isotretinoin and Lupus-Erythematosus--Discoid

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

Nail changes occur in about 25% of systemic lupus erythematosus (SLE) cases. Onycholysis has been reported as the most frequent abnormality in SLE. Nailbed hyperkeratosis may be observed in both SLE and discoid lupus erythematosus (DLE). Involvement of the nail apparatus in DLE is extremely uncommon and never restricted to it. We report on a patient in whom the clinical features on the proximal nailfold were similar to those observed on the skin of a patient with typical DLE. This has, to the best of our knowledge, not yet been reported. The patient also exhibited a very distinctive prominent subungual hyperkeratosis. Interestingly, the patient developed biological alterations suggesting a systematization of the disease. Only a combination of systemic corticoids, retinoids and antimalarials was able to achieve nail improvement and this partial resistance to therapy may be explained by the very unusual subungual hyperkeratosis.

Topics: Dermatologic Agents; Diagnosis, Differential; Drug Therapy, Combination; Fingers; Hand Dermatoses; Humans; Hydroxychloroquine; Isotretinoin; Lupus Erythematosus, Discoid; Lupus Erythematosus, Systemic; Male; Methylprednisolone; Middle Aged; Nail Diseases

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

A patient with systemic lupus erythematosus had the additional finding of hypertrophic lupus erythematosus. The lesions cleared with an 11-week course of isotretinoin alone. She has remained without recurrence for 9 months. This is the first reported case of total resolution of hypertrophic lupus erythematosus with a short course of isotretinoin.

Topics: Adult; Diagnosis, Differential; Female; Humans; Isotretinoin; Lupus Erythematosus, Discoid; Lupus Erythematosus, Systemic; Tretinoin

We describe a patient with a distinct verrucous variant of chronic discoid lupus erythematosus manifested by skin lesions resembling keratoacanthomas. The diagnosis of keratotic lupus was confirmed by characteristic immunofluorescence and ultrastructural findings and by an initial response to antimalarial therapy. Combination therapy with isotretinoin and hydroxychloroquine resulted in control of her previously refractory skin lesions, and the isotretinoin apparently played a key role in this improvement.

Topics: Aged; Biopsy; Drug Therapy, Combination; Female; Humans; Hydroxychloroquine; Isomerism; Isotretinoin; Keratosis; Lupus Erythematosus, Discoid; Skin; Tretinoin

Eight of ten patients with chronic or subacute cutaneous lupus erythematosus completed 16 weeks of oral isotretinoin therapy (80 mg/day). All eight patients noted an excellent clinical response without significant side effects. (Two patients did not return to initial two-week follow-up.) Peripheral blood B- and T-cell counts were unaffected by therapy. Therapy was associated with resolution of routine histopathologic abnormalities, conversion of abnormal lesional direct immunofluorescence microscopy to normal, normalization of the epidermis on electron microscopy, and reduction of all T cells near the dermoepidermal junction without change in ratio of T-helper/inducer cells to T-suppressor/cytotoxic cells. Isotretinoin is a clinically effective short-term therapy for chronic or possibly for subacute cutaneous lupus erythematosus. The primary mechanism of action remains unestablished.

Topics: Administration, Oral; Adult; Basement Membrane; Chronic Disease; Complement C3; Drug Evaluation; Female; Fibrin; Fluorescent Antibody Technique; Humans; Immunoglobulin G; Isotretinoin; Lupus Erythematosus, Discoid; Lymphocytes; Male; Middle Aged; Skin; Tretinoin