Isotretinoin and Adolescent Growth: A Systematic Review

Background Despite widespread use as an effective systemic therapy for adolescent acne, the effects of isotretinoin on pediatric skeletal development remain a subject of debate in the medical literature. Evidence characterizing its potential influence on growth plate maturation and skeletal outcomes is limited. Objectives To evaluate whether adolescent isotretinoin exposure affects final height, growth velocity, bone age, and growth plate integrity. Methods We conducted a qualitative systematic review following PRISMA guidelines. Human studies of adolescents exposed to isotretinoin reporting height, growth velocity, bone age, or epiphyseal changes were included. Studies on other retinoids, non‐human data, and reports without relevant outcomes were excluded. Results Twenty studies met inclusion criteria: two (2) trials ( n = 575 patients), six (6) observational studies, seven (7) case reports, three (3) narrative reviews, and two (2) regulatory sources. In a randomized double blind trial ( n = 358), lumbar spine bone mineral density increased 1.7 to 2.0 percent, with no change after height adjustment. An open‐label multicenter trial ( n = 217) showed a 1.4 percent increase in spine bone mineral density with stable hip measurements. Observational cohorts found no reduction in adult height, with some reporting slightly greater height compared to doxycycline controls. Case reports described rare physeal arrest, primarily in younger patients and with higher or prolonged exposure. Limitations Most included studies were small cohorts, case reports, or conference abstracts, limiting precision in estimating rare events. Outcome heterogeneity and inconsistent follow‐up precluded meta‐analysis. Large electronic health record cohorts lacked data on dose, duration, adherence, pubertal stage, and parental height, and the search was restricted to English‐language publications. Findings therefore argue against large differences in final height rather than excluding subtle effects. Conclusions Current evidence does not demonstrate a clinically significant reduction in final adult height among adolescents receiving standard acne‐dose isotretinoin. Rare growth‐plate complications have been reported, primarily in younger patients and in settings of higher cumulative exposure, prolonged treatment duration, or non‐acne indications. Further prospective studies are needed to better characterize rare physeal outcomes and dose–duration relationships.