accutane and growth plates

Dear Doctor,

The following was posted by another user...what is your response to this?...do you recommend bone age xrays for younger patients on accutane.  I have read that years of antibiotic use are not the best option either.  My 13 year old has begun 40mg accutane a few days ago and I am assuming the dosage could be increased if all goes well month by month.  Please advise...growth arrest would not be worth it.

Posted by another user in 2000:
"Last August my son was started on Acutane by a very good and thorough Physician's Assistant in a dermatologist office in California. He spent a great deal of time explaining the six month treatment, the possible side effects and complications. He explained the risk of liver problems and the need for blood work before and during treatment. He also said that the medication could also effect growth. He mentioned that during clinical trials two children stopped growing while on Acutane. He did say that the children were on different doses than what my son would be on.
Well, being the overly nervous mom that I am, I looked up Acutane in the Physicians Desk Reference. It mentioned the two children who stopped growing. It said they had premature closure of the epiphysis. I decided on my own to consult a pediatric orthopedist for a second opinion about the growth issue. I went to a doctor in Orinda California. He told me that he had never been asked about this before, but he suggested that we could do a Pre-treatment bone age x-ray and then do another in two months. After two months on Acutane I received a call from the Orthopedist who told me that in the two months my son was on Acutane his bone age went from 15 years to 17 years. He suggested that I take my son off the medication immediately and report it to the Dermatologist.
The Acutane was immediately stopped. I called the Dermatologist and Roche Laboratories(the maker of Acutane) and told them what happened to my son. They said they appreciated me for reporting it and said they will report it to the Food and Drug Administration. All of the medical records of my son's treatment and x-rays were sent to Roche Labs.
After seeing how easy it was to do a bone age study(just a hand x-ray) I would recommend to all parents who are considering putting their growing children on this drug to ask for pre-treatment bone age and another one about two months after treatment starts. Better yet, hold off on treatment until the child is done growing. If my child continued on this drug loosing one year of growth per month, he could have lost six years. Potentially all of his future growth."

[Alan Rockoff, MD]

Growth arrest, as you note, has been reported.  However, it's very rare.  There just isn't enough data to make firm recommendations about X-ray monitoring.  I can tell you that it isn't standard practice to obtain such X-rays.  As to how reliably predictive they are of side-effects, I simply don't know.

Dr. Rockoff

[2worriedmom]

If anyone has taken accutane during the growing years and has had significant growth after treatment, please post. Thanks!

[h200]

I was put on Accutane after antibiotics did not really work. (Tried many things) I was 18 and not worried about growth. I started at like 1/4 of a normal dose for about 1-2 mo, then jumped to 1/2 dose. My acne went away virtually overnight. (Usually it is supposed to take a long time) Once that happened I had the normal side effects - dry skin/eyes, etc. But once I jumped to 1/2 dose I got bi-polar depression, and that was not fun at all!

I was taken off right away once we figured out what was going on. My dermatologist retired and the new one 3 months later said "Have you ever tried accutane?" and I said "Did you even look at my medical history?".

I did not go back.

[DEBMOM]

I was on accutane when it was fairly new (1985). It worked great for me. I did not have a growth arrest. Honestly, as bad as my skin was, I would not have cared.

Best luck!