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What Is The Effect Of Accutane On Bone Age?
Question: what is the effect of isotretinoin (roaccutane) on bone age in a teenage male 16 to 17 years old?
Isosterinoin is used to treat acne.
Isosterinoin is used to treat acne.
Brief Answer:
Isotretinoin
Detailed Answer:
Hello and welcome to healthcaremagic
I am Dr. Kakkar. I have gone through your query and I have understood it.
Studies have found that Accutane even at low doses can cause advanced bone age and premature epiphyseal closure in teens that are still growing. This can result in noticeable stunted growth.
A teen of 16-17 years may still have long bones epiphyses that are not yet fused (there is a range of fusion e.g some of the long bone epiphyses fuse as late as 19-20 years). Therefore, Isotretinoin can produce some growth stunting at this age.
Regards
Isotretinoin
Detailed Answer:
Hello and welcome to healthcaremagic
I am Dr. Kakkar. I have gone through your query and I have understood it.
Studies have found that Accutane even at low doses can cause advanced bone age and premature epiphyseal closure in teens that are still growing. This can result in noticeable stunted growth.
A teen of 16-17 years may still have long bones epiphyses that are not yet fused (there is a range of fusion e.g some of the long bone epiphyses fuse as late as 19-20 years). Therefore, Isotretinoin can produce some growth stunting at this age.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr:
You said isotretinoin can cause advanced bone age. My question is ; does isotretinoin advance bone age period? As in will it advance bone age in a 16 to 17 year old male patient? And if the bone age is advanced does this not mean that child will stop growing sooner? And therefore be less taller? Would you prescribe isotretinoin to a 16 to 17 year old male with acne? How much would the bone age be advanced in a two month treatment ?
You said isotretinoin can cause advanced bone age. My question is ; does isotretinoin advance bone age period? As in will it advance bone age in a 16 to 17 year old male patient? And if the bone age is advanced does this not mean that child will stop growing sooner? And therefore be less taller? Would you prescribe isotretinoin to a 16 to 17 year old male with acne? How much would the bone age be advanced in a two month treatment ?
Brief Answer:
Isotretinoin
Detailed Answer:
Hi
-Does isotretinoin advance bone age period? Yes, studies have shown that.
-As in will it advance bone age in a 16 to 17 year old male patient? Yes, it may because many of the long bone epiphyses e.g Tibia and Femur don't close by 19-20 years of age.
-If the bone age is advanced does this not mean that child will stop growing sooner? And therefore be less taller? Yes, the longer the epiphyses remain open the greater the height attained. If the epiphyses fuse prematurely, final height attained may be less.
-Would you prescribe isotretinoin to a 16 to 17 year old male with acne? No, I wont.
-How much would the bone age be advanced in a two month treatment? Can't be estimated accurately for a 2 months course of Isotretinoin, but it has been studied that even low doses and shorter periods of Isotretinoin treatment, can have an effect on bone age.
Regards
Isotretinoin
Detailed Answer:
Hi
-Does isotretinoin advance bone age period? Yes, studies have shown that.
-As in will it advance bone age in a 16 to 17 year old male patient? Yes, it may because many of the long bone epiphyses e.g Tibia and Femur don't close by 19-20 years of age.
-If the bone age is advanced does this not mean that child will stop growing sooner? And therefore be less taller? Yes, the longer the epiphyses remain open the greater the height attained. If the epiphyses fuse prematurely, final height attained may be less.
-Would you prescribe isotretinoin to a 16 to 17 year old male with acne? No, I wont.
-How much would the bone age be advanced in a two month treatment? Can't be estimated accurately for a 2 months course of Isotretinoin, but it has been studied that even low doses and shorter periods of Isotretinoin treatment, can have an effect on bone age.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
What effect would accutane have on DHT levels? Would it harm penis growth?
What effect would accutane have on testicule growth in a 16 to 17 year old male. I read that it harms epyleal tissue causing them to dry out. I know these are in the testicles. Also lowered DHT would be bad for testicles. Please tell me your thoughts.
Also so is it safe to say that the isotretinoin reduced my final adult height; and if so by how much? 1/2 an inch; 1 inch; 2 inches?
which bones fuse later; the femurs or the spine? And how about the hands and feet?
And the fingers; do the tips of the fingers fuse before or after the other bones of the fingers?
What effect would accutane have on testicule growth in a 16 to 17 year old male. I read that it harms epyleal tissue causing them to dry out. I know these are in the testicles. Also lowered DHT would be bad for testicles. Please tell me your thoughts.
Also so is it safe to say that the isotretinoin reduced my final adult height; and if so by how much? 1/2 an inch; 1 inch; 2 inches?
which bones fuse later; the femurs or the spine? And how about the hands and feet?
And the fingers; do the tips of the fingers fuse before or after the other bones of the fingers?
Brief Answer:
Accutane side effects
Detailed Answer:
Hi.
No, it wont affect DHT levels at all and therefore it and wont harm penile or testicular growth.
Also so is it safe to say that the isotretinoin reduced my final adult height; and if so by how much? 1/2 an inch; 1 inch; 2 inches? It may have reduced your final height. I can't give you the exact measure.
There is a range which is described for fusion e.g Femoral epiphyses fuse between 15.5-19.5 years (proximal end) and 14.5-22 years (distal end). Vertebrae fuse at various times extending from 11-27 years of age.
Regarding the hands and feet the phalangeal epiphyses fuse with the shaft between 16-17 years. Distal phalanges fuse a little earlier than the proximal phalanges.
Hope this answers your query
Regards
Accutane side effects
Detailed Answer:
Hi.
No, it wont affect DHT levels at all and therefore it and wont harm penile or testicular growth.
Also so is it safe to say that the isotretinoin reduced my final adult height; and if so by how much? 1/2 an inch; 1 inch; 2 inches? It may have reduced your final height. I can't give you the exact measure.
There is a range which is described for fusion e.g Femoral epiphyses fuse between 15.5-19.5 years (proximal end) and 14.5-22 years (distal end). Vertebrae fuse at various times extending from 11-27 years of age.
Regarding the hands and feet the phalangeal epiphyses fuse with the shaft between 16-17 years. Distal phalanges fuse a little earlier than the proximal phalanges.
Hope this answers your query
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
when you say distal phalanxes you mean the bones in the fingertips.
Does accutane down regulate the DHT receptors? Does it down regulate the Alpha 5 aromatese receptors.
Is it possible to do a bone age x ray to see if my bone age is more advanced than my age of 38. IT would give me an idea if the accutane could have caused this?
And to be clear; it is true that accuatane will advance bone age over chronological age during treatment? If you take a two month treatment is it probable that bone age was advanced some; perhaps 6 months to one year?
This would probably mean lost height of 1 to 2 inches?
would isotretinoin effect distal finger phalanxes growth more than main phalanxes? And foot size more than other bones? I have feet which are smaller than my dad; and my fingers also. HE is shorter than me; so I do not fully understand.
Also my fingers are very narrow on the top two phalanxes. I do not understand why.
to be clear does isotretinoin advance bone age in almost all male patients who are under 20 and take it?
when does long bone growth stop in the arms? Forearms?
I took accutane when I was just turning 17.
I took it for two months.
I was growing at 3 inches a year the school year before taking accutane.
I did grow some as late as 20 years old.
Do you have any idea how much height I lost?
Does accutane down regulate the DHT receptors? Does it down regulate the Alpha 5 aromatese receptors.
Is it possible to do a bone age x ray to see if my bone age is more advanced than my age of 38. IT would give me an idea if the accutane could have caused this?
And to be clear; it is true that accuatane will advance bone age over chronological age during treatment? If you take a two month treatment is it probable that bone age was advanced some; perhaps 6 months to one year?
This would probably mean lost height of 1 to 2 inches?
would isotretinoin effect distal finger phalanxes growth more than main phalanxes? And foot size more than other bones? I have feet which are smaller than my dad; and my fingers also. HE is shorter than me; so I do not fully understand.
Also my fingers are very narrow on the top two phalanxes. I do not understand why.
to be clear does isotretinoin advance bone age in almost all male patients who are under 20 and take it?
when does long bone growth stop in the arms? Forearms?
I took accutane when I was just turning 17.
I took it for two months.
I was growing at 3 inches a year the school year before taking accutane.
I did grow some as late as 20 years old.
Do you have any idea how much height I lost?
Brief Answer:
Isotretinoin side effects
Detailed Answer:
Hi.
That is a volley of questions!!
Humerus (Arm) fuses at 10-15 years (proximal end) and 9-15 years (distal end)
Radius (Forearm) fuses at 14-19 years (proximal end) and 16-22 years (distal end)
As mentioned previously, Isotretinoin can cause premature epiphyseal fusion and therefore can affect the final height achieved. By how much? It cannot be measured retrospectively. It would affect all the epiphyses equally, those which are not yet fused.
At 38 years of age, X-rays wont help because all the epiphyses have already fused by now. Bone age can be determined with X-rays only if there are a few yet unfused epiphyses (means some have fused and some are yet to fuse).
As you can see from these examples, age determination is not an exact science. Ranges of fusion can span five, or even ten, years. If all the epiphyses have already fused (which they do by 38 years) then an alternate method of determining age must be used, rather than x-rays.
Regards
Isotretinoin side effects
Detailed Answer:
Hi.
That is a volley of questions!!
Humerus (Arm) fuses at 10-15 years (proximal end) and 9-15 years (distal end)
Radius (Forearm) fuses at 14-19 years (proximal end) and 16-22 years (distal end)
As mentioned previously, Isotretinoin can cause premature epiphyseal fusion and therefore can affect the final height achieved. By how much? It cannot be measured retrospectively. It would affect all the epiphyses equally, those which are not yet fused.
At 38 years of age, X-rays wont help because all the epiphyses have already fused by now. Bone age can be determined with X-rays only if there are a few yet unfused epiphyses (means some have fused and some are yet to fuse).
As you can see from these examples, age determination is not an exact science. Ranges of fusion can span five, or even ten, years. If all the epiphyses have already fused (which they do by 38 years) then an alternate method of determining age must be used, rather than x-rays.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
okay; but if istotretinoine does not cause pre mature eshpeseal closure; does it advance bone age? The way it works? Will it advance bone age in all male teenagers who take it during say a couple of months?
Brief Answer:
Isotretinoin side effects
Detailed Answer:
Hi.
Bone age is calculated on a set of x-rays. e,g if the lower end of humerus is fused that means the bone age is between 9-15 years and if proximal end of femur is also fused that means it is more than 15.5 years.
Suppose lower end of humerus normally fuses between 9-15 years of age but if the patient is on Isotretinoin, it may fuse at 8 years of age. Therefore the bone age is at least 9 years but the chronological age is still 8 years (since the epiphyses has closed prematurely, therefore the length of humerus wont increase further, where normally it would have increased for at least 1 more year if not more)
Yes, it would advance bone age in all.
Regards
Isotretinoin side effects
Detailed Answer:
Hi.
Bone age is calculated on a set of x-rays. e,g if the lower end of humerus is fused that means the bone age is between 9-15 years and if proximal end of femur is also fused that means it is more than 15.5 years.
Suppose lower end of humerus normally fuses between 9-15 years of age but if the patient is on Isotretinoin, it may fuse at 8 years of age. Therefore the bone age is at least 9 years but the chronological age is still 8 years (since the epiphyses has closed prematurely, therefore the length of humerus wont increase further, where normally it would have increased for at least 1 more year if not more)
Yes, it would advance bone age in all.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
so basically accutane will reduce reduce final height to some degree in all patients under 18 who take it? Do you agree? The height reaction will vary upon duration of treatment; dosage; age; the person , etc.
If so can I ask why such a medicine is not outlawed for use in patients under 18?
If so can I ask why such a medicine is not outlawed for use in patients under 18?
Brief Answer:
Isotretinoin
Detailed Answer:
Hi
That is a very pertinent question. The most reasonable explanation to that is this side effect is more of a concern in those who require repeated OR prolonged courses of Isotretinoin (when Isotretinoin is the only drug helpful for there skin problem e.g Icthyosis, Pityriasis Rubra Pilaris etc) rather than just a single course of Isotretinoin for a few months given in acne patients.
However studies have shown that even low doses and lesser duration of treatment with Isotretinoin can cause advancement of bone age (not to that extent as in those who require repeated courses).
It is therefore an individual choice as to give or not to give Isotretinoin during the teenage growth spurt. In young children growth stunting is not much of an issue. In general it should be avoided during pubertal growth spurt as it can accelerate epiphyseal closure (no matter to whatever lesser extent it does). However, it should be given in those with an absolute necessity for it. This side effect however has not been an issue that has been often raised. Probably more longer experience with this drug might change the recommendations of Isotretinoin usage in teenage.
Regards
Isotretinoin
Detailed Answer:
Hi
That is a very pertinent question. The most reasonable explanation to that is this side effect is more of a concern in those who require repeated OR prolonged courses of Isotretinoin (when Isotretinoin is the only drug helpful for there skin problem e.g Icthyosis, Pityriasis Rubra Pilaris etc) rather than just a single course of Isotretinoin for a few months given in acne patients.
However studies have shown that even low doses and lesser duration of treatment with Isotretinoin can cause advancement of bone age (not to that extent as in those who require repeated courses).
It is therefore an individual choice as to give or not to give Isotretinoin during the teenage growth spurt. In young children growth stunting is not much of an issue. In general it should be avoided during pubertal growth spurt as it can accelerate epiphyseal closure (no matter to whatever lesser extent it does). However, it should be given in those with an absolute necessity for it. This side effect however has not been an issue that has been often raised. Probably more longer experience with this drug might change the recommendations of Isotretinoin usage in teenage.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Okay; so basically; if you take it for two to three months it probably advances your bone age by perhaps up to one year? So it is like when I started taking it (oct 1992) around my 17th birthday my bones advanced to 18 quickly? So I lost that year of height growth? i believe that would be one to two inches? And about the hands and feet; you said these stop growing by 17 or so? I have to say my shoe size never changed after age 16. But i grew a couple of inches from 16 to 21. IS this normal?
Is there a way to tell if accutane reduced my growth? Can you for example take ratios of bones that would normally have closed before age 17 and ones that normally close after 17? Any other way to tell?
And what do you know about the effect of accutane on alpha 5 reductase; does it down regulate DHT receptors? Or reduce the level of DHT? So you know isotretinoin has been shown to cause testicular atrophy in male dogs.
Something about it altering the testosterone to DHT pathway (alpha 5 reductase) and altering the DHT level.
you said vertebrae fuse at different times. Is the variation among people or more so among different bones in the vertebrae; i have a ton of back x rays.
I have another question. Would accutane cause the larynx plate age to advance? Would this mean that the vocal cords would stop growing sooner.
Basically would my voice not be as deep as it would have been if i had not taken accutane? See; the vocal cords continue to lengthen until around 20 and the larynx continues to grow until 20 or so. Please advise.
Is there a way to tell if accutane reduced my growth? Can you for example take ratios of bones that would normally have closed before age 17 and ones that normally close after 17? Any other way to tell?
And what do you know about the effect of accutane on alpha 5 reductase; does it down regulate DHT receptors? Or reduce the level of DHT? So you know isotretinoin has been shown to cause testicular atrophy in male dogs.
Something about it altering the testosterone to DHT pathway (alpha 5 reductase) and altering the DHT level.
you said vertebrae fuse at different times. Is the variation among people or more so among different bones in the vertebrae; i have a ton of back x rays.
I have another question. Would accutane cause the larynx plate age to advance? Would this mean that the vocal cords would stop growing sooner.
Basically would my voice not be as deep as it would have been if i had not taken accutane? See; the vocal cords continue to lengthen until around 20 and the larynx continues to grow until 20 or so. Please advise.
Brief Answer:
You have nothing to worry
Detailed Answer:
Hi.
There is no way to tell how much height you lost because of Isotretinoin.
The variation in fusion of vertebrae is with respect to different bones in the vertebrae, with different bones fusing at different times.
See, the studies say that Isotretinoin can cause premature epiphyseal fusion. However this side effect is of more concern in those who require repeated doses OR prolonged courses of Isotretinoin. Therefore there is a need for caution in only those individuals!!! NOT EVERYONE. It has not been much of an issue in those who require a single course of Isotretinoin (just 2 months in your case!!). You have been worrying unnecessarily. Please don't. put your mind at ease and carry on with your life!!
I have already told you that in humans it does'nt affect DHT Levels, penile growth OR testicular growth neither does it affect Larynyx.
You have nothing to worry
Detailed Answer:
Hi.
There is no way to tell how much height you lost because of Isotretinoin.
The variation in fusion of vertebrae is with respect to different bones in the vertebrae, with different bones fusing at different times.
See, the studies say that Isotretinoin can cause premature epiphyseal fusion. However this side effect is of more concern in those who require repeated doses OR prolonged courses of Isotretinoin. Therefore there is a need for caution in only those individuals!!! NOT EVERYONE. It has not been much of an issue in those who require a single course of Isotretinoin (just 2 months in your case!!). You have been worrying unnecessarily. Please don't. put your mind at ease and carry on with your life!!
I have already told you that in humans it does'nt affect DHT Levels, penile growth OR testicular growth neither does it affect Larynyx.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Obviously, if you do not prescribe isotretinoin for acne there is reason to be concerned. There exist normal ratio of fumerus to forearm ; and normal ratios of vertebrae to to each other. Is it not possible to make an xray of back vertebrae; you could in theory see if some of them are abnormally small or large compared to the other ones? For example the ones that fuse after 17 might be missing more growth than the ones that fuse before 17?
Brief Answer:
Isotretinoin
Detailed Answer:
Hi.
Sure, I can understand your concern. I would suggest you to seek an appointment with an orthopedician. He can order a few X-Rays for you, to look for any discordant bone growth. I think that would be the best thing to do to put your mind at ease.
Regards
Isotretinoin
Detailed Answer:
Hi.
Sure, I can understand your concern. I would suggest you to seek an appointment with an orthopedician. He can order a few X-Rays for you, to look for any discordant bone growth. I think that would be the best thing to do to put your mind at ease.
Regards
Note: Hope the answers resolves your concerns, however for further guidance of skin related queries consult our Dermatologist.Click here to book a consultation
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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