isotretinoin and Folliculitis

In this chapter, we will discuss the most common alopecias due to drugs and other skin and systemic disorders. The following hair disorders will be analyzed: telogen effluvium (acute and chronic); anagen effluvium; folliculotropic mycosis fungoides; and folliculitis due to bacteria, fungi, parasites, human immunodeficiency virus disease, lupus erythematosus, and sarcoidosis. We will cover topics including the epidemiology, etiology, clinical picture, and diagnosis of and current treatments for each disease.

Topics: Alopecia; Anticonvulsants; Antidepressive Agents; Antineoplastic Agents; Dermatologic Agents; Dermatomycoses; Diet; Folliculitis; Herpes Zoster; HIV Infections; Humans; Isotretinoin; Lamotrigine; Lithium Compounds; Lupus Erythematosus, Systemic; Malnutrition; Mycosis Fungoides; Paroxetine; Sarcoidosis; Seasons; Skin Neoplasms; Starvation; Stress, Psychological; Syphilis; Triazines; Valproic Acid

Acne vulgaris is a common skin disorder that affects most individuals at some point in their lives. It may result in significant morbidity, including cutaneous scarring and psychological impairment. Current treatments include topical retinoids, benzoyl peroxide, topical and systemic antibiotics, and systemic isotretinoin. There are growing concerns of rising antibiotic resistance, significant side effects of isotretinoin therapy, and lack of safe and effective treatment for pregnant females. Recent advances in the pathogenesis of acne have led to a greater understanding of the underlying inflammatory mechanisms and the role the Propionibacterium acnes and biofilms. This has led to the development of new therapeutic targets. This article reviews emerging treatments of acne, including topical picolinic acid, topical antibiotic dapsone, systemic zinc salts, oral antibiotic lymecycline, new formulations of and synergistic combinations of benzoyl peroxide, photodynamic therapy with topical photosensitizers and potential acne vaccines.

Topics: Acne Vulgaris; Acneiform Eruptions; Administration, Cutaneous; Administration, Topical; Anti-Bacterial Agents; Benzoyl Peroxide; Dose-Response Relationship, Drug; Female; Folliculitis; Humans; Isotretinoin; Practice Guidelines as Topic; Practice Patterns, Physicians'; Pregnancy; Quality of Life; Rosacea

Topics: Acne Vulgaris; Administration, Oral; Adult; Anti-Bacterial Agents; Female; Folliculitis; Humans; Hyperandrogenism; Isotretinoin; Keratolytic Agents; Male; Pyoderma; Sex Factors

Topics: Baths; Calcinosis; Cat-Scratch Disease; Child; Diabetes Mellitus, Type 1; Folliculitis; Foot Dermatoses; Herpes Simplex; Humans; Hyperhidrosis; Isomerism; Isotretinoin; Joint Diseases; Lyme Disease; Skin Diseases; Tinea; Tretinoin

In the one year since isotretinoin has been available in the United States for the treatment of severe, recalcitrant, nodulocystic acne, there has been extensive clinical verification of the reports of its dramatic efficacy in the treatment of this troublesome disease. Proper selection of patients, as well as treatment with adequate doses of drug for 3 to 5 months, will most often result in significant clinical improvement or total clearing. Although dosages of less than 1 mg/kg/day may produce a nearly equivalent degree of improvement with somewhat fewer or less severe side effects, the recommended daily dose remains 1 mg/kg/day because lower dosages are associated with more frequent relapses. In severe cases, the daily dosage may be increased to 2 mg/kg/day. Teratogenicity, elevation of serum triglycerides, liver function abnormalities, pancreatitis, and pseudotumor cerebri may all be associated with isotretinoin therapy and require close monitoring of the patient.

Topics: Abnormalities, Drug-Induced; Acne Vulgaris; Adolescent; Adult; Animals; Central Nervous System; Chemical and Drug Induced Liver Injury; Folliculitis; Humans; Isotretinoin; Middle Aged; Mucous Membrane; Musculoskeletal System; Rats; Skin Diseases; Sweat Gland Diseases; Tretinoin

Human immunodeficiency virus-associated eosinophilic folliculitis is a pruritic eruption seen in advanced infection with human immunodeficiency virus. The associated pruritus causes considerable morbidity and is poorly responsive to conventional therapy. We studied whether isotretinoin would prove efficacious in the treatment of human immunodeficiency virus-associated eosinophilic folliculitis. Seven patients with biopsy specimen-proved human immunodeficiency virus-associated eosinophilic folliculitis were treated with a mean of 7.7 weeks of isotretinoin therapy and their responses were monitored.. All patients responded with complete symptomatologic and clinical remission within 1 to 4 weeks of isotretinoin therapy. Four (57%) of seven patients remained in complete remission after just one course of isotretinoin therapy, while three (43%) of seven patients experienced up to three brief relapses, all rapidly responsive to further isotretinoin therapy. Patients remained free of disease for up to 9 months after therapy.. Isotretinoin appears to be a promising treatment for human immunodeficiency virus-associated eosinophilic folliculitis. A double-blind, placebo-controlled trial is indicated.

Topics: Adult; Eosinophils; Folliculitis; HIV Infections; Humans; Isotretinoin; Male; Pilot Projects

Good to excellent clinical results have been obtained in the treatment of severe inflammatory acne (acne conglobata, acne fulminans, and acne conglobata with hidradenitis and dissecting cellulitis of the scalp) with orally administered isotretinoin (13-cis-retinoic acid). Similar promising results have been obtained in patients with severe rosacea and gram-negative folliculitis. Isotretinoin probably has multiple modes of action, including (1) inhibition of sebaceous gland activity, (2) inhibition of the growth of Propionibacterium acnes within the follicle, although the retinoid is not antibacterial, (3) inhibition of inflammation, and (4) alteration of the pattern of keratinization within the follicle, as demonstrated by light and ultrastructural studies.

Topics: Acne Vulgaris; Adolescent; Adult; Clinical Trials as Topic; Enterobacteriaceae Infections; Female; Folliculitis; Humans; Isomerism; Isotretinoin; Male; Rosacea; Skin; Tretinoin

A new treatment for cystic fibrosis combining 3 CFTR modulators-elexacaftor (ELX), tezacaftor (TEZ), and ivacaftor (IVA)-has recently been approved for cystic fibrosis treatment. The cutaneous adverse effects following treatment with this combination are poorly described in the literature.. To describe the clinicopathological features and treatment response of ELX-TEZ-IVA-associated acneiform eruptions in patients with cystic fibrosis.. This case series study was conducted in the Dermatology Department of Cochin Hospital, Paris, France, from July 2021 to June 2022 in collaboration with the Cochin Reference Center for Cystic Fibrosis. Referred patients were examined by senior dermatologists. All patients with cystic fibrosis treated with ELX-TEZ-IVA and referred for an acneiform rash were included.. Treatment with ELX-TEZ-IVA.. Onset of acneiform rash, type of lesions, and degree of severity, as well as treatments initiated and response, were evaluated. When performed, skin biopsies were reviewed.. This study included 16 patients (11 women [68.7%]) with a median (range) age of 27 (22-38) years. Six patients (37.5%) developed new-onset acneiform rashes, whereas 10 patients (62.5%) had a relapse (5 patients) or worsening (5 patients) of previous acne. The median (range) onset of acneiform rash was 45 (15-150) days. At inclusion, 11 patients (68.7%) had facial hyperseborrhea, 15 patients (93.7%) had noninflammatory lesions, and 14 (87.5%) had inflammatory lesions of seborrheic regions. Four patients (25.0%) had severe acne with deep inflammatory lesions and pitted scars. A specific pathological pattern of necrotizing infundibular crystalline folliculitis was observed in 4 patients. Topical acne treatments, antibiotics, and isotretinoin were used successfully in these patients, resulting in partial or complete remission in 12 patients (85.7% of patients reevaluated).. This case series study found that acneiform eruption is an adverse event associated with ELX-TEZ-IVA treatment in patients with cystic fibrosis. Most patients developed mild lesions. However, isotretinoin treatment may be necessary in some patients. The mechanism of ELX-TEZ-IVA-associated acneiform eruption is currently unknown, but the observation of necrotizing infundibular crystalline folliculitis in biopsied patients may guide further exploration.

Topics: Acne Vulgaris; Acneiform Eruptions; Adult; Cystic Fibrosis; Cystic Fibrosis Transmembrane Conductance Regulator; Drug Combinations; Exanthema; Female; Folliculitis; Humans; Isotretinoin; Male; Mutation; Young Adult

Topics: Eosinophilia; Folliculitis; Humans; Isotretinoin; Skin Diseases, Vesiculobullous

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

Perifolliculitis capitis abscedens et suffodiens (PCAS) is a rare chronic inflammatory dermatosis of the scalp, which is a refractory and recrudescent disease. Symptoms of PCAS include follicular papules, suppurative nodules, cysts, sinuses, fistulas, and these usually evolve into patchy alopecia or cicatricial alopecia, which seriously affects the beauty and quality of life of patients. In this paper, we report 3 cases of PCAS each of whom received 5% 5-aminolevulinic acid-based photodynamic therapy (ALA-PDT) combined with isotretinoin. Fire needle intervention was used as a pretreatment for ALA-PDT. All pretreatments and ALA-PDT were well tolerated. All patients showed complete clearance of skin lesions and 1 patient attained significant improvement of symptoms after 1 month of treatment. No patients had recurrence with minimum one year follow up. This suggests that topical ALA-PDT pre-treated by fire needle combined with oral isotretinoin could be an eff ;ective, non-invasive, safe method with low recurrence for PCAS.

Topics: Folliculitis; Humans; Isotretinoin; Photochemotherapy; Photosensitizing Agents; Quality of Life; Scalp Dermatoses

Actinic folliculitis (AF) is a rare recurrent seasonal photodermatosis, relatively newly characterized by nonpruritic, monomorphic pustules and papules appearing 4-24 h after exposure to sunlight. Lesions usually affect the face but also appear on the upper chest and arms. Resolution normally occurs within 7-10 days with cessation of sunlight exposure. AF is resistant to standard treatments used for acne vulgaris and acne rosacea, with only oral retinoids previously being reported as effective. We report the first two cases, to our knowledge, of AF responding extremely effectively to a topical retinoid.

Topics: Adapalene; Administration, Topical; Adult; Anti-Inflammatory Agents, Non-Steroidal; Female; Folliculitis; Humans; Isotretinoin; Photosensitivity Disorders; Skin Diseases, Vesiculobullous; Sunlight

The literature includes only a few reports of oral isotretinoin for the treatment of folliculitis decalvans (FD). This study aimed to determine the most effective dose and duration of oral isotretinoin monotherapy for achieving remission in FD patients.. This retrospective case series study included FD patients that were treated with oral isotretinoin. Patient demographics, clinical characteristics, and treatment details were obtained from the patients' medical records. Patients were contacted via telephone after treatment was completed and asked about any relapses, time period of relapses, and the long-term effects of the treatment.. The study included 39 male patients with a mean age of 37.9 ± 15.5 years. All of the patients received oral isotretinoin 0.1-1.02 mg/kg/day (10-90 mg/day) for a median duration of 2.5 months (range: 1-8 months). In all, 82.0% of patients healed after the treatment. Patients that received oral isotretinoin ≥0.4 mg/kg/day for ≥3 months responded better, and 66% of them never relapsed.. Contrary to general belief, oral isotretinoin monotherapy resulted in complete response in the majority of patients in this study. Based on this finding, we think oral isotretinoin ≥0.4 mg/kg/day should be given for ≥3 months to minimize the likelihood of relapse. In addition, we think oral isotretinoin monotherapy should be considered a promising treatment alternative for FD that warrants further research.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Alopecia; Dermatologic Agents; Folliculitis; Humans; Isotretinoin; Male; Middle Aged; Recurrence; Remission Induction; Retrospective Studies; 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

Eosinophilic pustular folliculitis is a secondary symptom associated with HIV infection appears as levels of CD4 lymphocyte cells and T4 lymphocyte cell. Isotretinoin, an analog of vitamin A (retinoid) alters the DNA transcription mechanism and interferes in the process of DNA formation. It also inhibits the eosinophilic chemotactic factors present in sebaceous lipids and in the stratum corneum of patients suffering from this ailment.. The present research was aimed to formulate isotretenoin-loaded invasomal gel to deliver and target the drug to pilosebaceous follicular unit.. Nine invasomal formulations (F1-F9) were prepared applying 3. Formulation F9 was selected as optimized formulation due to optimum results and highest %CDP of 85.94 ± 1.86% in 8 h. Transmission electron microscopy (TEM) suggested uniformity in vesicles shape and size in F9 and developed as invasomal gel (IG).. Clinical phase-I, phase-II, and phase-III studies will be required before using on human patients.. Confocal laser scanning microscopy (CLSM) validates that IG successfully reaches the pilosebaceous follicular unit and further studied on cell line (SZ-95) exhibited IC50 of ≤8 (25 μM of isotretenoin). Cell cycle analysis confirmed IG arrested the cell growth up to 82% with insignificant difference to pure isotretenion.

Topics: CD4 Lymphocyte Count; Cell Cycle; Eosinophilia; Folliculitis; HIV Infections; Humans; Isotretinoin; Microscopy, Confocal; Skin Diseases, Vesiculobullous

Folliculitis decalvans leads to scarring alopecia through inflammatory destruction of the hair follicle. Currently, antibiotics are most commonly used to treat this disease. However, treatment regimens with antibiotics feature a high relapse rate and encourage the development of resistant bacteria.. To evaluate the outcome of different treatment options for folliculitis decalvans.. Retrospective study to compare the efficacy of different treatment regimens in 28 patients with folliculitis decalvans.. The success of treatment with clindamycin and rifampicin, clarithromycin, dapsone and isotretinoin was analysed. The evaluation of the combination of clindamycin and rifampicin showed the lowest success rate in achieving long-term remission, since 80% of the patients relapsed shortly after end of treatment. Clarithromycin and dapsone were more successful with long-term and stable remission rates of 33% and 43% respectively. Treatment with isotretinoin was the most successful oral treatment in our analysis with 90% of the patients experiencing stable remission during and up to two years after cessation of the treatment.. The common use of antibiotics as first-line therapy in folliculitis decalvans needs to be re-evaluated critically and oral isotretinoin should be considered as valid treatment alternative.

Topics: Administration, Oral; Adult; Anti-Bacterial Agents; Clindamycin; Dermatologic Agents; Drug Therapy, Combination; Female; Folliculitis; Follow-Up Studies; Humans; Isotretinoin; Male; Middle Aged; Retrospective Studies; Rifampin; Scalp Dermatoses; Treatment Outcome; Young Adult

Perifolliculitis capitis abscedens et suffodiens or dissecting cellulitis of the scalp is a rare, chronic destructive folliculitis of the scalp, characterized by painful nodules, purulent drainage, sinus tracts, keloid formation and cicatricial alopecia. The cause of the disease is unknown, but it is similar in many features to hidradenitis suppurativa and acne conglobata. In our case report, the patient's dermatologic appearance included one slightly erythematous, infiltrated alopecic area with draining lesions in the right parietal part of the scalp with a few alopecic areas in other parts of the scalp. The identification of the infectious agent, repeated swabs and KOH examination/or fungal cultures and tissue sampling for histopathologic analysis were necessary to confirm the diagnosis of perifolliculitis capitis abscedens et suffodiens. The patient received systemic antibiotics (azithromycin and amoxicillin-clavulanate) and oral antimycotic therapy (fluconazole), followed by a long period of oral isotretinoin with local skin care, which led to resolution and thus inhibited the evolution to scarring and nodular stage of the disease. Thus, such combined approach could be useful for other patients with these dermatologic problems.

Topics: Biopsy, Needle; Dermatologic Agents; Disease Progression; Folliculitis; Follow-Up Studies; Humans; Immunohistochemistry; Isotretinoin; Male; Scalp Dermatoses; Severity of Illness Index; Treatment Outcome; White People

Topics: Adult; Colitis, Ulcerative; Dermatologic Agents; Folliculitis; Humans; Isotretinoin; Male

Perifolliculitis capitis abscedens et suffodiens (PCAS) is a rare scalp disease of unknown etiology which is hard to treat. It is often accompanied by scarring alopecia, acne conglobata, and recurrent fluctuant abscesses. PCAS belongs to the family of acne inversa (hidradenitis suppurativa). A 19-year-old man presented with PCAS for 2 years; multiple systemic antibiotic therapies and surgical approaches had shown no effect. Monotherapy with isotretinoin 80 mg daily for 4 weeks had not been successful. Combination therapy with dapsone 100 mg and isotretinoin 80 mg daily produced significant improvement. During 4 weeks of treatment significant clearing was achieved. Dapsone was reduced to 50 mg daily after 6 months, while isotretinoin was discontinued gradually. Now the patient is on dapsone 50 mg every other day and has remained free of recurrences for 6 months.

Topics: Adult; Dapsone; Dermatologic Agents; Drug Therapy, Combination; Folliculitis; Humans; Isotretinoin; Male; Scalp Dermatoses; Treatment Outcome

Folliculitis decalvans of the scalp is a recurrent, purulent follicular inflammation leading to scarring alopecia. We report on a 27-year-old man with folliculitis decalvans successfully treated with a combination of isotretinoin, corticosteroids, and clindamycin.

Topics: Administration, Oral; Adult; Clindamycin; Dermatologic Agents; Drug Therapy, Combination; Folliculitis; Humans; Isotretinoin; Male; Prednisolone; Scalp Dermatoses; Staphylococcal Infections

We report a case of actinic folliculitis in a 29-year-old woman who presented with a 10-year history of a recurrent pustular eruption affecting her face, typically appearing 4-6 h after exposure to sunlight. Actinic follicuitis is a rare photodermatosis, which falls into the same spectrum as acne aestivalis and actinic superficial folliculitis.

Topics: Adult; Dermatologic Agents; Female; Folliculitis; Humans; Isotretinoin; Photosensitivity Disorders; Skin Diseases, Vesiculobullous; Sunlight; Treatment Outcome

Gram-negative folliculitis may be the result of long-term antibacterial treatment in acne patients. It is caused by bacterial interference and replacement of the Gram-positive flora of the facial skin and the mucous membranes of the nose and infestation with Gram-negative bacteria. These Gram-negative bacteria include Escherischia coli, Pseudomonas aeruginosa, Serratia marescens, Klebsiella and Proteus mirabilis. The occurrence of Gram-negative folliculitis should be considered in acne patients in whom oral treatment with tetracyclines has not resulted in a significant improvement of acne lesions after 3-6 months' treatment. The occurrence of Gram-negative folliculitis in acne patients is believed to be generally underestimated, since correct sampling and bacteriology is rarely performed by clinicians. Gram-negative folliculitis in acne and rosacea patients is best treated with isotretinoin (0.5-1 mg/kg daily for 4-5 months).

Topics: Dermatologic Agents; Folliculitis; Gram-Negative Bacteria; Gram-Negative Bacterial Infections; Humans; Isotretinoin

Topics: Abscess; Adult; Folliculitis; Humans; Isotretinoin; Male; Scalp Dermatoses; Staphylococcal Infections

We report a 16-year-old Turkish patient who developed disseminated and recurrent infundibulofolliculitis (DRIF) and responded well to systemic isotretinoin therapy after three months.

Topics: Administration, Oral; Adolescent; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Folliculitis; Follow-Up Studies; Humans; Isotretinoin; Keratolytic Agents; Recurrence; Severity of Illness Index; Skin Diseases, Vesiculobullous; Treatment Outcome; Turkey

Topics: Adult; Anti-Bacterial Agents; Citrobacter; Enterobacteriaceae Infections; Folliculitis; Humans; Isotretinoin; Male; Pyoderma; Recurrence; Staphylococcal Skin Infections

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

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

We report a case of localized granuloma annulare, successfully treated with isotretinoin, which occurred as a consequence of waxing-induced pseudofolliculitis. To our knowledge this is the first reported clearance of localized granuloma annulare with isotretinoin and the first reported case of granuloma annulare as a sequel to pseudofolliculitis.

Topics: Adult; Female; Folliculitis; Granuloma Annulare; Hair Removal; Humans; Isotretinoin; Keratolytic Agents; Leg Dermatoses; Treatment Outcome; Waxes

Gram-negative folliculitis is an infection with gram-negative rods that most often occurs as a complication of prolonged broad-spectrum antibiotic therapy in patients suffering from acne and rosacea.. The bacteriologic and immunologic findings are reported in 46 patients, 39 men and 7 women, aged 16-79 (median, 28) years, with gram-negative folliculitis. Hypersensitivity reactions to various microbial recall antigens as well as granulocyte functions were evaluated. Quantitative measurements of serum levels of immunoglobulin M, G, A, and E, total complement activity, complement factors C3 and C4, and alpha-1-antitrypsin were performed.. The gram-negative organisms most frequently cultivated from nares, facial skin, and pustules were Klebsiella spp., Escherichia coli, Enterobacter spp., and Proteus spp. In all patients, deviations of one or more immune parameters were detected, including lowered serum concentrations of immunoglobulin M and alpha-1-antitrypsin, and elevated levels of immunoglobulin E. The humoral and cellular parameters were not influenced by isotretinoin therapy of gram-negative folliculitis.. These findings suggest that gram-negative folliculitis is not only a complication of long-lasting antibiotic treatment of acne and rosacea, but might be an entity of its own. Immunologic factors may play a critical role in the pathogenesis of gram-negative folliculitis.

Topics: Adolescent; Adult; Aged; alpha 1-Antitrypsin; Complement C3; Complement C4; Female; Folliculitis; Follow-Up Studies; Gram-Negative Bacteria; Gram-Negative Bacterial Infections; Humans; Immunoglobulins; Isotretinoin; Keratolytic Agents; Male; Middle Aged; Skin; Treatment Outcome

Eosinophilic folliculitis (EF) is a chronic, intensely pruritic condition of unknown pathogenesis that causes marked morbidity in those HIV patients whom it affects. There is a wide differential diagnosis of itchy skin conditions in HIV which are amenable to different treatments. It is therefore essential to take a biopsy of each suspected case and examine multiple sections of the biopsy to confirm or refute a diagnosis of EF. Treatment of EF can be difficult but we hope that by suggesting a rational approach to this and considering possible therapeutic options more patients may be helped with this troublesome dermatosis.

Topics: Administration, Topical; Anti-Infective Agents; Anti-Inflammatory Agents; Antifungal Agents; Eosinophilia; Folliculitis; Glucocorticoids; Histamine H1 Antagonists; HIV Infections; Humans; Insecticides; Isotretinoin; Itraconazole; Keratolytic Agents; Metronidazole; Permethrin; Pyrethrins; Skin Diseases; Ultraviolet Therapy

Disseminated and recurrent infundibular folliculitis, henceforth referred to as D.R.I.F., is a very rare, puritic, follicular, benign disease of unknown etiology seen mostly in black males. It is often self-limited and usually unresponsive to local or systemic treatment. However, vitamin A, either alone or combined with vitamin E, is occasionally effective. We report a case of a patient with D.R.I.F. treated successfully with isotretinoin.

Topics: Administration, Oral; Adult; Biopsy; Exanthema; Exocytosis; Folliculitis; Follow-Up Studies; Humans; Isotretinoin; Keratolytic Agents; Lymphocytes; Male; Pruritus; Recurrence; Vitamin A; Vitamin E

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: Acquired Immunodeficiency Syndrome; Adult; Eosinophilia; Folliculitis; Humans; Isotretinoin; Keratolytic Agents; Male; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Axilla; Biopsy; Female; Folliculitis; Humans; Isotretinoin; Keratolytic Agents; Parakeratosis; Skin

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

Perifolliculitis capitis abscedens et suffodiens is a rare, chronic and suppurative scalp disease. The treatment of this condition is difficult. CASE REPORT. We report a case successfully treated with isotretinoin at the dose of 2/3 mg/kg/day during eight month. DISCUSSION. The main difficulty is the maintenance of remission after drug withdrawal, so, duration of treatment has to be defined. A eight month's therapy seems to constitute the minimum duration in this pathology. A second course of isotretinoin is still possible if relapse occurs. CONCLUSION. A long course of isotretinoin can be considered as the most effective treatment in perifolliculitis capitis abscedens et suffodiens.

Topics: Adult; Folliculitis; Humans; Isotretinoin; Male; Scalp Dermatoses; Suppuration; Treatment Outcome

Gram-negative folliculitis is one of the complications of antibiotic treatment of acne. Isotretinoin is recognized as extremely effective for this condition. We describe 2 patients with gram-negative folliculitis following antibiotic treatment for acne who improved after 3-months of treatment with isotretinoin.

Topics: Acne Vulgaris; Adult; Anti-Bacterial Agents; Folliculitis; Humans; Isotretinoin

Topics: Abscess; Adult; Alopecia; Folliculitis; Humans; Isotretinoin; Male; Scalp Dermatoses; Suppuration

Topics: Adult; Drug Therapy, Combination; Folliculitis; Humans; Isotretinoin; Male; Scalp Dermatoses; Triamcinolone Acetonide

Dissecting folliculitis of the scalp can develop into an extensive, hypertrophic scarred lesion that is unresponsive to routine treatment. In these situations, radical excision of the affected area and concurrent perioperative treatment with isotretinoin (13-cis-retinoic acid) may be effective. The authors describe a case, illustrating the successful clinical application of this technique.

Topics: Adult; Alopecia; Combined Modality Therapy; Folliculitis; Follow-Up Studies; Humans; Isotretinoin; Male; Scalp; Scalp Dermatoses; Surgical Flaps; Tissue Expansion

A 19-year-old man with severe acne developed extensive scalp folliculitis and later superficial pyoderma gangrenosum following treatment with isotretinoin. A cyclical neutropenia was noted and bone marrow findings suggested myelodysplasia. We believe that isotretinoin was implicated in the development of overt symptoms in this patient whose haematological condition was previously asymptomatic.

Topics: Abdominal Pain; Acne Vulgaris; Adult; Folliculitis; Humans; Isotretinoin; Male; Prednisolone; Pyoderma; Skin

The case of a 30-year-old man with a 6-year history of eosinophilic pustular folliculitis (EPF) is reported. Isotretinoin (1 mg/kg/day) led to a dramatic improvement of all the lesions within 2 weeks. The withdrawal of the drug was followed by a recurrence after 10 days of the papulopustular, follicular and pruritic lesions. Reintroduction of isotretinoin was successful. The benefits of isotretinoin in the treatment of EPF have, to the best of our knowledge, never been reported previously. The mechanisms underlying this efficacy may involve the inhibition of the eosinophilic chemotactic factors thought to be present in sebaceous lipids and in the stratum corneum of patients suffering from EPF.

Topics: Adult; Eosinophilia; Folliculitis; Humans; Isotretinoin; Male

Topics: Adult; Dapsone; Eosinophilia; Female; Folliculitis; Humans; Isotretinoin; Skin Diseases, Vesiculobullous

Two female patients with an identical facial eruption, consisting of severe outbreaks of folliculitic pustules occurring 6 to 24 h following periods of intense sun exposure and persisting for several days, are reported. Both failed to improve with standard acne treatments, but responded well to oral isotretinoin therapy.

Topics: Adult; Female; Folliculitis; Humans; Isotretinoin; Photosensitivity Disorders

Gram-negative folliculitis was first described in 1968 and had since given rise to numerous publications. To our knowledge, no case has yet been published in France, although we observed 6 of them in 12 months. Between March, 1985 and March, 1986, samples of pus for bacteriological examination were obtained from all our patients with acnea vulgaris resistant to the standard treatment (i.e. oral tetracycline combined with topical applications of tretinoin or benzoyl peroxide), thus enabling us to detect patients who had a Gram-negative bacillus (GNB) in at least one pustule. Inflammatory and painful episodes were noted in every case. Tetracyclines, initially effective, gradually lost their activity. The lesions were always limited to the face and consisted of: either superficial small pustules located in the naso-labial line and on the upper lip and chin, associated with inflammatory papulopustular lesions of the cheeks and perioral region; or deeply sited and painful nodules of the cheeks. Various GNBs of the lactose-fermenting Gram-negative rod group were isolated from the superficial lesions, and a Proteus mirabilis strain from the deep lesions. The GNB was never found in all samples but only in 1 to 3 pustules. Four patients were treated with antibiotics proved to be active in vitro against the responsible organisms, and their lesions disappeared within a fortnight. Two patients were given isotretinoin in doses of 1 mg/kg/day with a satisfactory result after 2 and 3 months respectively. The prevalence of Gram-negative folliculitis is probably underestimated. The clinical picture is stereotyped. GNBs are found in some pustules but rarely in all.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Acne Vulgaris; Adult; Female; Folliculitis; Gram-Negative Bacteria; Humans; Isotretinoin; Male; Tetracyclines

Topics: Adult; Eczema; Folliculitis; Humans; Isotretinoin; Male; Tretinoin

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

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

Topics: Adult; Female; Folliculitis; Humans; Isotretinoin; Malassezia; Tretinoin

A 20-year old man with steatocystoma multiplex and pseudofolliculitis barbae was treated unsuccessfully with oral isotretinoin. Consistent with findings from previous reports, treatment with isotretinoin should be reserved for patients with steatocystoma multiplex suppurativum.

Topics: Adult; Epidermal Cyst; Folliculitis; Humans; Isomerism; Isotretinoin; Male; Skin Diseases; Tretinoin

The clinical and bacteriological findings are reported in 13 patients with gram-negative folliculitis before, during, and after treatment with isotretinoin (13-cis-retinoic acid). Patients were treated for 14-36 weeks with a daily dose of 0.5-1.5 mg isotretinoin/kg body weight. Inflammatory lesions were counted before and during weeks 2, 4, 8, 12, 16, 20, 24, 28, and 30 of therapy and again up to 172 weeks after cessation of treatment. In all patients there was an impressive improvement in clinical symptoms, especially a decrease in seborrhea and inflammatory lesions. Simultaneously, the gram-negative bacteria disappeared from the facial skin. Full clinical bacteriological remission was achieved in 9 patients within a period of up to 43 months, with minor recurrences of the disease in the remaining 4 patients.

Topics: Adolescent; Adult; Bacterial Infections; Dermatitis, Seborrheic; Female; Folliculitis; Gram-Negative Bacteria; Humans; Isotretinoin; Male; Time Factors; Tretinoin

Isotretinoin has been found to be effective in the treatment of Gram-negative folliculitis. We investigated the direct in vitro antibacterial activity of isotretinoin against Gram-negative species. The concentrations of isotretinoin tested were two and ten times greater than the maximal levels attained in the sera of patients receiving oral isotretinoin. Regardless of the inoculum size, each organism tested grew as well in isotretinoin-containing media as it did in the control medium. These findings suggest that the efficacy of isotretinoin in patients with Gram-negative folliculitis is due to mechanisms other than direct antimicrobial action.

Topics: Bacterial Infections; Folliculitis; Gram-Negative Bacteria; Humans; In Vitro Techniques; Isotretinoin; Tretinoin

Topics: Adult; Folliculitis; Humans; Isotretinoin; Male; Scalp Dermatoses; Tretinoin

Thirty-two patients with gram-negative folliculitis were treated with 0.47 to 1.0 mg/kg/day of isotretinoin. Serial microbiologic evaluations demonstrated rapid clearing of the face and nasal mucosa of gram-negative rods. The clinical response was rapid, complete, and induced prolonged remissions. Twenty-six of thirty-two patients developed Staphylococcus aureus nasal carriage by the end of the 20-week treatment course. Isotretinoin has decided advantages over previously reported therapies for gram-negative folliculitis.

Topics: Acne Vulgaris; Bacterial Infections; Folliculitis; Gram-Negative Bacteria; Humans; Isomerism; Isotretinoin; Tretinoin

Topics: Folliculitis; Humans; Isotretinoin; Tretinoin

Topics: Acne Vulgaris; Adolescent; Adult; Anti-Inflammatory Agents; Female; Folliculitis; Humans; Isotretinoin; Male; Rosacea; Skin Diseases; Tretinoin

Topics: Bacterial Infections; Folliculitis; Humans; Isotretinoin; Tretinoin