Isotretinoin Use Induces Epithelial Thickening, Stromal Thinning

Conceptual of problems on woman skin.
Study uses SD-OCT imaging to evaluate the change to the corneal epithelium.

Oral isotretinoin therapy for severe acne can increase epithelial thickness while decreasing the stroma, according to research published in Eye and Contact Lens. 

Researchers conducted a prospective, observational study using spectral-domain optical coherence tomography (SD-OCT) images to observe and evaluate changes in corneal epithelial thickness for patients using systemic isotretinoin, as well as to examine the overall changes using corneal topography.

The study included 40 patients (24 women) who underwent systemic isotretinoin therapy for acne vulgaris (mean, age, 26.2 years ± 5.4 years). Participants were examined at baseline, and at months 1, 3, and 6 of treatment. The statistical analysis included participants with tear-film breakup time longer than 10 seconds, Schirmer test measurements greater than 10 mm/5 minutes, and ocular surface disease index scores lower than 20 at baseline and after treatment. Imaging data included total corneal, epithelium, and stroma thickness maps. 

Investigators found a statistically significant difference in superior, inferior, and maximum thickness at months 1, 3, and 6 compared with baseline; no significant difference was identified for minimum thickness. 

An increase in epithelial thickness in each sector and zone was noted during isotretinoin treatment, most apparent during month 1. Mean difference of epithelial thickness (excluding inferonasal) from baseline to each evaluation month was statistically significant (P <.05 for all sectors and zones). Differences in stroma were statistically significant in the superior and inferior zones, as well as in terms of minimum and maximum thickness, for all 3 months compared with baseline.

When examined, investigators found, compared with baseline, that central corneal thickness, and other metrics at all 3 evaluations were statically significantly different; at months 3 and 6, thinnest pachymetry and index of surface variance also differed significantly. 

A negative moderate correlation between maximum epithelium thickness and thinnest pachymetry (P =.031) and central corneal thickness (P =.007) at month 1 was noted. 

“Isotretinoin treatment induces epithelial thickening and stromal thinning,” the research says. “Remodeling of corneal layers causes statistical differences in index of surface variance and pachymetry-related parameters.” Those pachymetry changes in the cornea returned to baseline at the third month after discontinuation of treatment, the study adds. 


Ozyol P, Ozyol E, Yildirim FE. Remodeling of cornea with isotretinoin treatment. Eye Contact Lens. Published online December 11, 2020. doi:10.1097/ICL0000000000000769