Isotretinoin effective for acne in those receiving gender-affirming therapy, study shows

Isotretinoin is well tolerated and effective for individuals receiving masculinizing gender-affirming hormonal therapy who have acne, according to a study published online May 29 in JAMA Dermatology.

James Choe, from Brigham and Women's Hospital in Boston, and colleagues examined clinical outcomes of isotretinoin among transgender and gender-diverse individuals receiving gender-affirming hormonal therapy in a multicenter retrospective case series study. Fifty-five patients aged 12 to 49 years who were receiving masculinizing gender-affirming hormonal therapy and prescribed isotretinoin for the management of acne were included.

The median isotretinoin course duration was six months, with a median cumulative dose of 132.7 mg/kg. The researchers found that isotretinoin was associated with improvement and clearance in 87.3 and 47.3% of patients, respectively. These rates increased to 97.0 and 63.6%, respectively, for the 33 patients treated with a cumulative dose of 120 mg/kg or more.

The risk of recurrence was 20.0% among the 20 patients who achieved acne clearance and had any subsequent health care encounters. Dryness, joint pain, and eczema were the most frequently reported adverse events (80.0, 14.5, and 9.1%, respectively). Laboratory abnormalities were rare. Cost, pharmacy issues, adverse effects, logistical reasons, and wound healing concerns for gender-affirming surgery were reasons for premature treatment discontinuation.

"Isotretinoin may play an underappreciated role in gender-affirming care," the authors write.

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