IBD risk in acne may be due to ‘shared mechanistic pathways’
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While acne was associated with incidence of inflammatory bowel disease, two drug classes used to treat acne had no such association, according to a study.
“There have been concerns about whether treatments for acne such as isotretinoin and oral antibiotics may be associated with inflammatory bowel disease,” study author John S. Barbieri, MD, MBA, of the department of dermatology at Brigham and Women's Hospital in Boston, told Healio. “However, an important consideration for studying these associations is whether acne itself may be associated with inflammatory bowel disease, as both processes share some of the same underlying inflammatory pathways.”
In the current propensity score matched cohort study, the researchers assessed whether exposure to isotretinoin, oral tetracycline-class antibiotics and/or acne itself carry associations with inflammatory bowel disease (IBD). Data were collected for the period between 2001 and 2022.
One-year incidence of IBD for patients with acne and/or treated with one of the two drug classes served as the outcome of interest.
“Our study design is unique in that we explored both the potential association between acne itself and inflammatory bowel disease as well as the potential association between acne treatments and inflammatory bowel disease,” Barbieri said. “We also tried to take steps to reduce the potential for confounding, which can lead to identification of spurious associations.”
Barbieri noted that previous research did not explore whether treatment with oral antibiotics before isotretinoin could lead to detection of those “spurious associations” between isotretinoin and inflammatory bowel disease.
Results showed that acne itself had a statistically significant association with risk for incident IBD (OR = 1.42; 95% CI, 1.23-1.65). However, no such association was observed for either drug class.
“We were surprised that we did not find an association between oral antibiotic exposure and risk of inflammatory bowel disease as one other study in acne and several other studies outside of acne have suggested that [this association may exist],” Barbieri said. “However, while we do not identify an association between oral antibiotic use in acne and inflammatory bowel disease, I would still encourage that oral antibiotics are prescribed thoughtfully given the risk of antibiotic resistance and other antibiotic associated complications.”
Barbieri concluded that while the risk for IBD in acne is statistically significant, it is small. “The risk may reflect shared underlying mechanistic pathways,” he said. “Our data also provide further reassurance that isotretinoin use for acne does not appear to be associated with a significant increased risk of inflammatory bowel disease.”