isotretinoin rarely may be associated with laboratory abnormalities like hypertriglyceridemia; however, the optimal approach to laboratory monitoring remains uncertain, and there is wide variation in clinical practice.

The present study established a consensus for isotretinoin laboratory monitoring among a diverse, international cohort of clinical and research experts in acne.

The study used a modified electronic Delphi process and administered four rounds of anonymous electronic surveys from 2021 to 2022. For laboratory tests reaching consensus (≥70% agreement) for inclusion, it asked extra questions regarding more time-specific monitoring throughout isotretinoin therapy in subsequent rounds. The participants were all international board-certified dermatologist acne experts.

The study outcome was to reach a consensus on key isotretinoin laboratory monitoring parameters. It finally observed-

• Involvement of 22 participants from 5 continents with a mean (SD) time in the practice of 23.7 (11.6) years and representing a variety of practice settings.
•  Participation rates ranged from 90% to 100% throughout the 4-rounds of study.
• The consensus was reached for the following:

• Check alanine aminotransferase within a month before initiation (89.5%) and at peak dose (89.5%) but not monthly (76.2%) or after treatment completion (73.7%); 
• Check triglycerides within a month before initiation (89.5%) and at peak dose (78.9%) but not monthly (84.2%) or after treatment completion (73.7%); 
• Do not check complete blood cell count or basic metabolic panel parameters anytime during isotretinoin treatment (all >70%); 
• Do not check gamma-glutamyl transferase (78.9%), bilirubin (81.0%), albumin (72.7%), total protein (72.7%), low-density lipoprotein (73.7%), high-density lipoprotein (73.7%), or C-reactive protein (77.3%) anytime.

 This Delphi study proposed a core set of laboratory tests to be evaluated before and during treatment with isotretinoin. The results of this study can guide clinical practice and clinical guidelines to optimize laboratory monitoring in patients undergoing isotretinoin treatment.

Xia E, Han J, Faletsky A, et al. Isotretinoin Laboratory Monitoring in Acne Treatment: A Delphi Consensus Study. JAMA Dermatol. 2022;158(8):942–948. doi:10.1001/jamadermatol.2022.2044