GILBERTS-SYNDROME AND ISOTRETINOIN

Introduction. Because of the potential hepatotoxicity of retinoids, pr escription of isotretinoin is always very carefully made in healthy su bjects, and prohibited in case of concomitant hepatopathy. Gilbert's s yndrome consists of chronic, mild, unconjugated hyperbilirubinemia. In this syndrome, isotretinoin has been reported twice to be perfectly t olerated, and once even beneficial. We report here a new case of good tolerance and even improvement of a Gilbert's syndrome during isotreti noin therapy. Case report. A 17-year-old man with Gilbert's syndrome p resented with a nodulocystic acne. Topical agents had been inefficient , and cyclines bad tolerated. Thus isotretinoin has been gradually int roduced, with a regular monitoring of the liver function. We observed a steady decrease of the bilirubinemia during the course of isotretino in, and then a reappearance of hyperbilirubinemia as soon as posology was diminished and particularly after Completion of isotretinoin thera py. Discussion. A review of the literature finds only very few cases o f hepatic injuries caused by isotretinoin, contrary to etretinate. Saf ely of isotretinoin in Gilbert's syndrome was first observed in 1984, but its beneficial effects have only recently been described by Wang e t al., and we report here a similar case. Pharmacological mechanisms r emain hypothetic. However, considering the prevalence of Gilbert's syn drome and its usual first expression during postpubertal period, it se ems to us interesting for therapeutic practice to know that isotretino in is not less safe in these patients.