Correlations among insulin-like growth factor-1, homocysteine, vitamin B12, and folic acid plasma levels following isotretinoin therapy in acne vulgaris patients

Background Many metabolic disturbances have been reported following the use of oral isotretinoin for the treatment of acne vulgaris. Objective This study aimed to investigate the plasma levels of insulin-like growth factor-1 (IGF-1), homocysteine (Hcy), vitamin B12, and folic acid before and after isotretinoin treatment. Patients and methods Sixty patients with moderate to severe acne vulgaris were included. Using a chemiluminescent immunoassay, plasma IGF-1, Hcy, vitamin B12, and folic acid levels were measured at baseline and following 4 months of isotretinoin therapy. Results Post-treatment values of IGF-1, vitamin B12, and folic acid were significantly lower, whereas post-treatment Hcy was significantly higher compared with the baseline values. Post-treatment IGF-1 tended to be correlated negatively with patients’ age, whereas vitamin B12 showed a significant positive correlation. There was a highly significant positive correlation between post-treatment and baseline values of IGF-1 and also folic acid. There was a significant negative correlation between post-treatment IGF-1 and baseline Hcy. The IGF-1 mean post-treatment value was significantly lower in responding than nonresponding patients. Conclusion Isotretinoin-treated patients should be monitored closely for plasma IGF-1, Hcy, folic acid, and vitamin B12. Isotretinoin may act through a decrease in the IGF-1 plasma level. Younger patients might be at a higher risk of developing vitamin B12 deficiency and older patients might be at risk of IGF-1 deficiency following isotretinoin therapy. Hyperhomocysteinemia and IGF-1 deficiency seem to be caused by the direct effects of isotretinoin on liver function, unrelated to vitamin B12 and folic acid serum levels.