A common but not well-known cause in anal fissure development and treatment failure: Isotretinoin treatment for acne vulgaris

Abstract

To investigate the underrecognized effects of isotretinoin as a cause of anal fissures (AF) and compare AF patients undergoing systemic isotretinoin treatment (SIT) and those not receiving this treatment. This study was conducted with 118 patients with newly diagnosed AF, 54 undergoing SIT (Group 1) and 64 not undergoing SIT (Group 2). The same clinical treatment modalities including first-line conservative and medical treatments during the first eight weeks, followed by interventional methods (botulinum injection or sphincterotomy) for unresponsive/recurrent cases were used for all patients. A comparative analysis was also performed. Age and body mass index (BMI) were statistically low in group 1 (p=0.003; p=0.032). Similarly, the VAS pain and Wexner constipation scores and the duration of symptoms were lower in group 1 than Group 2 (p=0.003, p<0.001, and p<0.001, respectively). Atypical fissure localization was clearly associated with group 1 (p=0.012), and although SIT did not increase the surgery rate, atypical fissures and longer symptom duration constituted the most important factors determining requirement of surgical. SIT, a very successful treatment for nodulocystic acne disease, can facilitate AF development in younger individuals with a low BMI even without significant constipation.