isotretinoin and Facial-Dermatoses

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

Presenile diffuse familial sebaceous hyperplasia (PDFSH) presents as extensive yellowish papules with central umbilication on the face without involvement of periorificial regions and occurs in adolescents or young adults with a positive family history. Thirteen cases of PDFSH have been reported in the English-language published work, 10 of which responded to oral isotretinoin from 0.5 to 1 mg/kg per day but recurrences were often observed. Herein, we report two cases of PDFSH, which were successfully managed without recurrence with prolonged low-dose isotretinoin (0.2 mg/kg per day, a cumulative dose of 41 and 64 mg/kg, respectively). Treatment protocols among different published works were reviewed to verify the efficacy of isotretinoin.

Topics: Administration, Cutaneous; Administration, Oral; Adult; Anti-Bacterial Agents; Biopsy; Cheek; Clinical Protocols; Dermatologic Agents; Facial Dermatoses; Female; Fluticasone; Humans; Hyperplasia; Isotretinoin; Maintenance Chemotherapy; Male; Recurrence; Sebaceous Glands; Treatment Outcome; Tretinoin

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

Lupoid or granulomatous rosacea is classified as a special form of rosacea which along with the typical rosacea symptoms features monomorphic yellow-brown and red papules and nodules on the cheeks and periorificial areas. Histology shows noncaseating epithelioid cell granulomas with surrounding mononuclear cell infiltrates. It is difficult to treat. Currently, the only officially approved systemic treatment is tetracycline. However, there is a broad experience with off-label use of isotretinoin (10-20 mg daily). We describe a patient with an excellent response to 20 mg isotretinoin daily.

Topics: Dermatologic Agents; Erythema; Facial Dermatoses; Female; Humans; Isotretinoin; Middle Aged; Off-Label Use; Rosacea; Treatment Outcome

Morbihan disease is classified as a special form of rosacea, which presents with persistent facial erythema and solid edema because of marked involvement of the lymphatic vessels. The cheeks, nose and forehead are particularly affected. Currently, the treatment options of this cosmetically very disturbing disease are limited. However, every attempt should be made to provide treatment because of the great emotional suffering of the patients. We review some new currently available therapeutic options for Morbihan disease. In our patient, we were able to achieve a significant improvement with systemic isotretinoin 30 mg/day over a period of 12 months.

Topics: Dermatologic Agents; Erythema; Facial Dermatoses; Female; Humans; Isotretinoin; Middle Aged; Rosacea; Treatment Outcome

Lupoid perioral dermatitis is classified as a special form of perioral dermatitis with dense aggregations of red-brown papules which display a lupoid infiltrate on diascopy. There are various treatment options ranging from total avoidance of all topical substances to different topical treatment. Cases resistant to therapy require systemic treatment, which, however, is off-label use. In our case we were able to achieve a significant improvement with systemic therapy with isotretinoin over a period of 6 months.

Topics: Dermatologic Agents; Facial Dermatoses; Female; Humans; Isotretinoin; Lupus Erythematosus, Systemic; Middle Aged; Mouth Diseases; Treatment Outcome

Rosacea fulminans (RF) is a rare facial dermatosis characterized by the sudden onset of severe facial inflammation consisting of numerous pustules, cystic swellings and coalescing sinuses. The standard treatment is the retinoid drug isotretinoin in combination with systemic corticosteroids or with high-dose oral tetracycline antibiotics. We report three recent cases of RF in pregnancy with differing obstetric outcomes: an intrauterine death, a termination of pregnancy, and a normal vaginal delivery. The pathogenesis of RF is considered and therapeutic options in pregnancy are reviewed.

Topics: Abortion, Induced; Acne Vulgaris; Adult; Anti-Bacterial Agents; Dermatologic Agents; Diabetes, Gestational; Drug Therapy, Combination; Erythromycin; Facial Dermatoses; Female; Fetal Death; Glucocorticoids; Humans; Isotretinoin; Oligohydramnios; Prednisolone; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Rosacea; Treatment Outcome

Atrophoderma vermiculatum (AV) is a rare disorder leading to reticular or honeycomb scarring of the face and responding poorly to treatment. A case is now presented of the successful induction of remission in the inflammatory component of the disease following a prolonged course of isotretinoin; improvement was then maintained after cessation of the treatment. In severe cases of AV with significant scarring, a trial of isotretinoin therapy is thus worthwhile in an attempt to stop progression of the disease and improve its cosmetic appearance.

Topics: Child; Facial Dermatoses; Female; Humans; Isotretinoin; Keratolytic Agents; Keratosis

Topics: Acne Vulgaris; Facial Dermatoses; Humans; Infant; Isotretinoin; Keratolytic Agents; Male

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

Sun exposure may lead to actinic keratoses (AKs), field cancerization, and skin cancer. Effective treatment of AKs and field cancerization is important. Oral and topical retinoids can be used for this purpose. To compare clinical, histological, and immunohistochemical effects of oral and topical retinoid for AKs and field cancerization on face and upper limbs of immunocompetent patients, as well as the impact on quality of life, safety, and tolerability.. This study compared 10 mg/day oral isotretinoin (ISO) to 0.05% tretinoin cream (TRE) every other night, associated with sunscreen (SPF 60). Patients of both genders, aged 50-75 years, underwent cryotherapy with liquid nitrogen for AKs at baseline and after 120 days when they were randomized into two groups, TRE (n = 31) and ISO (n = 30), for 6 months. Outcome measures were: number of AKs, histological (thickness of stratum corneum and epithelium) and immunohistochemical parameters (p53, Bcl-2 and Bax), dermatology life quality index (DLQI), and adverse events.. Both treatments reduced the number of AKs (around 28%), the thickness of stratum corneum, and expression of p53 and Bax. By contrast, the epithelium thickness and Bcl-2 expression increased. There was no difference in the outcomes between TRE and ISO. Both treatments improved quality of life and were well tolerated with minimal side effects.. Retinoids are effective and safe for field cancerization. Classical treatments for field cancerization (imiquimod and ingenol mebutate) are used for a short period; retinoids may be a good choice to intercalate with them and can be used continuously.

Topics: Administration, Cutaneous; Administration, Oral; Aged; Antineoplastic Agents; bcl-2-Associated X Protein; Facial Dermatoses; Female; Humans; Immunohistochemistry; Isotretinoin; Keratosis, Actinic; Male; Middle Aged; Proto-Oncogene Proteins c-bcl-2; Quality of Life; Skin Cream; Skin Neoplasms; Tretinoin; Tumor Suppressor Protein p53; Upper Extremity

Plane warts are a common therapeutic problem. Our aim was to assess the efficacy and safety of oral versus topical isotretinoin in the treatment of plane warts.. Forty patients with multiple plane warts were randomized into two groups. Group A was treated with oral isotretinoin capsules in the dose of 0.5 mg/kg/d and Group B with topical isotretinoin 0.05% in gel formulation once daily at night. Treatment was given to the patients for 3 months or until the complete clearance of lesions, whichever was earlier. Patients with complete response were followed up monthly for 4 months to record the relapse rate.. Results were analyzed in 16 patients of Group A and 13 patients of Group B. At the end of 3 months of therapy, 11 (69%) patients in Group A had complete remission whereas five (31%) had partial remission. In Group B, at the end of study, five (38%) patients had complete remission and six (46%) had partial remission, whereas two patients had no remission. The difference was statistically significant between two groups; P < 0.0001. The most common side effect in Group A was cheilitis. In Group B, five patients had to be dropped because they developed severe erythema and scaling.. Oral isotretinoin showed better and earlier response than topical isotretinoin. Oral isotretinoin should definitely be given a trial particularly in cases of multiple facial warts before trying various destructive procedures.

Topics: Administration, Cutaneous; Administration, Oral; Adult; Cheilitis; Dermatologic Agents; Erythema; Facial Dermatoses; Female; Humans; Isotretinoin; Male; Middle Aged; Remission Induction; Warts; Young Adult

The efficacy of low-dose oral isotretinoin in the treatment of seborrhea and seborrheic dermatitis has been poorly investigated in randomized studies.. This study was designed to determine the efficacy and safety of low-dose oral isotretinoin in the treatment of moderate to severe seborrhea and seborrheic dermatitis on the scalp and/or face.. A randomized, comparative clinical trial, using two groups, was conducted over 6 months. Patients in Group ISO were treated with isotretinoin 10 mg every other day. In Group X, patients received antiseborrheic topical treatment. Patient opinion, investigator assessment, scalp pruritus, sebum production, and quality of life (QoL) comprised the efficacy outcomes.. The intention-to-treat population comprised a total of 45 patients with mean ± standard deviation ages of 28.7 ± 5.8 years in Group ISO and 29.8 ± 6.5 years in Group X. The rate of sebum production significantly decreased in Group ISO. Patient opinion, investigator, and QoL assessments improved in both groups.. Low-dose oral isotretinoin can be a therapeutic modality for moderate to severe seborrhea and seborrheic dermatitis.

Topics: Administration, Ophthalmic; Adult; Dermatitis, Seborrheic; Dermatologic Agents; Facial Dermatoses; Female; Humans; Isotretinoin; Male; Patient Satisfaction; Pruritus; Quality of Life; Scalp Dermatoses; Sebum; Severity of Illness Index; Young Adult

Acne is an important health issue with a major psychological impact in addition to the physical problems it causes.. To investigate the superiority of mobile teledermatology in the care of patients with high-need facial acne in comparison to outpatient services with particular attention to treatment efficacy, safety, and patient compliance. Further, patient satisfaction with remote care was evaluated.. Sixty-nine consecutive patients (f: 25, m: 44, median age: 19 years, range: 13-37 years) were randomly allocated to either the teleconsultation (TCA) or the outpatient consultation (OCA) arm of the trial to receive isotretinoin treatment in weight and severity-dependent dosages over 24 weeks. Acne grading was performed by one examiner using the Global Acne Severity Scale (GEA) and the total lesion counting (TLC).. Due to noncompliance issues, 17 of 69 (24.6%) patients were excluded from the study, of who 10 had been assigned to the TCA (10/34; 29.4%) and 7 to the OCA (7/35; 20%). Both, in the TCA (GEA-score: ∆ = 2.25; TLC: ∆ = 89.08) and in the OCA (GEA-score: ∆ = 2.0; TLC: ∆ = 91.21) excellent and almost equivalent therapeutic outcomes were achieved. In the TCA, however, less patients experienced adverse reactions (P = 0.55). Even though additional live supervision would have been appreciated in some teledermatology cases, patients were satisfied with the mobile service and no consultation request was created.. Mobile teledermatology is an efficient, safe and well-accepted tool among patients with high-need acne constituting at least a valuable adjunct to outpatient care services. Further larger studies would be useful to confirm our findings.

Topics: Acne Vulgaris; Adolescent; Adult; Ambulatory Care; Body Weight; Dermatologic Agents; Facial Dermatoses; Female; Humans; Isotretinoin; Male; Patient Satisfaction; Severity of Illness Index; Telemedicine; Young Adult

Oral isotretinoin (ISO) is the only drug which promotes prolonged remission or cure of severe acne. It also has other properties, supporting its use for non-acne indications. Retinoic acid (RA) is gold standard treatment for photoaging. ISO for photoaging treatment was reported in non-controlled trials as alternative to RA, which causes skin irritation.. To compare clinical, histological, and immunohistochemical effects of low-dose ISO and 0.05% topical RA to treat photoaging.. Randomized, comparative, evaluator-blinded, single-center study. Twenty-four healthy, Caucasian, 50 to 75-year-old men and women (menopausal or sterilized) with advanced photoaging were included. Twelve subjects received ISO, 20 mg/day, and 12 subjects were treated with RA cream, for six months; both treatments were administered every other day, and moisturizer and sunscreen were also used. Outcome measures included patient assessments, blinded photographic evaluations, Life Quality Index, histological (HE, Verhoeff) and immunohistochemical (p53, collagen type I) evaluations, adverse events, liver function, lipid profile, and blood count. Statistical analysis with generalized estimating equations and repeated measures ANOVA tests was used.. Eleven subjects in each group completed the study. Patient and photographic assessments showed overall improvement in skin appearance. Quality-of-life scores were reduced for all subjects. Histological analysis revealed corneal layer diminution, epidermal thickness increase, and elastosis reduction. Immunohistochemical findings revealed significant epidermal p53 reduction and dermal collagen 1 increase. No differences were found between groups; laboratory tests showed no significant alterations.. Despite being safe and effective, low-dose ISO was not superior to 0.05% RA for advanced photoaging treatment.

Topics: Administration, Oral; Administration, Topical; Aged; Dermatologic Agents; Facial Dermatoses; Female; Humans; Isotretinoin; Keratolytic Agents; Male; Middle Aged; Skin Aging; Treatment Outcome; Tretinoin

Although the efficacy of isotretinoin in the treatment of acne is unquestioned, improvement of patient tolerance and acceptance of the drug are desirable. Furthermore, no data on acne-induced scarring during isotretinoin treatment are available.. In the present study, we have evaluated the efficacy and tolerability of an initial stepwise incremental (n = 83) or an initial high dose (n = 11) and a subsequent medium maintenance dosing of isotretinoin in outpatients treated for acne over a 7 year period.. Ninety-four patients with moderate to severe acne were treated for a mean duration of 8.3 months, at a mean daily dose of 31.4 mg. Follow-up and final evaluation were done during outpatient visits and with a standardized patient questionnaire.. Response to treatment was very good in 62.8% and good in 31.9% of patients, with only one treatment failure. Of the patients, 21.3% required retreatment after a mean interval of 7.7 months. Four patients refused or dropped out from treatment, 27% noted initial mild worsening of their acne, and none experienced severe adverse effects. Scars were present in 89.4% of patients, with improvement occurring in 67.9% during treatment.. The altogether good to excellent clinical response of acne lesions and acne scars, with a low side effect profile, warrants further study of this simple, modified treatment regimen in patients with acne and acne-induced scarring.

Topics: Acne Vulgaris; Adolescent; Adult; Child; Dose-Response Relationship, Drug; Facial Dermatoses; Female; Follow-Up Studies; Humans; Isotretinoin; Keratolytic Agents; Lipids; Male; Middle Aged; Musculoskeletal Diseases; Pain; Patient Compliance; Patient Satisfaction; Recurrence; Skin; Treatment Outcome

It is generally accepted that the inhibition of sebum excretion has a predictive value for anti-acne activity. Whereas oral 13-cisretinoic acid (13-cis-RA) decreases sebum excretion, it has not been shown so far if oral all-trans-retinoic acid (tretinoin, tRA) does so. The aim of this exploratory study was to investigate the effect of oral tRA on the sebum excretion rate (SER) in young male subjects.. 12 healthy volunteers with a baseline SER above 1.0 microgram/cm2/min were treated with 20 mg/day tRA for 4 weeks. The SER was measured at weeks 2 and 4. Adverse reactions were recorded.. The mean SER varied from 1.56 at baseline to 1.65 at week 2 and to 1.49 micrograms/cm2/min at week 4. Comparison with values obtained in the same subjects previously treated with either 13-cis-RA or 9-cis-retinoic acid indicated that tRA less sebosuppressive. Mucocutaneous reactions and headache were the most frequent side effects of oral tRA.. The lack of effect on the SER suggests that oral tRA would probably be ineffective against acne. The fact that, of the three isomers tested, only 13-cis-RA (which does not bind to nuclear receptors) shows activity may suggest that sebosuppression is not nuclear receptor mediated. We discuss other hypotheses related to pharmacokinetics.

Topics: Acne Vulgaris; Administration, Oral; Adult; Alitretinoin; Drug Eruptions; Facial Dermatoses; Headache; Humans; Isotretinoin; Keratolytic Agents; Lip Diseases; Male; Mucous Membrane; Retinoids; Sebum; Skin; Tretinoin

Retinoids have been shown to improve the manifestations of skin photodamage, including actinic keratoses.. The efficacy and tolerability of isotretinoin 0.1% cream in the treatment of actinic keratoses were evaluated in a randomized, double-blind, placebo-controlled, parallel-group study.. One hundred patients were randomly assigned to treatment with 0.1% cream or vehicle twice daily for 24 weeks to the face, the scalp, and the upper extremities. Patients were assessed every 4 weeks by the investigators, who counted and recorded the number of lesions in each treatment area. The 93 patients who had at least one postbaseline assessment were included for efficacy analysis. Local tolerability was evaluated at each study visit.. On the face, the reduction in number of actinic keratoses (mean +/- SEM) at the end of treatment was greater for patients treated with isotretinoin (3.9 +/- 0.6, i.e., 66% of patients with a reduction > 30%) than with placebo (1.7 +/- 0.5, i.e., 45% of patients with a reduction > 30%); this difference was statistically significant (p = 0.001). No significant drug effect was seen for lesions on the scalp or upper extremities. Mild to moderate local reactions with isotretinoin abated with reduced treatment frequency.. Our results suggest that isotretinoin 0.1% cream cannot compete with more rapid treatments of actinic keratoses. However, its effect on facial lesions may be beneficial during long-term treatment of associated sun-damaged skin.

Topics: Administration, Topical; Arm; Double-Blind Method; Facial Dermatoses; Humans; Isotretinoin; Keratosis; Scalp Dermatoses; Sunlight

Photodamaged skin is characterized clinically by coarseness, telangiectasia, wrinkling, discrete hyperpigmented and hypopigmented macules, atrophy, and ultimately the development of neoplasms. Studies on the UVB-irradiated hairless mouse indicate that topical application of tretinoin or isotretinoin induces structural modifications at the dermal level. Clinical trials indicate that tretinoin improves skin appearance in patients who have photodamage. This double-blind, vehicle-controlled clinical trial was conducted to determine whether 36 weeks of treatment with topical isotretinoin improves mildly to moderately photodamaged facial skin. After they gave written informed consent 776 patients were randomly assigned to 36 weeks of treatment with either vehicle cream or isotretinoin cream, applied once nightly. Efficacy was evaluated by means of physician and patient assessment and a blinded analysis of standardized photographs taken before and after treatment. When compared with vehicle, treatment with isotretinoin resulted in statistically significant improvement in overall appearance, fine wrinkling, discrete pigmentation, sallowness, and texture. Isotretinoin cream was well tolerated.

Topics: Administration, Cutaneous; Adult; Aged; Double-Blind Method; Drug Tolerance; Esthetics; Facial Dermatoses; Female; Humans; Isotretinoin; Male; Middle Aged; Patient Satisfaction; Pharmaceutical Vehicles; Skin; Skin Aging; Skin Pigmentation

Orally administered retinoids are synthetic derivatives of vitamin A. This new group of drugs (not yet available for general use in the United States) has been effective in experimental trials for treatment of a wide range of skin diseases. The current status of two of these drugs, isotretinoin (13-cis-retinoic acid) and etretinate (Ro 10-9359), is herein reviewed.

Topics: Acne Vulgaris; Administration, Oral; Child; Clinical Trials as Topic; Facial Dermatoses; Female; Humans; Isomerism; Isotretinoin; Keratins; Keratitis; Neoplasms; Psoriasis; Skin Diseases; Tretinoin; Xerostomia

Topics: Facial Dermatoses; Granuloma; Humans; Isotretinoin

A 32-year-old man presented with multiple reddish and skin-colored asymptomatic skin lesions over his face and ears present for a year. These lesions appeared in crops at variable intervals, healing with scarring over the next few months. He had received doxycycline and azithromycin for about 6 months without any relief. No history of flushing, worsening of lesions on sun exposure, or eating spicy food, was reported. He had no chronic illness or prolonged usage of any medication. The patient neither had abdominal pain, respiratory distress, or uveitis to suggest sarcoidosis nor accounted any personal or family history of tuberculosis. (

Topics: Adult; Facial Dermatoses; Granuloma; Humans; Isotretinoin; Male; Rosacea; Sarcoidosis

Topics: Facial Dermatoses; Humans; Isotretinoin; Rosacea

Lupus miliaris disseminatus faciei is an uncommon type of granulomatous rosacea characterized by a papular eruption in the central regions of the face. A 43-year-old woman presented with an asymptomatic papular eruption on the face that had developed over a period of five months. Physical examination revealed multiple, small, reddish-brown papules, distributed symmetrically on the central area of the face. A biopsy was taken, showing dermal epithelioid cell granulomas with central necrosis and surrounding lymphocytic infiltrate with multinucleate giant cells. No foreign bodies were found in granulomas and no mycobacterial or fungal components were detected. On the basis of these findings, the diagnosis of lupus miliaris disseminatus faciei was made. The patient was given oral isotretinoin 20mg/day with initial slow response. After 6 months' treatment the lesions completely disappeared. Many authors consider this entity to be a variant of granulomatous rosacea. It is a chronic condition that primarily affects young adults. Treatment is usually unsatisfactory. Therapies with corticosterois, tetracyclines, retinoids, clofazimine or topical tacrolimus have been described but there is a lack of controlled studies and convincing results. Our success with a 6-month course of low dose isotretinoin suggests consideration of a longer trial prior to abandoning this as treatment.

Topics: Administration, Oral; Adult; Dermatologic Agents; Drug Administration Schedule; Facial Dermatoses; Female; Humans; Isotretinoin; Rosacea

Lupus miliaris disseminates faciei (LMDF) is a rare inflammatory dermatosis characterized by an asymptomatic papular eruption in the central face, of which the etiology and pathogenesis are not clear. There is a lack of standard treatment recommendations, especially for severe cases. Here we report a new case of successful treatment of severe LMDF by the combination therapy of oral isotretinoin and methylprednisolone.

Topics: Facial Dermatoses; Granuloma; Humans; Isotretinoin; Methylprednisolone; Rosacea

Topics: Child; Child, Preschool; Dermatologic Agents; Facial Dermatoses; Granuloma; Humans; Isotretinoin; Male

Topics: Adult; Dermatitis, Seborrheic; Dermatologic Agents; Facial Dermatoses; Humans; Isotretinoin; Male; Severity of Illness Index; Treatment Outcome

As a result of concerns about hypertriglyceridemia, liver enzyme abnormalities, and leukopenia during isotretinoin therapy for acne, patients are often monitored closely with routine laboratory assessments, although the value of this practice has been questioned.. We conducted a cohort study of patients receiving isotretinoin for acne between January 1, 2008, and June 30, 2017, using the OptumInsights Electronic Health Record Database (Optum, Eden Prairie, MN) to evaluate the frequency of laboratory abnormalities. Poisson regression was used to evaluate for changes to the frequency of routine laboratory monitoring over time.. Among 1863 patients treated with isotretinoin, grade 3 or greater triglyceride and liver function testing abnormalities were noted in fewer than 1% and 0.5% of patients screened, respectively. No grade 3 or greater cholesterol or complete blood count abnormalities were observed. There were no meaningful changes in the frequency of laboratory monitoring over time.. Limitations include that we are unable to evaluate the clinical notes to understand the exact clinical decision making when clinicians encountered abnormal laboratory values.. Although laboratory abnormalities are rare and often do not influence management, frequent laboratory monitoring remains a common practice. There are opportunities to improve the quality of care among patients being treated with isotretinoin for acne by reducing the frequency of lipid and liver function monitoring and by eliminating complete blood count monitoring.

Topics: Acne Vulgaris; Administration, Oral; Adolescent; Cohort Studies; Databases, Factual; Dermatologic Agents; Facial Dermatoses; Female; Humans; Hyperlipidemias; Isotretinoin; Liver Function Tests; Male; Monitoring, Physiologic; Poisson Distribution; Prognosis; Retrospective Studies; Risk Assessment; Severity of Illness Index; Treatment Outcome; Triglycerides; Young Adult

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

Topics: Administration, Cutaneous; Adult; Anti-Infective Agents; Dapsone; Dermatologic Agents; Facial Dermatoses; Gels; Glucocorticoids; Granuloma; Humans; Isotretinoin; Lymecycline; Male; Prednisolone; Treatment Failure

Topics: Administration, Cutaneous; Adult; Drug Therapy, Combination; Facial Dermatoses; Female; Humans; Isotretinoin; Metronidazole; Necrosis; Prednisolone; Rosacea; Skin; Treatment Outcome

Topics: Administration, Oral; Biopsy; Face; Facial Dermatoses; Female; Humans; Hyperplasia; Isotretinoin; Neck; Pseudoxanthoma Elasticum; Sebaceous Glands; Skin; Treatment Outcome; Young Adult

Topics: Adult; Alopecia; Dermatologic Agents; Facial Dermatoses; Female; Fibrosis; Humans; Isotretinoin; Middle Aged; Remission Induction; Scalp; Skin Diseases, Papulosquamous

Topics: Adult; Alopecia; Dermatologic Agents; Facial Dermatoses; Female; Humans; Isotretinoin; Lichen Planus; Male; Middle Aged

Cloud-based image sharing technology allows facilitated sharing of images. Cloud-based image sharing technology has not been well-studied for acne assessments or treatment preferences, among international evaluators. We evaluated inter-rater variability of acne grading and treatment recommendations among an international group of dermatologists that assessed photographs.. This is a prospective, single visit photographic study to assess inter-rater agreement of acne photographs shared through an integrated mobile device, cloud-based, and HIPAA-compliant platform. Inter-rater agreements for global acne assessment and acne lesion counts were evaluated by the Kendall's coefficient of concordance while correlations between treatment recommendations and acne severity were calculated by Spearman's rank correlation coefficient.. There was good agreement for the evaluation of inflammatory lesions (KCC = 0.62, P < 0.0001), noninflammatory lesions (KCC = 0.62, P < 0.0001), and the global acne grading system score (KCC = 0.69, P < 0.0001). Topical retinoid, oral antibiotic, and isotretinoin treatment preferences correlated with photographic based acne severity.. Our study supports the use of mobile phone based photography and cloud-based image sharing for acne assessment. Cloud-based sharing may facilitate acne care and research among international collaborators.

Topics: Acne Vulgaris; Administration, Cutaneous; Adolescent; Adult; Anti-Bacterial Agents; Dermatologic Agents; Facial Dermatoses; Female; Humans; Internationality; Internet; Isotretinoin; Male; Observer Variation; Photography; Prospective Studies; Retinoids; Severity of Illness Index; Smartphone; Telemedicine; Young Adult

The prevalence of acne in the adult population is increasing, particularly in women. Spironolactone regulates sebaceous gland activity by blocking androgen receptor. To evaluate retrospectively the efficacy of spironolactone in women with acne. Data from 70 women of at least 20 years, treated for their acne between 2010 and 2015 with low-dose spironolactone (≤150 mg/day), were analysed. Remission was defined by the number of retentional lesions inferior or equal to five and inflammatory lesions inferior or equal to two on the face. Variables influencing the response were studied using the Cox model. The mean age was 31.3 years; 39 (56%) women had prior courses of isotretinoin and 53 (76%) had an oral contraception prior to treatment. Remission data from a median treatment period of six months (95% CI: 4-9) were obtained from 47 (71%) women. Markers for a positive response to spironolactone were a high number of inflammatory lesions at inclusion (OR: 1.08; 95% CI: 1.03-1.13; p = 0.001) and relapse with previous isotretinoin (OR: 2.46; 95% CI: 1.09-5.54; p = 0.03). The marker for a negative response was an association with oral contraceptives containing first or second-generation progestin (OR: 2.77; 95% CI: 1.35-5.71; p = 0.005). This retrospective data analysis confirms that the use of low doses of spironolactone is a valuable alternative in women with acne in whom oral isotretinoin has failed. Moreover, the analysis shows that first and second-generation oral contraceptives decrease the efficacy of spironolactone, confirming the interest of using two third or fourth-generation oral contraceptives.

Topics: Acne Vulgaris; Adult; Androgen Receptor Antagonists; Back; Contraceptives, Oral; Dermatitis, Seborrheic; Dermatologic Agents; Facial Dermatoses; Female; Humans; Isotretinoin; Middle Aged; Progestins; Retrospective Studies; Risk Factors; Severity of Illness Index; Spironolactone; Treatment Outcome; Young Adult

Topics: Adult; Axilla; Dermatologic Agents; Facial Dermatoses; Granuloma; Humans; Isotretinoin; Male; Scalp Dermatoses

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

Rosacea fulminans is a rare disorder of unknown cause, almost exclusively affecting women. There are only a few reported cases in men. The condition is characterized by the abrupt onset of pustules and nodules predominantly affecting the cheeks or chin without any systemic upset. We report the case of a 37-year-old man who presented with papulopustules, predominantly localized to his nose. Histopathological features were consistent with rosacea fulminans. The patient was managed with treatments including oral prednisolone, isotretinoin, and trimethioprim.

Topics: Adult; Anti-Infective Agents; Anti-Inflammatory Agents; Dermatologic Agents; Drug Therapy, Combination; Facial Dermatoses; Humans; Isotretinoin; Male; Nose; Prednisolone; Rosacea; Trimethoprim

Topics: Adenoma; Dermatologic Agents; Facial Dermatoses; Humans; Hyperplasia; Isotretinoin; Male; Middle Aged; Sebaceous Gland Neoplasms; Sebaceous Glands; Treatment Outcome

Topics: Acne Vulgaris; Adult; Dermatologic Agents; Drug Eruptions; Facial Dermatoses; Female; Granuloma, Pyogenic; Humans; Isotretinoin

Isotretinoin is one of the therapeutic options for rosacea. However, the response of erythema to treatment with isotretinoin is usually slow and incomplete with common (0.5-1 mg/kg/day) or low (10 mg/day) doses. This study investigated the efficacy of, and relapse on, 20 mg/day isotretinoin treatment in rosacea, with the aid of instrumental measurement of facial erythema and sebum levels. A 20 mg/day dose of isotretinoin was given for 4 months, and then the dose was tapered off within the following 6 months. A total of 25 patients were included in the study. Papule and pustule counts, erythema index, sebum level, dermatologist's and patient's erythema scores, and dermatologist's sebum scores were significantly lower in the first month of therapy compared with pre-treatment values (p < 0.05). Within a median follow-up of 11 months (95% confidence interval: 8.4-13.5 months) 45% of patients had a relapse. In conclusion, 20 mg/day isotretinoin was rapidly efficient for reducing both inflammatory lesions and erythema in rosacea.

Topics: Adult; Aged; Dermatologic Agents; Erythema; Facial Dermatoses; Female; Follow-Up Studies; Humans; Isotretinoin; Male; Middle Aged; Recurrence; Rosacea; Sebum; Severity of Illness Index; Statistics, Nonparametric

Folliculosebaceous cystic hamartoma (FSCH) is a relatively recently described malformation with follicular and sebaceous components and a particular type of stroma with adipocytes. We conducted an anatomo-clinical study in order to clarify the clinical and histological characteristics of FSCH.. We included all cases of FSCH diagnosed between 1985 and February 2011 at our dermatopathology laboratory. Clinical information was obtained from medical records and requests for histological examination.. We studied 25 cases of FSCH in 25 patients of mean age 51 years. The sex ratio was 1.3. The mean disease duration was 9 years. Lesions were described mainly as flesh-colored, occasionally pedunculated nodules and were found primarily on the face (60%). The diagnosis of FSCH had never been mentioned by the clinician. Histological examination revealed in all cases one or more follicular cystic structures surrounded by sebaceous glands in a stroma containing adipocytes. A number of variants were identified, such as the presence of a mucinous stroma, a neuroid component with protein S 100 expression, and rudimentary hair follicles in adjacent dermis. One case involved a proliferating cyst while another was on the scalp in the area of pre-existing radiodermatitis. Only one relapse was noted, 5 years after the initial excision.. FSCH is a benign, underdiagnosed lesion, localized on the face, particularly on the nose. It is dome-shaped or pedunculated and grows slowly. Differential diagnoses include nevus lipomatosus superficialis and "sebaceous" trichofolliculoma. FSCH can be readily identified by the presence of adipocytes and a fibrous stroma. One case was unique in its appearance of a large pedunculated nodule with a proliferating cyst. Prior to the invidualization of this entity, such cases were interpreted as nevus lipomatosus superficialis or "sebaceous" trichofolliculoma, although their histological appearance was inconsistent with such a diagnosis.

Topics: Acitretin; Adipocytes; Adolescent; Adult; Aged; Aged, 80 and over; Combined Modality Therapy; Diagnosis, Differential; Epidermal Cyst; Facial Dermatoses; Female; Follicular Cyst; Hair Follicle; Hamartoma; Humans; Isotretinoin; Lasers, Gas; Male; Middle Aged; Neoplasms, Basal Cell; Radiodermatitis; Retrospective Studies; Skin Diseases; Skin Neoplasms; Stromal Cells; Young Adult

Warts are benign epithelial proliferations of the skin and mucosa caused by infection with human papilloma viruses (HPV). Plane warts are mainly caused by HPV-3 and HPV-10. There is no single treatment that is absolutely effective, and different types of treatment may be combined. One must take into account the possibility of spontaneous regression, and so the therapeutic approach should not be too aggressive. Two case reports are presented of two immunocompetent patients with multiple plane warts successfully treated with low-dose systemic isotretinoin.

Topics: Adult; Dermatologic Agents; Facial Dermatoses; Female; Humans; Isotretinoin; Male; Warts; Young Adult

Topics: Biopsy; Child, Preschool; Dermatologic Agents; Facial Dermatoses; Female; Humans; Isotretinoin; Rosacea; Treatment Outcome

A 45-year-old male presented with a 6 month history of an enlarging smooth, erythematous plaque over the central part of his face. Mild erythema of both eyes was present. Sarcoidosis, Hansen disease, lupus vulgaris, cutaneous leishmaniasis, pseudolymphoma, foreign body granuloma, granuloma faciale, discoid lupus erythematosus, and granulomatous rosacea were considered in the differential diagnosis. CBC, urinalysis, renal function tests, liver function tests, serum electrolytes, and blood sugar were all normal. Chest X-ray and ECG revealed no abnormality. Serology for syphilis and HIV, and mantoux test were negative. Slit-skin smear, tissue smear and culture for AFB and fungi were negative. Skin biopsy revealed multiple non-caseating epitheloid granulomas around the pilosebaceous unit suggestive of granulomatous rosacea. Granulomatous rosacea, a rare entity comprising only about 10 percent of cases of rosacea can mimic many granulomatous conditions both clinically and histologically making the diagnosis an enigma. It usually presents as yellowish brown-red discrete papules on the face; non-caseating epithelioid granulomas are seen on histology examination. We herein report the case because it presented in atypical fashion, as a solitary indurated plaque on the nose, likely representing Morbihan's disease or solid persistent facial edema of rosacea (rosacea lymphedema).

Topics: Anti-Inflammatory Agents; Dermatologic Agents; Diagnosis, Differential; Facial Dermatoses; Humans; Isotretinoin; Male; Middle Aged; Nose; Prednisolone; Rosacea

We present two cases of cyclosporine-induced sebaceous hyperplasia in renal transplant recipients, successfully treated with isotretinoin. Both patients tolerated isotretinoin well, with no alteration in graft function. These cases provide support for the safe and effective use of oral isotretinoin in the treatment of cyclosporine-induced sebaceous hyperplasia in the kidney transplant population.

Topics: Adult; Cyclosporine; Dermatologic Agents; Facial Dermatoses; Humans; Hyperplasia; Immunosuppressive Agents; Isotretinoin; Kidney Transplantation; Male; Middle Aged; Sebaceous Glands

Topics: Acne Vulgaris; Adolescent; Adult; Dermatologic Agents; Dermatology; Facial Dermatoses; Female; Humans; Isotretinoin; Lupus Erythematosus, Cutaneous; Lupus Erythematosus, Discoid; Patient Preference; Quality of Life; Risk-Taking; Sarcoidosis; Self Concept; Suicide; Young Adult

Nodular amyloidosis is a primary cutaneous amyloidosis characterized by the deposition of amyloid L-type fibril proteins in the dermis. Clinical history and routine histology may not be sufficient to differentiate nodular amyloidosis from colloid milium. We present a case of a 45-year-old man with nodular amyloidosis, whose diagnosis was confirmed by the characteristic appearance of filaments on electron microscopy.

Topics: Acne Vulgaris; Amyloidosis; Dermatologic Agents; Diagnosis, Differential; Face; Facial Dermatoses; Humans; Isotretinoin; Male; Microscopy, Electron, Transmission; Middle Aged; Skin Diseases

Topics: Child; Dermatitis, Perioral; Diagnosis, Differential; Facial Dermatoses; Female; Granuloma; Humans; Isotretinoin; Metronidazole; Skin Diseases, Papulosquamous; Tetracycline

Topics: Acne Vulgaris; Administration, Oral; Administration, Topical; Adolescent; Benzoyl Peroxide; Contraceptives, Oral, Hormonal; Dermatologic Agents; Diagnosis, Differential; Facial Dermatoses; Female; Humans; Isotretinoin; Referral and Consultation; Retinoids; Tetracycline

Isotretinoin therapy for acne is often associated with mucocutaneous reactions that are usually dose dependent.. To describe the characteristics of five patients who presented with a peculiar facial rash that developed during or after a successful course of isotretinoin therapy for acne.. In this retrospective study, five patients who were treated with isotretinoin and who developed, during or following treatment, a peculiar facial eruption that has not previously been reported, are described. The clinical characteristics, laboratory findings, therapy, and course of the eruption are presented.. The rash was characterized by small, yellow, adherent, greasy scales, either flat-topped or spiky, mostly on the cheeks, that resembled seborrheic dermatitis. Cultures obtained in one case grew Staphylococcus coagulase-negative, Acinetobacter, and Pityrosporum ovale organisms. In another patient, microscopic study showed hyperkeratotic scales with many spores and Gram-negative coccobacilli. Topical administration of ointments containing chloramphenicol 3% for 2-3 weeks was curative.. Seborrheic dermatitis-like eruption may be another adverse cutaneous effect of isotretinoin treatment. Its pathogenesis probably involves a minimal toxic retinoid effect on epidermal differentiation with overgrowth of commensal microorganisms in susceptible individuals.

Topics: Acne Vulgaris; Administration, Topical; Adolescent; Adult; Anti-Bacterial Agents; Chloramphenicol; Dermatitis, Seborrheic; Dermatologic Agents; Facial Dermatoses; Female; Humans; Isotretinoin; Male; Retrospective Studies; 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: Adult; Dermatologic Agents; Epidermodysplasia Verruciformis; Facial Dermatoses; Humans; Isotretinoin; Male

Topics: Administration, Topical; Adult; Anti-Bacterial Agents; Drug Therapy, Combination; Facial Dermatoses; Female; Flushing; Follow-Up Studies; Humans; Isotretinoin; Risk Assessment; Rosacea; Severity of Illness Index; Treatment Outcome

Topics: Biopsy, Needle; Child; Erythema; Facial Dermatoses; Follow-Up Studies; Humans; Hypopigmentation; Immunohistochemistry; Isotretinoin; Male; Mucinosis, Follicular; Risk Assessment; Severity of Illness Index

Topics: Adolescent; Dermatologic Agents; Drug Eruptions; Facial Dermatoses; Humans; Isotretinoin; Male; Port-Wine Stain

Topics: Anticoagulants; Dermatologic Agents; Drug Interactions; Facial Dermatoses; Humans; Isotretinoin; Male; Middle Aged; Warfarin

Topics: Acne Vulgaris; Adult; Burns, Chemical; Facial Dermatoses; Female; Follow-Up Studies; Humans; Isotretinoin; Risk Assessment; Severity of Illness Index; Skin Care; Waxes

Topics: Carcinoma, Squamous Cell; Facial Dermatoses; Female; Gels; Humans; Isotretinoin; Lymphatic Metastasis; Middle Aged; Radiotherapy

Topics: Acne Vulgaris; Administration, Oral; Adolescent; Biopsy, Needle; Dose-Response Relationship, Drug; Drug Administration Schedule; Facial Dermatoses; Granuloma, Pyogenic; Humans; Immunohistochemistry; Isotretinoin; Male; Prognosis; Risk Assessment; Severity of Illness Index

A 19 year old man with severe acne conglobata and ulcerated pyoderma gangraenosum-like skin lesions on the face was first treated with isotretinoin (Roaccutan((R))), then immunosuppressively with prednisolone, diaminodiphenylsulfone (Dapson-Fatol((R))) and mycophenolate mofetil (Cellcept((R))). Under a daily maintenance dose of immunosuppressive treatment with 2.5 mg prednisolone and 1 g mycophenolate mofetil, weakness, muscle and joint aches appeared. Due to proteinuria, haematuria and an elevated antineutrophil cytoplasmic antibody (cANCA) and the histological detection of a leukocytoclastic vasculitis, the diagnosis of cANCA positive vasculitis of the skin and kidneys was established. Therapy with cyclophosphamide (Endoxan((R))) along with prednisolone was effective. An exact classification of this disease process was not possible.

Topics: Acne Vulgaris; Adult; Antibodies, Antineutrophil Cytoplasmic; Cyclophosphamide; Diagnosis, Differential; Drug Therapy, Combination; Endothelium, Vascular; Facial Dermatoses; Humans; Immunosuppressive Agents; Isotretinoin; Kidney; Male; Neutrophils; Prednisolone; Pyoderma Gangrenosum; Vasculitis

Pyoderma faciale is an inflammatory disease that until now was believed to occur only in women. Bacterial pathogens have not been found in most cases, and those found included only gram-positive microorganisms. We present 2 cases consistent with pyoderma faciale--one of them a 17-year-old adolescent boy--in which gram-negative bacteria were found. Enterobacter cloacae was found in one patient, and Klebsiella oxytoca was found in the other. Needle aspiration is the technique of choice in looking for pathogens in this disease.

Topics: Adolescent; Anti-Infective Agents; Ciprofloxacin; Cloxacillin; Drainage; Enterobacter cloacae; Facial Dermatoses; Female; Gram-Negative Bacterial Infections; Humans; Isotretinoin; Klebsiella oxytoca; Male; Needles; Penicillins; Pyoderma; Staphylococcus aureus

Topics: Acne Vulgaris; Drug Eruptions; Facial Dermatoses; Humans; Isotretinoin; Keratolytic Agents

Topics: Administration, Oral; Child, Preschool; Dermatologic Agents; Facial Dermatoses; Female; Humans; Isotretinoin; Rosacea; Skin; Treatment Outcome

Topics: Adult; Calcitriol; Diagnosis, Differential; Facial Dermatoses; Female; Humans; Impetigo; Isotretinoin; Phototherapy; Prednisolone; Pregnancy; Pregnancy Complications, Infectious; Thorax

Topics: Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Therapy, Combination; Facial Dermatoses; Female; Humans; Isotretinoin; Male; Prednisone; Prognosis; Rosacea; Severity of Illness Index; Treatment Outcome

Topics: Acne Vulgaris; Adult; Facial Dermatoses; Humans; Isotretinoin; Keratolytic Agents; Keratosis, Seborrheic; Male

The explosive onset of fluctuant facial papulonodules, usually in young women, is characteristic of pyoderma faciale. This disorder is neither a true pyoderma nor a variant of acne, but rather a severe form of rosacea. The most effective therapeutic modality appears to be isotretinoin, especially if preceded by a brief course of oral corticosteroids or a short interval of application of potent topical corticosteroids. Despite our concern about the potential adverse effects of systemic retinoids on underlying inflammatory bowel disease, isotretinoin was given to a patient with refractory pyoderma faciale. Response was dramatic, and no ill effects were encountered.

Topics: Adult; Colitis, Ulcerative; Facial Dermatoses; Female; Humans; Isotretinoin; Keratolytic Agents; Pyoderma; Rosacea; Terminology as Topic

Topics: Adult; Facial Dermatoses; Follow-Up Studies; Humans; Hyperplasia; Isotretinoin; Keratolytic Agents; Laser Therapy; Male; Neoplasms, Multiple Primary; Recurrence; Retreatment; Sebaceous Gland Neoplasms; Sebaceous Glands; Syndrome; Telangiectasis

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

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

We report the first case of eosinophilic pustular folliculitis (Ofuji's disease) which was successfully treated with acitretin.. A 50-year old women (HIV negative) had developed over 3 months an erythematopapulous plaque under the left orbit. The clinical and histological diagnosis was eosinophilic pustular folliculitis. Successive treatment with cetirizine then indomethacin was ineffective. Acitretin (0.5 mg/kg/d) was then started and led to cure within 1 month. Six weeks after the patient spontaneously stopped the treatment, the lesion recurred at the same localization. Further treatment with isotretinoin (0.5 mg/kg/d) was then given but did not alter progression of the lesion. Acitretin was then reintroduced at the same dose and again produced rapid cure. Acitretin was then tapered off to 10 mg/d then maintained at this dose as lesions reappeared with further dose reduction.. It is difficult to treat eosinophilic pustular folliculitis because of the random nature of response to different drugs. General corticosteroids, dapsone and indomethacin are classically proposed but with variable success. Isotretinoin is proposed on the hypothesis of a link with sebaceous secretion, but results have been contradictory. This drug was ineffective in our case. Acitretin did however provide very rapid improvement with an efficacy confirmed at reintroduction. This retinoid which does not have the specific action of isotretinoin could affect follicular keratinocytes which have been shown to be activated in this chronic skin disease.

Topics: Acitretin; Dapsone; Eosinophils; Facial Dermatoses; Female; Folliculitis; Humans; Isotretinoin; Keratolytic Agents; Middle Aged; Recurrence; Skin Diseases, Vesiculobullous; Treatment Outcome

Topics: Adult; Colitis, Ulcerative; Facial Dermatoses; Female; Humans; Isotretinoin; Keratolytic Agents; Pyoderma

We describe a 75-year-old man demonstrating the florid clinical features of actinic granuloma of O'Brien. This rare disfiguring condition is believed to result from a granulomatous reaction of the dermis to solar-induced elastosis and is poorly responsive to topical steroids. Twelve weeks' treatment with isotretinoin prevented the development of new granulomata and produced almost complete resolution of established lesions.

Topics: Aged; Facial Dermatoses; Granuloma; Humans; Isotretinoin; Keratolytic Agents; Male; Neck; Skin Diseases

Topics: Administration, Oral; Cell Nucleus; Cytoplasm; Facial Dermatoses; Follow-Up Studies; Histiocytes; Histiocytosis, Langerhans-Cell; Humans; Isotretinoin; Male; Middle Aged; Remission Induction; Scalp Dermatoses

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

The increased use of isotretinoin therapy for severe cystic acne has posed new problems for dermatologic surgeons. There have been recent reports in the literature of unexpected "atypical" scarring after dermabrasion in patients who have previously taken isotretinoin. This scarring was considered atypical because it occurred outside the typical "danger zones" (e.g., mandible and malar eminences) where scarring most often occurs after dermabrasion. This is the first reported case of atypical scarring in a patient who began isotretinoin therapy 2 months after dermabrasion.

Topics: Acne Vulgaris; Adult; Cicatrix, Hypertrophic; Combined Modality Therapy; Dermabrasion; Facial Dermatoses; Female; Humans; Isotretinoin

Topics: Adult; Eyebrows; Facial Dermatoses; Female; Humans; Isotretinoin; Keratosis

A male patient with severe cystic acne was treated with 13-cis-retinoic acid in a dosage of 1 mg/kg/day. Early flare-up of his acne and multiple pyogenic-like lesions on his face appeared during the second week of isotretinoin treatment. Histologic study of the lesions revealed granulation tissue. Possible etiologies for this phenomenon are discussed.

Topics: Acne Vulgaris; Adolescent; Facial Dermatoses; Granuloma; Humans; Isotretinoin; Male; Pyoderma

Topics: Adult; Facial Dermatoses; Female; Hair Removal; Humans; Isotretinoin; Skin

The treatment of scleromyxedema has been largely ineffective. We report improvement of scleromyxedema with myopathy after treatment with isotretinoin, 40 mg twice a day. We review other therapeutic modalities used for this disorder and discuss properties of isotretinoin that may have contributed to the favorable response.

Topics: Adult; Facial Dermatoses; Hand Dermatoses; Humans; Isotretinoin; Male; Muscular Diseases; Myxedema; Skin Diseases

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

Multiple keratoacanthomas developed on the face of a woman after radiation therapy to the nasal sinuses. Treatment with isotretinoin appeared to shorten her recovery period.

Topics: Facial Dermatoses; Female; Humans; Isotretinoin; Keratoacanthoma; Middle Aged; Paranasal Sinus Neoplasms; Radiotherapy, High-Energy

Topics: Acne Vulgaris; Adult; Drug Eruptions; Facial Dermatoses; Female; Humans; Isotretinoin; Patch Tests; Photosensitivity Disorders

A young woman with a persistent eruption of small granulomas about the mouth and chin was studied and granulomatous perioral dermatitis was diagnosed. Some authorities consider that perioral dermatitis is a circumscribed variant of rosacea; the findings in this case tend to show a relationship between the two conditions. Once conventional therapies failed to result in a response, the eruption cleared, leaving pitted, atrophic scarring after a twenty week course of isotretinoin treatment.

Topics: Administration, Oral; Adult; Diagnosis, Differential; Facial Dermatoses; Female; Granuloma; Humans; Isotretinoin; Rosacea

Topics: Administration, Oral; Adult; Aged; Aged, 80 and over; Facial Dermatoses; Female; Humans; Isotretinoin; Keratoacanthoma; Male; Middle Aged; Recurrence; Skin Diseases

Topics: Adult; Facial Dermatoses; Humans; Isotretinoin; Lupus Vulgaris; Male; Tretinoin

Topics: Adult; Facial Dermatoses; Female; Humans; Isotretinoin; Pyoderma; 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

Topics: Adult; Facial Dermatoses; Female; Forehead; Humans; Isotretinoin; Sarcoidosis; Skin; Tretinoin

Two cases of diffuse multiple lesions of sebaceous hyperplasia of the face are reported. The results of both medical and surgical therapies had been unsatisfactory. The patients were treated with low dose systemic isotretinoin (13-cis-retinoic acid) which resulted in complete clearing in one case and substantial clearing in the second. We suggest that in those patients cosmetically bothered by diffuse multiple lesions of sebaceous hyperplasia, for which other therapies are unsuccessful or unamenable to the patient, isotretinoin offers a safe, rational therapeutic option.

Topics: Aged; Facial Dermatoses; Humans; Hyperplasia; Isotretinoin; Male; Middle Aged; Sebaceous Glands; Skin Diseases; Tretinoin