Gastrointestinal Involvement

Retinoids may alter liver function tests, most commonly the transaminases but also other tests (alkaline phosphatase, lactic dehydrogenase, and bilirubin). Elevations of transaminase levels occur in approximately 15% of patients, but they generally return to normal within 2-4 weeks, even when therapy is continued. Severe hepatotoxic reactions resulting from retinoid use are rare and idiosyncratic. However, a correlation between long-term retinoid therapy and chronic liver toxicity has not been demonstrated. Nonspecific gastrointestinal side effects, such as nausea, diarrhea, and abdominal pain, have been reported with isotretinoin therapy but are infrequent. Although the oral administration of isotretinoin has been linked with inflammatory bowel disease flare-up, a causal relationship has not been established. In fact, isotretinoin has been given to patients with known Crohn's disease and ulcerative colitis without complications (Brecher and Orlow 2003, Ellis and Krach 2001, Katz et al. 1999, Peck and DiGiovanna 1999).

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