isotretinoin and Lupus-Erythematosus--Cutaneous

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

Cancer has been reported in patients with systemic lupus erythematosus (SLE). A possible association of the development of hematologic malignancies in patients with SLE has been suggested. In some patients, subacute cutaneous lupus erythematosus, a distinct subset of lupus erythematosus, has appeared, resolved, or both as a solid tumor-related paraneoplastic syndrome. A woman in whom a meningioma was diagnosed 44 years following the onset of subacute cutaneous lupus erythematosus is described; her skin lesions improved after starting isotretinoin therapy. The relationship between lupus erythematosus and neoplasia is summarized and the management of subacute cutaneous lupus erythematosus with retinoids is reviewed.

Topics: Administration, Topical; Aged; Anti-Inflammatory Agents; Clobetasol; Dermatologic Agents; Female; Fluocinonide; Glucocorticoids; Humans; Isotretinoin; Lupus Erythematosus, Cutaneous; Meningeal Neoplasms; Meningioma

Topics: Acne Vulgaris; Adolescent; Adult; Dermatologic Agents; Dermatology; Facial Dermatoses; Female; Humans; Isotretinoin; Lupus Erythematosus, Cutaneous; Lupus Erythematosus, Discoid; Patient Preference; Quality of Life; Risk-Taking; Sarcoidosis; Self Concept; Suicide; Young Adult

Various dermatologic manifestations are observed in the different lupus subsets. Lupus lesions are characterized by a dermo-epidermal dermatitis. Other lesions, vascular or non vascular, are essentially present in association with systemic lupus erythematosus. Acute, subacute and chronic lupus erythematosus are distinguishable according to their clinical aspects, pathological features and evolution. Acute lesions are either localized to the midface or widespread. Subacute lesions may be annular or psoriasiform. Chronic lupus erythematosus includes localized or widespread discoid lupus, lupus tumidus, chilblain lupus and panniculitis. Therapy of cutaneous lupus is mainly based on antimalarials and avoidance of sun irradiation. In refractory cutaneous lupus, no universal guidelines are currently available. Except for acrosyndromes and urticaria-like lesions, vascular lesions may be due to vasculitis or thrombosis. An accurate diagnosis is absolutely necessary since therapy is different in thrombosis and vasculitis. Non vascular and non lupus lesions are numerous, some of them require special treatment such as dapsone for bullous lupus.

Topics: Acitretin; Adrenal Cortex Hormones; Adult; Antimalarials; Clinical Trials as Topic; Dapsone; Dermatologic Agents; Diagnosis, Differential; Drug Combinations; Female; Glucosamine; Humans; Hydroxychloroquine; Immunosuppressive Agents; Infant, Newborn; Isotretinoin; Keratolytic Agents; Lupus Erythematosus, Cutaneous; Lupus Erythematosus, Discoid; Male; Middle Aged; Skin; Sulfasalazine; Thalidomide; Thrombosis; Ultraviolet Therapy; Vasculitis

We describe six patients with cutaneous manifestations of lupus erythematosus who were treated with isotretinoin, 1 mg/kg/day. In each case the cutaneous lesions had proved resistant to systemic corticosteroids and antimalarial therapy. Treatment with isotretinoin resulted in rapid clinical improvement in all cases. Recurrences were similarly rapid when the drug was discontinued. Side effects were minimal and easily controlled by adjustments in dose or by the use of lubricants.

Topics: Adult; Female; Humans; Isotretinoin; Lupus Erythematosus, Cutaneous; Prednisone; Recurrence

Topics: Aged; Chronic Disease; Drug Administration Schedule; Humans; Isotretinoin; Lupus Erythematosus, Cutaneous; Male

Twenty-four in- or out-patients (12 males and 12 females) with chronic cutaneous (CCLE) (n = 19) or subacute cutaneous (SCLE) (n = 5) lupus erythematosus have been treated with oral isotretinoin. The initial dose 0.15 mg/kg/day was progressively increased to a maximum of 0.50 mg/kg/day; the total treatment period was 16 weeks. One female patient with SCLE stopped the therapy for sudden fever. None of the other known side effects induced interruption of treatment. In 20 subjects (86.9%) isotretinoin therapy was associated with clearing or improvement of clinical lesions and histopathologic changes. Best responses with isotretinoin therapy was seen in patients with CCLE. No changes were observed in the laboratory parameters before, during, and at the end of the study. In the light of these results, isotretinoin can be considered as an effective and well-tolerated drug in the treatment of cutaneous lupus erythematosus.

Topics: Administration, Oral; Adult; Female; Humans; Isotretinoin; Lupus Erythematosus, Cutaneous; Male; Middle Aged