isotretinoin and Hand-Dermatoses

Nail changes occur in about 25% of systemic lupus erythematosus (SLE) cases. Onycholysis has been reported as the most frequent abnormality in SLE. Nailbed hyperkeratosis may be observed in both SLE and discoid lupus erythematosus (DLE). Involvement of the nail apparatus in DLE is extremely uncommon and never restricted to it. We report on a patient in whom the clinical features on the proximal nailfold were similar to those observed on the skin of a patient with typical DLE. This has, to the best of our knowledge, not yet been reported. The patient also exhibited a very distinctive prominent subungual hyperkeratosis. Interestingly, the patient developed biological alterations suggesting a systematization of the disease. Only a combination of systemic corticoids, retinoids and antimalarials was able to achieve nail improvement and this partial resistance to therapy may be explained by the very unusual subungual hyperkeratosis.

Topics: Dermatologic Agents; Diagnosis, Differential; Drug Therapy, Combination; Fingers; Hand Dermatoses; Humans; Hydroxychloroquine; Isotretinoin; Lupus Erythematosus, Discoid; Lupus Erythematosus, Systemic; Male; Methylprednisolone; Middle Aged; Nail Diseases

Topics: Administration, Oral; Adult; Female; Granuloma Annulare; Hand Dermatoses; Humans; Isotretinoin; Leg Dermatoses

We present two patients who developed pseudoporphyria whilst taking isotretinoin (Roaccutane). At that time, both patients were receiving other agents which could be incriminated as causing their pseudoporphyria. However, it is significant that these other agents had been longstanding and that the porphyria-like cutaneous changes did not develop until after the introduction of the isotretinoin (Roaccutane). In both cases, withdrawal of the isotretinoin resulted in clinical improvement of their cutaneous signs. The interaction of isotretinoin and another agent, rather than isotretinoin independently, may be involved in the development of pseudoporphyria.

Topics: Adult; Female; Hand Dermatoses; Humans; Isotretinoin; Male; Porphyrias

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