isotretinoin and HIV-Infections

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

The connection between P. ovale and seborrhoeic dermatitis has been clearly demonstrated in a number of treatment studies but we still do not know how P. ovale induces skin lesions. An enhanced growth of P. ovale cannot be the cause, because a number of studies with quantitative determinations of P. ovale have not been able to show any difference in the number of yeast cells between patients and healthy controls. The number of P. ovale is probably only important for the individuals who are susceptible to seborrhoeic dermatitis. An abnormal immune response to P. ovale could be another explanation. Sohnle et al. have shown that P. ovale can activate complement by both the classical and the alternative pathway. A defective cell-mediated immunity to P. ovale in patients with seborrhoeic dermatitis has been demonstrated by Wikler et al. In patients with AIDS, who are known to have a diminished T-cell function, a high incidence of seborrhoeic dermatitis has been found. Activation of the alternative complement pathway by P. ovale, which does not require T-cell function, could be an explanation for the inflammatory response. I also believe that the skin lipids are important in the pathogenesis. An improvement of seborrhoeic dermatitis has been demonstrated after treatment with drugs that reduce the sebum excretion. Pityrosporum has lipase activity and may generate free fatty acids, which could also contribute to the inflammatory response. There are a number of factors which are probably important in the pathogenesis of seborrhoeic dermatitis, that is, the number of P. ovale, P. ovale lipase activity, skin lipids, immune function, heredity, atmospheric humidity and emotional state. A reduction in the number of P. ovale in patients suffering from seborrhoeic dermatitis and being treated with antimycotic treatment is, at the present state of knowledge, the best way to treat the disease.

Topics: Acquired Immunodeficiency Syndrome; Adrenal Cortex Hormones; Dermatitis, Seborrheic; HIV Infections; Humans; Imidazoles; Incidence; Isotretinoin; Malassezia; Mental Disorders; Occupational Diseases; Organometallic Compounds; Prevalence; Propylene Glycol; Propylene Glycols; Pyridines; Selenium Compounds; Succinates; Ultraviolet Therapy

Topics: Adult; Aged; Antiretroviral Therapy, Highly Active; Female; Follow-Up Studies; HIV Infections; Humans; Hysterectomy; Isotretinoin; Middle Aged; Neoplasm Recurrence, Local; New Orleans; Socioeconomic Factors; Treatment Outcome; Uterine Cervical Dysplasia

Topics: Administration, Oral; Adolescent; Adult; Disease Progression; Drug Administration Schedule; Female; HIV Infections; Humans; Isotretinoin; Neoplasms, Squamous Cell; Uterine Cervical Neoplasms

To estimate the efficacy of isotretinoin for prevention of progression of low-grade squamous intraepithelial lesions (SIL) of the cervix to high-grade lesions or invasive cervical cancer; to estimate the regression rate of low-grade SIL with isotretinoin and the toxicity of isotretinoin in this setting; and to correlate serum CD4 levels with progression of low-grade SIL.. A randomized, phase III, observation-controlled, multicenter trial was performed in which 117 human immunodeficiency virus (HIV)-positive women with low-grade SIL of the cervix received either oral isotretinoin at 0.5 mg/kg per day for 6 months or observation. Papanicolaou smears and colposcopy/biopsy were done at regular intervals during follow-up. The primary endpoint was progression to high-grade SIL or cervical cancer.. Twenty-one of 102 women (20.6%) completing follow-up experienced progression to high-grade SIL, 13 in the observation group and eight in the isotretinoin group. This difference was not significant (P =.29). No cases of invasive cancer were seen. Baseline CD4 levels were lower than anticipated (median 329 cells/mm(3)), but not associated with time to progression (P =.36). Most subjects (63 of 102, 61.7%) used highly active antiretroviral therapy. Subjects under age 30 were more likely to progress than those older than 30 (P =.046).. Isotretinoin was not associated with longer time to progression of low-grade SIL. This appears to be a chronic condition in HIV-positive women, with a low risk of progression and significant rate of resolution. As in the general population, observation without excisional therapy may be appropriate for HIV-positive women with low-grade SIL.

Topics: Adult; CD4 Lymphocyte Count; Disease Progression; Female; HIV Infections; Humans; Isotretinoin; Uterine Cervical Dysplasia; Uterine Cervical Neoplasms

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

Topics: Exanthema; HIV Infections; Humans; Isotretinoin; Scleromyxedema

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

The purpose of this study was to determine whether the progression of low-grade squamous intraepithelial lesions of the cervix in women with the human immunodeficiency virus can be predicted reliably by standard cytologic testing.. As part of a previously reported trial, 288 biopsy specimens were collected from 117 women with the human immunodeficiency virus. These specimens underwent central and local interpretation, which were compared and correlated with cytologic results. Ninety-two subjects had matched cytologic/histologic pairs at study termination, which were compared to determine whether cytologic testing was predictive of progression.. Of the central histologic interpretations, 26 of 288 interpretations (9%) differed from local results, 97 of 246 cytologic/histologic pairs (39%) were discordant, and 21 subjects had progression to high-grade squamous intraepithelial lesions by histologic evidence. Cytologic testing showed high-grade squamous intraepithelial lesions in 4 of 21 specimens (sensitivity, 19%). The remaining cytologic specimens were either low-grade squamous intraepithelial lesions or were normal.. This substudy of pathologic results from a randomized clinical trial suggests that, although the risk of progression of low-grade squamous intraepithelial lesions is low, follow-up cytologic testing is unreliable. Colposcopic evaluation with directed biopsies should be continued.

Topics: Antineoplastic Agents; Biopsy; Carcinoma, Squamous Cell; Cervix Uteri; Clinical Trials, Phase III as Topic; Colposcopy; Disease Progression; Female; Follow-Up Studies; HIV Infections; Humans; Isotretinoin; Predictive Value of Tests; Prognosis; Randomized Controlled Trials as Topic; Uterine Cervical Dysplasia; Uterine Cervical Neoplasms; Vaginal Smears

Topics: Acne Vulgaris; Anti-HIV Agents; Drug Therapy, Combination; HIV Infections; HIV-1; Humans; Indinavir; Isotretinoin; Reverse Transcriptase Inhibitors

Topics: Adult; Anti-HIV Agents; Drug Interactions; HIV Infections; HIV Protease Inhibitors; Humans; Isotretinoin; Keratolytic Agents; Lipodystrophy; Male; Receptors, Retinoic Acid

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