Research Letter
Evaluation of CPK levels during acne treatment with oral isotretinoin
Bruna Maggioni Busetti
, David Rubem Azulay, Felipe Aguinaga, Edgar Ollague Cordova
Corresponding author
Instituto de Dermatologia Professor Rubem David Azulay, Santa Casa de Misericórdia do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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"paginaFinal" => "627" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Bruna Maggioni Busetti, David Rubem Azulay, Felipe Aguinaga, Edgar Ollague Cordova" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Bruna Maggioni" "apellidos" => "Busetti" "email" => array:1 [ 0 => "drabrunambusetti@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "David Rubem" "apellidos" => "Azulay" ] 2 => array:2 [ "nombre" => "Felipe" "apellidos" => "Aguinaga" ] 3 => array:2 [ "nombre" => "Edgar Ollague" "apellidos" => "Cordova" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Instituto de Dermatologia Professor Rubem David Azulay, Santa Casa de Misericórdia do Rio de Janeiro, Rio de Janeiro, RJ, Brazil" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 736 "Ancho" => 1508 "Tamanyo" => 80581 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">CPK versus total dose of isotretinoin.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Isotretinoin is an effective medication in the treatment of acne, which can have adverse musculoskeletal effects. However, factors associated with elevated creatine phosphokinase (CPK) levels are not well established.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">A retrospective study was carried out with 63 patients from Instituto de Dermatologia aiming at evaluating the levels of creatine phosphokinase (CPK) in patients using oral isotretinoin (ISO) for the treatment of acne. The parameters assessed in the medical record included the cumulative dose of ISO, weight and body mass index (BMI). The analysis of the correlation between the CPK levels and the variables was performed using Pearson's correlation coefficient.</p><p id="par0015" class="elsevierStylePara elsevierViewall">To assess the correlation between CPK variation and total cumulative dose, the data were plotted on a scatter plot (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Pearson’s coefficient between the two variables was found to be 0.3, which indicates there is a correlation between the cumulative dose of ISO and CPK levels, albeit a weak correlation.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Knowing that the cumulative dose varies according to each patient’s weight, a hypothesis was raised that the relationship between the increase in CPK would be associated with the weight and not with the cumulative dose. When correlating the weight with CPK levels (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>) using Pearson's coefficient, the result is 0.4, showing a moderate correlation in this case, therefore slightly higher than the correlation of the cumulative dose.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Finally, the correlation between patient BMI and CPK variation was analyzed, since BMI reflects body composition better than weight by itself. Among the studied patients, information was obtained to calculate the BMI in only 30 of them. A moderate positive correlation was also found, with Pearson's coefficient equal to 0.4. When patients were divided into three classes of BMI (underweight, normal weight and overweight) and plotted on the graph shown in <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>, a gradual increase in the maximum CPK value was observed in the group with an increase in the mean BMI.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Recent data show that body composition has been a potent contributor to CPK variability after exercise. Several studies have reported that body fat is a significant factor in muscle damage.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Heled et al. reported that individuals with a higher CPK elevation after exercise have a higher percentage of body fat than those with a lower one.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Paschalis et al. found that overweight women with an average of 31% body fat and 29.5 kg/m<span class="elsevierStyleSup">2</span> of BMI had a higher CPK elevation after exercise compared to women with normal body weight and BMI.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> A study of 119 male high school-age patients divided them into high responders (CPK > 2000 IU/L) and low responders (CPK < 500 IU/L) to CPK increase after exercise, and when the body composition was compared with CPK variation, high responders had a higher percentage of body fat compared to low responders. However, there were no significant differences in muscle mass and BMI between the low and high response groups.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Although these studies were carried out in patients submitted to physical activity, these data reinforce the results of the present study, which suggests that patients with higher weight/BMI are at a higher risk of CPK increase during the use of ISO, unprecedented literature data until now.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Although the relationship between body fat and muscle damage is not fully understood, the possible mechanisms can be inferred from several studies on obesity.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Kriketos et al. reported that individuals with a high percentage of body fat had more type II muscle fibers in biopsied muscles in comparison with non-obese individuals. Type II fibers are known to be more prone to damage than type I fibers. Moreover, obese individuals generally had reduced physical activity. Therefore, obese individuals showed greater muscle damage due to a lesser adaptation.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">In conclusion, a correlation was observed between the cumulative dose of ISO and the increase in CPK levels, which are believed to reflect the patients’ weight /BMI, since the latter variables showed a higher level of statistical significance. This finding has already been observed in studies that correlated CPK variations after physical exercise with body composition and BMI. The present study is the first to demonstrate that patients using ISO that have a high BMI may show a higher elevation in CPK levels. Studies with a larger number of patients are required to confirm this association.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0045" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors’ contribution</span><p id="par0050" class="elsevierStylePara elsevierViewall">Bruna Maggioni Busetti: Statistical analysis; design and planning of the study; drafting and editing of the manuscript; collection, analysis and interpretation of data.</p><p id="par0055" class="elsevierStylePara elsevierViewall">David Rubem Azulay: Effective participation in research orientation; critical review of the manuscript.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Felipe Aguinaga: Approval of the final version of the manuscript; design and planning of the study; drafting and editing of the manuscript; collection, analysis and interpretation of data; effective participation in research orientation.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Edgar Ollague Cordova: Drafting and editing of the manuscript; collection, analysis and interpretation of data.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0070" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Financial support" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Authors’ contribution" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-12-13" "fechaAceptado" => "2020-08-16" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">How to cite this article: Busetti BM, Azulay DR, Aguinaga F, Cordova EO,. Evaluation of CPK levels during acne treatment with oral isotretinoin. An Bras Dermatol. 2021;96:626–7.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 736 "Ancho" => 1508 "Tamanyo" => 80581 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">CPK versus total dose of isotretinoin.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 773 "Ancho" => 1508 "Tamanyo" => 41590 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">CPK versus weight.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 786 "Ancho" => 1508 "Tamanyo" => 56037 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">CPK versus mean BMI of the groups.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Creatine phosphokinase values during isotretinoin treatment for acne" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Y. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 1 | 3 | 4 |
| 2024 October | 139 | 72 | 211 |
| 2024 September | 218 | 81 | 299 |
| 2024 August | 228 | 104 | 332 |
| 2024 July | 174 | 102 | 276 |
| 2024 June | 126 | 109 | 235 |
| 2024 May | 113 | 60 | 173 |
| 2024 April | 131 | 76 | 207 |
| 2024 March | 101 | 76 | 177 |
| 2024 February | 124 | 82 | 206 |
| 2024 January | 101 | 44 | 145 |
| 2023 December | 65 | 56 | 121 |
| 2023 November | 79 | 76 | 155 |
| 2023 October | 68 | 90 | 158 |
| 2023 September | 106 | 84 | 190 |
| 2023 August | 63 | 30 | 93 |
| 2023 July | 108 | 55 | 163 |
| 2023 June | 74 | 51 | 125 |
| 2023 May | 70 | 16 | 86 |
| 2023 April | 46 | 12 | 58 |
| 2023 March | 73 | 47 | 120 |
| 2023 February | 56 | 31 | 87 |
| 2023 January | 56 | 28 | 84 |
| 2022 December | 59 | 34 | 93 |
| 2022 November | 94 | 66 | 160 |
| 2022 October | 85 | 49 | 134 |
| 2022 September | 66 | 66 | 132 |
| 2022 August | 45 | 55 | 100 |
| 2022 July | 54 | 75 | 129 |
| 2022 June | 63 | 51 | 114 |
| 2022 May | 54 | 75 | 129 |
| 2022 April | 59 | 63 | 122 |
| 2022 March | 65 | 63 | 128 |
| 2022 February | 52 | 43 | 95 |
| 2022 January | 84 | 69 | 153 |
| 2021 December | 86 | 60 | 146 |
| 2021 November | 62 | 66 | 128 |
| 2021 October | 95 | 89 | 184 |
| 2021 September | 130 | 86 | 216 |
| 2021 August | 45 | 60 | 105 |
| 2021 July | 24 | 26 | 50 |
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