Background Patients with cystic acne (CA) on Isotretinoin (Iso) therapy
might present muscular symptoms as side effect of the drug. Myalgia,
weakness, hypotension are also some of the main characteristics of
carnitine (car) deficiency.
Methods Two hundred and thirty (N = 230) patients with CA were treated
with Isotretinoin (0.5 mg/kg per 24 h). All the patients were requested
to visit our out-patient department at the onset of muscular symptoms.
Laboratory tests including car (total, free, acylcarnitine) were
determined in blood and urine before treatment, at the onset of muscular
symptoms and after the end of a 45 day study. Fifty percent of the
patients with muscular involvement received L-carnitine (100 mg/kg per
24 h per os) (group C) and 50% placebo (group P).
Results Their laboratory tests showed the well known increases of their
liver enzymes and lipids, whereas car blood levels were remarkably
decreased at the onset of their muscular symptoms and or at the end of
the study. Their supplementation with L-car, in patients of group C (N =
20) without Iso discontinuation or reduction, resulted in the
disappearance of their muscular symptoms within 5-6 days and
normalisation not only of the increased levels of their liver enzymes
but also those of car, at the 45 day of their therapy. Additionally, the
patients who received placebo (group P, N = 20) continued complaining
for mualgias, The rest of the patients (group A, N = 190) did not
experience any muscular symptoms, their laboratory tests showed
elevation of liver enzymes and lipids and a decrease in car levels in
the blood whereas a remarkable increase of car excretion was determined
in their urine.
Conclusions Iso therapy decreases car blood levels in patients with CA.
L-car supplementation might treat liver and muscular side effects of the
drug. These hopeful preliminary results need further investigation. (C)
1999 Elsevier Science B.V. All rights reserved