QShould we consider recommending oral omega 3 supplementation to our patients on isotretinoin for acne vulgaris?

Medically reviewed by Nick Brownstone, MD

Isotretinoin for acne vulgaris is arguably the most efficacious treatment for our patients suffering from recalcitrant acne. The most commonly encountered side effects in our daily practice are mucocutaneous in nature. Dry eyes, lips, skin, and nasal mucosa are to be expected on therapy provided optimal drug absorption and patient compliance.

Therefore, it is imperative that we know how to manage these side effects in order to enhance patient adherence and achieve the desired clinical outcome of clear skin. Omega-3 supplementation has been investigated to this end due to its ability to provide many benefits.¹ Not only has omega-3 supplementation been shown to help alleviate dry eye syndrome,² especially in contact lens wearers,³ it also exerts anti-inflammatory benefits that could improve eczema which may be encountered on isotretinoin.⁴ Additionally, administration of omega-3 fatty acids was shown to reduce trans epidermal water loss thereby reducing skin xerosis in rats.⁵ This supplement also exerts cardioprotective effects by way of reducing serum triglyceride and total cholesterol levels, while increasing high-density lipoprotein concentration.⁶

Omega-3 fatty acid supplements are readily accessible, affordable, and generally regarded as safe. It would be reasonable to consider adding this to our treatment paradigm for patients on isotretinoin, particularly those with abnormal lipid parameters, dry eye syndrome, and those prone to dry skin, eczema, and nose bleeds. Patients that wear contact lenses can also benefit from oral administration of omega-3 fatty acids. This is a relatively easy measure to implement into our isotretinoin treatment protocol to help to reduce the well-known mucocutaneous side effects of isotretinoin, thereby optimizing patient adherence and clinical outcomes.

References:

1. Mirnezami M, Rahimi H. Is Oral Omega-3 Effective in Reducing Mucocutaneous Side Effects of Isotretinoin in Patients with Acne Vulgaris?. Dermatol Res Pract. 2018;2018:6974045. Published 2018 May 29. doi:10.1155/2018/6974045
2. Kangari H., Eftekhari M. H., Sardari S., et al. Short-term consumption of oral omega-3 and dry eye syndrome. Ophthalmology. 2013;120(11):2191–2196. doi: 10.1016/j.ophtha.2013.04.006
3. Bhargava R, Kumar P. Oral Omega-3 Fatty Acid Treatment for Dry Eye in Contact Lens Wearers. Cornea. 2015;34(4):413-420. doi:https://doi.org/10.1097/ico.0000000000000386