THE MUSCULOSKELETAL SIDE EFFECTS OF ORAL ISOTRETINOIN: A NARRATIVE REVIEW

Introduction: This narrative review aims to summarize the current literature on the musculoskeletal adverse effects of oral isotretinoin, discuss potential mechanisms and clinical implications, and highlight key considerations for clinicians in patient monitoring. Method: Publications between January 1983 and August 2025 were reviewed through PubMed, Google Scholar, and ScienceDirect. The keywords “isotretinoin”, “retinoids”, “musculoskeletal system,” “sacroiliitis,” “spondylarthropathies,” “arthritis,” “hyperostosis,” “osteoporosis,” “hypercalcemia,” “myalgia,” “creatine kinase” and “rhabdomyolysis” were used. Only English-language publications were included. No formal methodological quality scale was applied; instead, study relevance, sample quality, and clinical contribution were considered. Systematic reviews, clinical studies, case series, and case reports were included. The findings were summarized in a narrative manner and evaluated in terms of clinical practice. Results: Musculoskeletal adverse effects of isotretinoin include axial like symptoms (e.g., inflammatory back pain, sacroiliitis, enthesitis), peripheral arthritis, hyperostosis, premature epiphyseal closure, osteoporosis, hypercalcemia, myalgia, and elevated creatine kinase levels. Back pain, arthralgia, and myalgia are the most common side effects, typically emerging within the first three months of treatment. Sacroiliitis is usually acute, HLA-B27-negative, and resolves after drug discontinuation. Bone effects are primarily observed with prolonged, high cumulative doses, whereas vitamin D metabolism may be affected even in short courses. Muscle involvement is generally mild but may rarely lead to rhabdomyolysis with intensive exercise. Conclusion: Musculoskeletal side effects of isotretinoin are generally mild and reversible but may mimic spondyloarthropathies or other rheumatologic disorders. Awareness, baseline risk assessment (including vitamin D status), and early recognition are essential to avoid misdiagnosis and unnecessary interventions. Collaboration between dermatology and musculoskeletal specialists is recommended for optimal management.