Successful Isotretinoin Use in an Acne Patient with Medium-Chain Acyl-CoA Dehydrogenase Deficiency

Vollständiger Abstract

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Medium-chain acyl-CoA dehydrogenase deficiency (MCADD) is a rare autosomal recessive disorder impairing fatty acid oxidation and predisposing to metabolic crises. Isotretinoin, a vitamin A derivative for severe acne, alters lipid metabolism and theoretically could worsen this risk. No prior cases of isotretinoin use in MCADD patients have been reported. This report describes the case of a 21-year-old woman with MCADD who presented with moderate papular acne refractory to topical therapy. She was initiated on isotretinoin 10 mg/day with stepwise escalation to 80 mg/day. Baseline and follow-up hepatic function, lipid panel, and vitamin A levels remained normal. She achieved full remission, with only mild cheilitis as an adverse effect. Although isotretinoin may theoretically impair oxidative metabolism, this patient tolerated treatment without metabolic decompensation. This case suggests isotretinoin can be safely used in select MCADD patients with monitoring of vitamin A levels.