Frågedatum: 2004-06-28
RELIS database 2004; id.nr. 20704, DRUGLINE
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Can isotretinoin cause splitting of the nails?/nA 62-year-old woman treated with isotretinoin for r



Fråga: Can isotretinoin cause splitting of the nails? A 62-year-old woman treated with isotretinoin for rosacea have developed lamellar distal splitting of two finger nails after five months of isotretinoin use. Isotretinoin was withdrawn but the patient´s symtoms remained three months after withdrawal.

Sammanfattning: There are a few case reports describing splitting of nails during isotretinoin treatment. In the present case it is possible that the symtoms are due to isotretionin usage.

Svar: Three published case reports of splitted nails during isotretinoin therapy were found in the literature (1,2,3).

The first publication describes a 38-year-old woman who received three courses of isotretinoin treatment for nodulocystic acne. Six weeks after she had started each four month long course she developed a central ridge and proximal splitting of a thumbnail. She also had horisontal ridges but they were not as prominent as the central ridge. The nail changes resolved about four weeks after withdrawal of each course (1).

The second case was a 31-year-old woman treated with isotretinoin for acne. She developed median canaliform dystrophy on all her finger nails eight weeks after treatment initiation. Her nail growth returned to normal one year after she had stopped taking isotretinoin (2).

The last case concerned a 23-year-old woman treated with isotretinoin for acne. At her second monthly control during treatment her toenails had lost their lustre and were fragile. One month later she had got bilateral toenail onycholysis (3).

In the Swedish adverse drug reaction register there is one case of paronychia of a total of 210 reports associated with isotretinoin use (4). In WHO:s adverse drug reactions database there are 191 reports of nail disorders due to isotretinoin treatment reported and one case of onycholysis (5). However, these reports are not evaluated as to the cause relationship.

The mechanism behind this adverse drug reaction is unknown but might be due to dyskeratosis within the nail matrix leading to nail fragility and dystrophy (1,6).

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