine and Division of Dermatology, Nova Southeastern University, Miami, Florida, USA.

Abstract

Monitoring specific values at baseline and throughout treatment is standard of care for isotretinoin therapy; however, creatine kinase (CK) blood monitoring is often excluded. Herein, we describe the importance of CK monitoring during isotretinoin therapy to assess the risk of rhabdomyolysis and potential renal damage, regardless of muscle-related symptom presentation. We present 2 patients with hyperCKemia: a 16-year-old male on isotretinoin whose CK levels were elevated (7,325 U/L) when rhabdomyolysis symptoms were present, and an asymptomatic 18-year-old male with elevated CK levels (35,000 U/L) before starting isotretinoin. Based on our experience, we strongly recommend obtaining CK levels to monitor for and potentially prevent rhabdomyolysis and its associated complications.

Keywords: Creatine kinase; Isotretinoin; Rhabdomyolysis.

Publication types

Case Reports