isotretinoin and Inflammation

Acne fulminans (AF) is a rare and severe form of inflammatory acne presenting clinically with an abrupt outburst of painful, hemorrhagic pustules and ulceration, that may or may not be associated with systemic symptoms, such as fever, polyarthritis, and laboratory abnormalities. It typically affects male teenagers with a pre-existing acne. Although the pathogenetic mechanism has not been established yet, a role of genetic, abnormal immunologic response, drugs intake, hormonal imbalance and viral infection, as causal factors, has been identified. AF may occur as a single disease or may be associated with other disorders. Traditionally, AF has been classified, on the basis of the presence of systemic involvement, in "acne fulminans" and acne fulminans "sine fulminans," when no systemic involvement is present. Recently, four clinical variants have been proposed: acne fulminans with systemic symptoms (AF-SS), acne fulminans without systemic symptoms (AF-WOSS), isotretinoin-induced acne fulminans with systemic symptoms (IIAF-SS), isotretinoin-induced acne fulminans without systemic symptoms (IIAF-WOSS). The diagnosis of AF is usually based on clinical history and physical examination. No specific laboratory abnormalities are generally found. In selected cases, biopsy and/or radiologic imaging are helpful for a correct diagnosis. The treatment significantly differs from severe acne according to severity of clinical presentation and possible systemic involvement. Currently, systemic corticosteroids (prednisolone) and retinoids (isotretinoin) represent the first choice of treatment. Dapsone, cyclosporine A, methotrexate, azathioprine, levamisole, and biological agents such as anakinra, infliximab, adalimumab may be considered as alternative therapies in selected cases. Adjunctive topical and physical therapies may also be considered.

Topics: Acne Vulgaris; Acquired Hyperostosis Syndrome; Adolescent; Adrenal Cortex Hormones; Adult; Androgens; Anti-Inflammatory Agents; Arthralgia; Combined Modality Therapy; Debridement; Dermatologic Agents; Diagnosis, Differential; Disease Progression; Female; Humans; Immunosuppressive Agents; Inflammation; Isotretinoin; Lasers, Dye; Low-Level Light Therapy; Male; Photochemotherapy; Propionibacteriaceae; Retinoids; Symptom Assessment; Young Adult

The central role of inflammation in acne is now more clearly understood. Adapalene, a third-generation topical retinoid, down-regulates toll-like receptor 2 expression and inhibits activator protein-1 activity. In a fixed-dose combination, adapalene and benzoyl peroxide (BPO) act synergistically on inflammatory patterns through regulation of innate immunity. In addition to reducing inflammatory and non-inflammatory lesions, adapalene/BPO helps prevent lesion and microcomedone formation. The combination of a topical retinoid and antimicrobial agent remains the preferred approach for almost all patients with acne. In cases of more severe disease, there is a clinical benefit in combining adapalene/BPO with an oral antibiotic for 12 weeks. Most recently, adapalene/BPO plus doxycycline 200 mg was found to be highly effective when compared with isotretinoin in the treatment of patients with severe acne with nodules. Long-term maintenance therapy is needed for most patients. Retinoids are the preferred agents, with BPO added in patients with more severe disease if needed. Adapalene is anticomedogenic, reduces comedones and has anti-inflammatory properties, while BPO is a unique antimicrobial agent not shown to induce microbial resistance after more than 50 years of use. Maintenance therapy for 6 months with adapalene/BPO prevents relapse among patients with severe acne and continues to reduce disease symptoms.

Topics: Acne Vulgaris; Adapalene; Anti-Bacterial Agents; Benzoyl Peroxide; Dermatologic Agents; Doxycycline; Drug Combinations; Gels; Humans; Inflammation; Isotretinoin

From the first reliable descriptions of acne in the early 19th century, dermatologists recognized it as a disease of the pilosebaceous follicle. Until the middle of the 20th century, they hypothesized that seborrhoea, follicular keratosis and microorganisms could be individually responsible for the acne lesions. Inflammation was only regarded as the final and inescapable step of the acne process. Although the importance of these factors has been reevaluated, recent works still regarded them as mandatory. In the 1970s, the onset of isotretinoin dramatically improved acne management. It also provided great opportunities for a better understanding of the pathogenic factors of acne. This study analyzes their genesis and development from the seminal contributions until recent advances.

Topics: Acne Vulgaris; Animals; Anti-Bacterial Agents; Dermatitis, Seborrheic; Dermatologic Agents; Diet; Gram-Positive Bacterial Infections; History, 16th Century; History, 17th Century; History, 18th Century; History, 19th Century; History, 20th Century; History, 21st Century; Hormones; Humans; Inflammation; Isotretinoin; Propionibacterium acnes; Sebum; Skin Diseases, Bacterial; Vitamin A

Proliferative vitreoretinopathy (PVR) is a vision-threatening disease and a common complication of surgery to correct rhegmatogenous retinal detachment (RRD). Several models of the pathogenesis of this disease have been described with some of these models focusing on the role of inflammatory cells and other models focusing on the role of growth factors and cytokines in the vitreous which come into contact with intraretinal and retinal pigment epithelial cells. New experiments have shed light on the pathogenesis of PVR and offer promising avenues for clinical intervention before PVR develops. One such target is the indirect pathway of activation of platelet-derived growth factor receptor alpha (PDGRα), which plays an important role in PVR. Clinical trials assessing the efficacy of 5-fluorouracil (5-FU) and low-molecular-weight heparin (LMWH), daunorubicin, and 13-cis-retinoic acid, among other therapies, have yielded mixed results. Here we review inflammatory and other mechanisms involved in the pathogenesis of PVR, we highlight important clinical trials, and we discuss how findings at the bench have the potential to be translated to the bedside.

Topics: Animals; Clinical Trials as Topic; Daunorubicin; Fluorouracil; Heparin, Low-Molecular-Weight; Humans; Inflammation; Isotretinoin; Receptor, Platelet-Derived Growth Factor alpha; Vitreoretinopathy, Proliferative

Topics: Acne Vulgaris; Adrenal Cortex Hormones; Autoimmune Diseases; Humans; Inflammation; Isotretinoin; Prognosis; Severity of Illness Index

The retinoids are synthetic derivatives of vitamin A. Isotretinoin (13-cis-retinoic acid) is now being widely used in the United States for severe acne and etretinate is available in Europe and other countries for psoriasis. These drugs are also effective for a number of other skin diseases. This is an attempt to review basic knowledge of retinoids with which the practicing dermatologist should be familiar, to review the current status of studies, and to speculate on the present and future roles of these drugs in dermatology.

Topics: Acne Vulgaris; Etretinate; Humans; Inflammation; Isotretinoin; Keratins; Psoriasis; Retinoids; Sebum; Skin Diseases; Skin Neoplasms; Sweat Gland Diseases; Tretinoin; Vitamin A

Hydrating and emollient products are often recommended to patients under isotretinoin therapy to control the most frequent mucocutaneous side effects and to improve adherence to treatment.. To assess, using noninvasive biophysical tests, the clinical and instrumental effectiveness of a hydrating gel-cream compared with placebo as an adjuvant to isotretinoin for treatment of facial skin in patients with inflammatory acne.. Prospective, double-blind, randomized study, using MULTI SKIN MC750, on the adjuvant effect of a hydrating gel-cream for acne (active product) vs. a gel-cream without active substances (placebo). Follow-up lasted 3 months.. Sixty-six patients were included. Thirty-four were administered the active product, and 32 placebo. Though the number of lesions fell significantly in both groups, the mean number of papules on day 30 was significantly lower in the active product group. The active product group showed a significant increase in hydration, while the placebo group showed a significant increase in transepidermal water loss (TEWL). Seborrhoea decreased significantly in both groups; there were no differences between them.. Compared with placebo, the specific gel-cream with active products as an adjuvant to oral isotretinoin improved hydration, prevented TEWL increase, and reduced inflammatory acne lesions after 30 days.

Topics: Acne Vulgaris; Administration, Oral; Adolescent; Adult; Dermatologic Agents; Double-Blind Method; Female; Gels; Glycerol; Humans; Inflammation; Isotretinoin; Male; Placebos; Skin; Skin Physiological Phenomena; Water Loss, Insensible; Young Adult

The risk of malignant transformation of oral preneoplastic lesion (OPL) is difficult to assess. DeltaNp63 is an early oncoprotein associated with mucosal tumorigenesis. The purpose of this study was to assess DeltaNp63 expression in OPL and its role as a marker of oral cancer risk.. DeltaNp63 expression was determined using immunohistochemistry in 152 OPL patients included in a clinical trial comparing retinyl palmitate alone or plus beta-carotene with low-dose 13-cis-retinoic acid. The associations between DeltaNp63 expression as well as DeltaNp63 expression with other potential risk factors for oral cancer development were analyzed.. DeltaNp63 expression was positive in 41 (27%) patients, clusters of intraepithelial inflammatory cells (EIC) were noted in 37 (26%) patients, and podoplanin (previously reported) was positive in 56 (37%) patients. Significantly more patients whose lesions were DeltaNp63 positive or exhibited EIC developed oral cancers. In the multicovariate analysis including age, treatment, and histologic status as cofactors, positive DeltaNp63 expression was associated with an increased hazard ratio of 3.308 (95% confidence interval, 1.663-6.580; P = 0.0007). Patients whose lesions showed positive DeltaNp63, podoplanin, and EIC had the highest oral cancer risk with a hazard ratio of 4.372 (95% confidence interval, 1.912-9.992; P = 0.0005) and 61% oral cancer development rate at 5 years compared with 15% of other OPL patients (P < 0.0001).. DeltaNp63 overepression in OPL is associated with increased oral cancer risk. Together, DeltaNp63, podoplanin, and EIC may be used as biomarkers to identify OPL patients with substantially high oral cancer risk.

Topics: Antineoplastic Combined Chemotherapy Protocols; beta Carotene; Biomarkers, Tumor; Carcinoma, Squamous Cell; Diterpenes; Female; Follow-Up Studies; Gene Expression Regulation, Neoplastic; Genetic Predisposition to Disease; Humans; Inflammation; Isotretinoin; Leukoplakia, Oral; Male; Membrane Glycoproteins; Middle Aged; Mouth Neoplasms; Prognosis; Retinyl Esters; Trans-Activators; Transcription Factors; Tumor Suppressor Proteins; Up-Regulation; Vitamin A

Inflammatory linear verrucous epidermal nevus (ILVEN) is a rare and chronic skin disorder, which may trouble the patient considerably. The condition is generally believed to be resistant to therapy, although some authors have reported success with several treatments. including dithranol and etretinate. The present case, a classical presentation of ILVEN, again illustrates the refractoriness to various treatments, including an experimental treatment with topical 13-cis-retinoic acid. A review of the literature on therapeutic possibilities of ILVEN is presented. Based on our own observations and literature data, it is attractive to hypothesize that a positive result with treatments such as dithranol and retinoids should be interpreted as an antipsoriatic effect in ILVEN with superimposed psoriasis.

Topics: Adolescent; Anthralin; Female; Humans; Inflammation; Isotretinoin; Nevus; Skin Neoplasms

Eight patients with a long-standing hidradenitis suppurativa were treated with isotretinoin, 0.71 to 1.2 mg/kg/day, as a single agent for 4 months and have had follow-up of at least 2 months. The clinical status was judged as cleared in one patient, almost cleared in three patients, improved in one patient, not changed in two patients, and worse in one patient.

Topics: Adolescent; Adult; Apocrine Glands; Clinical Trials as Topic; Female; Follow-Up Studies; Humans; Inflammation; Isotretinoin; Male; Middle Aged; Sweat Gland Diseases; Sweat Glands; Time Factors; Tretinoin; Vulvitis

In the present study, we aimed to develop a novel isotretinoin delivery model for treating skin diseases, revealing its potential advantages in drug delivery and targeted therapy. Using a self-assembly strategy, we grafted a dendrimer, based on a well-defined branched structure for nanomedical devices, with a well-defined nanoarchitecture, yielding spherical, highly homogeneous molecules with multiple surface functionalities. Accordingly, a self-assembled dendrimer-conjugated system was developed to achieve the transdermal delivery of isotretinoin (13cRA-D).. Herein, 13cRA-D showed remarkable controlled release, characterized by slow release in normal tissues but accelerated release in tissues with low pH, such as sites of inflammation. These release characteristics could abrogate the nonteratogenic side effects of isotretinoin and allow efficient skin permeation. Moreover, 13cRA-D exhibited high therapeutic efficacy in acne models. Based on in vitro and in vivo experimental results, 13cRA-D afforded better skin penetration than isotretinoin and allowed lesion targeting. Additionally, 13cRA-D induced minimal skin irritation.. Our findings suggest that 13cRA-D is a safe and effective isotretinoin formulation for treating patients with skin disorders.

Topics: Acne Vulgaris; Dendrimers; Drug Delivery Systems; Humans; Inflammation; Isotretinoin; Skin

Oral isotretinoin (ISO) can effect markers of inflammation in patients with acne vulgaris. Systemic immune-inflammation index (SII) and systemic inflammation response index (SIRI) were described as novel inflammatory and prognostic biomarkers. The present study aimed to evaluate the effectiveness of SII, SIRI, and other inflammatory markers in patients with acne vulgaris who receive isotretinoin therapy.. One hundred fifty-six patients with moderate-to-severe acne vulgaris who received at least 3 months of ISO treatment (0.5-1 mg/kg/day) and 100 healthy individuals were enrolled in the study. The medical records and laboratory findings of the participants were reviewed retrospectively. Pre-treatment and post-treatment neutrophil, lymphocyte, monocyte, and platelet counts, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), monocyte-lymphocyte ratio (MLR), SII, SIRI, total cholesterol, LDL cholesterol, triglyceride, HDL cholesterol, aspartate aminotransferase (AST), and alanine aminotransferase (ALT) were analysed.. Before ISO treatment, patients with moderate-to-severe acne vulgaris had significantly higher platelet counts than healthy controls (. SII and SIRI are better parameters as an indicator of the anti-inflammatory effect of isotretinoin than other inflammatory markers.

Topics: Acne Vulgaris; Biomarkers; Cholesterol, LDL; Humans; Inflammation; Isotretinoin; Retrospective Studies; Triglycerides

Topics: Female; Humans; Inflammation; Isotretinoin; Male; Urethra; Vulva

Topics: Acne Vulgaris; Apoptosis; Arachidonate 5-Lipoxygenase; Cell Line; Cell Proliferation; Humans; Inflammation; Isotretinoin; Leukotrienes; Sebaceous Glands; Sterol Regulatory Element Binding Protein 1; Time Factors

We aimed to investigate the effect of systemic isotretinoin therapy on normal and wounded nasal septal mucosa histopathologically in an experimental rabbit model.. Circular mucosal defect with a 7 mm diameter was made in the left septum of 12 New Zealand white rabbits. The rabbits were divided into two groups (six rabbits in each group) oral isotretinoin was given with olive oil at the operation day to the first group. The control group was only oil given group. The harvested septum mucosas were divided into four groups (1-wounded-drug given side, 2-unwounded and drug-given side, 3-wounded-control and 4-unwounded-control side). The diameter of the defect, mucosal thickness, epithelial thickness, ciliated cell level, goblet cell level and inflammation were evaluated every week for 4 weeks.. At both wounded and normal side, thinning of normal respiratory ciliated epithelium was observed in the postoperative period. In study group at the wounded side; mean mucosal thickness was measured 139.66 µ (± 26.24), and in the control group, mean mucosal thickness was 238.33 µ (± 39.7) at the wounded side. (p < 0.001). The difference between the groups in thickness of normal septal mucosa was also statistically significant (p = 0.016) [190 µ (± 14.6) and 256.66 µ (± 44.66)]. The average cilia level was observed 1.16 in the wounded study group, while the average level was 2.33 in the wounded control group (p = 0.012). Average score measurements of the regenerated mucosa suggested that isotretinoin-given wounded animals have reduced goblet cell recovery, compared to the control both on the regenerated and unwounded mucosas (p = 0.007, p = 0.002, respectively). Inflammation was significantly higher in the wounded isotretinoin group (p = 0.018).. Oral isotretinoin has negative effects on epithelial and ciliary regeneration, significantly reduces mucosal thickness and goblet cell counts of the normal and regenerated mucosa, causes severe inflammation and significant reactive changes.

Topics: Animals; Cell Count; Cilia; Dermatologic Agents; Goblet Cells; Inflammation; Isotretinoin; Male; Nasal Mucosa; Nasal Septum; Rabbits; Regeneration

Topics: Acne Vulgaris; Adult; Back Pain; Dermatologic Agents; Female; Humans; Inflammation; Isotretinoin; Male; Young Adult

This protocol describes microsphere-based protease assays for use in flow cytometry and high-throughput screening. This platform measures a loss of fluorescence from the surface of a microsphere due to the cleavage of an attached fluorescent protease substrate by a suitable protease enzyme. The assay format can be adapted to any site or protein-specific protease of interest and results can be measured in both real time and as endpoint fluorescence assays on a flow cytometer. Endpoint assays are easily adapted to microplate format for flow cytometry high-throughput analysis and inhibitor screening.

Topics: Animals; Biotinylation; Flow Cytometry; Fluorescence Resonance Energy Transfer; Green Fluorescent Proteins; High-Throughput Screening Assays; Humans; Inflammation; Kinetics; Microspheres; Peptide Hydrolases; Peptides; Reproducibility of Results; Temperature

We report a case of severe "bodybuilding acne" in a 22-year-old patient. Treatment with isotretinoin paradoxically led to exaceibation and occurrence of pyogenic granuloma-like lesions.

Topics: Acne Vulgaris; Adult; Anabolic Agents; Androgens; Anti-Bacterial Agents; Causality; Cefotiam; Dermatologic Agents; Granulation Tissue; Granuloma, Pyogenic; Humans; Inflammation; Isotretinoin; Male; Necrosis; Suppuration; Testosterone; Weight Lifting

The pathogenesis of acne vulgaris is multifactorial and entails the interplay of hormonal, microbial and immunological events. The bacterium Propionibacterium acnes is involved in the induction of comedogenesis and maintenance of the inflammatory phase of acne. Toll-like Receptor 2 (TLR2) expressed on mononuclear inflammatory cells and possibly on keratinocytes and sebocytes is thought to be of vital importance in mediating P. acnes-induced inflammatory response in acne vulgaris. This work aimed to study the degree of expression of TLR2 on peripheral blood monocytes (PBM) from patients with non-inflammatory and inflammatory acne and to investigate the influence of systemic isotretinoin therapy on TLR2 expression. Sixteen patients with predominantly non-inflammatory acne, 16 patients with predominantly inflammatory acne and 16 age and sex matched healthy subjects were involved in this study. Cell surface expression of CD14 and TLR2 were determined by cell surface staining and flowcytometry. TLR2 expression was analyzed for 12 patients with severe and/or scaring inflammatory acne after oral isotretinoin therapy for two months. The mean fluorescence intensity (MFI) of TLR2 on PBM reported a statistically significant difference between patients with non-inflammatory acne, patients with inflammatory acne and control subjects. MFI of TLR was significantly lower for patients with inflammatory acne after systemic isotretinoin therapy. Data obtained suggest that TLR2 expression on PBM is an important event in acne pathogenesis and targeting this molecule might be a useful therapeutic goal in the future.

Topics: Acne Vulgaris; Adolescent; Dermatologic Agents; Female; Humans; Inflammation; Isotretinoin; Lipopolysaccharide Receptors; Male; Monocytes; Propionibacterium acnes; Toll-Like Receptor 2

Glioblastoma is the deadliest brain tumor that remains incurable. We examined efficacy of combination of retinoid and interferon-gamma (IFN-gamma) in human glioblastoma T98G and U87MG cells. We conjectured that retinoid could induce differentiation with down regulation of telomerase activity to increase sensitivity to IFN-gamma for apoptosis in glioblastoma cells. Indeed, treatment of cells with 1 muM all-trans retinoic acid (ATRA) or 1 muM 13-cis retinoic acid (13-CRA) for 7 days induced astrocytic differentiation with upregulation of glial fibrillary acidic protein (GFAP) and down regulation of telomerase activity. Wright staining and ApopTag assay showed, respectively, morphological and biochemical features of apoptosis in glioblastoma cells following exposure to 200 units/ml IFN-gamma for 48 h. Induction of differentiation was associated with decreases in levels of nuclear factor kappa B (NFkappaB), inducible nitric oxide synthase (iNOS), and production of nitric oxide (NO) so as to increase sensitivity to IFN-gamma for apoptosis. Notably, IFN-gamma induced signal transducer and activator of transcription-1 (STAT-1) to bind to gamma-activated sequence (GAS) of the target gene. Also, IFN-gamma activated caspase-8 and cleaved Bid to truncated Bid (tBid) for translocation to mitochondria. Fura-2 assay showed increases in intracellular free [Ca2+] and activation of calpain in apoptotic cells. Besides, increases in Bax:Bcl-2 ratio and mitochondrial release of cytochrome c and Smac into the cytosol activated caspase-9 and caspase-3 for apoptosis. Taken together, our results showed that retinoid induced astrocytic differentiation with down regulation of telomerase activity and enhanced sensitivity to IFN-gamma for increasing apoptosis in human glioblastoma cells.

Topics: Apoptosis; Apoptosis Regulatory Proteins; BH3 Interacting Domain Death Agonist Protein; Calcium-Binding Proteins; Caspase 1; Caspase 8; Cell Differentiation; Down-Regulation; Glial Fibrillary Acidic Protein; Glioblastoma; Humans; Inflammation; Interferon-gamma; Intracellular Signaling Peptides and Proteins; Isotretinoin; Mitochondria; Mitochondrial Proteins; Nitric Oxide Synthase Type II; Retinoids; Telomerase; Tretinoin; Tumor Cells, Cultured; Up-Regulation

Topics: Acne Vulgaris; Acneiform Eruptions; Adolescent; Diagnosis, Differential; Humans; Inflammation; Isotretinoin; Joint Diseases; Male; Radiography; Sacroiliac Joint

Medical records of 30 dogs with histologically confirmed sebaceous adenitis that were treated with isotretinoin or etretinate were reviewed. Akitas and Standard Poodles were overrepresented, compared with the general hospital population. Thirteen dogs had concurrent pyoderma. The retinoids were administered for a minimum of 2 months. Dosage for the 13 dogs treated with isotretinoin only ranged from 0.8 to 3.5 mg/kg of body weight/d (mean, 1.4 mg/kg/d). Dosage for the 10 dogs treated with etretinate only ranged from 0.7 to 1.8 mg/kg/d (mean, 1.1 mg/kg/d). Two dogs were first given isotretinoin (mean dosage, 1.5 mg/kg/d) and, when they did not respond, were subsequently given etretinate (mean dosage, 0.85 mg/kg/d). Five dogs were first given etretinate (mean dosage, 1 mg/kg/d) and, when they did not respond, were subsequently given isotretinoin (mean dosage, 1.6 mg/kg/d). For the 20 dogs treated with isotretinoin, 1 was lost to follow-up; 9 of the remaining 19 had a successful outcome (> 50% reduction in severity of scaling and extent of alopecia, compared with pretreatment appearance). For the 17 dogs treated with etretinate, 9 had a successful outcome. Outcome could not be predicted on the basis of clinical signs or histologic findings, and a prognosis could not be determined on the basis of whether sebaceous glands were evident histologically.

Topics: Alopecia; Animals; Biopsy; Dog Diseases; Dogs; Etretinate; Female; Follow-Up Studies; Inflammation; Isotretinoin; Male; Pyoderma; Retrospective Studies; Sebaceous Glands; Skin; Skin Diseases; Treatment Outcome

Topics: Androgen Antagonists; Anti-Bacterial Agents; Anti-Infective Agents, Local; Female; Humans; Inflammation; Isotretinoin; Male; Skin Transplantation; Surgical Flaps; Sweat Gland Diseases

Hidradenitis suppurativa, a chronic relapsing disease of apocrine gland-bearing areas, most frequently occurs in the axillae, groin, perineal, and perianal regions. Hidradenitis of vulva is frequently misdiagnosed and inadequately treated. The case of a 15-year-old nulliparous black female adolescent referred for evaluation of multiple draining fistulas of the anogenital region is presented. Diagnostic studies for granulomatous disease were negative. Results of a barium enema were normal and biopsies were compatible with the diagnosis of hidradenitis suppurativa. She was treated for 22 weeks with isotretinoin, 1 mg/kg daily, with an excellent response. Side effects were minor and included cheilitis, mild xerosis, and a transient elevation of serum alkaline phosphatase levels. Few patients with severe hidradenitis have been responsive to this synthetic vitamin A derivative. A review of the literature indicates that the results of treatment with isotretinoin for hidradenitis have been at best equivocal. Isotretinoin should never be used during pregnancy because of known teratogenic effects. Women of childbearing age must use effective contraception during treatment.

Topics: Adolescent; Anus Diseases; Female; Humans; Inflammation; Isotretinoin; Perineum; Suppuration; Sweat Gland Diseases; Tretinoin; Vulvar Diseases

Topics: Adolescent; Adult; Female; Humans; Inflammation; Isotretinoin; Male; Middle Aged; Sweat Gland Diseases; Tretinoin

A total of 261 adverse ocular reactions occurred in 237 patients who received isotretinoin, a commonly used drug in the treatment of severe cystic acne. Blepharoconjunctivitis, subjective complaints of dry eyes, blurred vision, contact lens intolerance, and photodermatitis are reversible side effects. More serious ocular adverse reactions include papilledema, pseudotumor cerebri, and white or gray subepithelial corneal opacities; all of these are reversible if the drug is discontinued. Reported cases of decreased dark adaptation are under investigation. Isotretinoin is contraindicated in pregnancy because of the many reported congenital abnormalities after maternal use (including microphthalmos, orbital hypertelorism, and optic nerve hypoplasia).

Topics: Acne Vulgaris; Cataract; Conjunctivitis; Cysts; Eye; Eye Diseases; Eyelid Diseases; Humans; Inflammation; Isotretinoin; Photosensitivity Disorders; Skin Diseases; Tretinoin; Vision Disorders

Topics: Acne Vulgaris; Adolescent; Betamethasone; Clobetasol; Granulation Tissue; Humans; Inflammation; Isotretinoin; Male; Tretinoin

Twelve patients with acne vulgaris treated with isotretinoin for 4 months showed increased levels of immunoglobulins and helper T cells at 8 weeks and increased levels of B cells at 16 weeks.

Topics: Acne Vulgaris; alpha-Macroglobulins; Complement C3; Female; Humans; Immunoglobulins; Inflammation; Isotretinoin; Lymphocytes; Male; Tretinoin

56 patients with nodulocystic acne, hidrosadenitis (2 cases) and steatocystoma multiplex (2 cases) were treated with oral isotretinoin. 52 patients cleared completely or were much improved without local treatment; 2 failures involved patients with steatocystoma, while 2 patients with ano-inguinal lesions were only improved. 19 patients received a dose of 0.5 mg/kg/day for six months; in 37 patients the dose was adapted to the initial response but did not exceed 1 mg/kg/day. Reversible elevated triglyceride concentration was observed in 5% of the patients. 18 patients were followed up and 4 (22%) presented moderate relapses.

Topics: Acne Vulgaris; Administration, Oral; Adolescent; Adult; Dose-Response Relationship, Drug; Epidermal Cyst; Female; Humans; Inflammation; Isotretinoin; Male; Sweat Gland Diseases; Tretinoin

Isotretinoin was administered orally for 16 weeks, in a dosage of 1 mg/kg/day, to seven men with severe acne. A 36.2% reduction of nodulocystic lesions was observed at the conclusion of treatment and a 47.2% reduction was noted at the end of a 16-week follow-up period. However, there was an 88.4% decrease in sebum production and a marked reduction histologically in sebaceous gland size after 16 weeks of treatment, with a partial recovery of glandular activity at 32 weeks. The failure to observe a more striking overall response clinically resulted primarily from two of the seven patients showing worsening or no improvement of their disease, despite profound sebaceous gland inhibition. These findings suggest that the marked sebostatic effect of isotretinoin may not be the sole explanation for its mechanism of action in reducing the severity of acne.

Topics: Acne Vulgaris; Adult; Epidermis; Humans; Inflammation; Isotretinoin; Male; Sebaceous Glands; Sebum; Tretinoin

Topics: Female; Humans; Inflammation; Isotretinoin; Sweat Gland Diseases; Tretinoin

Sixteen patients with care acne conglobata, acne fulminans, acme tetrade were treated orally with 13-cis-retinoic acid, 1-2 mg/kg body weight for 12 weeks. A maintenance dose of 0.5 mg/kg in ten cases and the use of no further medication in six other cases for an additional 12 weeks followed. A 40% potassium iodide ointment was used on the upper back under occlusive dressing conditions to induce an inflammatory reaction. Four inflammatory parameters were assessed in all subjects before and during oral treatment: erythema (0-2+), edema (0-2+), papules (numbers), and pustules (numbers). All patients showed excellent improvement. Additionally, the inflammatory reaction in all patch-tests was significantly reduced: erythema from 1.13 to 0.34 (P less than or equal to 0.01); edema from 1.06 to 0.25 (P less than or equal 0.0005); papules from 6.75 to 1.86 (P less than or equal to 0.01); and pustules from 10.44 to 1.56 (P less than or equal to 0.0025). We suggest that 13-cis-retinoic acid acts as a strong anti-inflammatory agent in addition to its known function as a sebostaticum.

Topics: Acne Vulgaris; Adolescent; Adult; Anti-Inflammatory Agents; Humans; Inflammation; Isotretinoin; Male; Tretinoin