isotretinoin and Lupus-Erythematosus--Systemic

In this chapter, we will discuss the most common alopecias due to drugs and other skin and systemic disorders. The following hair disorders will be analyzed: telogen effluvium (acute and chronic); anagen effluvium; folliculotropic mycosis fungoides; and folliculitis due to bacteria, fungi, parasites, human immunodeficiency virus disease, lupus erythematosus, and sarcoidosis. We will cover topics including the epidemiology, etiology, clinical picture, and diagnosis of and current treatments for each disease.

Topics: Alopecia; Anticonvulsants; Antidepressive Agents; Antineoplastic Agents; Dermatologic Agents; Dermatomycoses; Diet; Folliculitis; Herpes Zoster; HIV Infections; Humans; Isotretinoin; Lamotrigine; Lithium Compounds; Lupus Erythematosus, Systemic; Malnutrition; Mycosis Fungoides; Paroxetine; Sarcoidosis; Seasons; Skin Neoplasms; Starvation; Stress, Psychological; Syphilis; Triazines; Valproic Acid

Lupoid perioral dermatitis is classified as a special form of perioral dermatitis with dense aggregations of red-brown papules which display a lupoid infiltrate on diascopy. There are various treatment options ranging from total avoidance of all topical substances to different topical treatment. Cases resistant to therapy require systemic treatment, which, however, is off-label use. In our case we were able to achieve a significant improvement with systemic therapy with isotretinoin over a period of 6 months.

Topics: Dermatologic Agents; Facial Dermatoses; Female; Humans; Isotretinoin; Lupus Erythematosus, Systemic; Middle Aged; Mouth Diseases; Treatment Outcome

Systemic isotretinoin has been used to treat severe acne vulgaris for 20 years. However, isotretinoin also represents a potentially useful choice of drugs in many dermatologic diseases other than acne vulgaris. Diseases such as psoriasis, pityriasis rubra pilaris, condylomata acuminata, skin cancers, rosacea, hidradenitis suppurativa, granuloma annulare, lupus erythematosus and lichen planus have been shown to respond to the immunomodulatory, anti-inflammatory and antitumor activities of the drug. Isotretinoin also helps prevent skin cancers such as basal cell carcinoma or squamous cell carcinoma. A combination of systemic isotretinoin and interferon-alpha-2a may provide a more potent effect than isotretinoin alone in the prevention and treatment of skin cancers.Systemic isotretinoin may be considered as an alternative drug in some dermatologic diseases unresponsive to conventional treatment modalities. However, randomized clinical trials aimed at determining the role of systemic isotretinoin therapy in dermatologic diseases other than acne vulgaris are required.

Topics: Acne Vulgaris; Anti-Bacterial Agents; Anti-Infective Agents; Anti-Inflammatory Agents; Condylomata Acuminata; Dermatologic Agents; Drug Therapy, Combination; Granuloma Annulare; Hidradenitis Suppurativa; Humans; Isotretinoin; Keratolytic Agents; Lichen Planus; Lupus Erythematosus, Systemic; Pityriasis Rubra Pilaris; Psoriasis; Rosacea; Sebaceous Glands; Skin Diseases; Skin Neoplasms

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

13-cis-Retinoic acid (13-CRA), a water-soluble vitamin A analog and 5'-lipoxygenase inhibitor, was tested in vitro for effects on excess oxidative metabolism and DNA damage in mitogen-stimulated lymphocytes from patients with systemic lupus erythematosus (SLE), because other 5'-lipoxygenase enzyme inhibitors were shown to lower the excess oxidative metabolism in SLE cells. Excess chemiluminescence (CL) was abolished within minutes after the addition of 1 x 10(-6) M 13-CRA in five of five CL-positive mitogen-stimulated SLE lymphocytes, and was lowered in five of eight samples after 48 to 72 h culture. Similarly, low concentrations of 13-CRA for 48-72 h largely prevented the S1 nuclease-sensitive DNA changes/DNA damage observed in CL-positive lupus lymphocytes in vitro. However, 13-CRA did not affect DNA damage in four of four CL-negative lymphocyte samples. 13-CRA, like other retinoic acid compounds, was known to stimulate B-cell activities in vivo and in vitro but effects on dividing lupus T cells had not been studied. 13-CRA further inhibited the diminished PHA-stimulated lupus T-cell growth in tissue culture at a concentration of 9 x 10(-6) M in three of five lupus lymphocyte samples. 13-CRA has positive and negative effects on multiple aspects of the immune system and it is not clear whether 13-CRA will have positive or adverse clinical effects on SLE patients. Close attention to vitamin A and vitamin "supplements" in patients with SLE may answer this question.

Topics: Cells, Cultured; DNA Damage; Humans; Isotretinoin; Luminescent Measurements; Lupus Erythematosus, Systemic; Lymphocyte Activation; Lymphocytes; Oxidation-Reduction

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

Isotretinoin, a synthetic retinoid that has been prescribed for over 500,000 patients with cystic acne, has been associated with both spinal hyperostosis and a disorder similar to diffuse idiopathic skeletal hyperostosis. We describe a syndrome of tendon and ligament calcification, primarily in extraspinal locations, that we have observed after long-term therapy for psoriasis and disorders of keratinization with etretinate, another synthetic retinoid. Of 38 patients who had received etretinate (average dose, 0.8 mg per kilogram of body weight per day; average duration, 60 months), 32 (84 percent) had radiographic evidence of extraspinal tendon and ligament calcification. The most common sites of involvement were the ankles (29 patients [76 percent]), pelvis (20 patients [53 percent]), and knees (16 patients [42 percent]); spine involvement was uncommon in this group of etretinate-treated patients. Involvement tended to be bilateral and multifocal. Fifteen (47 percent) of the 32 affected patients had no bone or joint symptoms at the sites of radiographic abnormality. Thus, tendon and ligament calcification can occur without vertebral involvement as well as in association with it (for example, as part of the spectrum of diffuse idiopathic skeletal hyperostosis). We have identified extraspinal tendon and ligament calcification as a toxic effect that is commonly associated with long-term etretinate therapy.

Topics: Adult; Aged; Calcinosis; Etretinate; Female; Humans; Isotretinoin; Knee Joint; Ligaments; Lupus Erythematosus, Systemic; Male; Middle Aged; Pelvis; Prospective Studies; Psoriasis; Radiography; Skin Diseases; Spinal Diseases; Tendons; Tretinoin