Isotretinoin-induced epistaxis among acne vulgaris patients: A cross sectional study from Saudi Arabia

Hanan Ibrahim Almuzaini; Ali Saeed Alamri; Razan Ibrahim Almuzaini

doi:10.15537/smj.2024.45.12.20240791

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Table 1

- Summary of key demographic parameters of study participants (N=230).

Variable	Male group n (%)	Female group n (%)	P-value
Number of patients (%)	33 (14.3%)	197 (85.7%)	<0.0001^{^*}
Age (years), mean±SD	25.45±8.1	25.96±5.2	0.6342
Marital state
Single	22 (66.6%)	151 (76.6%)	0.2390
Married	9 (27.3%)	39 (19.8%)
Divorced	2 (6.1%)	7 (3.6%)
Duration of isotretinoin therapy (months), mean±SD	6.01 ± 3.5	5.41 ± 3.1	0.3222

P-value for scale variables was calculated using unpaired t-test (for Mean ± standard deviation [SD]), and using Fisher’s exact test (for number and %)

↵* Statistically significant difference between male and female groups (p<0.05);

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Table 2

- Summary of isotretinoin-related key adverse events.

Variable	Total study population (N=230)	P-value^{^*}	Male group (n=33) n (%)	Female group (n=197) n (%)	P-value^{^§}
Reported ≥1 adverse effects of isotretinoin therapy
Yes	189 (82.2%)	<0.0001^{^*}	23 (69.7%)	166 (84.3%)	0.0289§
No	41 (17.8%)	<0.0001^{^*}	10 (30.3%)	31 (15.7%)	0.0289§
Increase skin sensitivity to sunlight
Yes	127 (55.2%)	0.1550	17 (51.5%)	110 (55.8%)	0.7069
No	103 (44.8%)	0.1550	16 (48.5%)	87 (44.2%)	0.7069
Xerophthalmia
Yes	177 (77%)	<0.0001^{^*}	21 (63.6%)	156 (79.2%)	0.0716
No	53 (23%)	<0.0001^{^*}	12 (36.4%)	41 (20.8%)	0.0716
Average dose causing Xerophthalmia (mg)	29.1 ± 10	-	32 ± 8.3	30.77 ± 9.36	0.5781
Dry lips
Yes	213 (92.6%)	<0.0001^{^*}	31 (93.9%)	182 (92.4%)	0.7522
No	17 (7.4%)	<0.0001^{^*}	2 (6.1%)	15 (7.6%)	0.7522
Average dose causing dry lips (mg)	30.9 ± 9.2	-	28.33 ± 9.1	29.18 ± 10.2	0.6683
Obstructed nose
Yes	77 (33.1%)	<0.0001^{^*}	10 (30.3%)	66 (33.5%)	0.8715
No	154 (66.9%)	<0.0001^{^*}	23 (69.7%)	131 (66.5%)	0.8715
Average dose causing obstructed nose (mg)	32.02 ± 9.4	-	28.88 ± 9.3	32.6 ± 9.3	0.2696
Dry nose
Yes	155 (67.4%)	<0.0001^{^*}	20 (60.6%)	135 (68.5%)
No	75 (32.6%)	<0.0001^{^*}	13 (39.4%)	62 (31.5%)	0.4853
Average dose causing dry nose (mg)	32.13 ± 9.3	-	29.5 ± 7.6	31.9 ± 9.3	0.2836

↵* Statistically significant difference between variables in the total study population (p<0.05).
↵§ Statistically significant difference between male and female groups (p<0.05).

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Table 3

- Summary of isotretinoin-related epistaxis in the study population.

Variable	Total study population (N=230)	P-value^{^*}	Male group (n=33)	Female group (n=197)	P-value^{^§}
Prevalence of epistaxis
Yes	104 (45.2%)	0.2030	14 (42.4%)	90 (45.7%)	0.8505
No	126 (54.8%)	0.2030	19 (57.6%)	107 (54.3%)	0.8505
Past history of nose bleeding before isotretinoin therapy
Yes	20 (8.7%)	<0.0001^{^*}	3 (9.1%)	17 (8.6%)	0.9306
No	210 (91.3%)	<0.0001^{^*}	30 (90.9%)	180 (91.4%)	0.9306
Prevalence of epistaxis among patients with prior history of nasal bleeding
Yes	18/20 (90.0%)	<0.001^{^*}	3 (15%)	15 (75%)	<0.05^{^§}
No	2/20 (10.0%)	<0.001^{^*}	1 (5%)	1 (5%)	<0.05^{^§}
Prevalence of epistaxis among patients with dry nose
Yes	75/155 (48.4%)	<0.05^{^*}	34 (21.9%)	41 (26.5%)	0.9411
No	80/155 (51.62%)	<0.05^{^*}	45 (29%)	35 (22.6%)	0.9411
Prevalence of epistaxis among patients with obstructed nose
Yes	53/77 (68.83%)	<0.001^{^*}	22 (28.6%)	31 (40.3%)	0.05^{^*}
No	24/77 (31.17%)	<0.001^{^*}	5 (6.5%)	19 (24.7%)	0.05^{^*}
Severity of epistaxis
1^st degree	76/104 (73.1%)	<0.0001^{^*}	10/14 (71.4%)	66/90 (73.3%)	0.8812
2^nd degree	28/104 (26.9%)	<0.0001^{^*}	4/14 (28.6%)	24/90 (26.7%)	0.8812
Frequency of epistaxis
1^st degree	71/104 (68.3%)	<0.0001^{^*}	11/14 (78.6%)	60/90 (66.7%)	0.6584
2^nd degree	24/104 (23.1%)		2/14 (14.3%)	22/90 (24.4%)
3^rd degree	9/104 (8.6%)		1/14 (7.1%)	8/90 (8.9%)
Duration of epistaxis
Less than 10 minutes	95/104 (91.4%)	<0.0001^{^*}	12/14 (85.7%)	83/90 (92.2%)	0.7682
10-30 minutes	9/104 (8.6%)	<0.0001^{^*}	2/14 (14.3%)	7/90 (7.8%)	0.7682
Need of blood transfusion after epistaxis
Yes	2/104 (1.9%)	<0.0001^{^*}	0/14 (0%)	2/90 (2.2%)	0.5733
No	102/104 (98.1%)	<0.0001^{^*}	14/14 (100%)	88/90 (97.8%)	0.5733
Management of epistaxis in emergency room
Yes	7/104 (6.7%)	<0.0001^{^*}	2/14 (14.3%)	5/90 (5.6%)	0.5225
No	97/104 (93.3%)	<0.0001^{^*}	12/14 (85.7%)	85/90 (94.4%)	0.5225
Need for hospital admission for managing epistaxis
Yes	2/104 (1.9%)	<0.0001^{^*}	0/14 (0%)	2/90 (2.2%)	0.5733
No	102/104 (98.1%)	<0.0001^{^*}	14/14 (100%)	88/90 (97.8%)	0.5733

Values are presented as number and (%).

↵* Statistically significant difference between variables in the total study population (p<0.05).
↵^§ Statistically significant difference between male and female groups (p<0.05).

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Table 4

- Awareness of precautionary measures during the use of isotretinoin.

Variable	Total study population (N=230)	P-value^{^*}	Male group (n=33)	Female group (n=197)	P-value^{^§}
Dermatologist advised to visit an ENT doctor, at least once, while using isotretinoin
Yes	15 (6.5%)	<0.0001^{^*}	0	5 (7.6%)	0.1368
No	215 (93.5%)	<0.0001^{^*}	33 (100%)	182 (92.4%)	0.1368
Dermatologist advised to put moisturizing ointments for the nose while using isotretinoin?
Yes	89 (38.7%)	0.0029^{^*}	13 (39.4%)	76 (38.6%)	1.0000
No	141 (61.3%)	0.0029^{^*}	20 (60.6%)	121 (61.4%)	1.0000
Personal awareness of the need to moisten your nose while using isotretinoin?
Yes	108 (47%)	0.4796	11 (33.3%)	97 (49.2%)	0.1308
No	122 (53%)	0.4796	22 (66.7%)	100 (50.8%)	0.1308

Values are presented as number and (%).

ENT: ear-nose-throat

↵* Statistically significant difference between variables in the total study population (p<0.05).
↵^§ Statistically significant difference between male and female groups (p<0.05).