isotretinoin and Mycosis-Fungoides

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

The association of systemic sarcoidosis and malignant lymphoma is known as the 'sarcoidosis-lymphoma syndrome'. Cutaneous involvement is rare in this syndrome. We report a 52-year-old woman who was diagnosed as having tumour-stage mycosis fungoides. Complete remission was achieved by combination therapy consisting of isotretinoin, interferon (IFN) alpha, electron beam irradiation, photochemotherapy and topical corticosteroids. Three years later, the patient developed systemic sarcoidosis characterized by yellowish papules on the abdominal wall and the eyelids that histologically revealed non-caseating granulomas, multiple fine-nodular interstitial pulmonary infiltrates on chest X-ray, hilar lymphadenopathy, decreased vital capacity and increased lymphocyte count in bronchoalveloar lavage fluid. As opposed to most of the reported cases, in our patient the manifestation of cutaneous lymphoma preceded the diagnosis of systemic sarcoidosis. We review the cases reported in the literature and discuss a possible causal and temporal relationship as well as the role of IFN alpha in the development of sarcoidosis.

Topics: Anti-Inflammatory Agents; Combined Modality Therapy; Female; Humans; Interferon-alpha; Isotretinoin; Keratolytic Agents; Methylprednisolone; Middle Aged; Mycosis Fungoides; Phototherapy; Sarcoidosis; Skin Neoplasms; Syndrome

Topics: Animals; Etretinate; Humans; Isotretinoin; Keratosis; Mycosis Fungoides; Retinoids; Skin Neoplasms; Vitamin A

Thirty-nine patients with mycosis fungoides in various stages or Sézary syndrome were treated with isotretinoin and 29 with etretinate as single drug therapy. Complete remission within 2 months was obtained with isotretinoin in 8 cases (21%) and partial remission in another 15 cases (38%). Etretinate induced complete remission in 5 cases (21%) and partial remission in 11 (46%). Only 1 case with Sézary syndrome went into partial remission. The first sign of remission occurred in 2 to 4 weeks. During continued treatment remissions could not always be maintained. Isotretinoin and etretinate were considered to be of equal potency in the treatment of mycosis fungoides.

Topics: Drug Eruptions; Etretinate; Humans; Isotretinoin; Lymphatic Metastasis; Mycosis Fungoides; Remission Induction; Sezary Syndrome; Skin Neoplasms; Tretinoin

Retinoids exert their biologic effects by binding to intracellular retinoic-acid receptors (RARs) and/or retinoid X receptors (RXRs). Early-stage mycosis fungoides (MF) has been effectively treated with bexarotene, an RXR-agonist, with overall response (OR) rates 54-67% and complete response (CR) rates 7-27%. Data on RAR-agonist monotherapy are limited.. To analyze the effectiveness of RAR-agonist monotherapy for early-stage MF.. Data on patients with early-stage MF treated with acitretin/isotretinoin monotherapy at a tertiary cutaneous lymphoma clinic in 2010-2017 were collected retrospectively from the medical files.. Thirty-five patients (26 males) of median age 50 years (range 8-83) with early-stage MF (IA 9, IB 26) underwent 37 treatment events: 25 acitretin and 12 isotretinoin at a median dosages of 0.3 mg/kg (range 0.2-0.9) and 0.2 mg/kg (range 0.1-0.7), respectively. Median time to maximal response was 6 months for both (range 1-10 for acitretin, 3-16 for isotretinoin); median treatment duration was 10 months (range 3-46) for acitretin, and 9 months (range 3-55) for isotretinoin. OR was 64% for acitretin and 80% for isotretinoin, and CR, 4% and 8%, respectively. Side-effect profiles were as previously reported for retinoids.. Early-stage MF patients may benefit from low dose RAR-agonist monotherapy, although the CR rate is low.

Topics: Acitretin; Adolescent; Adult; Aged; Aged, 80 and over; Child; Dermatologic Agents; Female; Humans; Isotretinoin; Male; Middle Aged; Mycosis Fungoides; Retinoid X Receptors; Retrospective Studies; Skin Neoplasms; Young Adult

A seven-year-old castrated male Yorkshire terrier dog was presented for a recurrent skin disease. Erythematous skin during the first visit progressed from multiple plaques to patch lesions and exudative erosion in the oral mucosa membrane. Biopsy samples were taken from erythematous skin and were diagnosed with epitheliotropic T cell cutaneous lymphoma by histopathology and immunochemical stain. In serum chemistry, the dog had a hypercalcemia (15.7 mg/dl) and mild increased alkaline phosphatase (417 U/l). Immunohistochemistry was performed to detect parathyroid hormone-related peptide (PTH-rP) in epitheliotropic cutaneous lymphoma tissues but the neoplastic cells were not labeled with anti-PTH-rP antibodies. The patient was treated with prednisolone and isotretinoin. However, the dog died unexpectedly.

Topics: Animals; Dog Diseases; Dogs; Fatal Outcome; Isotretinoin; Male; Mycosis Fungoides; Prednisolone; Skin Neoplasms

Topics: Antineoplastic Agents; Humans; Isotretinoin; Male; Middle Aged; Mycosis Fungoides; Skin Neoplasms

Although cutaneous T-cell lymphoma (CTCL), including mycosis fungoides (MF) and Sézary syndrome, is often responsive to treatment, few current therapies increase survival or consistently induce durable remissions, especially in advanced disease.. In an effort to improve treatment efficacy and outcome in CTCL, a combined modality protocol using 3 to 4 consecutive phases of therapy was initiated in 1987 at M.D. Anderson Cancer Center, Houston, Tex.. During a period of 15 years between 1987 and 2001, 95 patients with early-stage (Ia-IIa, n = 50) and late-stage (IIb-IVb, n = 45) MF were treated with subcutaneous interferon-alpha and oral isotretinoin, followed by total-skin electron beam therapy, and long-term maintenance therapy with topical nitrogen mustard and interferon-alpha. Patients with late-stage (IIb-IVb) disease also received 6 cycles of combination chemotherapy before electron beam therapy.. Combined modality therapy yielded a response rate of 85% with a 60% complete response rate. Among 38 patients with early-stage disease and 18 patients with late-stage disease achieving complete response, 9 (24%) patients with early-stage MF and 3 (17%) patients with late-stage MF achieved sustained remissions lasting more than 5 years. The median disease-free survival (DFS) for early and late stages of disease was 62 and 7 months, with 5-year Kaplan-Meier estimated rates of 50% and 27%, respectively. Current median overall survival times on combined modality are 145 months for patients with early-stage disease and 36 months for those with late-stage disease. Death was attributable to CTCL disease in 17 (55%) of 31 cases. The Kaplan-Meier estimates for 5-year survival are 94% for early-stage and 35% for late-stage disease. Univariate survival analysis in this patient population reveals statistically significant associations of clinical stage with overall response rates (P =.02), DFS (P =.03), and overall survival (P <.0001); age with DFS (P =.001) and overall survival (P =.04); and T stage (P <.0001) and lactate dehydrogenase (P =.007) with overall survival. By multivariate analysis using a Cox proportional hazards model, only age was significantly associated with DFS (hazard ratio 2.9), and only stage with overall survival (hazard ratio 18.2).. This nonrandomized and uncontrolled CTCL study gives supportive evidence that this multiphased combined modality regimen is well tolerated and may yield higher response rates and DFS than total-skin electron beam therapy alone, but provides no evidence for a change in survival.

Topics: Adult; Aged; Combined Modality Therapy; Drug Therapy, Combination; Female; Humans; Interferon-alpha; Isotretinoin; Lymphoma, T-Cell, Cutaneous; Male; Middle Aged; Mycosis Fungoides; Neoplasm Staging; Prognosis; Proportional Hazards Models; Survival Analysis; Treatment Outcome

Cutaneous T-cell lymphoma (CTCL) may respond to many therapies, but long-term disease-free survival is uncommon. Patients with advanced disease have a median survival of approximately 3 years.. Our purpose was to combine known effective agents sequentially to determine whether we could achieve remission in more patients or for longer duration.. Patients with mycosis fungoides (n = 23) or Sézary syndrome (n = 5) were treated with 4 months of recombinant interferon alfa together with isotretinoin, followed by total skin electron beam therapy alone (for stage I to II disease) or preceded by chemotherapy (for stage III to IV disease). Maintenance therapy consisted of interferon for 1 year and topical nitrogen mustard for 2 years.. Twenty-eight patients were treated. The overall response rate (complete and partial remissions) was 82%. Although the median duration of remission was 5 months in patients with stage III to IV disease, two patients remain in complete remission at 39 + and 46 + months. In patients with stage I to II disease the median duration of remission has not been reached at a median follow-up of 18 months. Five patients, all with stage III to IV disease, have died. Overall, the regimen was well tolerated with one treatment-related death from neutropenic sepsis.. Combined modality therapy may be effective for the treatment of CTCL with similar response rates to other current therapies.

Topics: Administration, Cutaneous; Adult; Aged; Antineoplastic Agents; Antineoplastic Agents, Alkylating; Cause of Death; Combined Modality Therapy; Disease-Free Survival; Female; Follow-Up Studies; Humans; Interferon Type I; Isotretinoin; Keratolytic Agents; Male; Mechlorethamine; Middle Aged; Mycosis Fungoides; Neoplasm Staging; Radiotherapy Dosage; Radiotherapy, High-Energy; Recombinant Proteins; Remission Induction; Sezary Syndrome; Skin Neoplasms; Survival Rate

Topics: Acitretin; Antineoplastic Combined Chemotherapy Protocols; Calcitriol; Female; Humans; Isotretinoin; Lymphoma, T-Cell, Cutaneous; Mycosis Fungoides; Remission Induction; Skin Neoplasms

Retinoids, including isotretinoin, have demonstrated antiproliferative and antineoplastic activity in laboratory and clinical trials. In a phase II trial, 25 patients with extensive mycosis fungoides were evaluated for response to isotretinoin. There was a 44% (11 patients) objective clinical response rate with three clinical complete responses without concomitant evidence of pathologic clearing of the disease. An additional 24% (six patients) showed a minor degree of clinical improvement. The median time to response was two months (range, 0.5 to eight months) and the median response duration was eight months or longer (range, one to 25 months). Chronic toxic reactions consisted primarily of drying of the skin and mucous membranes and resulted in dose reduction in the majority of patients. It is concluded that isotretinoin produces significant clinical benefit to some patients with mycosis fungoides.

Topics: Adult; Aged; Aged, 80 and over; Drug Eruptions; Drug Evaluation; Female; Humans; Isotretinoin; Male; Middle Aged; Mycosis Fungoides; Sezary Syndrome; Skin Neoplasms; Tretinoin; Triglycerides

A 56-year-old man with a 7-year history of well-documented mycosis fungoides is reported. Because the patient was a treatment failure with topical nitrogen mustard due to severe allergic contact dermatitis, and because of recent reports of the efficacy of retinoid compounds, he was treated with a 6-month course of isotretinoin with total clearing of his skin lesions. Previous case reports and possible mechanisms of action are reviewed.

Topics: Humans; Immunity; Isotretinoin; Male; Middle Aged; Mycosis Fungoides; Nitrogen Mustard Compounds; Skin Neoplasms; Tretinoin

A dermatitis occurring during the treatment of mycosis fungoides with A vitamin analogues (13-cis-retinoic acid and etretinate) and mimicking a progression of the disease is described. It is considered to be a skin reaction due to the treatment. Its benign nature is revealed by histology showing a lymphocytic infiltrate without any atypical sign.

Topics: Aged; Diagnosis, Differential; Drug Eruptions; Etretinate; Humans; Isotretinoin; Middle Aged; Mycosis Fungoides; Skin; Skin Neoplasms; Tretinoin

Twenty patients with mycosis fungoides and four with Sézary's syndrome were treated with 13-cis-retinoic acid as single therapy in an initial dose of 1 to 2 mg per kg body weight in most cases. Complete remission in mycosis fungoides was obtained in six cases (33%) and partial remission in another ten cases (50%). No convincing response was observed in three cases, and progression of limited nodular lesions occurred in one case. In cases responding to treatment the first sign of remission was observed within two to four weeks. Our short-term experience is that the drug is effective in early as well as advanced stages of mycosis fungoides. Patients with Sézary's syndrome, however, did not respond to the same extent.

Topics: Adult; Aged; Female; Humans; Isomerism; Isotretinoin; Male; Middle Aged; Mycosis Fungoides; Sezary Syndrome; Skin Neoplasms; Time Factors; Tretinoin

Four patients with refractory cutaneous T-cell lymphoma (mycosis fungoides) were treated with 13-cis-retinoic acid. Near complete clearing of extensive tumours and plaques was seen in one patient, who remains in partial remission with continued improvement after fifteen months. Two patients showed improvement in pruritus and 50% reduction in plaques by four and six weeks, respectively. The fourth patient had improvement in pruritus and clearing of plaques, but dryness and scaling necessitated reduction and eventually withdrawal of the treatment.

Topics: Adult; Aged; Female; Humans; Isotretinoin; Male; Middle Aged; Mycosis Fungoides; Skin Neoplasms; Time Factors; Tretinoin

Topics: Humans; Isotretinoin; Mycosis Fungoides; Tretinoin