PUBLIC USAGE OF ISOTRETINOIN IN SAUDI ARABIA: AN ONLINE SURVEY

Sarah K. Alharbi 1 and Amal A. Kokandi 2 (MSc, MD). 1. Medical intern, Faculty of Medicine, King Abdulaziz University, Saudi Arabia. 2. Department of dermatology, Faculty of Medicine, King Abdulaziz University, Saudi Arabia. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History

Previous study showed some redundancy in the dermatologist adherence to recommendations regarding isotretinoin prescription to females of childbearing potentials (AlGhamdi KM et al., 2011 ) .Additionally, it has been shown that isotretinoin can be purchased online with little or no restriction (Lagan BM et al., 2014) In Saudi, this medication can not be purchased from the pharmacy without medical prescription. But no regulation on the prescribing physician status and sometimes can be supplied from some pharmacies without prescription. It ISSN: 2320-5407 Int. J. Adv. Res. 5(12), 260-263 261 was noticed lately that some patients were taking this medication without prescription (Alrwisan AA et al., 2014), or the medication was advocated by pharmacists or some family members.
The aim of this study is to explore isotretioin (Roaccutane as the main and widely known brand) use among acne patients without dermatologist supervision at Saudi Arabia. To our knowledge this is the first study of its kind in Saudi Arabia.

Methods:-
This is a non-interventional cross-sectional survey. It was conducted through distribution of online questionnaires over one month at August 2016 directed to acne sufferers from all regions of Saudi Arabia through social Medias.
The questionnaire was broadly divided into 3 categories of demographics, Anthropometry measures and Roaccutane using information. First part contained socio-demographic variables (age, gender, educational level and place of residency). Second part consisted of 2 items, height and weight to allow for the calculation of body mass index of patients. Third part contained 10 questions and provided details about Roaccutane usage. It included a question of whether he/ she have ever suffered from acne, if he/ she have visited a dermatologist for this problem, and if he/ she have used Roaccutane and if yes, if he/ she had a dermatologist consultation before using the medication. Sources of advice of using Roaccuatane if not dermatologist (pharmacist, relatives, friends, website, or others). Additional questions about the dose ( 10mg daily, 20mg daily, more than 20mg daily, unknown ), effictiveness of Roaccutane ( yes, no), appearance of side effect ( yes, no) and the side effects (dryness, headache, abdominal pain, blurring of vision or any other side effects).
The returned questionnaires entered into a database and analyzed by using SPSS version 22.

Results:-
In total 401 responded to the questionnaire. Of those 320 suffered from acne. These were included for further analysis, of which 238 (74.4%) were female and 82 (25.6%) were male. The majority was from the age group of 20-30 years and 268 (83.8%) had university educational level. The mean score of BMI was 23.6±4.5 (range 14-39) ( Table 1).
The majority of the participants reported started having acne at the age of 14-20 years. More than half (52.2%) visited dermatologist.
A total of 154 (48.1%) used Roaccutane. Ten mg per day was used by 7 subjects (4.6%), 20 mg/day and more than 20 mg/day were used by 59 subjects each (38.3 %) and the dose was unknown in 29 subjects (18.8%). The most common side effect was dryness (76.2%) ( Table 2) Thirty one subjects used Roaccutane without medical consultation (9.69% of study subjects). The characteristics of this group is presented in table 3.

Discussion:-
This study's aim is to explore isotretinoin (Roaccutane as the main and widely known brand) use among acne patients without dermatologist supervision at Saudi Arabia. To our knowledge this is the first study of its kind in Saudi Arabia. In this study nearly 10% (31 cases) acne sufferers reported using Roaccutane by advice from other than doctors. Females (14 cases) constituted 45% of them. They were mainly from the age group of 20-30 years. More than third of them used the medication with doses of more than 20 mg. They were advised to use Roaccutane by pharmacists, friends, relatives and others.
These results indicate the feasibility of using the medication without proper medical supervision and the lack of public awareness of its requirements. Teratogeneicty is a major concern in using this medication and as mentioned earlier; femlaes in the childbearing age has used it without medical consultation.
Although a recent meta-analysis (Lee YH et al., 2016) of the effect of isotretinoin on the laboratory changes suggest that monthly laboratory monitoring is not needed, there should be at least a baseline investigations. Apart from mucocutaneous side effects other side effects are not common. Other side effects can be encountered by patients 262 rarely as intracranial hypertension. This is supposed to be a medical emergency. In case the patient is using this without prescription it might not be mentioned in case of any complaint and could be missed as a cause of the problem.
Study limitation include the nature of the study, being a web based study. So, it might not be very representative. Nevertheless, it demonstrates the accessibility of Isotretinoin with a possible consequences of side effects specially the teratogenecity if used by pregnant females.
In conclusion considerable number of acne patients used isotretinoin without medical prescription which warrants more vigorous restriction on its dispensing and need for public awareness efforts to prevent critical side effects of the medication.