isotretinoin and Behcet-Syndrome

Acne is the most common disease of the skin. It affects 85% of teenagers, 42.5% of men, and 50.9% of women between the ages of 20 and 30 years.96,97 The role of hormones, particularly as a trigger of sebum production and sebaceous growth and differentiation, is well known. Excess production of hormones, specifically androgens, GH, IGF-1, insulin, CRH, and glucocorticoids, is associated with increased rates of acne development. Acne may be a feature in many endocrine disorders, including polycystic ovary disease, Cushing syndrome, CAH, androgen-secreting tumors, and acromegaly. Other nonendocrine diseases associated with acne include Apert syndrome, SAPHO syndrome, Behçet syndrome and PAPA syndrome. Acne medicamentosa is the development of acne vulgaris or an acneiform eruption with the use of certain medications. These medications include testosterone, progesterone,steroids, lithium, phenytoin, isoniazid, vitamins B2, B6, and B12, halogens, and epidermal growth factor inhibitors. Management of acne medicamentosa includes standard acne therapy. Discontinuation of the offending drug may be necessary in recalcitrant cases. Basic therapeutic interventions for acne include topical therapy, systemic antibiotics,hormonal agents, isotretinoin, and physical treatments. Generally, the severity of acne lesions determines the type of acne regimen necessary. The emergence of drug-resistant P acnes and adverse side effects are current limitations to effective acne management.

Topics: Acne Vulgaris; Acquired Hyperostosis Syndrome; Acrocephalosyndactylia; Anti-Bacterial Agents; Behcet Syndrome; Dermatologic Agents; Drug-Related Side Effects and Adverse Reactions; Endocrine System Diseases; Hormones; Humans; Isotretinoin; Low-Level Light Therapy; Phototherapy

To evaluate the long-term remission efficacy and safety of isotretinoin in the treatment of Behcet's disease (BD).. This single-blind, controlled therapeutic study was conducted in the Department of Dermatology and Venereology at Baghdad Teaching Hospital from February 2011 to January 2012. Thirty patients with BD were included in this work. Each patient received isotretinoin 20 mg orally once daily for 3 months. They were assessed at week 2 and then monthly depending on the Clinical Manifestation Index (CMI) and to record any side effects. At week 12, isotretinoin was stopped and patients were given placebo therapy in a form of glucose capsules for another 3 months.. Thirty patients were treated, 14 (46.6%) males and 16 (53.3%) females, with a male to female ratio of 1:1. Their ages ranged from 16 to 64 years (mean +/- standard deviation [SD], 38.4 +/- 10.9 years). During the first 3 months of therapy, the pathergy test, oral pathergy test, and C-reactive protein were significantly minimized. The CMI before isotretinoin therapy ranged between 2 and 8 (mean +/- SD, 4.933 +/- 1.91). After therapy, within the first 14 days, the mean CMI started to decline to a lower level, and it continued to decline significantly until week 12. It then started to increase through week 4 of placebo therapy, but remained statistically significant until the second month of placebo therapy. Isotretinoin therapy also had a statistically significant effect in reducing oral ulcers and skin manifestations.. Isotretinoin is an effective therapeutic and prophylactic drug in the management of BD.

Topics: Administration, Oral; Adolescent; Adult; Behcet Syndrome; Dermatologic Agents; Female; Follow-Up Studies; Hospitals, Teaching; Humans; Iraq; Isotretinoin; Male; Middle Aged; Remission Induction; Single-Blind Method; Time Factors; Treatment Outcome; Young Adult

Isotretinoin-induced keloid formation has occasionally been reported in patients who have undergone dermabrasion or laser treatment. This report describes a man with Behçet's disease (BD) who was prescribed isotretinoin for nodulocystic acne. After approximately 8 weeks of this treatment, the patient developed extensive keloids. There are no previous reports of possible isotretinoin-induced keloid formation in the setting of BD. This article discusses possible connections between BD, keloid formation and isotretinoin, which may be manifested in this case.

Topics: Acne Vulgaris; Adult; Behcet Syndrome; Drug Eruptions; Humans; Isotretinoin; Keloid; Keratolytic Agents; Male