isotretinoin and Alopecia

Dissecting cellulitis of the scalp is a primary scarring alopecia. Isotretinoin is commonly referenced in the literature as a treatment for dissecting cellulitis. The objective of this article was to conduct a review and meta-analysis to assess the efficacy of isotretinoin for treating dissecting cellulitis of the scalp.. The following databases were searched for articles prior to 23 June, 2019: PubMed, Embase, Cochrane Central, CINAHL, and Web of Science. Multi-patient studies (more than three) that reported on the administration of isotretinoin for dissecting cellulitis were included. A pooled meta-analysis for improvement of disease burden after isotretinoin administration in patients with dissecting cellulitis of the scalp was performed. A fixed-effects model was used.. Five articles were ultimately used for the quantitative meta-analysis. The overall efficacy rate of isotretinoin in treating dissecting cellulitis of the scalp was estimated to be 0.9 with a 95% confidence interval (0.81-0.97). The sensitivity analysis suggested that the overall efficacy is still very high, with a range of 0.83-0.94. Recurrence was seen in 24% (6/25) of patients. Common associated diseases amongst patients with dissecting cellulitis of the scalp were acne conglobata 20% (30/151) and hidradenitis suppurativa 19% (11/72).. Isotretinoin is an effective treatment for improving symptoms of dissecting cellulitis of the scalp. Disease recurrence is a common finding for those who undergo successful treatment.

Topics: Adolescent; Adult; Alopecia; Cellulitis; Child; Dermatologic Agents; Female; Humans; Isotretinoin; Male; Middle Aged; Recurrence; Retrospective Studies; Scalp Dermatoses; Treatment Outcome; Young Adult

In this chapter, we will discuss the most common alopecias due to drugs and other skin and systemic disorders. The following hair disorders will be analyzed: telogen effluvium (acute and chronic); anagen effluvium; folliculotropic mycosis fungoides; and folliculitis due to bacteria, fungi, parasites, human immunodeficiency virus disease, lupus erythematosus, and sarcoidosis. We will cover topics including the epidemiology, etiology, clinical picture, and diagnosis of and current treatments for each disease.

Topics: Alopecia; Anticonvulsants; Antidepressive Agents; Antineoplastic Agents; Dermatologic Agents; Dermatomycoses; Diet; Folliculitis; Herpes Zoster; HIV Infections; Humans; Isotretinoin; Lamotrigine; Lithium Compounds; Lupus Erythematosus, Systemic; Malnutrition; Mycosis Fungoides; Paroxetine; Sarcoidosis; Seasons; Skin Neoplasms; Starvation; Stress, Psychological; Syphilis; Triazines; Valproic Acid

We present a 65-year-old man with Darier disease with pityriasis amiantacea on the scalp, alopecia, and congenital facial nerve palsy.

Topics: Acantholysis; Aged; Alopecia; Darier Disease; Facial Nerve Diseases; Humans; Isotretinoin; Male; Pityriasis; Sarcoplasmic Reticulum Calcium-Transporting ATPases; Scalp

Treatment of frontal fibrosing alopecia (FFA) is complicated and challenging. In this study, we evaluated the efficacy of combining topical tacrolimus with isotretinoin versus finasteride in patients with FFA.. Thirty-one patients with FFA were divided randomly into two groups. Therapeutic regimen of the first group (group A, n = 16) was isotretinoin and tacrolimus (Capsule isotretinoin 20 mg daily and topical tacrolimus 0.1% BD). The second group (group B, n = 15) was given finasteride and tacrolimus (Tablet finasteride 2.5 mg daily and topical tacrolimus 0.1% BD). Patients were treated and followed up periodically for 12 weeks. Evaluation of the treatment efficacy was based on Patient Global Assessment and Physician Global Assessment scales. Objective evaluation was based on improving the severity of skin lesions by viewing serial images taken from the affected areas.. Physician Global Assessment (PGA) was significantly better in the group A as compared with the group B at 4 weeks (p = 0.038). Physician satisfaction in the group A was better than the group B at 12 weeks, but this was not statistically significant (p > 0.05). Patient Global Assessment and patient satisfaction in the group A was better than the group B at 8 and 12 weeks, but it was not statistically significant (p > 0.05).. Although both therapeutic regimens were effective in the treatment of FFA, treatment with tacrolimus and isotretinoin is significantly more effective than tacrolimus and finasteride.

Topics: Alopecia; Finasteride; Humans; Isotretinoin; Lichen Planus; Tacrolimus; Treatment Outcome

Facial papules reflecting the lichenoid inflammation of facial vellus hair follicles can occur in the backgrounds of frontal fibrosing alopecia, lichen planopilaris (LPP), or even alone. In the present study, we aimed to compare systemic and topical isotretinoin in the treatment of facial LPP.. In a prospective randomized trial, 26 patients with facial LPP were randomly allocated to receive either 20 mg/day oral isotretinoin or isotretinoin 0.05% gel every night for 6 months. Global Aesthetic Improvement Scale (GAIS) and patient's satisfaction questionnaire were used at 1, 3, and 6 months after treatment to evaluate the outcomes.. In both oral and topical isotretinoin groups, facial papules were significantly improved at all follow-up visits, resulting in statistically significant improvements (p = 0.005 and p = 0.007, respectively, for oral and topical groups) in GAIS score mean difference from month 1 to month 6. Overall levels of patient satisfaction were high in both groups, and no significant difference was observed between two groups (p = 0.107). However, the mean GAIS score at 3 and 6 months after treatment showed significantly greater improvements in oral isotretinoin group compared to topical group (1.85 ± 0.62 vs. 1.03 ± 0.49 at month 3, p = 0.004; 2.45 ± 54 vs. 1.59 ± 0.62 at month 6, p = 0.008). Overall, patients could well tolerate the treatments; however, topical therapy was associated with fewer side effects.. Both oral and topical isotretinoin were found to be effective in improving facial papules; however, oral isotretinoin was significantly more efficacious. Considering safety profile of topical isotretinoin, it can be administrated as maintenance therapy for patients with facial LPP.

Topics: Alopecia; Humans; Isotretinoin; Lichen Planus; Prospective Studies

Frontal fibrosing alopecia (FFA) is a scarring alopecia with no promising treatment.. To evaluate the additive efficacy of oral isotretinoin to topical treatments.. Between November 2017 and August 2018, FFA patients were randomly assigned to receive either isotretinoin (20 mg/d) plus topical treatments (clobetasol 0.05% and tacrolimus 0.1%) or monotherapy with topical treatments. Treatments' efficacy was evaluated through Frontal Fibrosing Alopecia Severity Index (FFASI) after two and 6 months.. From 38 participants, 28 patients completed the study. Facial papules improved after 6 months (. Small sample size and lost to follow-up.. Isotretinoin combined with topical treatments is more effective than monotherapy with clobetasol and tacrolimus for FFA.. (IRCT.ir) IRCT2017091736173N1.

Topics: Alopecia; Clobetasol; Forehead; Humans; Isotretinoin; Tacrolimus

Dissecting cellulitis (DC) is a chronic inflammatory primary neutrophilic scarring alopecia. It predominantly affects the vertex and occipital regions of Afro-descendent men. Female DC is uncommon, and little is known about this condition in childhood. This paper reports a pediatric female case of DC with an excellent therapeutic response to low-dose oral isotretinoin.

Topics: Alopecia; Cellulitis; Child; Chronic Disease; Female; Humans; Isotretinoin; Scalp Dermatoses

Topics: Alopecia; Humans; Isotretinoin; Lichen Planus

Topics: Alopecia; Humans; Isotretinoin; Lichen Planus; Skin Abnormalities

The literature includes only a few reports of oral isotretinoin for the treatment of folliculitis decalvans (FD). This study aimed to determine the most effective dose and duration of oral isotretinoin monotherapy for achieving remission in FD patients.. This retrospective case series study included FD patients that were treated with oral isotretinoin. Patient demographics, clinical characteristics, and treatment details were obtained from the patients' medical records. Patients were contacted via telephone after treatment was completed and asked about any relapses, time period of relapses, and the long-term effects of the treatment.. The study included 39 male patients with a mean age of 37.9 ± 15.5 years. All of the patients received oral isotretinoin 0.1-1.02 mg/kg/day (10-90 mg/day) for a median duration of 2.5 months (range: 1-8 months). In all, 82.0% of patients healed after the treatment. Patients that received oral isotretinoin ≥0.4 mg/kg/day for ≥3 months responded better, and 66% of them never relapsed.. Contrary to general belief, oral isotretinoin monotherapy resulted in complete response in the majority of patients in this study. Based on this finding, we think oral isotretinoin ≥0.4 mg/kg/day should be given for ≥3 months to minimize the likelihood of relapse. In addition, we think oral isotretinoin monotherapy should be considered a promising treatment alternative for FD that warrants further research.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Alopecia; Dermatologic Agents; Folliculitis; Humans; Isotretinoin; Male; Middle Aged; Recurrence; Remission Induction; Retrospective Studies; Young Adult

Topics: Alopecia; Fibrosis; Humans; Isotretinoin; Lichen Planus

Topics: Alopecia; Fibrosis; Humans; Isotretinoin; Lichen Planus

Topics: Adult; Alopecia; Dermatologic Agents; Facial Dermatoses; Female; Fibrosis; Humans; Isotretinoin; Middle Aged; Remission Induction; Scalp; Skin Diseases, Papulosquamous

Folliculitis decalvans (FD) is a rare neutrophilic cicatricial alopecia that poses a therapeutic challenge.. To describe the therapeutic response in a large number of cases of FD with long-term follow-up and analyze potential prognostic factors associated with severity of form and with a better therapeutic response.. This multicenter prospective study included patients with FD who had a minimum of 5 years of follow-up. Severity was assessed by the maximum diameter of the cicatricial area. Therapeutic response was evaluated according to stabilization of the size of the cicatricial areas and the improvement in clinical symptoms.. A total of 60 patients (37 men [61.7%] and 23 women [38.3%]) with a mean age of 40 years were included. Earlier age of onset (P = .01) was statistically associated with severity of form. Treatment with rifampicin and clindamycin, tetracyclines, and intralesional steroids was the most effective. No statistically significant prognostic factors predicting a better therapeutic response were found.. Because FD is a rare disease, the main limitation was the sample size.. An earlier age of onset was associated with the severe form of the disease. The proposed specific therapeutic protocol can be a very useful tool in clinical dermatologic practice.

Topics: Adrenal Cortex Hormones; Alopecia; Anti-Bacterial Agents; Cicatrix; Cohort Studies; Combined Modality Therapy; Female; Folliculitis; Follow-Up Studies; Humans; Isotretinoin; Male; Minoxidil; Multivariate Analysis; Photochemotherapy; Retrospective Studies; Risk Assessment; Scalp Dermatoses; Spain; Time Factors; Treatment Outcome

Topics: Adult; Alopecia; Dermatologic Agents; Facial Dermatoses; Female; Humans; Isotretinoin; Lichen Planus; Male; Middle Aged

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

An 18-year-old man presented for evaluation of a 1-year history of painful nodules on the scalp with associated hair loss. Physical examination revealed multiple confluent, fluctuant, boggy nodules on the scalp with overlying alopecic patches. Based on these findings, a diagnosis of dissecting cellulitis of the scalp was made and the patient was successfully treated with oral isotretinoin therapy.

Topics: Adolescent; Alopecia; Cellulitis; Humans; Isotretinoin; Male; Scalp; Scalp Dermatoses; Skin Diseases, Genetic

Topics: Alopecia; Hair Follicle; Humans; Isotretinoin

This study aimed to assess the efficacy of systemic retinoids in treating frontal fibrosing alopecia (FFA). It was based on a retrospective analysis of 54 female patients with FFA treated with: oral isotretinoin at the daily dose of 20 mg (29/54) or acitretin at the daily dose of 20 mg (11/54) or with oral finasteride 5 mg/daily (14/54). The study was conducted between 2007 and 2017. The basic of the study is the measurement of distance between the frontal hairline and the glabellar crease prior to the commencement of treatment and after 6, 12, and 24 months. The treatment with systemic retinoids lasted between 12 and 16 months (the mean duration of treatment was 13.5 months). The primary treatment goal was defined as no further progression of disease after 12 months of treatment, while the secondary treatment goal was defined as no further progression of disease following the discontinuation of systemic retinoids. The primary treatment goal was achieved by 76% (23/29) of patients treated with isotretinoin, 73% (8/11) of patients treated with acitretin, and 43% (6/14) of patients treated with finasteride. The secondary treatment goal was achieved by 72% (21/29) of patients treated with isotretinoin, 73% (8/11) of patients treated with acitretin, and 43% (6/14) of patients treated with finasteride. Thus, the administration of systemic retinoids may be beneficial for the stabilization of frontal hairline in patients with FFA.

J Drugs Dermatol. 2017;16(10):988-992.

Topics: Acitretin; Administration, Oral; Alopecia; Dermatologic Agents; Disease Progression; Female; Finasteride; Humans; Isotretinoin; Middle Aged; Retrospective Studies; Time Factors; Treatment Outcome

Dissecting cellulitis of the scalp is a chronic, relapsing, inflammatory disease of the scalp that results in scarring alopecia. We present a case of a 32-year-old man with recalcitrant disease who is now responding to treatment with isotretinoin. The pathogenesis, clinical presentation, disease associations, and histopathological findings are reviewed. Treatment can be challenging. The literature on medical and surgical therapeutic options is reviewed.

Topics: Adult; Alopecia; Cellulitis; Dermatologic Agents; Humans; Isotretinoin; Male; Methicillin-Resistant Staphylococcus aureus; Scalp Dermatoses; Staphylococcal Infections

A 27-year-old man presented with a 10-year history of scarring alopecia on the vertex of the scalp associated with follicular crusting and pustule formation, and a papular eruption on the posterior neck. Additionally, there was keratosis pilaris on the cheeks, eyebrows and thighs. Histology from the vertex showed scarring with a mixed perifollicular inflammatory infiltrate and foci of acute suppurative folliculitis. With clinical correlation, the diagnosis of keratosis follicularis spinulosa decalvans and concurrent acne keloidalis nuchae was made. The association of keratosis follicularis spinulosa decalvans with acne keloidalis nuchae has not previously been described. The patient responded to treatment with oral isotretinoin 20 mg (0.25 mg/kg) daily for 12 months.

Topics: Acne Keloid; Adult; Alopecia; Anti-Bacterial Agents; Anti-Inflammatory Agents; Darier Disease; Eyebrows; Humans; Isotretinoin; Male; Neck; Scalp Dermatoses; Treatment Outcome

A 27-year-old male patient presented with scaly erythema and crusts on the scalp. Since birth, he suffered from dry skin and inflammation of the eyelids. Scarring alopecia was noticed in some regions of his scalp. Folliculitis spinulosa decalvans was diagnosed. Therapy with isotretinoin and topical corticosteroids was without effect. In contrast, 100 mg of Dapsone per day led to resolution of the inflammatory signs. This enabled him to cover the disfiguring scarring alopecia with a permanent hairpiece. His condition has been stable after 18 months without the enlargement of the scarred alopecic areas.

Topics: Adrenal Cortex Hormones; Adult; Alopecia; Anti-Inflammatory Agents, Non-Steroidal; Blepharitis; Cicatrix; Dapsone; Erythema; Folliculitis; Follow-Up Studies; Humans; Isotretinoin; Keratolytic Agents; Male; Scalp Dermatoses; Skin Diseases; Treatment Outcome

Medical records of 30 dogs with histologically confirmed sebaceous adenitis that were treated with isotretinoin or etretinate were reviewed. Akitas and Standard Poodles were overrepresented, compared with the general hospital population. Thirteen dogs had concurrent pyoderma. The retinoids were administered for a minimum of 2 months. Dosage for the 13 dogs treated with isotretinoin only ranged from 0.8 to 3.5 mg/kg of body weight/d (mean, 1.4 mg/kg/d). Dosage for the 10 dogs treated with etretinate only ranged from 0.7 to 1.8 mg/kg/d (mean, 1.1 mg/kg/d). Two dogs were first given isotretinoin (mean dosage, 1.5 mg/kg/d) and, when they did not respond, were subsequently given etretinate (mean dosage, 0.85 mg/kg/d). Five dogs were first given etretinate (mean dosage, 1 mg/kg/d) and, when they did not respond, were subsequently given isotretinoin (mean dosage, 1.6 mg/kg/d). For the 20 dogs treated with isotretinoin, 1 was lost to follow-up; 9 of the remaining 19 had a successful outcome (> 50% reduction in severity of scaling and extent of alopecia, compared with pretreatment appearance). For the 17 dogs treated with etretinate, 9 had a successful outcome. Outcome could not be predicted on the basis of clinical signs or histologic findings, and a prognosis could not be determined on the basis of whether sebaceous glands were evident histologically.

Topics: Alopecia; Animals; Biopsy; Dog Diseases; Dogs; Etretinate; Female; Follow-Up Studies; Inflammation; Isotretinoin; Male; Pyoderma; Retrospective Studies; Sebaceous Glands; Skin; Skin Diseases; Treatment Outcome

Keratosis follicularis spinulosa decalvans (KFSD) is a rare X-linked disorder of keratinization of the hair follicle associated with corneal dystrophy. The clinical picture is characterized by solid follicular hyperkeratosis, especially on the exposed skin, sparse eyebrows/eyelashes, follicular scaling and scarring alopecia of the scalp, dry skin and ocular symptoms with keratitis and photophobia. We describe the three stages of the disease: onset, inflammation and partial remission and the treatment appropriate in each. Two patients in the inflammatory stage of KFSD, with recurrent deep, fibrosing folliculitis and perifolliculitis followed by spreading and scarring alopecia on the scalp, responded to oral therapy with retinoids. In both cases there was a distinct and lasting remission of the inflammation and stabilization of the spreading alopecia after treatment with etretinate (Tigason), up to 0.8 mg/kg body weight, or isotretinoin (Roaccutan), 0.5 mg/kg body weight, for 12 weeks. The follicular spinulous hyperkeratosis became softer, but persisted. Thus, oral therapy with retinoids appears helpful in the inflammatory stage of KFSD, even though there is little improvement in the follicular hyperkeratosis.

Topics: Administration, Oral; Adult; Alopecia; Darier Disease; Dose-Response Relationship, Drug; Drug Administration Schedule; Etretinate; Female; Humans; Isotretinoin; Male; Pedigree; Scalp; Skin

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

Dissecting folliculitis of the scalp can develop into an extensive, hypertrophic scarred lesion that is unresponsive to routine treatment. In these situations, radical excision of the affected area and concurrent perioperative treatment with isotretinoin (13-cis-retinoic acid) may be effective. The authors describe a case, illustrating the successful clinical application of this technique.

Topics: Adult; Alopecia; Combined Modality Therapy; Folliculitis; Follow-Up Studies; Humans; Isotretinoin; Male; Scalp; Scalp Dermatoses; Surgical Flaps; Tissue Expansion

Systemic treatment of adult male New Zealand albino rabbits with 13-cis-retinoic acid (isotretinoin) resulted in a reduction in the size of the meibomian gland. Clinical signs of toxicity included weight loss, alopecia, dry skin and mild conjunctival erythema with crusting on the eyelid margin. Histopathologic findings included thickening of duct and ductule epithelium, decrease in acinar tissue, accentuation of basaloid cells and evidence of periacinar fibrosis. The model presents the first experimental data to indicate that systemic 13-cis-retinoic acid effects meibomian gland structure in a laboratory model. Future functional studies of this model may yield important insights into the relationships between meibomian gland morphology, function, the ocular surface and the pathogenesis of blepharo-conjunctivitis.

Topics: Alopecia; Animals; Blepharitis; Body Weight; Conjunctivitis; Eyelid Diseases; Isotretinoin; Male; Meibomian Glands; Rabbits

Forty patients suffering of different forms of acne (papulo-pustular, nodulo-cystic, conglobata, rosacea), all in severe conditions and non-responding to other treatments, have been administered 13-cis-retinoic acid p.o. The treatment resulted in a complete and ultimate healing in 31 pts (77.5%) and a marked amelioration in the remaining 9 cases. The initial drug dosage was 40 mg/die (an average of 0.66 mg/kg/die) but it was reduced along the treatment to 2.5 mg/die, a still effective dose. The average treatment duration was 24 weeks (range: 12 to 40). The tolerance was generally excellent, but some adverse effect have been recorded, mainly localized in the skin and mucosa. Increases of total serum cholesterol (66% of the cases) and of triglyceride (72%) level have been observed. This effect was reversible at the end of the treatment. As a conclusion we can confirm that the 13-cis-retinoic acid is the most effective drug for the pharmacotherapy of severe acne.

Topics: Acne Vulgaris; Adult; Alkaline Phosphatase; Alopecia; Cholesterol; Drug Tolerance; Epistaxis; Female; Humans; Isotretinoin; Male; Pruritus; Rosacea; Transaminases; Tretinoin; Triglycerides