isotretinoin and Bacterial-Infections

Acne vulgaris is a common skin disorder. Although it is most prevalent in the second decade of life, its beginnings are heralded by increased activity of the sebaceous glands and faulty follicular keratinization, which are already evident in mid to late childhood. The subsequent and increasing proliferation of the follicular anaerobic diphtheroid microflora contribute further as an important pathogenic factor in the generation of inflammatory lesions. Treatments of acne, therefore, are aimed at reducing the follicular anaerobic bacteria, counteracting the follicular hyperkeratosis, and inhibiting the activity of sebaceous glands.

Topics: Acne Vulgaris; Adolescent; Anti-Bacterial Agents; Anti-Infective Agents, Local; Bacterial Infections; Benzoyl Peroxide; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Isomerism; Isotretinoin; Keratosis; Male; Propionibacterium acnes; Sebaceous Glands; Sebum; Tretinoin; Triamcinolone Acetonide

Isotretinoin (13-cis-retinoic acid) is commonly used for the treatment of acne vulgaris. We included 55 patients in this prospective study, and inspected them before, while and after therapy with isotretinoin regarding ocular side effects. Careful slit-lamp inspection, measurement of break-up-time and Schirmer-test and microbiological investigations of the conjunctival flora were performed. While staphylococcus aureus was cultured from the conjunctival sac before application of isotretinoin in 7.3%, this percentage increased to 61.8% during therapy. A pathological decrease of break-up-time was realized in 69.1% of the cases, the development of blepharitis in 40%. But in spite of the alteration of conjunctival flora, bacterial conjunctivitis developed in just 7.3% of the cases. However, only 34.5% of the patients showed symptoms of a conjunctivitis sicca, in spite of the impressive diminution of break-up-time in so many cases. All ocular side effects of isotretinoin were treatable and disappeared completely within 1 month after stopping therapy.

Topics: Acne Vulgaris; Adult; Bacterial Infections; Blepharitis; Conjunctiva; Conjunctivitis; Eye Diseases; Female; Humans; Isotretinoin; Male; Staphylococcus aureus; Tears

We report the case of two siblings, one of whom presented isotretinoin-induced eruptive pyogenic granulomas in the course of severe acne, and the other developed isotretinoin-induced acne fulminans. A possible underlying common pathogenic process of these two side-effects of isotretinoin is discussed.

Topics: Acne Vulgaris; Adolescent; Bacterial Infections; Drug Eruptions; Humans; Isotretinoin; Male; Suppuration

The clinical and bacteriological findings are reported in 13 patients with gram-negative folliculitis before, during, and after treatment with isotretinoin (13-cis-retinoic acid). Patients were treated for 14-36 weeks with a daily dose of 0.5-1.5 mg isotretinoin/kg body weight. Inflammatory lesions were counted before and during weeks 2, 4, 8, 12, 16, 20, 24, 28, and 30 of therapy and again up to 172 weeks after cessation of treatment. In all patients there was an impressive improvement in clinical symptoms, especially a decrease in seborrhea and inflammatory lesions. Simultaneously, the gram-negative bacteria disappeared from the facial skin. Full clinical bacteriological remission was achieved in 9 patients within a period of up to 43 months, with minor recurrences of the disease in the remaining 4 patients.

Topics: Adolescent; Adult; Bacterial Infections; Dermatitis, Seborrheic; Female; Folliculitis; Gram-Negative Bacteria; Humans; Isotretinoin; Male; Time Factors; Tretinoin

A 13-month-old child with lamellar ichthyosis and numerous cutaneous and systemic infections died following an abrupt episode of severe hypotension. Postmortem examination revealed white matter vacuolation in the brain stem tegmentum and cerebellar hemispheres similar to that seen in toxicity from hexachlorophene, to which our patient was not exposed. The patient had been treated with many commonly used medications, including 13-cis-retinoic acid, a relatively new drug with apparent therapeutic benefit in hyperkeratotic dermatoses. This had been given systemically during the patient's last week of life. Possible relationships between the white matter lesions and extrinsic toxic agents are discussed.

Topics: Anti-Bacterial Agents; Anti-Infective Agents; Bacterial Infections; Brain Stem; Central Nervous System Diseases; Cerebral Ventricles; Drug Therapy, Combination; Female; Humans; Ichthyosis; Infant; Isotretinoin; Mycoses; Myelin Sheath; Skin Diseases, Infectious; Tretinoin; Vacuoles

Isotretinoin has been found to be effective in the treatment of Gram-negative folliculitis. We investigated the direct in vitro antibacterial activity of isotretinoin against Gram-negative species. The concentrations of isotretinoin tested were two and ten times greater than the maximal levels attained in the sera of patients receiving oral isotretinoin. Regardless of the inoculum size, each organism tested grew as well in isotretinoin-containing media as it did in the control medium. These findings suggest that the efficacy of isotretinoin in patients with Gram-negative folliculitis is due to mechanisms other than direct antimicrobial action.

Topics: Bacterial Infections; Folliculitis; Gram-Negative Bacteria; Humans; In Vitro Techniques; Isotretinoin; Tretinoin

Thirty-two patients with gram-negative folliculitis were treated with 0.47 to 1.0 mg/kg/day of isotretinoin. Serial microbiologic evaluations demonstrated rapid clearing of the face and nasal mucosa of gram-negative rods. The clinical response was rapid, complete, and induced prolonged remissions. Twenty-six of thirty-two patients developed Staphylococcus aureus nasal carriage by the end of the 20-week treatment course. Isotretinoin has decided advantages over previously reported therapies for gram-negative folliculitis.

Topics: Acne Vulgaris; Bacterial Infections; Folliculitis; Gram-Negative Bacteria; Humans; Isomerism; Isotretinoin; Tretinoin

Topics: Bacterial Infections; Folliculitis; Humans; Isotretinoin; Tretinoin