isotretinoin and Hyperplasia

Sebaceous gland hyperplasia (SGH) is a benign cutaneous proliferation of the sebaceous glands that primarily affects the elderly group and frequently appears in individuals receiving long-term ciclosporin therapy such as organ transplant recipients. In the latter group, SGHs are usually multiple in number and occur predominantly on the face. Patients may find their appearance cosmetically undesirable and, in some cases, may result in significant negative psychological impact. There is, therefore, a demand for safe and effective treatment for SGH particularly in this patient group. A variety of treatment modalities have been previously described including electrodessication,surgery, cryotherapy, oral isotretinoin, lasers, and topical photodynamic therapy (PDT).. The objective of this paper is to review the various treatment modalities for SGH. We performed a systematic literature review using the National Library of Medicine's PubMed Database, whereby we included articles that met the following criteria: published in English, not focused on SGH in rhinophyma, studies with adult sample with SGH lesions, and studies with patients with SGH related to ciclosporin.. Our findings show that the literature is categorized according to the treatment modalities ranging from conventional techniques such as oral isotretinoin and cryotherapy to more advanced topical PDT, lasers and a combination of both. We found that effectiveness does not depend on the technique itself but instead on the number of lesions, financial cost, psychological factors, skin phototype and age.. Our work shows that SGH can be treated effectively by customizing the treatment modality according to different parameters, while effectively maintaining clearance of SGH lesions with best cosmetic outcome.

Topics: Adult; Aged; Humans; Hyperplasia; Isotretinoin; Photochemotherapy; Sebaceous Gland Diseases; Sebaceous Glands; United States

Presenile diffuse familial sebaceous hyperplasia (PDFSH) presents as extensive yellowish papules with central umbilication on the face without involvement of periorificial regions and occurs in adolescents or young adults with a positive family history. Thirteen cases of PDFSH have been reported in the English-language published work, 10 of which responded to oral isotretinoin from 0.5 to 1 mg/kg per day but recurrences were often observed. Herein, we report two cases of PDFSH, which were successfully managed without recurrence with prolonged low-dose isotretinoin (0.2 mg/kg per day, a cumulative dose of 41 and 64 mg/kg, respectively). Treatment protocols among different published works were reviewed to verify the efficacy of isotretinoin.

Topics: Administration, Cutaneous; Administration, Oral; Adult; Anti-Bacterial Agents; Biopsy; Cheek; Clinical Protocols; Dermatologic Agents; Facial Dermatoses; Female; Fluticasone; Humans; Hyperplasia; Isotretinoin; Maintenance Chemotherapy; Male; Recurrence; Sebaceous Glands; Treatment Outcome; Tretinoin

Hypertrophic lupus erythematosus (HLE) produces not only disfiguring and long-lasting skin changes, but also proves to be particularly resistant to therapy. In a patient with a disease refractory to conventional therapy, we observed a predominantly CD4+ T cell infiltrate that we sought to target therapeutically.. The patient was treated with the CD11a-directed monoclonal antibody efalizumab together with 10 mg isotretinoin and 5 mg prednisone.. Within 6 months, the inflammatory hyperkeratotic plaques were almost completely healed, with minimal residual erythema and scarring. The cutaneous lupus activity and severity index score decreased from 8 to 4 of a total of 14 points, and pseudoepitheliomatous hyperplasia and CD4 T cell infiltrates within the lesions were reduced.. HLE features interface dermatitis and epidermal hyperplasia, which are both explainable by T-cell-mediated immunologic effects. Correspondingly, our case responded well to the treatment with efalizumab. While the withdrawal of efalizumab from the market leaves patients with psoriasis many other options for effective therapy, it disproportionately affects patients with T-cell-mediated orphan diseases like refractory HLE.

Topics: Adult; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; CD4-Positive T-Lymphocytes; Dermatologic Agents; Drug Therapy, Combination; Humans; Hyperplasia; Isotretinoin; Lupus Erythematosus, Cutaneous; Male; Prednisone; Treatment Outcome

Topics: Administration, Oral; Biopsy; Face; Facial Dermatoses; Female; Humans; Hyperplasia; Isotretinoin; Neck; Pseudoxanthoma Elasticum; Sebaceous Glands; Skin; Treatment Outcome; Young Adult

Topics: Adenoma; Dermatologic Agents; Facial Dermatoses; Humans; Hyperplasia; Isotretinoin; Male; Middle Aged; Sebaceous Gland Neoplasms; Sebaceous Glands; Treatment Outcome

Topics: Dermatologic Agents; Humans; Hyperplasia; Isotretinoin; Lasers, Gas; Maintenance Chemotherapy; Male; Middle Aged; Sebaceous Glands; Secondary Prevention

We present two cases of cyclosporine-induced sebaceous hyperplasia in renal transplant recipients, successfully treated with isotretinoin. Both patients tolerated isotretinoin well, with no alteration in graft function. These cases provide support for the safe and effective use of oral isotretinoin in the treatment of cyclosporine-induced sebaceous hyperplasia in the kidney transplant population.

Topics: Adult; Cyclosporine; Dermatologic Agents; Facial Dermatoses; Humans; Hyperplasia; Immunosuppressive Agents; Isotretinoin; Kidney Transplantation; Male; Middle Aged; Sebaceous Glands

Sebaceous hyperplasia is a common benign lesion composed of sebaceous glands. It is characterized as yellow or flesh-toned papules with central umbilication. The authors report the case of a 57-year-old Caucasian female with a longstanding history of sebaceous hyperplasia refractory to treatment on her face. Isotretionoin was used as an alternative therapy and was found to be effective.

Topics: Dermatologic Agents; Female; Humans; Hyperplasia; Isotretinoin; Middle Aged; Sebaceous Glands

Vitamin A and its derivatives (retinoids) are capable of inhibiting vascular smooth muscle cell proliferation in vitro. The present study examines the effect of two retinoids, all-trans retinoic acid and 13-cis retinoic acid, on intimal hyperplasia following arterial injury. After receiving varying doses of all-trans retinoic acid or 13-cis retinoic acid, 78 male Sprague-Dawley rats underwent standard balloon catheter denudation of the left common carotid artery. Morphometric analysis and immunohistochemistry for proliferating cell nuclear antigen was performed at early and late time points. Intimal/medial ratios were reduced in a dose-dependent fashion for animals treated with all-trans retinoic acid (P = 0.001) and 13-cis retinoic acid (P = 0.004). Proliferating cell nuclear antigen labeling indices were reduced after treatment with all-trans retinoic acid and 13-cis retinoic acid at early time points post-injury. At a dose of 10 mg/kg, both all-trans retinoic acid and 13-cis retinoic acid inhibited vessel remodeling as measured by increases in luminal diameter (P < 0.05) and external elastic lamina (P < 0.05). Retinoids are an attractive clinical option for the treatment of restenosis following angioplasty and arterial surgery.

Topics: Animals; Carotid Artery Injuries; Carotid Artery, Common; Catheterization; Hyperplasia; Isotretinoin; Male; Proliferating Cell Nuclear Antigen; Rats; Rats, Sprague-Dawley; Tretinoin; Tunica Intima

Familial sebaceous gland hyperplasia is a benign entity with onset at puberty and a tendency to worsen with age. It is characterized by a nevoid symmetric pattern in the sebaceous areas of the face sparing the orbital, perinasal, preauricular and perioral areas showing prominent follicular openings and interfollicular dermal yellowish or white prominent skin. Usually, the face is affected, with the neck, column and thorax affected in a milder pattern. We describe a family with familial nevoid sebaceous gland hyperplasia in three consecutive generations. All the patients were successfully treated with oral isotretinoin. The pedigree suggests autosomal dominant inheritance with incomplete penetrance.

Topics: Adult; Female; Humans; Hyperplasia; Isotretinoin; Male; Middle Aged; Pedigree; Sebaceous Gland Diseases

Topics: Adult; Facial Dermatoses; Follow-Up Studies; Humans; Hyperplasia; Isotretinoin; Keratolytic Agents; Laser Therapy; Male; Neoplasms, Multiple Primary; Recurrence; Retreatment; Sebaceous Gland Neoplasms; Sebaceous Glands; Syndrome; Telangiectasis

Topics: Administration, Oral; Adult; Chronic Disease; Erythema; Facial Dermatoses; Female; Humans; Hyperplasia; Hypertrophy; Isotretinoin; Keratolytic Agents; Male; Middle Aged; Sebaceous Glands

Although retinoids have proven to be effective as chemopreventive agents in reversing premalignant oral lesions and preventing second primary tumors, their mechanisms of chemopreventive efficacy in clinical settings have not been established. To better define this mechanism, we studied p53 protein and retinoic acid receptor beta (RAR-beta) expression in 52 baseline biopsy samples taken from premalignant oral lesions. We then studied p53 expression in 39 matched samples and RAR-beta expression in 38 matched samples before and after treating them with isotretinoin. The study results were then compared with clinical responses. To detect p53 protein expression, 4-micrometer sections of formalin-fixed, paraffin-embedded tissue specimens were used for immunohistochemical analysis with a monoclonal anti-p53 antibody, and levels of p53 expression were recorded with a labeling index (LI). Expression of RAR-beta mRNA was determined using nonradioactive in situ hybridization, and the staining intensity of RAR-beta mRNA was semiquantitated using scores from 0 (no expression) to 3+ (highest expression). p53 protein was detected in 85% of all lesions. High p53 protein expression (LI >/= 0.2) was detected in 25% of the lesions at baseline and in 18% of the lesions after isotretinoin therapy. The clinical response was 65% for lesions having low p53 expression (LI < 0.2) and 27% for lesions having high p53 expression (P = 0.027). Expression of RAR-beta mRNA was detected in 40% of the patients at baseline and increased to 90% of the patients after isotretinoin therapy (P < 0. 001). Seventy-two percent of the patients having low p53 expression had no RAR-betamRNA expression at baseline, whereas 22% of the patients having high p53 expression had no RAR-beta expression, which suggests that patients having low p53 expression tended to lose RAR-beta mRNA expression in their tissues. Eighty-three percent of patients having low p53 expression had up-regulation of RAR-beta mRNA after isotretinoin therapy, compared with 22% of patients with high p53 expression (P = 0.003). We correlated baseline p53 protein expression with RAR-beta modulation and clinical responses to isotretinoin therapy. The patients with low p53 protein expression at baseline and up-regulation of RAR-beta after isotretinoin therapy achieved a 70% rate of major response. The patients with low p53 protein expression and either no change or down-regulation of RAR-beta or with high p53 expression and up-regulation o

Topics: Adult; Aged; Aged, 80 and over; Anticarcinogenic Agents; Chemoprevention; Female; Humans; Hyperplasia; In Situ Hybridization; Isotretinoin; Leukoplakia; Male; Middle Aged; Mouth Neoplasms; Receptors, Retinoic Acid; RNA, Messenger; Transcription, Genetic; Tumor Suppressor Protein p53

We report a 43-year-old woman with sebaceous gland hyperplasia that occurred in a diffuse pattern of aggregated papular lesions involving her entire face, neck, and upper chest. Comedones, pustules, and inflammatory papules were absent. The eruption was accompanied by marked seborrhea. Histopathological examination showed enlargement of sebaceous acini, an increased number of immature sebocytes in foci, and a dilated follicular infundibulum. Immunohistochemical investigation showed cytokeratin 14 (CK 14) expression in the keratinocytes of the infundibulum, the isthmus, and sebaceous duct and in the mature and immature sebocytes; CK 17 expression in the keratinocytes of the sebaceous duct; CK 1 expression in the keratinocytes of the infundibulum; and an enhanced expression of the proliferation cell antigen Ki-67 (MiB1) in the immature sebocytes. With CK 18 and CK 19, no staining was observed. Oral therapy with isotretinoin (13-cis-retinoic acid) resulted in remarkable improvement in < or = 3 months. Histopathological and immunohistochemical examination after therapy showed markedly reduced sebaceous glands, a decrease in the staining of MiB1-positive immature sebocytes, and enhanced expression of CK 19 in immature sebocytes and sebaceous duct cells. Diffuse sebaceous gland hyperplasia is a rare variant of seboglandular proliferative disorders that is distinct from the well-known circumscribed type.

Topics: Administration, Oral; Adult; Cytokines; Dermatitis, Seborrheic; Face; Female; Gene Expression Regulation, Neoplastic; Hair Follicle; Humans; Hyperplasia; Immunohistochemistry; Isotretinoin; Keratinocytes; Keratolytic Agents; Neck; Sebaceous Glands; Thorax

We report the case of a young man with extreme sebaceous gland hyperplasia that occurred in a diffuse pattern of aggregated papular lesions involving the entire face, neck and upper chest, together with marked seborrhoea oleosa. Oral therapy with 13-cis-retinoic acid (isotretinoin) resulted in remarkable improvement within a few weeks. Parallels from our case are drawn to familial sebaceous hyperplasia, reported by Dypre et al. in 1980 [6], and to a case of a young man with severe sebaceous gland hyperplasia and facial seborrhoea, reported by de Villez et al. in 1982. We suggest that these types of seboglandular proliferative disorders be classified as diffuse (presenile) sebaceous gland hyperplasia in contrast to the well-defined senile circumscribed variant, and that they be regarded as a separate entity.

Topics: Adult; Humans; Hyperplasia; Isotretinoin; Male; Sebaceous Glands; Skin Diseases; Tretinoin

Hyperplasia of sebaceous glands is a common cause of papulonodular facial lesions that occur in middle-aged and older patients. Recently, several cases of premature sebaceous gland hyperplasia have been reported. In these patients the lesions had persisted despite vigorous attempts at therapy. We present a case of premature sebaceous gland hyperplasia that was successfully treated with isotretinoin.

Topics: Adult; Dermatologic Agents; Humans; Hyperplasia; Isotretinoin; Male; Sebaceous Glands; Skin Diseases; Tretinoin

Two cases of diffuse multiple lesions of sebaceous hyperplasia of the face are reported. The results of both medical and surgical therapies had been unsatisfactory. The patients were treated with low dose systemic isotretinoin (13-cis-retinoic acid) which resulted in complete clearing in one case and substantial clearing in the second. We suggest that in those patients cosmetically bothered by diffuse multiple lesions of sebaceous hyperplasia, for which other therapies are unsuccessful or unamenable to the patient, isotretinoin offers a safe, rational therapeutic option.

Topics: Aged; Facial Dermatoses; Humans; Hyperplasia; Isotretinoin; Male; Middle Aged; Sebaceous Glands; Skin Diseases; Tretinoin

Topics: 9,10-Dimethyl-1,2-benzanthracene; Animals; Antineoplastic Agents; Benzoates; Cell Differentiation; Cell Division; Guinea Pigs; Humans; Hyperplasia; In Vitro Techniques; Isotretinoin; Neoplasms, Experimental; Rabbits; Retinoids; Skin; Skin Neoplasms; Tretinoin; Vitamin A

Topics: Female; Humans; Hyperplasia; Isotretinoin; Middle Aged; Sebaceous Glands; Skin Diseases; Tretinoin