Effects of Oral Isotretinoin Therapy on Nasal Dryness and Nasal Obstruction in Patients with Acne Vulgaris: Objective and Subjective Assessments Based on the Dose and Duration of Therapy

Introduction: This study aimed to evaluate the effect of oral isotretinoin therapy on nasal dryness and nasal obstruction in patients with acne vulgaris. Methods: A total of 102 patients with acne vulgaris (mean +/- standard deviation age, 21.1 +/- 3.4 years; female, 64.7%) initiating systemic isotretinoin treatment [in 0.25 mg/kg/day (n=35) or 0.5 mg/kg/day (n=67) doses] were enrolled in this prospective study. Data on nasal obstruction [via nasal obstruction symptom evaluation (NOSE)] and nasal dryness via a psychometric response scale [visual analog scale (VAS)] and nasal Schirmer test values (right and left Schirmer values) were recorded at baseline. Nasal dryness (VAS and nasal Schirmer test) and nasal obstruction (NOSE) assessments were repeated at months 2 and 4 of treatment in isotretinoin groups. Results: The right Schirmer values at month 2 (p<0.05) in the 0.25 mg isotretinoin group and right (p<0.01 for each) and left (p<0.001 and p<0.01, respectively) Schirmer values at months 2 and 4 in the 0.5 mg isotretinoin group significantly decreased from baseline, while VAS scores at months 2 and 4 (p<0.001 and p<0.01, respectively) significantly increased in the 0.5 mg isotretinoin group. Conclusion: Our findings revealed the association of isotretinoin treatment with the occurrence of nasal dryness but not with nasal obstruction in patients with acne vulgaris, particularly with the high-dose daily regimen, regardless of treatment duration. The nasal Schirmer test is an objective assessment of nasal dryness in patients receiving isotretinoin therapy and the potential benefit of low-dose isotretinoin in reducing the risk of nasal dryness.