isotretinoin and Granuloma

Three male patients with severe nodulocystic acne were treated with oral isotretinoin in a dosage of 0.5 to 1.0 mg/kg/day. A flare of their disease developed, characterized by an inflammatory, hemorrhagic, pyogenic, granuloma-like response of previously crusted acne lesions. This reaction occurred between the sixth and ninth weeks of treatment and was confined entirely to the chest and back. The severity of the reaction prompted the administration of oral prednisone and, in two cases, the discontinuation of isotretinoin therapy. In one patient, pyoderma gangrenosum developed on the thigh. The exact incidence of this pyogenic, granuloma-like reaction to isotretinoin is unknown, although we have seen it in three of 66 patients with nodulocystic acne treated with this drug. The cause of the reaction is unknown, but it may be due to the increased skin fragility and vascular proliferation known to be induced by isotretinoin.

Topics: Acne Vulgaris; Administration, Oral; Adult; Double-Blind Method; Drug Eruptions; Granuloma; Hemorrhage; Humans; Isotretinoin; Male; Pyoderma; Skin Ulcer; Tretinoin

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

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

Granulomatous periorificial dermatitis is a clinical variant of periorificial dermatitis. We present the case of an 18-year-old girl with several reddish papular lesions in the perioral, perinasal, and periorbital regions unresponsive to conventional therapy. After 6 months of therapy with low-dose oral isotretinoin, the lesions fully remitted.

Topics: Administration, Oral; Adolescent; Dermatitis, Perioral; Dermatologic Agents; Dose-Response Relationship, Drug; Female; Granuloma; Humans; Isotretinoin

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

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

Topics: Adrenal Cortex Hormones; Adult; Aged; Anti-Bacterial Agents; Breast Diseases; Colchicine; Diabetes Mellitus, Type 2; Drug Resistance; Female; Granuloma; Humans; Hypertension; Immunosuppressive Agents; Isotretinoin; Male; Pyoderma Gangrenosum; Remission Induction; Tacrolimus

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

Acne rosacea is a common dermatologic condition which is usually diagnosed by its clinical presentation. This article describes an unusual presentation of acne rosacea and the diagnosis of this condition using fine-needle aspiration biopsy. To our knowledge, the fine-needle aspiration findings of acne rosacea have not been previously described and illustrated in the cytology literature.

Topics: Adult; Biopsy, Needle; Connective Tissue; Female; Granuloma; Humans; Isotretinoin; Rosacea

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

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

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

A case of excess granulation tissues in a patient treated with isotretinoin by a severe cystic acne is reported. Other cases described in the literature are reviewed.

Topics: Acne Vulgaris; Adolescent; Granulation Tissue; Granuloma; Humans; Isotretinoin; Male; Skin Diseases; Tretinoin

Four weeks after the introduction of a therapeutic regimen with 80 mg 13-cis-retinoic acid/day, a 16-year-old male patient developed oozing hypergranulation with vulnerable masses within acne lesions. These local symptoms were accompanied by fever, fatigue, weight loss, polyarthralgia and myalgia, similar to acne fulminans. In spite of these unusual reactions treatment was continued. Local steroid ointments were additionally applied. Within a short period of time regression of granulations and normalization of the general health condition was observed. After 4 months, therapy was discontinued. The patient's acne had totally healed and did not relapse within an observation period of 2 years.

Topics: Acne Vulgaris; Administration, Topical; Adolescent; Granulation Tissue; Granuloma; Humans; Isotretinoin; Male; Skin Diseases; Tretinoin; Wound Healing

This paper reports on the association of two uncommon side effects of isotretinoin therapy for cystic acne: paronychia and excess granulation tissue in the nail sulci. An explanation for these side effects is suggested, but the exact pathogenesis remains obscure.

Topics: Acne Vulgaris; Adult; Female; Granuloma; Humans; Isotretinoin; Nail Diseases; Paronychia; Tretinoin

Disseminated granuloma annulare is often a chronic disorder that may prove refractory to treatment and lead to prolonged cosmetic disfigurement. In a patient with disseminated granuloma annulare that was unresponsive to multiple therapeutic regimens, administration of isotretinoin resulted in rapid clearing of nearly all lesions. To our knowledge this is the first reported case in which this agent was used to treat disseminated granuloma annulare.

Topics: Female; Granuloma; Humans; Isotretinoin; Middle Aged; Skin; Skin Diseases; Tretinoin

Topics: Adrenal Cortex Hormones; Granuloma; Humans; Isotretinoin; Occlusive Dressings; Tretinoin

Topics: Acne Vulgaris; Adolescent; Granuloma; Humans; Isotretinoin; Male; Time Factors; Tretinoin

Topics: Acne Vulgaris; Adolescent; Chronic Disease; Follow-Up Studies; Granuloma; Humans; Isotretinoin; Male; Skin Diseases; Tretinoin

Topics: Adolescent; Drug Eruptions; Granuloma; Humans; Isotretinoin; Male; Tretinoin

Topics: Adolescent; Granuloma; Humans; Isomerism; Isotretinoin; Male; Paronychia; Skin Diseases; Tretinoin

In our clinical trials of isotretinoin therapy for cystic acne and etretinate treatment of psoriasis, eight patients had growth of excessive granulation tissue. The granulation tissue was found in resolving acne lesions in one patient taking isotretinoin. Among the psoriatic patients taking etretinate, the granulation tissue usually was seen adjacent to nail plates. In two patients, the side effect caused them to stop retinoid therapy. The tissue response did not appear to be related to the daily or cumulative retinoid dose.

Topics: Acne Vulgaris; Adolescent; Adult; Aged; Granulation Tissue; Granuloma; Humans; Isotretinoin; Male; Middle Aged; Psoriasis; Skin Diseases; Tretinoin