isotretinoin and Hemorrhage

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: Adolescent; Adult; Anus Diseases; Drug Eruptions; Dyspareunia; Female; Genital Diseases, Female; Genital Diseases, Male; Hemorrhage; Humans; Isotretinoin; Male; Middle Aged; Mucositis; Sebaceous Glands; Young Adult

Isotretinoin is a vitamin A derivative used for serious acne that is refractory to other modes of treatment. The most common side effects include dryness of the skin and mucous membranes. Itching as a result of neurological, hematological and ocular side effects has also been reported. Here, we present a 19-year-old female patient who developed premacular hemorrhage and consequent loss of vision in the left eye after oral use of isotretinoin. To the best of our knowledge, this is the first report of the development of premacular hemorrhage as a result of isotretinoin use.

Topics: Acne Vulgaris; Adult; Blindness; Dermatologic Agents; Eye Diseases; Female; Hemorrhage; Humans; Isotretinoin; Young Adult

Topics: Acne Vulgaris; Adolescent; Factor VIII; Hemophilia A; Hemorrhage; Humans; Isotretinoin; Male