Fewer lab tests needed for pediatric patients on isotretinoin

WAILEA, Hawaii — For pediatric acne patients on isotretinoin, laboratory monitoring is still necessary, but not at the levels previously believed, according to a presentation at the Maui Derm meeting.

Full panels of laboratory tests were previously conducted each year for children on isotretinoin, James R. Treat, MD, professor of clinical pediatrics at Children’s Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, said during his presentation. However, recent research has shown that such frequent monitoring may not be needed.

Previously it was believed that a full panel including alanine transaminase (ALT), aspartate aminotransferase (AST), triglycerides, complete blood count (CBC), creatine kinase (CK) and other tests be run annually, but now testing for just ALT and triglyceride levels at baseline and peak dose is adequate.

“Kids hate getting blood draws. I hate getting blood draws,” Treat said. “Kids really don’t like labs and they are often also tough sticks. So, if you’re doing a full hepatic function panel, you will often get elevated ASTs in children.”

Pregnancy tests should continue to be completed regularly, but testing for rhabdomyolysis with a CK test and CBC abnormalities — which are both extremely rare in isotretinoin-treated patients — is not needed unless there are other markers to warrant the tests.

“There are special scenarios where you do want to do more labs, but for the majority of patients, you don’t need to do that,” Treat said. “Check ALT and triglycerides before you start and when you get to your peak dose, and then you probably don’t need to do it again.”