isotretinoin and Chronic-Disease

Acne is the most common skin disease, affecting up to 95% of adolescents. Severe episodes of acne can cause considerable physical and psychological scarring, and overexpression of transforming growth factor-β can lead to formation of hypertrophic scars and keloids. The severity of acne in adolescence is associated with a positive history of severe acne in first-degree relatives, especially the mother. In most cases acne is a chronic disease, and it is often a component of systemic diseases or syndromes. All forms of severe acne require systemic treatment. The available options include oral antibiotics, hormonal antiandrogens for female patients and oral isotretinoin, as well as other combination treatments. Oral isotretinoin is the only drug available that affects all four pathogenic factors of acne. However, due to possible serious side-effects, a European directive states that oral isotretinoin should be used only as a second-line therapy in cases of severe, nodular and conglobate acne. The pharmaceutical quality of generic isotretinoin products and the obtainability of isotretinoin through e-pharmacies without prescription raise new therapeutic problems. New anti-inflammatory compounds, such as the 5-lipoxygenase inhibitor zileuton, may replace systemic antibiotics in the future, especially under the scope of antibiotic resistance prevention. This review looks into the various options and latest approaches, and factors to consider, when combating severe acne.

Topics: Acne Vulgaris; Administration, Oral; Adolescent; Adrenal Cortex Hormones; Adult; Androgen Antagonists; Anti-Bacterial Agents; Chronic Disease; Cicatrix; Dermatologic Agents; Female; Humans; Isotretinoin; Male; Practice Guidelines as Topic; Teratogens

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

Keratosis lichenoides chronica is a rare dermatosis characterized by a distinctive seborrheic dermatitis-like facial eruption, together with violaceous, papular, and nodular lesions on the extremities and trunk typically arranged in a linear and reticulate pattern. We describe a patient with KLC who had the typical features of this disease and responded partially to treatment with oral isotretinoin.

Topics: Adult; Biopsy, Needle; Chronic Disease; Diagnosis, Differential; Female; Humans; Isotretinoin; Keratolytic Agents; Keratosis; Lichenoid Eruptions; Remission Induction; Skin

Phymas are slowly progressive, disfiguring disorders of the face and ears that represent the end stage of rosacea, a common centrofacial dermatosis. Phymas are probably caused by the sequelae of chronic edema and its related connective tissue and sebaceous gland hypertrophy. Rhinophyma is the commonest among them. Analogous swellings may occur on the chin (gnatophyma), forehead (metophyma), one or both ears (otophyma), and eyelids (blepharophyma). Although rhinophyma has been traditionally associated with alcoholism, there is no evidence to support this association. Four variants of rhinophyma (glandular, fibrous, fibroangiomatous, actinic) can be recognized on clinical and histological basis. The development of skin cancer, such as basal cell carcinoma or squamous cell carcinoma, in rhinophyma appears to be a matter of accidental coincidence of different diseases. Although phymas are best treated surgically, they may be a worthwhile indication for nonsurgical treatment modalities such as systemic isotretinoin. Phymas do not resolve spontaneously.

Topics: Anti-Bacterial Agents; Chronic Disease; Dermatologic Agents; Eye Diseases; Humans; Isotretinoin; Prognosis; Rhinophyma; Rosacea; Sunscreening Agents

Acne inversa (synonyms: acne triad, acne tetrad or hidradenitis suppurativa, and others) is an inflammatory disease that develops mostly in the axillae, under the breasts and in the anogenital region. The new term, acne inversa, encompasses what was previously called the occlusion triad or tetrad. The disease is relatively common, but the diagnosis is frequently missed. Many different modalities of treatment are recommended in the literature. Radical surgical intervention should be performed at the earliest recognized stage. In the light of experience with our own patients, we propose surgical intervention with wide excision and subsequent healing by secondary intent.

Topics: Acne Vulgaris; Adult; Anti-Bacterial Agents; Chronic Disease; Combined Modality Therapy; Female; Humans; Isotretinoin

Protocols for treating acne with isotretinoin have varied widely because some factors associated with relapse and treatment duration have not yet been fully determined. This paper evaluates the effectiveness of conventional, low, and intermittent isotretinoin dosage protocols in the treatment of moderate acne and investigates the relationships between GAGS score, treatment duration and relapse rate. The 107 patients with moderate acne were randomly divided into three groups who received isotretinoin for 24 weeks (Group A: 0.5-1 mg/kg/day; Group B: 0.25-0.4 mg/kg/day; Group C: 0.5-0.7 mg/kg/day for 1 week out of every 4 weeks). The results show that both conventional and continuous low doses achieved full clinical effectiveness with minimum relapse rates. However, fewer side effects and better patient satisfaction were reported with the low dose. Significant differences in GAGS scores after 24 weeks were found between groups B and C (p = 0.037) and between groups A and C (p < 0.001), while no significant differences were found between groups A and B (p = 0.153). It was observed that relapse rate increased with initial GAGS score. The average relapse rate was 58.0% for those with initial GAGS scores of 25-30 compared with 5.5% for those with scores of 19-24. It was also noticed that, among the patients who relapsed, the highest percentage (56.3%) were in the age group <20 years. However, GAGS (β = 0.646, t = 8.323, p < 0.001) was found to be a better predictor of relapse than age (β = 0.083, t = 1.073, p = 0.286). These results suggest that initial GAGS score is an important factor in determining the treatment protocol for moderate acne. Furthermore, this study recommends that a low-dose treatment is most suitable when GAGS <25, as it can achieve complete clearance of acne with minimal relapses and side effects.

Topics: Acne Vulgaris; Adult; Chronic Disease; Clinical Protocols; Dermatologic Agents; Drug-Related Side Effects and Adverse Reactions; Humans; Isotretinoin; Randomized Controlled Trials as Topic; Recurrence; Treatment Outcome; Young Adult

Management of oral candidiasis depends on an accurate diagnosis, identification and elimination of predisposing factors, and, often, use of antifungal agents. Chronic hyperplastic candidosis (CHC) is considered a premalignant lesion of the oral mucosa, occurring as speckled or homogeneous white lesions. If the lesions are untreated, a minor proportion may become dysplastic and progress to carcinoma. The traditional treatment of this lesion is based on the use of antifungal agents. The aim of this study was to examine the efficacy of 0.18% isotretinoin for treatment of nystatin-resistant candidiasis. Isotretinoin was administered topically twice a day for one month to six patients affected by nystatin-resistant CHC. In all six patients, daily antimycotic topical therapy with nystatin for 30 days had failed to resolve the candidal stomatitis. After one month of isotretinoin treatment, five of the six patients were negative for Candida, whereas in untreated control patients the situation was unchanged. Only one patient with suspected sicca syndrome was found to have oral Candida 15 days after the last administration of isotretinoin. None of the patients had any complaints about the medication. These findings suggest that 0.18% isotretinoin applied twice a day for one month is able to suppress nystatin-resistant candidiasis.

Topics: Administration, Topical; Antifungal Agents; Candidiasis, Oral; Chronic Disease; Drug Resistance, Fungal; Female; Humans; Isotretinoin; Male; Middle Aged; Nystatin; Pilot Projects

Topics: Acne Vulgaris; Chronic Disease; Cross-Sectional Studies; Dermatologic Agents; Humans; Inflammatory Bowel Diseases; Isotretinoin

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

Isotretinoin (ISO) is a synthetic vitamin A derivative which has been used for treatment-resistant acne vulgaris. Although most musculoskeletal side effects of ISO are common, including myalgia, arthralgia, and back pain, sacroiliitis is one of the uncommon side effects. ISO-induced sacroiliitis usually completely resolves within a few months by the cessation of the drug.. In this paper, we present a 26-year-old female patient with chronic sacroiliitis that was probably induced by ISO and not resolved by the discontinuation of the drug.. In this patient, sacroiliitis was overlooked for three years. Therefore, ISO usage should be considered in the differential diagnosis of sacroiliitis and low back pain.

Topics: Acne Vulgaris; Adult; Anti-Inflammatory Agents, Non-Steroidal; Arthralgia; Chronic Disease; Dermatologic Agents; Diagnosis, Differential; Female; Follow-Up Studies; Humans; Indomethacin; Isotretinoin; Low Back Pain; Myalgia; Sacroiliitis; Treatment Outcome

Acne vulgaris is the most prevalent chronic skin disease in the United States, affecting nearly 50 million people per year, mostly adolescents and young adults. Potential sequelae of acne, such as scarring, dyspigmentation, and low self-esteem, may result in significant morbidity. Typical acne lesions involve the pilosebaceous follicles and the interrelated processes of sebum production, Cutibacterium acnes (previously called Propionibacterium acnes) colonization, and inflammation. Acne may be classified as mild, moderate, or severe based on the number and type of skin lesions. Multiple treatment agents and formulations are available, with each agent targeting a specific area within acne pathogenesis. Treatment selection is based on disease severity, patient preference, and tolerability. Topical retinoids are indicated for acne of any severity and for maintenance therapy. Systemic and topical antibiotics should be used only in combination with benzoyl peroxide and retinoids and for a maximum of 12 weeks. Isotretinoin is used for severe, recalcitrant acne. Because of the risk of teratogenicity, patients, pharmacists, and prescribers must register with the U.S. Food and Drug Administration-mandated risk management program, iPledge, before implementing isotretinoin therapy. There is limited evidence for physical modalities (e.g., laser therapy, light therapy, chemical peels) and complementary therapies (e.g., purified bee venom, low-glycemic-load diet, tea tree oil); therefore, further study is required.

Topics: Acne Vulgaris; Adolescent; Adult; Anti-Bacterial Agents; Benzoyl Peroxide; Chronic Disease; Complementary Therapies; Curriculum; Dermatologic Agents; Education, Medical, Continuing; Female; Humans; Isotretinoin; Laser Therapy; Male; Phototherapy; United States; Young Adult

Topics: Chronic Disease; Dose-Response Relationship, Drug; Drug Administration Schedule; Erythema; Facial Dermatoses; Follow-Up Studies; Humans; Hyperpigmentation; Immunohistochemistry; Isotretinoin; Male; Middle Aged; Recurrence; Retreatment; Severity of Illness Index; Time Factors; Treatment Outcome

Topics: Administration, Oral; Adult; Amyloidosis, Familial; Biopsy, Needle; Chronic Disease; Diagnosis, Differential; Female; Follow-Up Studies; Humans; Immunohistochemistry; Isotretinoin; Pruritus; Skin Diseases, Genetic; Treatment Outcome

Morbihan disease, which consists of solid facial edema, is a rare complication of rosacea, a common cutaneous disorder in middle-aged individuals. The characteristic features of Morbihan disease are its chronic course, typical clinical picture, lack of specific laboratory and histopathologic findings, and refractoriness to therapeutic measures. Since its initial description in 1957, only a small number of cases have been reported in the dermatologic literature. We report a 54-year-old man who developed a two-year duration of erythema and edema that affects the upper and mid face, with accentuation in the periorbital region. Patch tests excluded an allergic contact dermatitis and histopathologic investigation showed small, nodular clusters of epithelioid cells in the dermis that were consistent with sarcoidal granulomata. A diagnosis of Morbihan disease was made owing to the combination of clinical and histopathologic findings. Therapeutic options for the disease remain unsatisfactory and treatments reported in the literature include systemic glucocorticoids, oral tetracyclines, thalidomide, isotretinoin, ketotifen, and clofazimine. Our patient failed a six-to-seven months course of minocycline prior to presentation and has since experienced improvement on gradually-increasing doses of isotretinoin.

Topics: Chronic Disease; Dermatologic Agents; Dermis; Edema; Erythema; Face; Histiocytes; Humans; Isotretinoin; Lymphocytes; Male; Middle Aged

Retinoids are anti-proliferative and anti-inflammatory compounds. We had previously shown that retinoids alleviate kidney damage in acute models of renal disease. We now examined whether retinoids are also effective in a chronic renal ablation model. Subtotally nephrectomized rats (SNx; two-third ablation) were compared to sham-operated controls (sham). SNx rats were administered either 10 mg/kg b.w. (low dose, LD) or 40 mg/kg b.w. (high dose, HD) isotretinoin or vehicle (n = 10 per group). The experiment was terminated after 16 weeks. Systolic blood pressure was significantly higher after SNx compared to sham but lower in SNx with LD isotretinoin (vs. SNx + vehicle). Compared to SNx + vehicle, SNx + LD isotretinoin had lower glomerular cell numbers, less glomerular hypertrophy and sclerosis, and less interstitial expansion. Morphological improvement in SNx + LD isotretinoin was accompanied by improvement in creatinine clearance and reduced urinary albumin excretion. In contrast, HD isotretinoin caused aggravation of renal damage with fibrinoid necroses of vessels and elevated urinary albumin excretion despite lower blood pressure. The dichotomous effects of isotretinoin are at least in part due to time- and dose-dependent alterations of transforming growth factor beta1 and collagen IV gene expression as also suggested by cell-culture studies in vascular smooth muscle cells. In addition, isotretinoin affected the systemic and the renal renin-angiotensin system (which was further analyzed in a model of angiotensin II infusion of the rat). Isotretinoin failed to cumulate at LD but cumulated at HD in SNx. We conclude that LD isotretinoin attenuates progressive renal damage, whereas HD isotretinoin cumulates and aggravates renal damage independent of blood pressure reduction.

Topics: Albuminuria; Animals; Anti-Inflammatory Agents, Non-Steroidal; Blood Pressure; Cells, Cultured; Chronic Disease; Collagen Type V; Dermatologic Agents; Dose-Response Relationship, Drug; Gene Expression Regulation; Isotretinoin; Kidney Diseases; Male; Muscle, Smooth, Vascular; Myocytes, Smooth Muscle; Nephrectomy; Rats; Rats, Sprague-Dawley; Time Factors; Transforming Growth Factor beta1

Chronic allograft nephropathy is characterized by chronic inflammation and fibrosis. Because retinoids exhibit anti-proliferative, anti-inflammatory, and anti-fibrotic functions, the effects of low and high doses of 13-cis-retinoic acid (13cRA) were studied in a chronic Fisher344-->Lewis transplantation model. In 13cRA animals, independent of dose (2 or 20 mg/kg body weight/day) and start (0 or 14 days after transplantation) of 13cRA administration, serum creatinine was significantly lower and chronic rejection damage was dramatically reduced, including subendothelial fibrosis of preglomerular vessels and chronic tubulointerstitial damage. The number of infiltrating mononuclear cells and their proliferative activity were significantly diminished. The mRNA expression of chemokines (MCP-1/CCL2, MIP-1alpha/CCL3, IP-10/CXCL10, RANTES/CCL5) and proteins associated with fibrosis (plasminogen activator inhibitor-1, transforming growth factor-beta1, and collagens I and III) were strikingly lower in treated allografts. In vitro, activated peritoneal macrophages of 13cRA-treated rats showed a pronounced decrease in protein secretion of inflammatory cytokines (eg, tumor necrosis factor-alpha, interleukin-6). The suppression of the proinflammatory chemokine RANTES/CCL5 x 13cRA in fibroblasts could be mapped to a promoter module comprising IRF-1 and nuclear factor-kappaB binding elements, but direct binding of retinoid receptors to promoter elements could be excluded. In summary, 13cRA acted as a potent immunosuppressive and anti-fibrotic agent able to prevent and inhibit progression of chronic allograft nephropathy.

Topics: Animals; Cells, Cultured; Chemokines; Chromatography, High Pressure Liquid; Chronic Disease; Creatinine; Dose-Response Relationship, Drug; Electrophoretic Mobility Shift Assay; Fibroblasts; Graft Rejection; Humans; Immunohistochemistry; Immunosuppressive Agents; Isotretinoin; Kidney; Kidney Transplantation; Macrophages, Peritoneal; Male; Rats; Rats, Inbred Lew; Reverse Transcriptase Polymerase Chain Reaction; RNA, Messenger; Transplantation, Homologous

Topics: Adult; Chronic Disease; Dermatologic Agents; Female; Humans; Isotretinoin; Male; Middle Aged; Retrospective Studies; Rosacea

Topics: Administration, Oral; Chronic Disease; Dose-Response Relationship, Drug; Drug Administration Schedule; Follow-Up Studies; Granuloma Annulare; Humans; Isotretinoin; Male; Middle Aged; Treatment Outcome

Retinoids, derivatives of vitamin A, have strong anti-inflammatory and antiproliferative properties. We previously demonstrated that the pan-agonists all-transretinoic acid (RA) and isotretinoin (13-cis RA) alleviate renal damage in rat acute glomerulonephritis (GN) induced by anti-Thy-1.1 mAb OX-7.. The present study examined the effects of low dose and high dose treatment with isotretinoin in the chronic glomerulonephritis model, Thy-GN. Thy-GN was induced by a single intravenous injection of monoclonal antibody (mAb) 1-22-3 in uninephrectomized Wistar rats (N = 7 to 10 per group). Control and nephritic groups were treated with vehicle (veh), low dose isotretinoin (2 mg/kg body wt), or high dose isotretinoin (10 mg/kg body wt). The experiment was terminated 60 days after induction of Thy-GN.. In animals with Thy-GN, isotretinoin abrogated the increase in blood pressure and significantly reduced albuminuria. Glomerulosclerosis index, glomerular and interstitial cell counts, as well as the area of the interstitial space were significantly lower in nephritic rats treated with low and high dose isotretinoin compared to vehicle-treated nephritic controls. Treatment with isotretinoin also significantly reduced the number of glomerular and interstitial macrophages. The increase of transforming growth factor (TGF)-beta1, TGF receptor II and prepro-endothelin-1 gene expression in vehicle-treated nephritic rats was significantly attenuated by isotretinoin.. Treatment with isotretinoin significantly reduces glomerular and interstitial damage in rats with chronic glomerulonephritis as indicated by different functional and histological markers. Retinoids may provide a novel therapeutic option for the treatment of glomerulonephritis.

Topics: Albuminuria; Animals; Blood Pressure; Body Weight; Chronic Disease; Collagen Type I; Creatinine; Fibronectins; Gene Expression; Glomerulonephritis; Isotretinoin; Kidney; Kidney Glomerulus; Kidney Tubules; Male; Rats; Rats, Wistar

Folliculitis decalvans is a chronic purulent folliculitis resulting in permanent hair loss and follicular atrophy. We report 32-year-old identical female twins presenting with relapsing pruritic outbreaks on the scalp resulting in areas of permanent baldness. Staphylococcus aureus was detected in the lesions of both women. Histopathology confirmed the diagnosis of folliculitis decalvans. Immunological testing showed no alteration of the immune system. To our knowledge, this is the first report on folliculitis decalvans occurring in identical twins, suggesting a possible genetic component in this disease.

Topics: Adult; Anti-Inflammatory Agents; Astringents; Biopsy; Chronic Disease; Diseases in Twins; Drug Therapy, Combination; Female; Folliculitis; Humans; Isotretinoin; Keratolytic Agents; Methylprednisolone; Staphylococcal Skin Infections; Zinc Sulfate

Although knowledge concerning the dermatological treatment of chronic acne has grown considerably in recent years, relatively few studies have assessed the impact of effective physical intervention upon the psychoemotional functioning of patients. Hypotheses regarding the psychological impact of acne were developed using concepts drawn from evolutionary psychology. A sample of 34 patients (19 men and 15 women) with chronic acne were assessed for psychological, emotional and dermatological symptomatology using a variety of self-report questionnaires over four time-points during 16 weeks treatment with isotretinoin. Thirty-four patients completed the first assessment, 21 the second, 20 the third and 15 the fourth and final assessment. At the first assessment, prior to isotretinoin treatment, 15 patients (44%) reported clinically significant levels of anxiety, while six patients (18%) reported clinically significant depression. Women with acne were significantly more embarrassed than their male counterparts about their skin disease. Treatment with isotretinoin produced significant improvements across a wide variety of psychological functions, although the emotional status of patients appeared to be more resistant to change. Acne appears to be a condition which has the potential to damage, perhaps even in the long term, the emotional functioning of some patients.

Topics: Acne Vulgaris; Adolescent; Adult; Anxiety Disorders; Chronic Disease; Depressive Disorder; Emotions; Female; Follow-Up Studies; Humans; Isotretinoin; Keratolytic Agents; Male; Mental Disorders; Psychiatric Status Rating Scales; Psychometrics

There is a very small number of patients who suffer from acne even in the sixth and seventh decades of life. These patients have suffered from acne for most of their lives, 30-60 years, and have often received multiple courses of antibiotics over many years. We saw 10 such patients over 4 years. One received oral isotretinoin 1 mg/kg per day, but was unable to tolerate the adverse effects of cheilitis and developed hyperlipidaemia. We subsequently treated nine others with oral isotretinoin, 0.25 mg/kg per day, for 6 months; in six the acne had virtually cleared by 3-4 months while the other three cleared by 6 months. Up to 36 months after therapy these patients have remained clear of acne except for one who relapsed after 11 months. Therefore, as these patients respond well with few side-effects both in the long- and short-term to low-dose isotretinoin, they should be treated with isotretinoin, although at the lower starting dose of 0.25 mg/kg per day compared with younger patients who are treated with 0.5-1 mg/kg per day, and the treatment maintained for 6 months.

Topics: Acne Vulgaris; Aged; Chronic Disease; Drug Administration Schedule; Female; Follow-Up Studies; Humans; Isotretinoin; Keratolytic Agents; Male; Middle Aged

Topics: Administration, Oral; Adult; Chronic Disease; Erythema; Facial Dermatoses; Female; Humans; Hyperplasia; Hypertrophy; Isotretinoin; Keratolytic Agents; Male; Middle Aged; Sebaceous Glands

Topics: Aged; Chronic Disease; Drug Administration Schedule; Humans; Isotretinoin; Lupus Erythematosus, Cutaneous; Male

Roaccutan efficacy and tolerance in severe forms of acne eruption (ball-shaped and conglobate) and in acne rosacea were under study. The treatment started with a daily dose of 60 mg, then the dose was gradually reduced. The course took 8-12 weeks. Roaccutan was sufficiently effective in severe forms of acne eruption and was well tolerated by the patients. Side effects, such as lip and skin dryness, are possible in the course of therapy.

Topics: Acne Vulgaris; Adolescent; Adult; Chronic Disease; Drug Evaluation; Humans; Isotretinoin; Male; Middle Aged; Remission Induction; Time Factors

Roakkutan was used in the treatment of 49 patients with severe acne vulgaris and 8 patients with rosacea. The treatment was highly effective. The primary and maintenance daily doses of the drug are suggested and the terms of therapy defined.

Topics: Acne Vulgaris; Adolescent; Adult; Chronic Disease; Drug Evaluation; Female; Humans; Isotretinoin; Male; Rosacea; Time Factors

Acne keloidalis nuchae is characterized by keloidal papules and plaques. The lesions are located on the occipital scalp and posterior neck. This rare therapy-resistant condition is nearly always seen in men, particularly in negroes. Advanced stages of the disease require surgical excision with split-thickness skin grafts or treatment with a CO2 laser. Oral therapy with 13-cis-retinoic acid (isotretinoin) in a 23-year-old white man resulted in remarkable improvement within a few weeks.

Topics: Administration, Oral; Adult; Chronic Disease; Dose-Response Relationship, Drug; Folliculitis; Humans; Isotretinoin; Male; Scalp Dermatoses; Skin

Eight of ten patients with chronic or subacute cutaneous lupus erythematosus completed 16 weeks of oral isotretinoin therapy (80 mg/day). All eight patients noted an excellent clinical response without significant side effects. (Two patients did not return to initial two-week follow-up.) Peripheral blood B- and T-cell counts were unaffected by therapy. Therapy was associated with resolution of routine histopathologic abnormalities, conversion of abnormal lesional direct immunofluorescence microscopy to normal, normalization of the epidermis on electron microscopy, and reduction of all T cells near the dermoepidermal junction without change in ratio of T-helper/inducer cells to T-suppressor/cytotoxic cells. Isotretinoin is a clinically effective short-term therapy for chronic or possibly for subacute cutaneous lupus erythematosus. The primary mechanism of action remains unestablished.

Topics: Administration, Oral; Adult; Basement Membrane; Chronic Disease; Complement C3; Drug Evaluation; Female; Fibrin; Fluorescent Antibody Technique; Humans; Immunoglobulin G; Isotretinoin; Lupus Erythematosus, Discoid; Lymphocytes; Male; Middle Aged; Skin; Tretinoin

The clinical response to isotretinoin (13-cis-retinoic acid) in 11 patients with generalized pustular psoriasis was evaluated. Control of pustulation and systemic symptoms was achieved in ten cases, but additional therapy was required to produce complete clearing of all psoriatic lesions. Also, the efficacy of isotretinoin and etretinate in the treatment of chronic plaque psoriasis was compared in 29 patients. Isotretinoin was found to be less effective than etretinate in the treatment of chronic plaque psoriasis.

Topics: Adult; Aged; Biopsy; Chronic Disease; Etretinate; Female; Humans; Isotretinoin; Male; Middle Aged; Psoriasis; Tretinoin

Topics: Acne Vulgaris; Adolescent; Chronic Disease; Follow-Up Studies; Granuloma; Humans; Isotretinoin; Male; Skin Diseases; Tretinoin

Severe forms of rosacea are a new indication for the treatment with 13-cis retinoic acid. Results of therapy and duration of remission were in five patients, treated in this way, much better than compared to standard therapeutic measurements.

Topics: Adult; Chronic Disease; Humans; Isotretinoin; Middle Aged; Rosacea; Tretinoin