Erratum: Association of inflammatory bowel disease incidence with isotretinoin usage: A meta-analysis and systematic review (Journal of the American Academy of Dermatology (2025) 92(2) (385), (S019096222403072X), (10.1016/j.jaad.2024.11.001))

To the Editor: While oral isotretinoin has been a long-standing remedy for nodulocystic and persistent moderate to severe acne, its potential correlation with inflammatory bowel disease (IBD) has yet to find a consensus.¹² Thus, this meta-analysis seeks to clarify this controversy by examining the risk of getting IBD and its 2 subtypes, Crohn's disease (CD) and ulcerative colitis (UC), after isotretinoin usage. We searched PubMed, EMBASE, Web of Science and Google Scholar from inception to March 2023 for studies comparing the risk of new-onset IBD in isotretinoin vs placebo individuals. Two reviewers independently extracted data from the included studies and assessed the quality of the included studies using the Newcastle Ottawa Scale (NOS).³ The Mantel–Haenszel random-effect model was used to calculate the risk of IBD, CD, and UC from isotretinoin exposure using risk ratios (RRs) with 95% CIs. Nine studies were included in this study, with a combined total of 10,558,900 patients. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram is presented in Supplementary Fig 1, available via Mendeley at https://data.mendeley.com/datasets/9fmt5kysw2/1. All of the included studies had a good quality, according to NOS. Supplementary Table I, available via Mendeley at https://data.mendeley.com/datasets/9fmt5kysw2/1 shows the summary and baseline characteristics of the included studies. The pooled analysis revealed a marginally elevated, albeit non-statistically significant risk of IBD with isotretinoin use (RR = 1.15 [0.92, 1.42], P = .22, I2 = 56%). Notably, after sensitivity analysis that excluded a particular outlier study, the association achieved statistical significance (RR = 1.21 [1.02, 1.45], P = .03), Fig 1. Furthermore, the risk of CD in isotretinoin-treated patients versus the placebo group was not significant (RR = 0.89 [0.60, 1.33], P = .58), however, a deeper sensitivity analysis revealed a significantly decreased risk (RR = 0.75 [0.58, 0.98], P = .03), as depicted in Supplementary Fig 2, A, available via Mendeley at https://data.mendeley.com/datasets/9fmt5kysw2/1. In contrast, the risk for UC remained nonsignificant even after sensitivity analysis (RR = 1.18 [0.88, 1.57], P = .28), Supplementary Fig 2, B, available via Mendeley at https://data.mendeley.com/datasets/9fmt5kysw2/1. Limitations of this meta-analysis are that the included studies may be subject to ascertainment bias, inconsistent control of oral antibiotic exposure, such as tetracyclines, and failure to fully account for the known association between acne and IBD, potentially confounding the observed risk. Our findings demonstrate that patients exposed to isotretinoin, when compared to placebo, may have a small increased risk of developing IBD. However, for most patients treated with isotretinoin, increased risk of IBD does not appear to be a treatment-limiting concern.