isotretinoin and Nail-Diseases

Topics: Acne Vulgaris; Adolescent; Dermatologic Agents; Humans; Isotretinoin; Male; Nail Diseases

Isotretinoin has various effects on nails. However, the mechanism of how isotretinoin affects the nail plate is unknown. We aimed to investigate the effects of isotretinoin on morphology, growth rate, and thickness of the nail plate.. A total of 70 acne vulgaris patients treated with isotretinoin and a control group consisting of 68 healthy volunteers were included in the study. Isotretinoin treatment was started at a dose of 0.5 mg/kg per day. Nail changes were noted; length and thickness of the nail plate were measured in all participants every month.. The medians of nail growth rates in the isotretinoin and control groups were 3.16 (2.87-3.57) mm/month and 2.89 (2.56-3.19) mm/month, respectively. The medians of nail thickness in the isotretinoin and control groups were 0.47 (0.38-0.53) mm and 0.50 (0.40-0.65) mm, respectively. Statistically significant differences were observed between the groups in terms of nail growth rate and thickness (P < 0.01, P = 0.02, respectively). Nail findings were observed in nine out of 70 patients (12.8%), mostly onychoschizia.. Isotretinoin gradually increases the nail growth rate and thins the nail plate over time during the course of isotretinoin treatment. Dermatologists prescribing isotretinoin should also consider the nail changes, which may impact the life quality of patients.

Topics: Acne Vulgaris; Humans; Isotretinoin; Nail Diseases; Nails; Quality of Life

Topics: Acne Vulgaris; Administration, Topical; Dermatologic Agents; Humans; Isotretinoin; Male; Nail Diseases; Nails; Young Adult

Elkonyxis and median nail distrophy are very rare nail fold disorders due to the damage in nail matrix and proximal nail fold. Herein, we report a patient with both elkonyxis and median nail distrophy occured two months into a treatment course of isotretinoin that is to our knowledge for the first time.

Topics: Acne Vulgaris; Adolescent; Dermatologic Agents; Female; Humans; Isotretinoin; Nail Diseases

This paper describes the association of two unusual side effects of treatment with isotretinoin for severe acne: paronychia and excess granulation tissue in the nails furrows. We report a case of male patient aged 19 years, who in the course of the 36th week of treatment with isotretinoin for acne grade III showed erythema, edema, excess granulation tissue and onychocryptosis in various nail beds of hands and feet, with no history of trauma associated. A literature review revealed few reports of these adverse events, and two clinical patterns of exuberant granulation tissue has been described: one in periungual location and other in lesions of previous acne. The rarity and lack of knowledge on the best treatment for granuloma-like reactions make this theme a considerable challenge.

Topics: Acne Vulgaris; Granulation Tissue; Granuloma, Pyogenic; Humans; Isotretinoin; Male; Nail Diseases; Paronychia; Treatment Outcome; Young Adult

The project was aimed at development of isotretinoin nail lacquer and assessment of its penetration efficiency across human nail plate. Preliminary studies (hydration enhancement factor and SEM) aided the selection of thioglycolic acid as permeation and eugenol was selected as local anesthetic in the formulation. The nail lacquer was optimized by 3(2) factorial design and a total of nine formulations were prepared and screened. In vitro adhesion and ex vivo permeation (cumulative drug permeation per unit area (CDP/A) = 6.61 ± 0.57 mg/cm(2)) across bovine hoof guided the selection of F3 as optimized formulation that was improvised. Viscosity adjustments to improve handling characteristics were affected by incorporation of ethyl cellulose (6%; F3M1) that scaled the viscosity to 312.681 cp and insignificantly (p > 0.05) affected CDP/A (6.32 ± 0.45 mg/cm(2)). In comparison to marketed preparation (Retino-A cream) F3M1 afforded two fold increase in CDP/A. The permeation characteristics were defined by Higuchi model (r(2) = 0.964) and flux value of 176 μg/cm(2)/h. Confocal laser scanning microscopy, after 72 h of nail lacquer application, revealed extensive distribution of the fluorescent tracer across the human nail plate in comparison to control that was confined to the top layer. Conclusively, an efficacious and stable nail lacquer of isotretinoin was developed for potential clinical topical use to target the drug to nail bed in treatment of nail psoriasis.

Topics: Administration, Topical; Adult; Animals; Cattle; Dermatologic Agents; Dosage Forms; Drug Stability; Hoof and Claw; Humans; Isotretinoin; Nail Diseases; Nails; Permeability; Psoriasis; Young Adult

Topics: Acne Vulgaris; Dermatologic Agents; Drug Administration Schedule; Female; Humans; Isotretinoin; Middle Aged; Nail Diseases

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

A 23 year old woman who presented with severe acne had been treated with 40 mg/day isotretinoin. On her monthly control, severe cheilitis and bilateral toe nail onycholysis were observed. It is well known that systemic retinoids have several side effects. Although dystropic nail, paronichia-like changes, median nail dystrophy have previously been reported with isotretinoin therapy, onycholysis is rare. In this report, we describe a case with isotretinoin induced nail fragility and onycholysis.

Topics: Acne Vulgaris; Administration, Oral; Adult; Female; Humans; Isotretinoin; Keratolytic Agents; Nail Diseases

Topics: Adult; Female; Humans; Isotretinoin; Nail Diseases

This paper reports on the association of two uncommon side effects of isotretinoin therapy for cystic acne: paronychia and excess granulation tissue in the nail sulci. An explanation for these side effects is suggested, but the exact pathogenesis remains obscure.

Topics: Acne Vulgaris; Adult; Female; Granuloma; Humans; Isotretinoin; Nail Diseases; Paronychia; Tretinoin

Two patients, a father and son, with pachyonychia congenita were treated with orally administered isotretinoin because the extreme deformity and discomfort associated with their massive keratoderma interfered with their work and school, respectively. While clinical benefits could not be sustained, electron microscopic findings compatible with suppression of abnormal keratinization were observed. In addition, skin biopsy samples were analyzed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis, and the gels were then subjected to a lectin overlay technique with concanavalin A labeled with iodine 125. The distribution of specific glycoproteins was found to be different for lesional as against normal epidermis. The procedure was repeated after oral treatment with isotretinoin. The labeled glycoprotein pattern of the lesional epidermis was clearly distinguishable from both the pretreatment lesional and the normal epidermis; it was mostly intermediate between the two. The normal epidermis was virtually unaffected by the retinoid treatment.

Topics: Adult; Child; Glycoproteins; Humans; Isotretinoin; Keratosis; Male; Microscopy, Electron; Nail Diseases; Skin; Tretinoin