How safe and effective is prescribing oral isotretinoin to treat acne in patients on renal dialysis? A systematic review

Summary Background Patients on renal dialysis often develop severe acne. In spite of this, the literature remains scarce about the use of isotretinoin for the treatment of acne in this group of patients, and many clinicians remain apprehensive and hesitant to use it. Aim To systematically review the literature surrounding the safety and efficacy of isotretinoin for the treatment of acne in patients on renal dialysis. Methods Four electronic databases (MEDLINE, Embase, CINAHL, Emcare) were systematically searched in March 2021. The search strategy incorporated the terms ‘isotretinoin’, ‘renal’, ‘kidney’, ‘dialysis’ and ‘acne’, along with terms closely related to these. Studies were considered eligible if they reported the use of isotretinoin for treatment of acne in patients with renal impairment or on renal dialysis, and if they had relevant implications to this topic. Results The search resulted in a total of 63 results. Using the PRISMA approach, 11 articles were deemed relevant to this review: 1 randomized single‐blinded placebo‐controlled trial, 2 case series, 2 retrospective studies and 6 case reports. Hence the level of evidence was mostly low (Grading of Recommendations, Assessment, Development and Evaluations level 3). Conclusion This review of the literature suggests that low‐dose isotretinoin (10–20 mg) can safely and successfully be used to treat severe acne in patients on renal dialysis, leading to a significant improvement in their quality of life. As the current literature on this topic is scarce, more studies would be beneficial to further establish the safe use of isotretinoin in patients on renal dialysis.