Analysis: Pediatric Isotretinoin Use Not Linked to Shorter Adult Height

Contrary to previous reports, isotretinoin use among pediatric patients was not associated with shorter height by adult age in a new study. In fact, investigators observed that patients who took the common acne vulgaris drug at an early are were on average taller than the observed population at adulthood.

In new data presented at the American Academy of Dermatology (AAD) 2024 Annual Meeting in San Diego, CA, this week, a team of Boston-based investigators found results of associated adulthood height with pediatric isotretinoin use to be contrary to evidence of premature epiphyseal closure in such patients. The findings were consistent for both male and female patients.

Isotretinoin is an oral retinoid therapy that has been marketed to treat patients with acne for the last 4 decades. Though a tried and true method of care for patients who may not respond to standard acne therapy, previous research has suggested a potential impairment in growth among treated patients due to the premature fusion of growth plates. Investigators, led by Hannah L. Cole, a student at Harvard Medical School, considered the association between stunted growth and pediatric isotretinoin risk via retrospective cohort analysis.

Cole and colleagues used the TriNetX research database to identify patients with acne who were treated with isotretinoin at ≤18 years old and who had adult body height measurement data available. The team compared such patients to a control cohort of patients with acne and adult body height measurement data who were instead treated with doxycycline at ≤18 years old and not isotretinoin. They noted that doxycycline, a tetracycline antibiotic, is another common acne drug that contains no known risk of stunted growth among pediatric users.

The analysis included 6832 male patients treated with isotretinoin, 4279 female patients treated with isotretinoin, 14,987 male patients treated with doxycycline, and 20,228 female patients treated with doxycycline. Investigators sought significant differences in adult body height based on pediatric acne treatment—stratified by gender—via Welch’s t-test.

Not only did investigators observe that the cohort of isotretinoin-treated patients did not have a lower mean body height in adulthood compared to the doxycycline cohort—they observed a statistically significantly higher mean body height among the patients who took isotretinoin. The difference versus the control population was significant among both males (P = .020875) and females (P = .000005).

Though the research was limited by the inability to interpret the duration of treatment with either isotretinoin or doxycycline, as well as contributing factors including parental height of treated patients, the team concluded their findings warrant further exploration into the effects of patient age at first isotretinoin treatment, the dose and duration of treatment, and the contributing effect of other factors.

“These findings provide evidence against an association between isotretinoin treatment and premature epiphyseal closure among pediatric acne patients and can inform treatment recommendations for pediatric acne,” Cole and colleagues wrote.

References

1. ^{Cole HL, Shen L. Association Between Pediatric Isotretinoin Treatment and Adult Body Height in Acne Patients. Paper presented at: American Academy of Dermatology (AAD) 2024 Annual Meeting. March 8 – 12, 2024. San Diego, CA.}
2. ^{Cardoso-Demartini AA, Boguszewski CL, Boguszewski MCS. Potential Effects of Oral Isotretinoin on Growth Plate and Height. Endocrines. 2023; 4(2):281-292. https://doi.org/10.3390/endocrines4020023}