The effect of oral isotretinoin on the barrier function of the lips of acne patients and the protective role of moisturizer

Abstract

Background: Oral isotretinoin is an effective treatment for acne patients, and this agent may cause variable side effects. Among them, cheilitis is the most common symptom that occurs in virtually all these patients. Objective: We wanted to assess the functional changes of the lips of acne patients who were treated with oral isotretinoin by measuring the transepidermal water loss (TEWL), and we evaluated the benefit of using a moisturizing cream as an adjunctive treatment to oral isotretinoin. Methods: We measured the TEWL of the lips and cheeks in 17 acne patients who were treated with oral isotretinoin for 6 weeks. Then we compared the changes of the patients and the differences of the TEWL of the lip according to the dose of isotretinoin. In addition, we compared the TEWL change of the lips between 10 patients who were treated with oral isotretinoin and moisturizer cream (PHYSIOGEL® A.I. Cream) with that of 10 patients who received only isotretinoin. Results: The TEWL of the lip increased significantly during isotretinoin treatment while the TEWL of the cheek showed no noticeable increase. The increase of the TEWL of the lip was more definite in the 20 mg isotretinoin group than that of the 10 mg isotretinoin group. However, the TEWL of the lip remained stable in the patients treated with oral isotretinoin and moisturizer cream. Conclusion: The lips are vulnerable to the mechanism of isotretinoin due to the poor barrier function of the parakeratotic mucosal epithelium with incomplete corneocyte formation. Therefore, regular use of moisturizer on the lips is recommended as an adjunctive treatment along with oral isotretinoin. (Korean J Dermatol 2008;46(10):1353-1356).