Isotretinoin (13-cis retinoic acid) is a vitamin A derivative of retinoic acid. It was
approved by the FDA in 1982 for the treatment of severe, refractory nodulocystic acne.
Isotretinoin has been used effectively alone in the treatment of acne for 35 years.
Isotretinoin is used in a daily dose range of 0.5-1 mg/kg/day. Starting treatment with
high doses increases the risk of acute exacerbation, inflammation and scarring and is not
recommended. The side effects of this treatment are often dose-dependent and the most
common side effects are related to the skin and mucous membranes. Hypervitaminosis
A-related side effects affecting the skin, eye, neurologic, hepatic and skeletal-muscular
system are available. On the skin; dryness, cheilitis, dryness in the eyes, epistaxis,
itching, dryness in the eyes may be observed. Ocular findings include xerophthalmia,
conjunctivitis, night blindness, keratitis and optic neuritis. Pseudotumor cerebri, a
rare side effect, is characterized by severe headache, nausea and visual changes. As a
result, side effects such as forgetfulness, headache, decreased concentration, menstrual
irregularity, increased blood lipid and transaminase levels, myalgia, arthralgia and low
back pain may be observed during isotretinoin use . Isotretinoin-associated bilateral or
unilateral sacroiliitis is among other reported side effects. Sacroiliitis is usually
seen as acute sacroiliitis days or weeks after the start of isotretinoin treatment.
Recent literature suggests that the reduction of pro-inflammatory cytokines (e.g. TNF-α,
IL-1β, IL-6) and the release of anti-inflammatory myokines (e.g. IL-6, IL-10) are the key
mechanisms of exercise in inflammatory rheumatic diseases. In addition, the function of
regulatory T-cells is enhanced by exercise, which also reduces oxidative stress and
improves the function of these cells. A review of the benefits of exercise in PsA was
carried out, with findings including reduced disease activity, improved physical function
and decreased inflammation. Moreover, discourse is had on the psychological advantages of
physical exertion, including a reduction in symptoms of depression and anxiety. The
impact of exercise on AS was evaluated, with improvements in spinal mobility, pain and
inflammation being emphasised. They also discuss the role of exercise. They discuss how
exercise can reduce oxidative stress. They also discuss how exercise can improve
cardiovascular health. They focus on this in relation to AS patients. So, the hypothesis
of this study was predicated on the theory that regular exercise reduces disease burden
by improving joint mobility, muscle strength and overall physical function, in addition
to its salutary anti-inflammatory effects. The H1 hypothesis of this study was that
regular exercise programmes have a favourable impact on the adverse musculoskeletal
effects of isotretinoin treatment.
Material-Method:
In this study, it was planned to investigate the effects of stretching and sacroiliac
mobilization exercises on musculoskeletal pain and sacroileitis, which are side effects
of the drug, on musculoskeletal pain and quality of life in patients started on
isotretinoin treatment. Between August 2025 and January 2026, patients who applied to the
dermatology outpatient clinic and planned to start isotretinoin will be informed about
the study, one group will be taught a sacroiliac stretching and mobilization exercise
program and will be asked to perform these exercises 10 times in 2 sets every day. The
other group will consist of patients who do not exercise and take medication. Within the
scope of this prospectively planned study, it is planned to evaluate the patients by
collecting data in 4 stages. The first stage will be collected before the start of
isotretinoin treatment, the second stage in the 1st month of treatment, the third stage
in the 3rd month of treatment and the last stage in the 6th month of treatment by
evaluating pain measurement and quality of life. Musculoskeletal pain measurements,
quality of life, and conditions occurring during follow-up will be evaluated and compared
between the exercising group and the non-exercising group.
Pain measurement; The pain sensitivity of the subjects to pressure will be evaluated with
a pain meter device called algometer. Algometer Commender Jtech Medical 801-478 USA brand
digital algometer will be used in the evaluation. This device is already in current use
and belongs to the researchers themselves. The algometer will be used to measure the
trapezius muscle trunk, latissimus dorsi muscle trunk and sacroiliac joints bilaterally 3
times each. Before the measurement, the areas will be marked and the algometer will be
placed perpendicular to these points and the subjects will be asked to report the first
sensation of pain. The pain threshold will be recorded in pounds (1kg=2.2 pounds) by
reading the value on the indicator.
Quality of Life measurement; World Health Organization Quality of Life (WHOQOL-SHORT
FORM) is a statement-based measure developed to assess perception, personal goals,
standards and concerns within one's own culture and values. The WHOQOL-SHORT FORM
measures the following domains: physical health, psychological health, social
relationships and environment. High scores indicate high quality of life, while low
scores indicate low quality of life. Turkish validity and reliability has been realized
(4).
Hypothesis(es): Regular exercises will have a positive effect on pain and quality of
daily life levels in patients started on isotretinoin treatment.
