isotretinoin and Acute-Disease

Rosacea fulminans, previously called pyoderma faciale, is an inflammatory disease considered a dramatic form of rosacea rather than of acne. Typical features are: exclusive facial involvement of young women, sudden onset of large nodules without other signs of acne, remission without scarring or with minimal scars, no recurrences or systemic symptoms. Oral isotretinoin associated with a short course of systemic and topical corticosteroids represent the recommended treatment. Personal observation of 5 cases has induced us to make a review of worldwide literature in order to better define this clinical entity. In our opinion, rosacea fulminans is a valid diagnosis, but clinical criteria should be rigorously respected to fully exclude rosacea conglobata and acne fulminans.

Topics: Acne Vulgaris; Acute Disease; Administration, Cutaneous; Adolescent; Adult; Dermatologic Agents; Female; Glucocorticoids; Humans; Isotretinoin; Rosacea; Young Adult

Oral isotretinoin revolutionized acne treatment when it was introduced in 1982 in the USA. However, its use was restricted to patients with severe nodulocystic acne. Today its use worldwide has expanded to treat also patients with less severe but scarring acne who are responding unsatisfactorily to conventional therapies. These recommendations assess the potential for use of oral isotretinoin as a safe and effective treatment for severe nodulocystic acne unresponsive to conventional therapy, and acne of any severity that causes scarring or is associated with psychological distress.

Topics: Acne Vulgaris; Acute Disease; Administration, Oral; Adolescent; Adult; Australia; Chronic Disease; Dermatologic Agents; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Resistance, Microbial; Evidence-Based Medicine; Female; Health Planning Guidelines; Humans; Isotretinoin; Male; Maximum Tolerated Dose; Prognosis; Recurrence; Risk Factors; Severity of Illness Index; Stress, Psychological; Treatment Outcome

The use of chemical agents that induce differentiation of malignant cells to normal cells has held great promise as an adjunct to standard chemotherapy. In vitro data has shown that 13-cis-retinoic acid can differentiate certain leukemia cell lines (e.g., HL-60) into stable granulocyte cells. In this study, oral 13-cis-retinoic acid was administered to four patients with the myelodysplastic syndrome (MDS) and to four patients with acute nonlymphocytic leukemia (ANLL). None of the MDS patients showed an hematologic response to the drug, while three of four ANLL patients responded with normalized peripheral blood counts. The side effects of the drug at 80-120 mg/d (dry skin, cheilitis, epistaxis) were self limiting.

Topics: Acute Disease; Cell Differentiation; Hemoglobins; Humans; Isotretinoin; Leukemia; Middle Aged; Myelodysplastic Syndromes; Tretinoin

Topics: Acne Vulgaris; Acute Disease; Adult; Clinical Trials as Topic; Depression; Female; Headache; Humans; Isotretinoin; Male; Middle Aged; Skin Diseases

Topics: Acne Vulgaris; Acute Disease; Adolescent; Dermatologic Agents; Humans; Isotretinoin; Male; Pancreatitis

Topics: Abdominal Pain; Acute Disease; Adolescent; Adult; Dermatologic Agents; Female; Humans; Isotretinoin; Male; Pancreatitis; Risk Factors; Young Adult

Topics: Acne Vulgaris; Acute Disease; Anti-Inflammatory Agents, Non-Steroidal; Biomarkers; Dermatologic Agents; Female; Glucocorticoids; Humans; Isotretinoin; Magnetic Resonance Imaging; Sacroiliitis; Treatment Outcome; Young Adult

Topics: Acne Vulgaris; Acneiform Eruptions; Acute Disease; Administration, Oral; Adult; Dermatologic Agents; Dose-Response Relationship, Drug; Female; Humans; Isotretinoin; Male; Retrospective Studies; Treatment Outcome

Topics: Acne Vulgaris; Acute Disease; Adult; Depression; Dermatologic Agents; Female; Humans; Isotretinoin; Suicide, Attempted

Topics: Acne Vulgaris; Acute Disease; Administration, Oral; Adult; Female; Humans; Isotretinoin; Myopia

A 19-year-old female patient is presented who was taking isotretinoin for severe, nodulocystic acne. She subsequently developed abdominal pain during the course of treatment, thought to be related to an adverse reaction to the medication. A concerning side effect of isotretinoin is hypertriglyceridemia, which may be a cause of pancreatitis. A lipase level was determined to be elevated in this case. The patient was diagnosed with acute pancreatitis and the offending agent was discontinued. Clinicians need to be aware of the side effects when prescribing isotretinoin for recalcitrant acne.

Topics: Abdominal Pain; Acne Vulgaris; Acute Disease; Adult; Dermatologic Agents; Female; Humans; Isotretinoin; Lipase; Pancreatitis; Triglycerides

Topics: Acne Vulgaris; Acute Disease; Adolescent; Depression; Humans; Isotretinoin; Male

13-cis retinoic acid + (OH)2 vitamin D3 + low-dose 6-thioguanine and cytarabine were tested in 26 patients with acute myeloid leukemia (AML) and in 4 patients with myelodysplastic syndrome (MDS) (median age 72.5), ineligible for standard chemotherapy. The response rate was 50%, with 27% complete remission. The median survival of the whole group and responders was 7.5 (1-47+) and 16.5 months (3.5-47+), respectively.

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols; Calcitriol; Cytarabine; Disease Progression; Female; Humans; Isotretinoin; Leukemia, Myeloid; Male; Middle Aged; Myelodysplastic Syndromes; Thioguanine

Topics: Acne Vulgaris; Acute Disease; Adult; Creatine Kinase; Dermatologic Agents; Humans; Isotretinoin; Male; Myoglobinuria; Rhabdomyolysis

Isotretinoin is a vitamin-A derivative most commonly utilized in the treatment of severe recalcitrant nodulocystic acne. Derangement of lipid metabolism leading to increased triglyceride and cholesterol level has been reported after taking this drug. We report the case of a 43-year-old female with no identifiable risk factor for pancreatitis who developed acute pancreatitis associated with hyperlipidemia while being treated with isotretinoin for hidradenitis suppurativa. To our knowledge, this is the third reported case of isotretinoin-induced hyperlipidemia leading to acute pancreatitis.

Topics: Acute Disease; Adult; Female; Hidradenitis Suppurativa; Humans; Hyperlipidemias; Isotretinoin; Pancreatitis

The association between isotretinoin therapy and depressive symptoms in acne patients has generated much recent interest but has not been systematically explored. A 17-year-old man with acne vulgaris developed symptoms of acute depression two weeks after beginning isotretinoin therapy. The depressive symptoms improved with reduction of isotretnoin dose and treatment with sertraline. Of note, however, is that when the isotretinoin dose was again increased, the depressive symptoms recurred despite clearing of the skin, leading to an unsuccessful suicide attempt. Isotretinoin was finally discontinued and the depression rapidly resolved. Although the effects of hypervitaminosis A may be involved aetiologically, the predictive factors of drug-related depression remain unclear. Significant depressive symptoms that develop during the course of treatment need close monitoring and may necessitate both antidepressant therapy and discontinuation of the drug. Given the uncertain causal relationship between isotretinoin and depression, versus the potential psychological benefits of effective acne treatment, systematic studies exploring the impact of isotretinoin on mood are needed.

Topics: Acne Vulgaris; Acute Disease; Adolescent; Depression; Humans; Isotretinoin; Male; Suicide, Attempted

Topics: Acne Vulgaris; Acute Disease; Adult; Asthma; Female; Humans; Isotretinoin; Keratolytic Agents; Time Factors

Topics: Acne Vulgaris; Acute Disease; Adult; Appendicitis; Female; Humans; Isotretinoin; Male

Topics: Acne Vulgaris; Acute Disease; Adolescent; Drug Therapy, Combination; Humans; Isotretinoin; Male; Prednisone; Roxithromycin; Tetracycline

Topics: Acne Vulgaris; Acute Disease; Adolescent; Adult; Arthritis; Female; Humans; Isotretinoin; Keratolytic Agents; Male

Topics: Acne Vulgaris; Acute Disease; Adolescent; Ankle Joint; Arthritis; Follow-Up Studies; Humans; Isotretinoin; Keratolytic Agents; Male

Topics: Acute Disease; Adolescent; Esophagitis; Humans; Isotretinoin; Keratolytic Agents; Male

Topics: Acne Vulgaris; Acute Disease; Adult; Fatigue; Female; Humans; Isotretinoin; Keratolytic Agents; Male; Muscle Weakness; Muscular Diseases; Pain

A 17 year-old young man developed two episodes of acute pancreatitis, separated by a 2 year interval and associated with isotretinoin therapy. In 1989, vesicular sludge without lithiasis was evidenced and in 1991, gall bladder stones were found by cholecystectomy. Concomitantly, transient dysfibrinogenemia and thrombopenia were present. It is interesting to note that far away from the use of isotretinoin, the patient suffered from another episode of acute pancreatitis without any coagulation disorder. The involvement of Roaccutane in cellular differentiation is discussed as well as its causal association with acquired dysfibrinogenemia and transient thrombocytopenia.

Topics: Acute Disease; Adolescent; Fibrinogens, Abnormal; Humans; Isotretinoin; Keratolytic Agents; Male; Pancreatitis; Recurrence; Thrombocytopenia

We report a case of acute arthritis of the knee which occurred in a dose-dependent manner during treatment with isotretinoin. Recurrence was seen at rechallenge. Only three observations of acute arthritis induced by isotretinoin have been reported in the literature. This side effect is rare and does not require drug withdrawal but rather an adapted dose.

Topics: Acne Vulgaris; Acute Disease; Adult; Arthritis; Humans; Isotretinoin; Knee Joint; Male

Topics: Acne Vulgaris; Acute Disease; Adolescent; Humans; Isotretinoin; Joint Diseases; Leukocyte Count; Male; Sacroiliac Joint

We describe a case of a 16-year old boy, who presented with sudden onset of an extreme pustular reaction in seborrhoeic areas of the skin with accompanying general malaise such as fever and arthralgia. This picture is one of fulminant acne, which is a rare disease, for which reason diagnosis may be delayed. Permanent scarring of the skin is inevitable, but scarring may be reduced if early treatment with 13 cis-retinoid is started.

Topics: Acne Vulgaris; Acute Disease; Adolescent; Diagnosis, Differential; Humans; Isotretinoin; Male

We report three cases of acute Achilles tendonitis following administration of isotretinoin for acne vulgaris. In this rarely documented side-effect, the symptoms were intimately related to the isotretinoin therapy. Modification of dose regimes permitted control of the tendonitis and an eventual successful response to isotretinoin therapy. Oral isotretinoin has been in use for more than 10 years and is known to cause a wide variety of predictable side-effects the most common of which are cutaneous and dose related. Musculoskeletal problems are also well known to occur and these include myalgia, arthralgia and less commonly arthritis and muscle damage, however, isolated Achilles tendonitis has been reported on a rare and sporadic basis. We wish to report a series of three patients who developed acute Achilles tendonitis during administration of isotretinoin for acne.

Topics: Achilles Tendon; Acne Vulgaris; Acute Disease; Adult; Female; Humans; Isotretinoin; Male; Tendinopathy

Topics: Acne Vulgaris; Acute Disease; Adolescent; Depressive Disorder; Humans; Isotretinoin; Male

Topics: Acne Vulgaris; Acute Disease; Adolescent; Arthritis, Reactive; Humans; Isotretinoin; Male; Sacroiliac Joint

The use of isotretinoin in therapeutical dermatology has proved to be of great benefit in a series of cutaneous processes, especially in cystic and conglobate acne, where it produces excellent results with a dose of 1 mg/kg/daily. However, its use is not without complications, the majority of which are well known, and doubtlessly others will be brought to light. As for a case of pseudoacne fulminans, the possible etiopathogenic mechanisms of this type of reaction, are under discussion.

Topics: Acne Vulgaris; Acute Disease; Adolescent; Humans; Isotretinoin; Male; Tretinoin

Topics: Acne Vulgaris; Acute Disease; Adult; Arthritis; Humans; Isotretinoin; Male; Tretinoin

Twenty-eight patients with severe acne and one with hidradenitis suppurativa and acne were treated for 12 to 16 weeks with a new synthetic retinoid, isotretinoin (Roaccutane). The average dose was 0.56 mg/kg/day. Patients were seen weekly for four weeks and then fortnightly for the remaining treatment period, being evaluated both qualitatively and quantitatively. Twenty-five patients had an excellent response. Two to five months after the end of treatment no patient had relapsed. No patient withdrew because of side effects, but all suffered dry lips. This study confirms the potential of isotretinoin in the treatment of severe acne.

Topics: Acne Vulgaris; Acute Disease; Adult; Capsules; Cheilitis; Drug Evaluation; Female; Follow-Up Studies; Humans; Isotretinoin; Male; Time Factors; Tretinoin

A patient developed transient, acute myopia while on isotretinoin (Accutane) therapy for acne. This idiosynactic adverse reaction has not been previously described. There was a clear relationship between restarting the Accutane and recurrence of the transient myopia.

Topics: Acne Vulgaris; Acute Disease; Adult; Female; Humans; Isotretinoin; Myopia; Tretinoin

Treatment with isotretinoin (retinoic acid), which is frequently used in the control of acne, is associated with transient arthralgias in up to 16% of patients. We encountered two cases of acute, aseptic arthritis of the knee in male patients receiving isotretinoin, during the third week and third month of therapy. Synovial fluid obtained from one of the patients was noninflammatory. The drug concentration in the synovial fluid was 131 ng/mL--a level that was compatible with diffusion from the blood (simultaneous serum concentration, 229 ng/mL). Arthritis resolved in both patients without sequelae, despite continuation of drug treatment in one of them. This observation indicates that arthritis with joint effusion may complicate isotretinoin use; it also suggests that alternative measures should be considered before administering the drug to patients with rheumatologic disorders.

Topics: Acne Vulgaris; Acute Disease; Adult; Arthritis; Humans; Isotretinoin; Male; Tretinoin

Topics: Acne Vulgaris; Acute Disease; Administration, Oral; Humans; Isotretinoin; Tretinoin