Exploring the Incidence and Risk Factors of Dyslipidemia in Patients with Severe Acne Vulgaris on Systemic Isotretinoin Therapy: Findings from a Prospective Study

<i>Background and Objectives</i>: Oral isotretinoin has revolutionized the treatment of severe acne vulgaris. Isotretinoin is associated with multiple adverse effects, one of which is dyslipidemia (DLP). <i>Materials and Methods</i>: This single-center prospective study recruited 498 patients who were eligible for isotretinoin for severe acne. Risk factors for hyperlipidemia and serum lipids were assessed at baseline. Patients received daily doses ranging from 0.25 to 1 mg/kg of their body weight, and their fasting serum lipids were checked regularly until they reached a cumulative dose of 120-150 mg/kg. Our primary objective is to investigate dyslipidemia incidence and predictors, while the secondary objective is to assess the impact of dose reduction on lipid panels. <i>Results</i>: Our sample was primarily female (n = 380, 76.3%), with a normal Body Mass Index (23.2 ± 4.0) and a mean age of 20.7 (±4.1) years. About 72.5% had a family history of acne, 17.1% a family history of dyslipidemia. Around 17.3% reported tobacco use. A total of 57 (11.4%) patients on isotretinoin developed DLP. Smoking was independently associated with a higher risk of dyslipidemia (OR 1.97, 95% CI [1.01, 3.82], <i>p</i> = 0.046). The mean onset of DLP was at 3.23 (±2.13) months. A total of 52 patients out of the 57 had a dose reduction of 10 mg (n = 5) or 20 mg (n = 47). A dose reduction of 50% was found to significantly improve triglyceride levels. <i>Conclusions</i>: More than 1 out of 10 patients on isotretinoin developed DLP. Tobacco use was significantly associated with developing DLP. Dose reduction significantly impacted a decrease in triglyceride levels.