For dermatologists searching for consensus on isotretinoin monitoring – keep looking. There is no consensus to be found from a new survey of U.S. dermatologists.

There were some trends among the 2,322 responses to the national email survey of American Academy of Dermatology members, but the researchers at the University of Vermont in Burlington said that no real agreement on monitoring emerged.

When asked about the frequency of lab testing, most respondents said that they check lipids (63%) and liver aminotransferases (63%) and do a CBC (60%) at baseline. For most, monthly monitoring involves a lipid panel (75%) and liver enzymes (74%), with 57% including a monthly CBC and 39% getting a basic metabolic panel, Julia G. Hobson, MD, and her associates reported (J Drugs Dermatol. 2017;16[6]:557-64).

Very few dermatologists do any testing when the dosage is changed – a lipid panel and liver enzymes being the most popular response at 10% – or when therapy is completed – a lipid panel (8%) and liver enzyme check (8%) were the most common, they said.

In response to abnormal test results, 75% of respondents would take patients off isotretinoin if their liver enzyme levels were three times normal, and 89% would stop the medication if the enzyme level were four times normal. Between 30% and 40% of dermatologists would “order further testing” if liver enzyme levels were even slightly elevated, the investigators said.

Most respondents (70%) would not make a change if triglyceride levels were twice normal or less, and 72% would stop isotretinoin if triglyceride levels were four times normal, but “only 26% would add a lipid-lowering agent when triglyceride levels reach three times normal,” Dr. Hobson and her associates wrote.

“Based on the available literature and low incidence of adverse events, less monitoring is probably required,” they said, adding that “over-monitoring may no longer be justified or considered a good use of resources.”

The investigators said that they had no conflicts of interest to report.