isotretinoin and Abscess

Several good-quality randomised trials brought useful information on how to manage severe skin infections and develop anti-staphylococcus strategies. Trials on common warts did not bring any valuable solution. Rituximab and omalizumab have seen their indications becoming more precise or broadened. Meta-analyses have been particularly numerous, but most of the time with no decisive conclusion, since this methodology presents strong limitations for studying safety data. Most important work has been rather directed toward analysing safety data rather than efficacy. Among the most important results, are those from a retrospective cohort of patients taking isotretinoin: suicidal risk has to be linked to severe acne itself, rather than to the drug.

Topics: Abscess; Adalimumab; Anti-Bacterial Agents; Antibodies, Anti-Idiotypic; Antibodies, Monoclonal, Humanized; Antibodies, Monoclonal, Murine-Derived; Cicatrix; Dermatologic Agents; Dermatology; Humans; Immunologic Factors; Immunosuppressive Agents; Isotretinoin; Methicillin-Resistant Staphylococcus aureus; Methotrexate; Omalizumab; Papillomavirus Vaccines; Rituximab; Sirolimus; Skin Diseases; Transforming Growth Factor beta3

The draining sinus is an unpleasant complication of acne conglobata, acne fulminans, acne inversa, rosacea conglobata and rosacea fulminans (pyoderma faciale). It is most common on the face, especially in the nasolabial folds, and on the neck below the mandibular line. Clinically, it is an elongated (2-5 cm long), elevated, periodically inflamed lesion, which sporadically discharges pus. The lesion persists with no tendency to spontaneous regression. Histopathologically, it consists of elaborate, epithelialized galleries connected to the skin surface at multiple points. It contains corneocytes, hairs, bacteria, serum, inflammatory cells and epitheloid granulomas. A surgical thread placed into the skin provides a model in which the generation of sinus tracts can be studied. Therapy is difficult. Intralesional corticosteroid injection, cryosurgery and isotretinoin are not always very effective. Sometimes complete excision of the lesion is necessary. The draining sinus is a special form of scar analogous to the pilonidal cyst.

Topics: Abscess; Acne Vulgaris; Adolescent; Adrenal Cortex Hormones; Adult; Animals; Combined Modality Therapy; Cryosurgery; Cutaneous Fistula; Female; Humans; Injections, Intralesional; Isotretinoin; Male; Rosacea; Skin

Dissecting folliculitis (DF) or dissecting cellulitis of the scalp is regarded as a rare disease with disfiguring scarring alopecia. This study aimed to analyze the features of DF and to propose a classification to define its severity.. A hospital-based retrospective study was conducted. Patients with a histopathological diagnosis or clinical features leading to diagnosis of DF were included and classified into three stages.. Among the 66 patients recruited (63 men / 3 women, mean age 24.9 years), multiple interconnected alopecic nodules involving the vertex scalp were the main feature. Histopathology showed an extensive inflamed granulation abscess forming a dissection plane in the lower dermis/subcutis in the acute stage. Lymphocytic infiltration was predominant in seven of 21 histology specimens. Overweight and obesity were noted in 29 of 45 patients examined. No association with smoking was found. There was comorbidity with acne conglobata in 15 of 66 patients, two of whom had acne inversa. Longer disease duration and greater number of nodules were associated with higher severity of DF (p < 0.05). A complete remission rate of 25 % was achieved by any treatment, and a rate of 37.5 % was achieved with oral isotretinoin alone.. DF is not uncommon in Taiwan. An association with obesity needs to be clarified.

Topics: Abscess; Acne Vulgaris; Adult; Alopecia; Cellulitis; Comorbidity; Female; Granulation Tissue; Humans; Isotretinoin; Lymphocytosis; Male; Obesity; Overweight; Retrospective Studies; Scalp; Scalp Dermatoses; Skin Diseases, Genetic; Treatment Outcome

Isotretinoin is frequently prescribed for the treatment of acne vulgaris. Among the numerous documented adverse effects, most common are xerostomia and cheilitis. Lip abscesses as a consequence of cheilitis present dramatically and may pose a diagnostic challenge.. We present a case of a 15-year-old boy with a severe lip abscess requiring incision and drainage and hospital admission for intravenous antibiotic treatment of methicillin-resistant Staphylococcus aureus. We discuss the pathophysiologic characteristics of isotretinoin therapy and the likely causative role that the medication played in the development of the lip abscess.. Although rare, lip abscesses related to isotretinoin therapy present with substantial morbidity and should be promptly recognized. Misdiagnosis of mucositis and angioedema may delay appropriate therapy.

Topics: Abscess; Acne Vulgaris; Adolescent; Anti-Bacterial Agents; Dermatologic Agents; Drainage; Hospitalization; Humans; Isotretinoin; Lip Diseases; Male; Methicillin-Resistant Staphylococcus aureus; Staphylococcal Infections

Severe scarring acne is frequently treated with isotretinoin. Patients treated with this drug may expect some of the more common complications including mucositis. Less common complications may also occur in a small number of patients. While undergoing treatment, patients may become colonized with Staphylococcus bacteria. However, the incidence of perioral abscess formation in patients taking isotretinoin is not commonly reported and the onset of this adverse event may masquerade as angioedema or severe mucositis.This article presents a case of a significant perioral abscess and discuss the need for prompt recognition as well as treatment of the infection.The case reported is unique due to the extent and severity of the abscess.

Topics: Abscess; Acne Vulgaris; Adolescent; Anti-Bacterial Agents; Cicatrix; Dermatologic Agents; Humans; Isotretinoin; Lip Diseases; Male; Methicillin-Resistant Staphylococcus aureus; Severity of Illness Index; Staphylococcal Infections

Topics: Abscess; Adult; Folliculitis; Humans; Isotretinoin; Male; Scalp Dermatoses; Staphylococcal Infections

Topics: Abscess; Adult; Alopecia; Folliculitis; Humans; Isotretinoin; Male; Scalp Dermatoses; Suppuration

A patient with hyperimmunoglobulin E syndrome is described. Recurrent cutaneous staphylococcal abscesses were a prominent feature and had been resistant to treatment with antibiotics and surgical drainage. Following a 4-month course of treatment with isotretinoin, he developed no further abscesses over a 6-month follow-up period. Detailed immunological investigations were undertaken before and after treatment and no change was found to account for his improvement. We consider that the beneficial effects of isotretinoin in this situation are likely to be due to a reduction in sebaceous gland size and activity, rather than to any effect on the underlying disorder.

Topics: Abscess; Adolescent; Humans; Hypergammaglobulinemia; Immunoglobulin E; Isotretinoin; Male; Skin Diseases, Infectious; Staphylococcal Infections; Tretinoin