Three dermatologists at the University of Vermont are urging an end to routine blood tests for liver enzymes and triglycerides in patients taking isotretinoin, the acne medication once sold as Accutane.
In a JAMA Dermatology viewpoint released today, Joseph C. Pierson, chair of the university’s dermatology department, and residents Taylor M. Pong and Mark L. Derbyshire state that for patients without risk factors, testing should occur only when symptoms appear. They believe this approach would reduce patient anxiety over temporary lab fluctuations and lower healthcare expenses.
A 2022 review in the British Journal of Dermatology examined 125 studies. It found adverse events detected by blood tests happened less than once in every 10,000 tests. The review concluded that routine monitoring in healthy young people was unnecessary and could flag minor, non-serious abnormalities.
The team also highlights that the National Institutes of Health’s LiverTox database assigns isotretinoin its lowest certainty rating for liver injury. The drug shares this rating with spironolactone and acyclovir, both of which use symptom-based monitoring. Terbinafine, an antifungal with stronger evidence of liver risk, requires no routine blood tests.
Costs play a role in their argument. With high-deductible insurance plans growing more common, unnecessary testing burdens patients and the healthcare system. “We must be better stewards of healthcare resources,” the authors write, “particularly when our efforts ease financial strain.”
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The move to reduce testing isn’t new. In 2022, an international group of experts stopped recommending monthly liver enzyme and triglyceride tests. They proposed a baseline test and another at peak dosage instead. Pierson’s team now wants to limit testing even more.
Isotretinoin has a long history of controversy. Approved by the FDA in 1982, it was soon linked to severe birth defects. This led to a boxed warning and a risk evaluation program to prevent pregnancy exposure. Lawsuits have also connected the drug to inflammatory bowel disease and, in some cases, suicide, though research hasn’t proven a direct link.
The medication remains one of the most effective treatments for severe acne. Side effects like dryness and joint pain are typically manageable, and dermatologists have improved patient selection to reduce complications. The testing debate reflects a wider tension in medicine: balancing caution with practicality, and evidence with real-world costs.
For now, the proposal is just a viewpoint. If adopted, it could signal another shift in the drug’s evolution from a tightly controlled medication to one with a more flexible monitoring approach.
Some clinics have already begun adjusting their protocols to reflect these changing standards.
