isotretinoin and Edema

Morbihan disease (MD) is considered a rare complication of rosacea, which is difficult to diagnose and challenging to treat. Here, we performed a systematic review of available case reports and case series to summarize key clinical and pathologic features of and successful treatment regimens for MD. We conducted a search of the PubMed/MEDLINE, EMBASE, and Cochrane electronic databases from their inception to the date of search on March 6, 2023. We found that MD affects patients in the fifth decade of life on average, more commonly reported in male than female (69% vs 31%). Clinically, MD affects the eyelids, cheeks, and forehead most commonly, presenting as non-pitting, erythematous edema or an edematous plaque. On biopsy, the pathologic features, such as dermal edema, sebaceous hyperplasia, perivascular and periadnexal inflammatory infiltrate, and granulomatous reaction, are frequently reported. Out of 55 patients who were able to achieve complete response without recurrence, 35% of patients were treated with isotretinoin and 22% were treated with tetracycline antibiotics with a daily dosage range of 20-80 mg and 40-200 mg, respectively. Out of those 55 patients, 22% and 7% were treated successfully with surgical intervention and intralesional injection of steroids, respectively. Additionally, lymphatic drainage has been shown to be an effective adjunctive therapeutic tool. More studies are necessary to understand the disease mechanism to improve the diagnosis of and develop evidence-based therapies for MD.

Topics: Edema; Erythema; Female; Humans; Isotretinoin; Male; Rosacea; Treatment Outcome

Isotretinoin (13-cis-retinoic acid) is a retinoid that is used to treat cystic acne, comedonal acne, and other diseases. For the treatment of acne, isotretinoin is dosed at 0.5 to 2 mg/kg daily for 5 months with a target total dose of approximately 120 mg/kg. Its most common side effects are mucocutaneous and ocular in nature (ie, cheilitis, ocular sicca, and decreased dark adaptation). It can also cause xerosis. Patients should be made aware of these side effects before taking isotretinoin and also that utilization of moisturizers and eye drops can help to mitigate such side effects. Sometimes, however, the dose of isotretinoin needs to be decreased to reduce the induction of side effects. Isotretinoin's most significant side effect is the induction of birth defects if a fetus is exposed to isotretinoin, which is pregnancy category X. Isotretinoin should be used with 2 forms of birth control by fecund women. It can rarely increase serum levels of triglycerides, which can, if very elevated, be related to the development of pancreatitis and xanthomas. Isotretinoin's well-documented but rarer side effects include intracranial hypertension. It can induce bony changes. A review of the literature demonstrates that isotretinoin is not linked to depression and suicide. Facial swelling has been linked to isotretinoin use in 3 previous case reports. We note herein the first case of facial swelling that occurred in an acne patient being treated with isotretinoin who at the time the swelling developed had no cysts, comedones, pustules, or evidence of bacterial infection. Possible reasons for the patient's facial swelling include some type of retinoid induced angioedema, exacerbation of inflammation by isotretinoin, and isotretinoin induced capillary leak syndrome.

Topics: Acne Vulgaris; Administration, Topical; Adult; Dose-Response Relationship, Drug; Drug Administration Schedule; Edema; Face; Follow-Up Studies; Humans; Isotretinoin; Male; Risk Assessment; Severity of Illness Index

The thick-skinned nose is still one of the most challenging aspects of rhinoplasty. The possible effects of oral isotretinoin on cosmetic results of rhinoplasty in patients with thick nasal skin have been considered during recent years.. In this double-blind placebo-controlled clinical trial, 48 cases were divided into two groups randomly. Oral isotretinoin (0.5-mg/kg) was started on the 31st day after surgery and given every other day for 1 month and after that daily for two additional months in the first group. The second group received a placebo in the same form, sequence and interval as the first group. The cosmetic results based on patient satisfaction and ranking by an expert surgeon were compared between the two groups at 3 months, 6 months and 1 year after surgery.. Patient satisfaction and ranking by an expert surgeon in the isotretinoin group at 3 months and 6 months after surgery were significantly better than in the placebo group (p value < 0.05); however, at 12 months after surgery there was no statistically significant difference between the two groups (p value > 0.05).. Though postoperative use of oral isotretinoin in patients with thick nasal skin accelerates improvement in cosmetic results during the early months after surgery, it does not significantly affect the final cosmetic result 1 year after surgery.. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Topics: Administration, Oral; Adolescent; Adult; Dose-Response Relationship, Drug; Double-Blind Method; Drug Administration Schedule; Edema; Esthetics; Female; Follow-Up Studies; Humans; Isotretinoin; Male; Middle Aged; Nasal Septum; Nose Diseases; Postoperative Complications; Prospective Studies; Reference Values; Rhinoplasty; Severity of Illness Index; Skin; Time Factors; Treatment Outcome; Wound Healing; Young Adult

Morbihan disease is characterized by erythema and solid edema in the two upper thirds of the face. Underlying factors are an imbalance in lymphatic drainage, chronic inflammation, and mast cells leading to fibrosis. Treatment options known thus far have led to unsatisfactory results and have often been associated with a greater risk of side effects; even invasive options have been applied. This study presents four patients treated with a combination of ultra-low-dose isotretinoin and antihistamines for a mean duration of 14 months. While no side effects other than dryness of the lips were noted, a significant reduction of the erythema and edema could be observed in all patients. Specialists evaluated the treatment's success by photodocumentation and measured a 91.5% alleviation of erythema, and 85% reduction of edema, respectively. Based on these results, this new regimen in the therapeutic approach toward Morbihan disease is suggested due to its anti-inflammatory features and low risk of side effects.

Topics: Acne Vulgaris; Anti-Inflammatory Agents; Edema; Erythema; Histamine Antagonists; Humans; Isotretinoin

Topics: Dermatologic Agents; Drainage; Edema; Facial Dermatoses; Humans; Isotretinoin; Male; Syndrome; Young Adult

Topics: Ankle; Bone Marrow Diseases; Child; Edema; Humans; Isotretinoin; Male; Neuroblastoma

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

We report a case of acute sacroiliitis with severe disability after only 3 weeks of isotretinoin therapy with graduate reduction of pain, limitation and muscle incompetence after discontinuation of the drug and ACTH-depo injection and Ethodolac therapy. Naranjo probability scale indicated a probable relationship between isotretinoin therapy and bilateral sacroiliitis. We discussed possible mechanisms of sacroiliitis and disability due to isotretinoin treatment.

Topics: Acne Vulgaris; Adrenocorticotropic Hormone; Adult; Anti-Inflammatory Agents, Non-Steroidal; Arthralgia; Arthritis; Dermatologic Agents; Disability Evaluation; Edema; Etodolac; Humans; Iatrogenic Disease; Isotretinoin; Low Back Pain; Magnetic Resonance Imaging; Male; Muscle Weakness; Radiography; Sacroiliac Joint; Treatment Outcome; Whole Body Imaging

Topics: Adolescent; Dermatologic Agents; Edema; Face; Humans; Isotretinoin; Male; Treatment Outcome

Topics: Acne Vulgaris; Administration, Oral; Adult; Dermatologic Agents; Drug Therapy, Combination; Edema; Erythema; Facial Dermatoses; Glucocorticoids; Humans; Isotretinoin; Male; Prednisone; Treatment Failure

Topics: Acne Vulgaris; Adult; Edema; Face; Humans; Isotretinoin; Male; Middle Aged

Topics: Drug Therapy, Combination; Edema; Facial Dermatoses; Histamine H1 Antagonists; Humans; Isotretinoin; Keratolytic Agents; Ketotifen; Male; Middle Aged; Rosacea

Periodontal health in relation to systemic retinoid medication was evaluated retrospectively in patients with Papillon-Lefèvre Syndrome (PLS). The material consisted of 18 children/young adults ranging from 8 to 28 years of age, all with a confirmed diagnosis of PLS. 9 participants, comprising a medication group, had been on long-term (range 1.5-9 years) retinoid medication for their cutaneous lesions. The remaining 9 served as controls. Regardless of whether or not retinoid medication was received, every patient experienced an early and devastating periodontitis, with atypical edematous and erythematous gingiva, suppuration from deep gingival pockets and premature loss of teeth. No correlation could be found between the severity of skin involvement and the severity of periodontal involvement. An improvement with age could be seen for the cutaneous lesions but not for the periodontal condition. Systemic medication with retinoids had a favorable therapeutic effect on cutaneous lesions, and no severe complication/side effect could be seen after several years of continuous use. However, from the results of this study it can be concluded that, at least in a situation with poor compliance of daily oral home-care, no positive effect on the periodontal health in patients with PLS could be seen by the retinoid medication.

Topics: Adolescent; Adult; Child; Edema; Erythema; Etretinate; Female; Gingival Diseases; Gingival Pocket; Humans; Isotretinoin; Keratolytic Agents; Male; Papillon-Lefevre Disease; Patient Compliance; Periodontal Diseases; Periodontitis; Periodontium; Retrospective Studies; Skin; Suppuration; Tooth Exfoliation

Topics: Acne Vulgaris; Administration, Oral; Adult; Cellulitis; Edema; Facial Dermatoses; Humans; Isotretinoin; Male; Staphylococcal Skin Infections

A 20-year-old man suffering from acne vulgaris since the age of 12 developed a solid persistent inflammatory edema of the face through the last 2 years. The edema was resistant to conventional treatment of acne including various systemic and topical antibiotics, isotretinoin and interferon-gamma. Histopathologic examination revealed an extensive fibrosis of the middle and deeper corium with a dense lymphohistiocytic perivascular infiltrate, notably with many mast cells. The therapeutic combination of oral isotretinoin (0.5 mg/kg body weight daily) and ketotifen (2 mg daily) led to complete resolution of all facial lesions. The pathogenesis of persistent edema remains mysterious but may be related to chronic inflammation resulting in obstruction of lymph vessels or fibrosis induced by mast cells.

Topics: Acne Vulgaris; Adult; Drug Therapy, Combination; Edema; Face; Humans; Isotretinoin; Ketotifen; Male; Skin

Topics: Acyclovir; Adult; Edema; Eyelid Diseases; Facial Dermatoses; Herpes Simplex; Humans; Hypersensitivity, Immediate; Isotretinoin; Male

Persistent solid facial edema is considered a complication of acne vulgaris and has never been reported in the French literature. The authors report the cases of 2 patients, a 15-year old girl and a 20-year old man, who suffered from the condition for 1 and 2 years respectively. Clinical features and course are described. Treatment with isotretinoin in doses of 1 mg/kg/day administered during 6 and 8 months resulted in an 80 p. 100 and 50 p. 100 reduction of the edema respectively.

Topics: Acne Vulgaris; Adolescent; Adult; Edema; Face; Female; Follow-Up Studies; Humans; Isotretinoin; Male

We present two patients, a 20-year-old female and an 18-year-old male, who suffered from persistent solid facial edema as a complication of acne vulgaris. They were treated with isotretinoin with moderate response and thereafter with lymph massage with further response. The female patient also received clofazimine with good response.

Topics: Acne Vulgaris; Adolescent; Adult; Clofazimine; Dermatologic Agents; Edema; Face; Female; Humans; Isotretinoin; Male; Tretinoin

A case of persistent solid facial edema is described in a 17-year-old boy with moderate papulocystic acne. After a 20-week course of isotretinoin, the acne vulgaris resolved, and there was a moderate reduction in the facial edema.

Topics: Acne Vulgaris; Adolescent; Edema; Facial Dermatoses; Humans; Isotretinoin; Male; Tretinoin