isotretinoin and Kidney-Failure--Chronic

Rare are reports about isoretinoin treatment for acne in dialysis or kidney transplant patients whereas its efficacy and safety make it very interesting. Authors report here an additional observation of a 32 year-old young woman, hemodialyzed after one period of 12 years renal transplantation, and presenting a diffuse and severe acne. Treatment by isotretinoin with a moderate amount of 20 mg (0.38 mg/kg) per day cures this dermatosis in 2 months and half, without severe clinical side effect or significant metabolic disturbance, apart from a transient increase in parathormone rate.

Topics: Acne Vulgaris; Adult; Female; Graft Rejection; Humans; Isotretinoin; Kidney Failure, Chronic; Kidney Transplantation; Renal Dialysis

A case of acquired perforating dermatosis associated with diabetic nephropathy is described. The case is unusual in that the dermatosis first developed approximately 1 year after renal transplantation rather than at a time when renal function was more severely impaired or during haemodialysis. There was a partial response to treatment with isotretinoin but the use of this drug was limited by the development of hyperlipidaemia. The relevant literature is reviewed.

Topics: Adult; Diabetes Mellitus, Type 1; Diabetic Nephropathies; Humans; Hyperlipidemias; Isotretinoin; Keratolytic Agents; Kidney Failure, Chronic; Male; Skin Diseases

Some hemodialysis patients, without taking any acnegenic agents, developed severe nodulocystic acne with unknown causes. Because nodulocystic acne poorly responds to conventional acne therapy and increases the black pigmentation in the face, it severely interferes with the quality of life of these patients. To investigate whether isotretinoin is effective in treating hemodialysis patients with severe nodulocystic acne, we undertook a prospective, randomized, single-blind study. A total of 20 patients with nodulocystic acne participated in the study, of whom 18 completed it. Ten patients received isotretinoin 10 mg/day (5 mg/capsule) for 3 months as a study group and the other 10 took placebo for 3 months as a control group. The severity of acne and treatment-related side effects were evaluated monthly by a questionnaire and laboratory evaluation which included liver function tests, blood lipids and blood platelet counts. The results showed isotretinoin treatment significantly reduced the severity of acne of the study group patients after 1 month (scales of acne severity: 4.0 +/- 0.0 vs. 3.13 +/- 0.35, p < 0. 01) and 3 months (4.0 +/- 0.0 vs. 1.5 +/- 0.76, p < 0.01) of follow-up. In addition, the severity of acne of the study group patients was significantly less than that of the control group patients after 1 month (3.13 +/- 0.35 vs. 3.80 +/- 0.42, p < 0.01) and 3 months (1.5 +/- 0.76 vs. 3.70 +/- 0.48, p < 0.001) of treatment. Only mild side effects were noted. No significant changes of biochemical evaluation were found except that a mild elevation of aspartate aminotransferase was noted in the study group patients. However, two study group patients withdrew from the trial because of isotretinoin-related side effects and toxic hepatitis. In summary, our study first demonstrated that the small dose of isotretinoin effectively treated nodulocystic acne of hemodialysis patients and the side effects were mild. This result suggests that isotretinoin may be the treatment of choice for nodulocystic acne in end-stage renal disease patients with renal replacement therapy. The liver function and other isotretinoin-related side effects in these patients should be carefully monitored.

Topics: Acne Vulgaris; Adult; Female; Humans; Isotretinoin; Keratolytic Agents; Kidney Failure, Chronic; Male; Middle Aged; Prospective Studies; Renal Dialysis

The occurrence of acne in dialysed renal failure patients has rarely been reported and the clinical characteristics and therapeutic issues rarely studied in these patients.. Two men and two women, 33 to 56 years-old, with chronic renal failure and no past history of acne, developed severe acne under dialysis. The acne was excoriated in all cases and associated with prurigo-like lesions and intense pruritus, which made diagnosis difficult. Acne was profuse on the face and the trunk, but also on the neck (1 case) and the upper limbs (2 cases). No patient was taking acne-inducing substances. Various to therapies attempting to control pruritus were ineffective. However, anti-acne treatments (cyclines associated with local tretinoin in 1 case and oral isotreninoin in 3 cases) led to complete regression of the acne, pruritus and the prurigo-like lesions without relapse after a follow-up time of 4 months to 2 years.. Pruritus is frequent during renal failure. However, the occurrence of unexplained acne has only rarely been reported. Our patients' clinical picture was original, characterized by the late development, under dialysis, of severe and pruriginous acne, the pathogenesis of which is unknown. Because of the clinical and therapeutic implications (impaired quality of life, pigmentation or scarring and remarkable efficacy of oral isotretinoin) this clinical picture merits more attention, and the modalities for the prescription of isotretinoin in this context should be defined.

Topics: Acne Vulgaris; Administration, Oral; Adult; Diagnosis, Differential; Female; Humans; Isotretinoin; Kidney Failure, Chronic; Male; Middle Aged; Peritoneal Dialysis, Continuous Ambulatory; Prurigo; Renal Dialysis

Kyrle's disease is an uncommon dermatologic entity with characteristic clinical and histopathologic features. A case is recorded in a 63-year-old man undergoing hemodialysis for chronic renal failure. Systemic isotretinoin treatment for 13 weeks resulted in a complete clearance of the cutaneous lesions. Systemic treatment is effective and could be considered preferred therapy.

Topics: Eccrine Glands; Hair; Humans; Isotretinoin; Keratosis; Kidney Failure, Chronic; Male; Middle Aged; Renal Dialysis

Topics: Acne Vulgaris; Humans; Isotretinoin; Kidney Failure, Chronic; Male; Middle Aged; Renal Dialysis

Topics: Adolescent; Biopsy; Granulomatosis with Polyangiitis; Humans; Isotretinoin; Kidney; Kidney Failure, Chronic; Lung; Male; Tretinoin; Vasculitis