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Isotretinoin, spironolactone may be safe acne treatments in patients with lupus

Patients with lupus should avoid combined oral contraceptive pills and tetracycline-class medications for acne, whereas isotretinoin and spironolactone may be considered safe treatment options, according to a systematic review.

“When treating acne in this vulnerable patient population, clinicians should practice a highly individualized approach — one that takes into account the systemic manifestations of lupus erythematosus and the associated risk for drug-related adverse events,” wrote Mahtab Forouzandeh, MD, and Andrea D. Maderal, MD, both of the department of dermatology and cutaneous surgery at the University of Miami Miller School of Medicine.

In the systematic review covering 13 studies, Forouzandeh and Maderal examined safety outcomes from commonly prescribed oral acne medications for patients with lupus erythematosus.

Whether the photosensitivity found in lupus is worsened by using tetracycline medications is currently unknown. In this drug class, doxycycline is considered the most phototoxic drug while minocycline is considered the least.

Previous researchers have explored the potential for minocycline to induce new-onset lupus.

Other common medications for acne include azithromycin and erythromycin. Antibiotic allergy to erythromycin was found more likely in patients with lupus than in exposed controls, which manifested in rash, followed by nausea and vomiting. Researchers in the same study showed that tetracycline use had a lower risk for allergy.

With hormonal therapy, like oral contraceptive pills and spironolactone, the increased risk for thrombosis is significant, Forouzandeh and Maderal noted. Moreover, there is an increased risk for hypertension.

“When lupus erythematosus is associated with antiphospholipid antibodies, described in nearly 50% of systemic lupus erythematosus patients, an even greater increase in thrombotic events is observed,” Forouzandeh and Maderal wrote.

Combined oral contraceptive pills for acne treatment should be avoided in this population, according to Forouzandeh and Maderal.

Spironolactone is normally avoided in patients with renal insufficiencies.

Previous research deemed isotretinoin a safe option in patients with lupus.

“Researchers report that isotretinoin use results in podocytes regeneration, promotion of renal progenitor cell differentiation and a reduction in overall glomerular damage,” Forouzandeh and Maderal wrote.

However, acne recurrence can occur after discontinuation and isotretinoin may affect a patient’s lipid profile.

“Our recommendations against combined oral contraceptive pills and in favor of isotretinoin received the most favorable grading due to the quality and quantity of the studies available,” Forouzandeh and Maderal wrote. – by Abigail Sutton

Disclosures: The authors report no relevant financial disclosures.