isotretinoin and Dermatitis

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

Eighteen patients developed Staphylococcus aureus infection during or shortly after a five-month course of therapy with isotretinoin. Staphylococcus aureus was recovered both from lesions and from the anterior nares. In a prospective study, 4% of control patients treated with isotretinoin alone developed S aureus infection, while none who applied topical antibiotic to the anterior nares developed infection. Control patients had a 64% prevalence of anterior nares colonization with S aureus, compared with 18% in the topical antibiotic group.

Topics: Administration, Topical; Anti-Bacterial Agents; Dermatitis; Humans; Isotretinoin; Ointments; Staphylococcal Infections; Staphylococcus aureus; Tretinoin

Seborrheic dermatitis is a common, chronic, and recurrent inflammatory skin disease. There are few studies on oral isotretinoin in the treatment of seborrheic dermatitis. The aim of this research was to analyze the efficacy and safety of oral isotretinoin in the treatment of patients with moderate to severe seborrheic dermatitis.. This was a retrospective study. All included patients were diagnosed as moderate to severe seborrheic dermatitis and treated with oral isotretinoin from January 2019 to December 2020. Symptom Scale of Seborrheic Dermatitis (SSSD) was used to evaluate the overall severity status of disease.. A total of 48 patients with moderate to severe seborrheic dermatitis were enrolled, of which 26 patients were treated with oral isotretinoin at a dose of 20 mg/day, and 22 patients were treated with oral isotretinoin at a dose of 10 mg/day. The duration of treatment was 2.42 ± 0.98 months (range: 2-6 months). The absolute SSSD values were 10.63 ± 1.02 for all 48 patients, 10.95 ± 1.15 and 10.30 ± 1.11 for patients with a dose of 20 and 10 mg/day, respectively. At the endpoint, there were no significant difference in SSSD values between the two groups (2.21 ± 0.24 vs. 2.35 ± 0.46, P = 0.18). The patients were satisfied with the two treatment schemes, and the difference was not statistically significant (P = 0.78). The most common side effect was cheilitis; however, no serious adverse events occurred in either group.. When considering efficacy and safety, oral isotretinoin can be used to treat patients with moderate to severe seborrheic dermatitis.

Topics: Cheilitis; Dermatitis; Dermatitis, Seborrheic; Humans; Isotretinoin; Retrospective Studies

Rosacea fulminans is a rare and severe inflammatory dermatosis which affects predominantly childbearing women. It is characterized by sudden onset and it usually localizes exclusively on the centrofacial areas, presenting with numerous fluctuant inflammatory nodules and papules which may coalesce. Treatment with isotretinoin in combination with topical and systemic corticosteroids is successful. Clearance of lesions may be obtained under systemic treatment with no or minimal scarring outcomes. Due to rare incidence its pathophysiological mechanisms, diagnosis and management remain controversial. We report two cases of rosacea fulminans arisen in otherwise healthy people and completely healed after treatment. Our aim is to share our experience about this disease in order to increase knowledge about its diagnosis, management and its treatment. We also make a review of the literature of this peculiar dermatosis.

Topics: Administration, Oral; Adolescent; Adult; Dermatitis; Dermatologic Agents; Drug Therapy, Combination; Female; Glucocorticoids; Humans; Isotretinoin; Male; Remission Induction; Rosacea

An update is presented of bone changes taking place in association with oral treatment with the two most relevant synthetic retinoids, 13-cis-retinoic acid (isotretinoin; Roaccutan, Accutane) and etretinate (aromatic retinoid; Tigason, Tegison). All of the important clinical studies are reviewed, including our own results concerning etretinate-associated bone changes. While there are no more doubts about the potential bone toxicity of 13-cis-retinoic acid, the possibility of etretinate-induced bone changes probably occurring within a longer latency period cannot be conclusively assessed at present. The available clinical data concerning the potential skeletal toxicity of 13-cis-retinoic acid and etretinate should be carefully taken into consideration when determining the risk/benefit ratio, especially for long-term oral retinoid treatment.

Topics: Administration, Oral; Bone and Bones; Bone Diseases; Dermatitis; Etretinate; Humans; Isotretinoin; Retinoids; Risk; Tretinoin

Topics: Adult; Cysts; Dermatitis; Humans; Isotretinoin; Male; Tretinoin