isotretinoin and Cicatrix

It is generally believed that intervention on skin while on isotretinoin or within 6 to 12 months after treatment can lead to prolonged healing and abnormal scarring. The objective of this systematic review is to evaluate the body of evidence on concomitant use of isotretinoin and lasers for adverse events as a consequence of treatment. A PRISMA-compliant systematic review (Systematic Review Registration Number: CRD42017056492) of 12 electronic databases was conducted for the terms "laser" and "isotretinoin" or associated brand names from inception until June 2020. Subsequent reference search of studies meeting predefined inclusion criteria were conducted, and all articles were evaluated for bias and assigned levels of evidence to facilitate data synthesis. The search strategy produced 29 studies. Of 871 patients included in the studies of interest, 12 experienced transient adverse effects that resolved spontaneously, and only two presented with keloid formation, both from case reports. This systematic review suggests the risk associated with concomitant isotretinoin and laser use is small to absent. Further studies are needed, but these results suggest that current contraindications may be overly cautious.

Topics: Cicatrix; Dermatologic Agents; Humans; Isotretinoin; Lasers; Wound Healing

Acne should not be perceived as a self-limiting affliction of adolescence. Due to the growing problem of antimicrobial-resistant bacteria, restrictive use of peroral and topical antibiotics is recommended. There are a number of effective agents for topical treatment of mild to moderate acne. In cases of severe, therapy-resistant acne, treatment with peroral isotretinoin is recommended.

Topics: Acne Vulgaris; Administration, Oral; Administration, Topical; Adolescent; Algorithms; Anti-Bacterial Agents; Benzoyl Peroxide; Cicatrix; Dermatologic Agents; Humans; Isotretinoin; Quality of Life

Laboratory monitoring for patients on isotretinoin should include creatinine kinase in athletic males and the more liver-specific gamma glutamyltransferase. There is mounting evidence that acne pathophysiology includes a barrier defect and subsequent microbiome disruption. Avoidance of acne scars with early and aggressive treatment is a more efficient and cost-effective option than subsequent treatment. Laser and light treatments for acne and acne scars are plentiful but poorly supported by evidence-based medicine. The acne pipeline is rich with new chemical entities, new formulations, and combinations of older agents. The gold standard for acne therapy may be changing its face.

Topics: Acne Vulgaris; Anti-Bacterial Agents; Cicatrix; Creatine Kinase; Dermatologic Agents; Face; Humans; Intense Pulsed Light Therapy; Isotretinoin; Liver Function Tests; Microbiota; Photochemotherapy; Prebiotics; Probiotics; Retinoids; Sebum; Skin

Rosacea fulminans is a rare inflammatory condition of the central face marked by the abrupt onset of erythematous coalescing papules, pustules, nodules, and draining sinuses. Due to infrequent reporting in the literature, the pathophysiology, classification, and nomenclature of this condition remain controversial. This comprehensive review evaluated a total of 135 cases of rosacea fulminans for clinical and histopathologic features and reported treatment strategies. Patients were 91% female with an average age of onset of 31.3 years. Only 19% of cases reported duration of symptoms longer than 3 months, and reports of recurrence were uncommon. A majority of patients had history of rosacea or flushing, and common triggers included hormonal shifts, emotional stress, and medications. Extrafacial or systemic involvement was rare. Though oral and topical antibiotics were frequently utilized to treat rosacea fulminans, there was a clear shift in reported treatments for rosacea fulminans following the introduction of isotretinoin use in 1987, marked by increased reliance on isotretinoin in addition to topical and systemic corticosteroids. Newer treatments were associated with superior improvement compared with antibiotic monotherapy, most notably dramatically reduced rates of scarring, though reduced rates of disease recurrence were not evident. Several patterns revealed through this review reinforce the classification of rosacea fulminans as a severe yet distinct variant of rosacea and highlight key distinguishing clinical features and treatment options for optimal management.

Topics: Acne Vulgaris; Administration, Cutaneous; Administration, Oral; Anti-Bacterial Agents; Cicatrix; Dermatitis; Diagnosis, Differential; Drug Therapy, Combination; Facial Dermatoses; Glucocorticoids; Humans; Isotretinoin; Recurrence; Rosacea; Skin

The notion that systemic isotretinoin taken within 6 to 12 months of cutaneous surgery contributes to abnormal scarring or delayed wound healing is widely taught and practiced; however, it is based on 3 small case series from the mid-1980s.. To evaluate the body of literature to provide evidence-based recommendations regarding the safety of procedural interventions performed either concurrently with, or immediately following the cessation of systemic isotretinoin therapy.. A panel of national experts in pediatric dermatology, procedural/cosmetic dermatology, plastic surgery, scars, wound healing, acne, and isotretinoin was convened. A systematic PubMed review of English-language articles published from 1982 to 2017 was performed using the following search terms: isotretinoin, 13-cis-retinoic acid, Accutane, retinoids, acitretin, surgery, surgical, laser, ablative laser, nonablative laser, laser hair removal, chemical peel, dermabrasion, wound healing, safety, scarring, hypertrophic scar, and keloid. Evidence was graded, and expert consensus was obtained.. Thirty-two relevant publications reported 1485 procedures. There was insufficient evidence to support delaying manual dermabrasion, superficial chemical peels, cutaneous surgery, laser hair removal, and fractional ablative and nonablative laser procedures for patients currently receiving or having recently completed isotretinoin therapy. Based on the available literature, mechanical dermabrasion and fully ablative laser are not recommended in the setting of systemic isotretinoin treatment.. Physicians and patients may have an evidence-based discussion regarding the known risk of cutaneous surgical procedures in the setting of systemic isotretinoin therapy. For some patients and some conditions, an informed decision may lead to earlier and potentially more effective interventions.

Topics: Cicatrix; Dermatologic Agents; Dermatologic Surgical Procedures; Humans; Isotretinoin; Skin; Time Factors; Wound Healing

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

We review rosacea fulminans, a rare condition that may cause facial scarring and disfigurement. All physicians and health care professionals must be aware of this form of rosacea to treat or refer the patient. Early treatment of rosacea fulminans is essential to avoid scarring.

Topics: Administration, Oral; Cicatrix; Dermatologic Agents; Facial Dermatoses; Glucocorticoids; Humans; Isotretinoin; Quality of Life; Rosacea; Time Factors

Several good-quality randomised trials brought useful information on how to manage severe skin infections and develop anti-staphylococcus strategies. Trials on common warts did not bring any valuable solution. Rituximab and omalizumab have seen their indications becoming more precise or broadened. Meta-analyses have been particularly numerous, but most of the time with no decisive conclusion, since this methodology presents strong limitations for studying safety data. Most important work has been rather directed toward analysing safety data rather than efficacy. Among the most important results, are those from a retrospective cohort of patients taking isotretinoin: suicidal risk has to be linked to severe acne itself, rather than to the drug.

Topics: Abscess; Adalimumab; Anti-Bacterial Agents; Antibodies, Anti-Idiotypic; Antibodies, Monoclonal, Humanized; Antibodies, Monoclonal, Murine-Derived; Cicatrix; Dermatologic Agents; Dermatology; Humans; Immunologic Factors; Immunosuppressive Agents; Isotretinoin; Methicillin-Resistant Staphylococcus aureus; Methotrexate; Omalizumab; Papillomavirus Vaccines; Rituximab; Sirolimus; Skin Diseases; Transforming Growth Factor beta3

Topics: Acne Vulgaris; Administration, Oral; Administration, Topical; Anti-Bacterial Agents; Cicatrix; Dermatologic Agents; Hormones; Humans; Isotretinoin

In plastic-reconstructive surgery in recent decades silicone fluid has been injected for cosmetic reasons and has occasionally led to granulomas with foreign body reaction (siliconoma). A 77-year-old woman is presented who developed protuberant facial granulomas 15 years after the injection of silicone fluid to improve scars. Histopathology revealed large lipid-filled cells, surrounded by histiocytic cells and foreign body giant cells. Laser microprobe mass analysis (LAMMA) showed peaks consistent with PO2 and PO3, which are usually found in regions of foreign body reactions. Treatment with isotretinoin given orally in low doses (20 mg total dose per day) resulted in a complete resolution of the granulomas. The anti-inflammatory action of isotretinoin was the reason for selecting this treatment modality.

Topics: Aged; Cicatrix; Facial Dermatoses; Female; Forehead; Granuloma, Foreign-Body; Humans; Isotretinoin; Silicone Oils; Skin

Early acne scar intervention is important. Oral isotretinoin is widely used in patients with moderate to severe acne. Picosecond laser has shown a promising effect on scar clearance. However, there is a lack of reports on the efficacy and safety of early acne scar management by using 1064-nm picosecond laser in patients receiving low-dose oral isotretinoin. Twenty-four patients with atrophic acne scars of Fitzpatrick skin type III to V were enrolled. All patients were receiving low-dose oral isotretinoin (0.12-0.22 mg/kg/day) during the treatment. The face of the participants was randomly assigned to receive 2 sessions of fractional picosecond 1064 nm Nd: YAG laser (FxPico) treatment and 2 follow-ups, with an interval of 1 month (month 0-3). Clinical efficacy and safety were assessed by photographs, ECCA grading scale, the number of scar lesions melanin and erythema indexes (MI and EI), TEWL, DLQI, and patient satisfaction and the adverse events were recorded on every visit. FxPico significantly decreased the ECCA score and showed higher improvement in the ECCA score. FxPico treated side achieved a significant reduction in all acne scar types, while only boxcar scars and rolling scars showed higher improvement. TEWL but not MI or EI were significantly improved. DLQI and patient satisfaction were higher with the FxPico-treated side than control side. No adverse effects were observed and all the side effects observed were temporary and tolerable. Early intervention by FxPico on patients receiving low-dose oral isotretinoin is a safe and effective modality to improve atrophic acne scars.

Topics: Acne Vulgaris; Atrophy; Cicatrix; Humans; Isotretinoin; Lasers, Solid-State; Pilot Projects; Treatment Outcome

Acne scars are common in patients with moderate to severe acne. Isotretinoin is the first-line treatment for those patients, but whether oral isotretinoin can improve acne scar is not clear. Picosecond lasers (FxPico) has been reported to improve acne scars. In the present study, we evaluated the clinical efficacy of low-dose isotretinoin with or without FxPico treatment for acne scars.. A total of 48 patients with acne scars were enrolled and were randomly assigned to receive low dose oral isotretinoin or not. For all the patients in both treatment groups, one side of face were randomly assigned to be treated with picosecond laser. Assessments, including photos, échelle d'évaluation clinique des cicatrices d'acné (ECCA) and Global Acne Grading System (GAGS) score, the number of lesions, melanin and erythema indexes, transepidermal water loss were assessed at 0, 1, 2, and 3 month. Side effects, Dermatology Life Quality Index (DLQI) and satisfaction were recorded before and after the study.. A total of 44 patients completed the study (24 received oral low dose isotretinoin and 20 did not). Low dose oral isotretinoin treated group showed significant improvement on ECCA (from 112.5 [50-180] to 105 [50-160]), GAGS score (from 12.6 ± 3.3 to 10.1 ± 3.0), the count of papules (from 4.3 ± 3.7 to 1.0 ± 1.5) than the blank group, and higher improvement were noticed after isotretinoin combined with FxPico. All the side effects were temporary and tolerable, no adverse effects were observed. Higher DLQI and patients' satisfaction were achieved by oral isotretinoin alone and isotretinoin combined with FxPico.. This is the first paper showing the improvement of scars by early low dose-isotretinoin intervention with or without the combination of picosecond laser. Early intervention with oral low-dose isotretinoin is effective for the treatment and prevention of acne scars, the combined therapy with FxPico can achieve better outcome.

Topics: Acne Vulgaris; Cicatrix; Humans; Isotretinoin; Lasers; Treatment Outcome

Laser procedures for acne and acne scars have traditionally been postponed for at least 6 to 8 months after the end of systemic isotretinoin therapy. Lower dosages with more modern laser devices having unique energy parameters of high power in microsecond pulse durations have made it possible to administer laser therapy during or shortly after completion of isotretinoin therapy, thus reducing the risk of side effects of isotretinoin.. Patients with moderate to severe facial acne (n=46) and atrophic scars enrolled in a 6-month study. Genetic analysis of patients revealed the presence of polymorphisms of genes Col1A2, MMP3, ESR1, MMP1, and MMP7, which can lead to scar formation. Patients underwent low-dosage isotretinoin therapy (0.2-0.3 mg/kg/day) in combination with facial laser treatment using a 650-microsecond, 1064-nm Nd: YAG laser. Acne severity was graded using the Investigators Global Assessment (IGA) scale and quality of life was evaluated by the Dermatology Life Quality Index (DLQI).. IGA parameters decreased from 1.8 ± 0.2 (mean ± SD) initially to 0.5 ± 0.4 at the end of the study, a 72.3% reduction which was significant (P<0.01). The DLQI index decreased from 10.1 ± 1.3 initially to 2.8 ± 1.2, a 72.3%, a significant reduction (P<0.01). Inflammatory elements resolved without scarring. Laser treatment was well tolerated and improvement in pre-existing scars was noticeable.. The 650-microsecond, 1064-nm laser in combination with low-dose isotretinoin is safe and effective in patients with acne complicated by atrophic scars and genetically prone to post-acne scarring. J Drugs Dermatol. 2020;19(6):   doi:10.36849/JDD.2020.5108.

Topics: Acne Vulgaris; Adolescent; Adult; Cicatrix; Combined Modality Therapy; Dermatologic Agents; Female; Humans; Isotretinoin; Laser Therapy; Male; Severity of Illness Index; Treatment Outcome; Young Adult

Tranilast [N-(3,4-dimethoxycinnamoyl) anthranilic acid] has never been investigated for the prevention and treatment of acne scars.. To evaluate the efficacy and safety of tranilast 8% gel in improving the final appearance of patients with acne scarring concomitantly treated by isotretinoin.. This was a prospective, double-blind, split-face study, which enrolled 40 otherwise healthy participants (aged 18-49 years) with facial acne scars. For each patient, one half of the face were treated with tranilast 8% liposomal gel and the other half with a water-based placebo. Using the Global Aesthetic Improvement Scale (GAIS), acne scars were evaluated by two dermatologists and by the patients, and the patients also rated their satisfaction with the treatment and reported adverse effects.. In total, 32 participants completed the trial. The mean GAIS scores at 5 months post-treatment were significantly lower (better outcome) for the tranilast-treated side than the placebo-treated areas in patients concomitantly treated with isotretinoin (P < 0.001). All the isotretinoin-treated patients reported greater satisfaction and better general improvement in the skin's appearance and texture, and also greater improvement of pigment and redness on the tranilast 8% gel-treated side compared with the control side.. Combined topical application of tranilast 8% gel twice daily with oral isotretinoin treatment in the active phase of acne vulgaris may result in fewer scars, finer skin texture and enhanced appearance.

Topics: Acne Vulgaris; Administration, Cutaneous; Administration, Oral; Adolescent; Adult; Cicatrix; Dermatologic Agents; Double-Blind Method; Drug Therapy, Combination; Female; Gels; Humans; Isotretinoin; Male; Middle Aged; ortho-Aminobenzoates; Patient Satisfaction; Prospective Studies; Young Adult

Based on reports of poor wound healing and scarring, it is currently recommended that patients wait 6 months after completion of oral isotretinoin therapy before the safe initiation of laser treatment. Our aim was to evaluate the safety of non-ablative fractional laser (NAFL) treatment for acne scars within 1 month after isotretinoin therapy.. This was a randomized split-face controlled trial involving 10 patients with acne scars who had completed isotretinoin treatment. All patients received three treatments each spaced 4 weeks apart with an erbium-doped 1550 nm NAFL on one side of the face within 1 month after isotretinoin therapy. The untreated side acted as a control. Wound healing and adverse effects as well as acne scar improvement were evaluated by two blinded dermatologists.. All patients demonstrated normal wound healing post NAFL treatments, and neither hypertrophic scars nor keloids were observed. Acne scar improvement was satisfactory.. NAFL treatment for acne scarring appears to be well tolerated within 1 month of completing isotretinoin treatment. Dermatologists should reevaluate the current recommendation to wait 6 months after isotretinoin treatment for acne scar revision with lasers. Other larger studies are necessary to further challenge this dogma. Lasers Surg. Med. 49:886-890, 2017. © 2017 Wiley Periodicals, Inc.

Topics: Acne Vulgaris; Administration, Oral; Adolescent; Adult; Cicatrix; Dermatologic Agents; Female; Follow-Up Studies; Humans; Isotretinoin; Lasers, Solid-State; Single-Blind Method; Time Factors; Treatment Outcome; Young Adult

Acne is an inflammatory disease of the pilosebaceous follicles. Oral isotretinoin is the treatment of choice for severe acne. Exaggerated cicatrization related to oral isotretinoin was reported in the 1980s and 1990s. Currently, dermabrasion for acne scar revision is only recommended 6 to 12 months after the completion of oral isotretinoin treatment.. To evaluate the evolution of healing from manual chemabrasion of depressed scars resulting from acne conducted within 1 to 3 months after oral isotretinoin treatment.. This was an interventional, prospective study involving 10 patients with depressed facial scars. A medium-depth chemical peel was applied to the entire face. Manual sandpaper dermabrasion was performed to areas of scarring until the appearance of bloody dew. A 6-month reepithelization follow-up was conducted.. All of the patients presented with normal cicatrization, and neither hypertrophic scars nor keloids were observed. Depressed acne scar revision was satisfactory.. Our observations may contribute to the discussion of the negative influence of oral isotretinoin on wound healing. Other studies are necessary to reevaluate the current recommendation of a 6- to 12-month waiting period after oral isotretinoin treatment before performing dermabrasion or fractional ablative laser for acne scar revision.

Topics: Acne Vulgaris; Adolescent; Adult; Caustics; Chemexfoliation; Cicatrix; Dermabrasion; Dermatologic Agents; Female; Humans; Isotretinoin; Male; Time Factors; Treatment Outcome; Trichloroacetic Acid; Wound Healing; Young Adult

Acne vulgaris is a common inflammatory dermatosis capable of producing significant psychological and physical scarring. The following work describes the benefit of using a questionnaire as a clinical tool to identify acne patients who have developed psychological sequelae as a result of the disease process. In addition, the benefit of isotretinoin on psychological impact has also been highlighted by this work. A prospective clinical study examines the early use of isotretinoin in acne and demonstrates the beneficial effect of early therapy in minimising acne scarring. In summary, oral isotretinoin (Roaccutane/Accutane) provides a very effective therapy to prevent acne patients being 'scarred for life'!

Topics: Acne Vulgaris; Adaptation, Psychological; Administration, Oral; Adolescent; Adult; Cicatrix; Female; Follow-Up Studies; Humans; Isotretinoin; Keratolytic Agents; Male; Patient Satisfaction; Prospective Studies; Quality of Life; Severity of Illness Index; Surveys and Questionnaires

There is at present little published information on the current indications for isotretinoin as a treatment of acne vulgaris.. To investigate the factors which influence our current prescribing of isotretinoin: acne severity, response to previous therapy, scarring and psychological effect.. Data on the factors influencing treatment of 200 patients with isotretinoin between January 1993 and May 1994 were examined.. 41% of patients were prescribed isotretinoin for partial response to previous therapy, 26% for partial therapy and scarring and 17% for partial response to treatment and psychological disturbance. Only 16 patients received isotretinoin for severe acne.. Patients who show only partial response to conventional antibiotic therapy should be prescribed isotretinoin in order to minimize scarring and significant psychological disturbance, independently of the severity of the acne.

Topics: Acne Vulgaris; Adolescent; Adult; Anti-Bacterial Agents; Chi-Square Distribution; Cicatrix; Female; Humans; Isotretinoin; Male; Remission Induction; Severity of Illness Index

Acne vulgaris is a common chronic inflammatory disorder of the pilosebaceous unit. Survivin is an apoptosis inhibitor protein, and it contributes crucially to cell cycle regulation. This study measures the serum level of survivin in acne and post-acne scarring patients, and assesses the possible effect of isotretinoin therapy on its level.. Sixty participants, including 40 acne patients (Group IA, IB), and 20 age- and sex-matched controls (Group II) were included. Group IA included 20 patients with active moderate-to-severe acne without scarring, and this group was further prescribed oral isotretinoin therapy for 3 months. Group IB included 20 patients with post-acne scarring of a duration not more than 6 months, without evident active acne lesions. Serum survivin levels were measured in the three groups using an enzyme-linked immunosorbent assay.. There was a statistically significant higher serum survivin level in the acne scar group, followed by the active acne group, than in controls. In addition, there was a statistically significant reduction in survivin levels after treatment, and it was positively correlated with a reduction in the global acne grading system (GAGS) in the active acne group.. Survivin may play a role in the evolution of acne and acne scarring, and it could be a possible target for isotretinoin therapy.

Topics: Acne Vulgaris; Cicatrix; Dermatologic Agents; Humans; Isotretinoin; Skin; Survivin; Treatment Outcome

For over two decades, the acronym PAPA syndrome has been used to describe an autoinflammatory condition caused by missense mutations in the PSTPIP1 (proline-serine-threonine phosphatase interacting protein 1) gene and clinically characterized by the presence of pyogenic arthritis, pyoderma gangrenosum (PG), and acne (1,2). Due to the involvement of the PSTPIP1 gene in the regulation of innate immunity, mutations of this gene cause abnormal activation of inflammasomes, complexes of NLRP3/ASC/caspase-1 proteins. As a result, production of interleukin-1β, a key molecule that triggers synthesis of cytokines necessary for the recruitment of neutrophils, is significantly increased (2,3). Additionally, the levels of other pro-inflammatory cytokines, such as tumor necrosis factor-α (TNF-α), interferon-γ (INF-γ) and interleukin 17 (IL-7) are also elevated, which further disrupts inflammatory mechanisms in the microenvironment (4). Since hyperproduction of IL-1 and other involved cytokines is the predominant event in the pathogenesis, these molecules are promising targets in the treatment of PAPA syndrome. Corticosteroids and biologics are currently the most commonly used agents for inducing and hastening remission of symptoms (5). A substantial step forward in the treatment of PAPA syndrome has been the introduction of medications blocking the cytokines crucial in the pathogenesis of this disorder, with TNF-α and IL-1 inhibitors being the most frequent choice of such biological therapy (6). We report the case of a 22-year-old male patient with PAPA syndrome who was referred to our department 18 months ago due to exacerbation of skin changes. Initial presentation and subsequent evolution of disease in this patient matched the typical clinical pattern of PAPA syndrome. The first symptoms occurred at the age of two in the form of unspecific joint disease that was diagnosed as juvenile idiopathic arthritis. Subsequently, in the early adolescence the patient presented with new skin changes manifesting as severe acne and persistent pyoderma gangrenosum-like ulcers. At the same time, severity of joint involvement gradually decreased. After the characteristic phenotype of the disease had fully developed, suspicion of possible syndromic origin of symptoms arose. For this reason, genetic analysis was performed as requested by attending pediatricians at the University Clinical Center in Sarajevo, and E250Q mutation of the PSTPIP1 gene was detected. Thus, the diagnosis of PAP

Topics: Acne Vulgaris; Adalimumab; Adolescent; Adrenal Cortex Hormones; Adult; Biological Products; Cicatrix; Cytokines; Etanercept; Humans; Immunologic Factors; Infliximab; Interleukin 1 Receptor Antagonist Protein; Isotretinoin; Male; Prednisone; Pyoderma Gangrenosum; Quality of Life; Retrospective Studies; Tumor Necrosis Factor-alpha; Ulcer; Young Adult

Topics: Acne Vulgaris; Administration, Oral; Cicatrix; Cosmeceuticals; Dermatologic Agents; Humans; Isotretinoin; Lasers; Treatment Outcome

Acne vulgaris varies in clinical severity, from minimal comedonal disease to severe hemorrhagic and ulcerative lesions with scarring. While a family history confers a higher risk for developing acne, the correlation between heritability and clinical severity remains unclear.. To examine the natural history and heritability of severe acne with scarring in patients undergoing isotretinoin therapy.. A total of 101 subjects with severe acne with scarring and its variants, including acne conglobata and acne fulminans, were enrolled. All subjects and adult family members underwent an interview regarding their acne, and a corresponding "historical" Investigator's Global Assessment (hIGA) score (0 = clear, 1 = almost clear, 2 = mild, 3 = moderate, 4 = severe, 5 = very severe) was assigned. Study assessors performed an "examination" Investigator's Global Assessment (eIGA) based on the clinical examination of each subject (0 = clear, 1 = almost clear, 2 = mild, 3 = moderate, 4 = severe, 5 = very severe). A detailed family history and pedigree were documented.. Most subjects were Caucasian (44.5%) and male (79.2%) who had previously used doxycycline and/or minocycline (86.1%). The mean eIGA and hIGA scores were 2.7 and 4.4, respectively. 37.2% of subjects had one first-degree relative with a history of moderate or severe acne with scarring; of note, of the patients with hemorrhagic disease, 30% had at least one parent with moderate or severe acne.. Severe forms of acne often "cluster" in families, underscoring the heritable nature of acne and the prognostic value of a family history of moderate or severe disease.

Topics: Acne Vulgaris; Adult; Cicatrix; Doxycycline; Female; Humans; Isotretinoin; Male; Minocycline; Treatment Outcome

Cohort studies on the use of retinoids for hidradenitis suppurativa (HS) have yielded contradicting results. As the clinical presentation of HS is heterogeneous, with different predilection sites and hallmark features, it can be hypothesized that HS phenotypes are associated with the effectiveness of specific retinoid treatments.. The aim of this study was to evaluate the drug survival of oral retinoids in the treatment of HS and to establish predictors for longer treatment duration.. A retrospective, dual-center study was conducted in the Netherlands in adult HS patients treated with oral retinoids between 2011 and 2021. Drug survival analyses were performed through Kaplan-Meier survival curves. Additionally, Cox regression models were used to determine predictors for a longer drug survival.. In total, 102 patients were included. Overall drug survival of (low-dose) isotretinoin (n = 66) at 12 and 24 months was 44.2% and 15.5%, respectively. Termination of treatment was mostly due to ineffectiveness (26%). Presence of widespread comedones (p = 0.03) and the use of concomitant systemic medication (p = 0.04) were associated with a prolonged treatment duration. For acitretin (n = 36), the overall drug survival was 42.0% at 12 months and 37.4% at 24 months, and was also predominantly determined by ineffectiveness (28%). Interestingly, the scarring folliculitis phenotype (p < 0.05) was associated with prolonged drug survival time for acitretin treatment relative to the regular phenotype.. Comparable drug survival rates at 12 months for isotretinoin and acitretin were found. HS patients with widespread comedones and the scarring folliculitis phenotype could benefit from treatment with isotretinoin or acitretin, respectively.

Topics: Acitretin; Acne Vulgaris; Cicatrix; Cohort Studies; Folliculitis; Hidradenitis Suppurativa; Humans; Isotretinoin; Retinoids; Retrospective Studies

We aimed to evaluate the efficacy and safety of the 1,565 nm non-ablative fractional laser (NAFL) in combination with isotretinoin and pricking blood therapy (PBT) for treatment of AV.. A retrospective analysis of 60 patients with moderate-to-severe AV was performed. Four groups (. The triple therapy showed the highest improvement rate of inflammatory papules and boxcar atrophic scars. The patients receiving oral isotretinoin alone, double or triple therapy showed a significant decrease in volume of boxcar atrophic scars. The NAFL alone, double or triple therapy significantly decreased index of hemoglobin. Furthermore, the triple therapy significantly decreased indexes of hemoglobin and red areas as compared to the other three treatments. All four treatments significantly decreased indexes of pore sizes and wrinkles.. This study showed that the triple therapy is effective for treatment of AV, which is worthy of further evaluation and investigation.

Topics: Acne Vulgaris; Cicatrix; Humans; Isotretinoin; Laser Therapy; Lasers, Solid-State; Retrospective Studies; Treatment Outcome

Fractional microneedle radiofrequency (FMRF) systems are popular options for treating acne scars. However, treatment efficacy when used in combination with traditional ablative fractional laser (AFL) and the safety profile with concomitant use of isotretinoin remain unknown.. The aim of this study was to assess the safety and efficacy of an early intervention combination treatment protocol for inflammatory acne and acne scars.. The electronic records of 71 patients with inflammatory acne and acne scars were included in this retrospective observational study. Data were collected for all patients who received combination FMRF and AFL. Within the study group, 43 patients were receiving low-dose isotretinoin or had completed isotretinoin within the past 3 weeks.. The mean Scar Global Assessment score significantly decreased after 3 sessions of combination treatment (n = 71). Patients with inflammatory acne showed a significant decrease in the number of inflammatory lesions (n = 30). Patients with concomitant low-dose isotretinoin use reported a further decrease in Scar Global Assessment score (n = 43). There were no reported persistent side effects, including prolonged inflammatory reaction or scarring.. Combination treatment with FMRF and AFL is an effective and well-tolerated treatment modality for acne scars and inflammatory acne.

Topics: Acne Vulgaris; Administration, Oral; Adult; Cicatrix; Combined Modality Therapy; Dose-Response Relationship, Drug; Dry Needling; Female; Follow-Up Studies; Humans; Isotretinoin; Laser Therapy; Lasers, Gas; Male; Needles; Radio Waves; Radiofrequency Therapy; Retrospective Studies; Severity of Illness Index; Treatment Outcome; Young Adult

Acne is a chronic inflammatory relapsing disease that affect predominantly adolescents, with scarring as a frequent sequele. Early and appropriate therapy allows better management of the disease, longer remission, scars risk reduction, and improvement of quality of life. According to therapeutic algorithm, systemic isotretinoin can be used in severe acne and also in moderate forms resistant to other systemic treatments. The aims of this real-life observational study were to determine and compare the effectiveness of isotretinoin evaluated by Global Acne Grading System and Acne Quality of Life in moderate and in severe acne, correlation between efficacy and cumulative dose of isotretinoin, tolerability, and recurrence rate. Moreover, the differences in efficacy and tolerability between male and female patients were compared. The treatment with systemic isotretinoin led to an improvement in acne severity and quality of life in all observed subjects.

Topics: Acne Vulgaris; Administration, Oral; Adolescent; Cicatrix; Dermatologic Agents; Female; Humans; Isotretinoin; Male; Quality of Life; Treatment Outcome

Persistent adult acne is one of the most difficult types of acne to treat. It is a long-lasting disease with uncontrolled exacerbations that often result in scarring. The aim of this study was to analyze the influence of acne therapy used in adolescence on patients who later developed persistent adult acne. The use of oral antibiotics, isotretinoin, and topical retinoids in adolescence and their role in diminishing scar formation during adult acne was analyzed. This population-based study included 111 patients, 91 of whom had persistent adult acne. Results indicated that the use of isotretinoin or topical retinoids for adolescent acne decreased the risk for scar occurrence in adulthood.

Topics: Acne Vulgaris; Administration, Cutaneous; Administration, Oral; Adolescent; Adult; Anti-Bacterial Agents; Cicatrix; Dermatologic Agents; Female; Humans; Isotretinoin; Male; Retinoids

Truncal acne – acne vulgaris involving the chest, back, or shoulders – is thought to be present in more than half of patients with acne. Because the study of acne has been focused on the face, there are sparse data in the literature about the clinical characteristics and management options for truncal acne. It is thought that the pathogenic process is similar between the face and the back, suggesting that treatments studied on the face may be suitable for use on the back. It is not uncommon for patients to omit discussion of truncal acne with their treating physician, and it is likely that non-facial acne is under-diagnosed and under-treated. Scarring and pigmentary problems are common sequelae of acne on the trunk, underscoring the need for early and effective treatment as a preventive measure.\ \ Truncal acne merits consideration and should be more thoroughly studied. Initiating treatment with a topical retinoid combined with an antimicrobial agent is logical for most patients with truncal acne, and mirrors recommendations for facial acne; however, there are additional considerations for truncal acne such as extension of the lesions, risk of antibiotic resistance due to large surface areas treated for a prolonged duration, accessibility of lesions, and discoloration of clothing or bedding due to topical products. Oral isotretinoin is the treatment of choice when truncal acne is severe. This article reviews available information as well as recent recommendations for treatment.\ \ J Drugs Dermatol. 2019;18(12):1205-1208.

Topics: Acne Vulgaris; Administration, Cutaneous; Anti-Infective Agents; Cicatrix; Dermatologic Agents; Drug Therapy, Combination; Humans; Isotretinoin; Torso

Topics: Acne Vulgaris; Administration, Cutaneous; Adolescent; Chickenpox; Cicatrix; Dermatologic Agents; Female; Humans; Isotretinoin; Male; Skin; Skin Pigmentation; Treatment Outcome; Young Adult

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

Currently, the isotretinoin (13-cis-retinoic acid) package insert contains language advising the discontinuation of isotretinoin for 6 months before performing cosmetic procedures, including waxing, dermabrasion, chemical peels, laser procedures, or incisional and excisional cold-steel surgery. It is common practice to follow this standard because of concerns regarding reports of sporadic adverse events and increased risk of scarring.. To develop expert consensus regarding the safety of skin procedures, including resurfacing, energy device treatments, and incisional and excisional procedures, in the setting of concurrent or recent isotretinoin use.. The American Society for Dermatologic Surgery authorized a task force of content experts to review the evidence and provide guidance. First, data were extracted from the literature. This was followed by a clinical question review, a consensus Delphi process, and validation of the results by peer review.. The task force concluded that there is insufficient evidence to justify delaying treatment with superficial chemical peels and nonablative lasers, including hair removal lasers and lights, vascular lasers, and nonablative fractional devices for patients currently or recently exposed to isotretinoin. Superficial and focal dermabrasion may also be safe when performed by a well-trained clinician.

Topics: Chemexfoliation; Cicatrix; Dermabrasion; Dermatologic Agents; Dermatologic Surgical Procedures; Humans; Isotretinoin; Laser Therapy; Patient Safety; Skin Diseases

Topics: Cicatrix; Dermatologic Agents; Dermatologic Surgical Procedures; Humans; Isotretinoin; Perioperative Period; Postoperative Complications; Postoperative Hemorrhage; Retrospective Studies; Surgical Wound Dehiscence; Surgical Wound Infection; Time Factors; Wound Healing

Topics: Acne Vulgaris; Cicatrix; Dermatologic Agents; Humans; Isotretinoin; Lasers, Semiconductor; Lasers, Solid-State; Male; Skin; Young Adult

It is reported that patients on oral isotretinoin have greater risk of developing scars and delayed wound healing with invasive procedures. It is recommended that these procedures be resumed 6-12 months after the last dose of oral isotretinoin.. To assess and compare the safety and look for delayed wound healing, during invasive acne scar treatment and laser hair removal on (a) patients who were on oral isotretinoin, and (b) patients who were not on oral isotretinoin.. A comparative, retrospective study of 110 patients was done. Fifty-five patients with either acne scars or hirsutism who underwent procedures while on oral isotretinoin, and 55 patients who were not on oral isotretinoin were selected and grouped into A and B respectively. Group A patients were on 0.5 mg/kg/day isotretinoin orally through the entire procedure duration, while group B patients received topical medications alone. The subjects from both groups underwent invasive acne scar treatment and laser hair removal. Clinical and photographic assessment was done at baseline followed by four sessions with an interval of six weeks between each.. Isotretinoin had not resulted in any untoward effects in patients who underwent the procedures. Atypical scarring, delayed wound healing, keloids, or hypertrophic scars were not observed in any patient.. Isotretinoin does not appear to delay wound healing, and hence invasive procedures can be considered on patients on oral isotretinoin without any compromise on the outcome.

Topics: Acne Vulgaris; Administration, Oral; Adolescent; Adult; Cicatrix; Dermatologic Agents; Female; Hair Removal; Humans; Isotretinoin; Lasers; Male; Middle Aged; Retrospective Studies; Young Adult

Because acne scarring is associated with substantially reduced quality of life, early initiation of effective treatment is desirable. In previous reports, isotretinoin treatment was associated with increased scarring after cosmetic procedures, such as laser treatment, dermabrasion, and chemical peeling.. To evaluate wound healing after ablative carbon dioxide (CO2) fractional resurfacing for acne scarring conducted during and/or within 1 to 3 months of oral isotretinoin treatment.. The records of 20 patients with facial acne scars were included in this retrospective study. All patients were receiving isotretinoin treatment or had completed it within the previous 1 to 3 months. All patients received full-face fractional ablative CO2 laser treatment. Follow-up was for at least 6 months to evaluate side effects.. All patients showed normal reepithelialization and were satisfied with the results of the laser treatments. All adverse events were minor, and there were no hypertrophic scars or keloids.. Ablative CO2 fractional laser treatment for acne scarring seems to be safe regardless of isotretinoin use (10-60 mg/d). The authors' findings contribute to the discussion of whether oral isotretinoin treatment impairs wound healing after ablative laser treatment.

Topics: Acne Vulgaris; Administration, Oral; Adolescent; Adult; Carbon Dioxide; Cicatrix; Dermatologic Agents; Female; Humans; Isotretinoin; Lasers, Gas; Low-Level Light Therapy; Male; Republic of Korea; Retrospective Studies; Treatment Outcome

The application of systemic isotretinoin in the treatment of cutaneous photoaging has been well investigated. In addition, well-recognized topical antiaging therapies such as superficial chemical peeling (CP) with α-hydroxy acids have been shown to be more helpful when combined with low-dose oral isotretinoin. Even though the combination of systemic isotretinoin and medium to deep CP has been associated with serious side effects such as delayed wound healing and enlarged incidence of scarring, to date superficial CP and concomitant systemic isotretinoin have been considered safe.. In this report, we present the case of a patient receiving low-dose oral isotretinoin therapy who developed severe painful erythema and erosions that led to permanent hyperpigmentation and scarring of her face and neck after undergoing superficial CP with glycolic acid.. There is a potential risk of hyperpigmentation and scarring with the use of a combination of low-dose oral isotretinoin and glycolic acid peeling.

Topics: Administration, Oral; Adult; Cicatrix; Drug Therapy, Combination; Female; Glycolates; Humans; Hyperpigmentation; Isotretinoin

Acne scarring has lifelong sequelae. Fractional photothermolysis (FP) has been shown to provide fast recovery from acne within a short period, thereby aiding skin rejuvenation. Isotretinoin is a well-known, effective drug for the treatment of severe recalcitrant acne. This study investigated the safety and the efficacy of infrared fractional laser treatment in conjunction with low-dose isotretinoin for the treatment of acne and acne scars.. A 1550 nm Erbium-doped fiber laser was used to treat 35 patients with acne scarring. All the patients had taken isotretinoin (10 mg/day) for more than one month prior to the commencement of the fractional laser treatment.. There was no aggravation of acne scars, hypertrophic scars, or keloids. Most of the patients (33 patients) received reduced microthermal damage zone (MTZ) treatment. Eighty percent of the treated patients (28 patients) demonstrated more than a fair improvement. The total average score on the global acne scarring classification before treatment was 13.5, and the score after treatment was 11.2.. Acne and acne scars can be treated more effectively by concomitant use of an infrared fractional laser with low-dose isotretinoin with reduced MTZ densities. Most patients showed more than a fair improvement, and there was no aggravation of the scars.

Topics: Acne Vulgaris; Adolescent; Adult; Cicatrix; Combined Modality Therapy; Dermatologic Agents; Female; Humans; Isotretinoin; Lasers, Solid-State; Low-Level Light Therapy; Male; Middle Aged; Treatment Outcome; Young Adult

Pyoderma gangrenosum (PG) is an unusual skin condition causing inflammation and sterile ulceration. It may occur in the context of a systemic disease or in otherwise healthy patients following trauma. Treatment is immunosuppression. Surgical debridement may worsen the disease. Post-surgical PG of the breast is rare and in previous reports has occurred within days or weeks of surgery. We report a highly unusual case of PG occurring at an incision site seven years after reduction mammoplasty.

Topics: Adult; Cicatrix; Dermatologic Agents; Drug Therapy, Combination; Female; Glucocorticoids; Humans; Isotretinoin; Mammaplasty; Prednisolone; Pyoderma Gangrenosum; Surgical Wound Infection; Time Factors

Topics: Acne Vulgaris; Adult; Ceremonial Behavior; Cicatrix; Dermatologic Agents; Humans; Indians, North American; Isotretinoin; Male; Young Adult

Hidradenitis suppurativa (HS) may be associated with face and back lesions which are considered as acne.. To describe the skin lesions of a group of patients with HS.. Twelve patients were selected from a series of 648 patients on the basis of their specific skin lesions.. The patients (mostly male) had typical hidradenitis. On their face or back they had one or several of the following skin lesions which are not seen in acne: hypertrophic rope-like bridged scars, raised plaques with multiple carbuncle-like openings or with ulcerations, 'worm-eaten scars' and coalescent nodules with round ulcerations. All patients had deep round scars. Several had a pilonidal cyst or large epidermal cysts. Isotretinoin had been used by 7 patients with no effect.. Some HS patients have specific lesions of the face and back which are not acne and have to be treated differently.

Topics: Acne Vulgaris; Adult; Back; Cicatrix; Clindamycin; Dermatologic Agents; Epidermal Cyst; Face; Female; Hidradenitis Suppurativa; Humans; Isotretinoin; Male; Middle Aged; Pilonidal Sinus; Rifampin; Skin Ulcer; Treatment Outcome; Young Adult

Topics: Acne Vulgaris; Cicatrix; Dermatologic Agents; Health Knowledge, Attitudes, Practice; Humans; Isotretinoin

Severe scarring acne is frequently treated with isotretinoin. Patients treated with this drug may expect some of the more common complications including mucositis. Less common complications may also occur in a small number of patients. While undergoing treatment, patients may become colonized with Staphylococcus bacteria. However, the incidence of perioral abscess formation in patients taking isotretinoin is not commonly reported and the onset of this adverse event may masquerade as angioedema or severe mucositis.This article presents a case of a significant perioral abscess and discuss the need for prompt recognition as well as treatment of the infection.The case reported is unique due to the extent and severity of the abscess.

Topics: Abscess; Acne Vulgaris; Adolescent; Anti-Bacterial Agents; Cicatrix; Dermatologic Agents; Humans; Isotretinoin; Lip Diseases; Male; Methicillin-Resistant Staphylococcus aureus; Severity of Illness Index; Staphylococcal Infections

Dissecting cellulitis of the scalp (DCS) is a suppurative, neutrophillic dermatosis. Therapies typically provide short-term improvement and include antibiotics, prednisone, and isotretinoin, as well as radiation, surgical excision, and laser ablation. The authors report the use of the tumor necrosis factor (TNF) blocker, adalimumab, to successfully treat a 39-year-old male with a long-standing history of DCS.

Topics: Adalimumab; Anti-Inflammatory Agents; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Cellulitis; Cicatrix; Humans; Isotretinoin; Keratolytic Agents; Male; Middle Aged; Scalp; Skin; Tumor Necrosis Factor-alpha

It is generally believed that any intervention in skin while on isotretinoin or within 6 months after the treatment can lead to prolonged healing and scarring.. The objective was to evaluate the side effects of laser hair removal in patients undergoing isotretinoin treatment.. Seven female patients undergoing isotretinoin therapy for acne were treated with a diode laser with a wavelength of 810 nm, a contact-cooling device, and a variable pulse width of 50 to 1000 ms. All volunteers received first treatment in the axillary or bikini area at 21 J/cm(2) (80 W) and the second treatment was done in the same area at 24 J/cm(2) (90 W). Six volunteers received additional treatments of chin area with a fluence of 21 or 24 J/cm(2). All volunteers were evaluated and photographed 1 week and 1 month after each treatment and degree of erythema, pigmentary change, vesiculation, swelling, and scarring was documented.. There was no erythema, pigmentary change, swelling, or scarring at any follow up visits. One volunteer presented with a bulla 1 week after second treatment, which was resolved at 1-month follow-up. All volunteers were satisfied with the degree of hair removal with two treatments.. This limited study suggests that diode laser hair removal is safe in patients undergoing isotretinoin therapy.

Topics: Adolescent; Adult; Cicatrix; Female; Hair Removal; Humans; Isotretinoin; Lasers; Middle Aged

Topics: Acne Vulgaris; Cicatrix; Cosmetics; Humans; Isotretinoin; Rosacea

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

Topics: Cicatrix; Dermabrasion; Fluorocarbons; Humans; Hypertrophy; Hypothermia, Induced; Isotretinoin

The treatment of acne vulgaris depends on its causes. The focal point of its etiopathogenesis is the raised sebum production, but a major part is also played by the proliferative and retentive hyperkeratosis in the infra-infundibulum and the proliferation of acne bacteria. Since the clinical syndrome of acne consists of many factors, combined treatment is always required. Besides from treating the seborrhoea, the hyperkeratosis and the inflammatory alterations, it is very important to provide psychological guidance for the patient. We discuss the individual active substances and explain their application and side effects. Thanks to the new powerful active substances which have been available in the last few years to the therapist, he is in a position of successfully treating over 90% of patients suffering from acne thanks to individually adapted and differentiated treatment; but this also forces him to assimilate his knowledge continuously to the newest standard.

Topics: Acne Vulgaris; Cicatrix; Combined Modality Therapy; Cyproterone; Humans; Hygiene; Isotretinoin; Nutritional Physiological Phenomena

Topics: Acne Vulgaris; Cicatrix; Combined Modality Therapy; Female; Humans; Isotretinoin; Male

Topics: Acne Vulgaris; Administration, Topical; Adrenal Cortex Hormones; Benzoyl Peroxide; Cicatrix; Contraceptives, Oral, Hormonal; Humans; Isotretinoin; Minocycline; Propionibacterium acnes; Tetracycline; Tretinoin

Topics: Acne Vulgaris; Anti-Bacterial Agents; Benzoyl Peroxide; Cicatrix; Female; Hormones; Humans; Isotretinoin; Tretinoin