isotretinoin and Pityriasis-Rubra-Pilaris

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

Topics: Acne Vulgaris; Adolescent; Child; Child, Preschool; Darier Disease; Etretinate; Female; Humans; Ichthyosis; Infant; Isomerism; Isotretinoin; Keratins; Keratoderma, Palmoplantar; Male; Pityriasis Rubra Pilaris; Psoriasis; Skin Diseases; Skin Diseases, Vesiculobullous; Tretinoin

Topics: Acne Vulgaris; Administration, Oral; Adolescent; Dermatitis, Exfoliative; Half-Life; Humans; Ichthyosis; Isotretinoin; Neoplasms; Pityriasis Rubra Pilaris; Psoriasis; Tretinoin

Topics: Clinical Trials as Topic; Humans; Ichthyosis; Isotretinoin; Keratosis; Pityriasis Rubra Pilaris; Skin Diseases; Tretinoin

Forty-five patients with pityriasis rubra pilaris were treated with oral 13-cis-retinoic acid (isotretinoin). There was marked improvement in the degree of erythema, in duration, and scaling noted within 4 weeks. Remission or maintained improvement persisted after stopping therapy in many of the patients. The drug is a significant addition to the therapeutic armamentarium in this difficult-to-treat disease.

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Clinical Trials as Topic; Female; Humans; Infant; Isomerism; Isotretinoin; Male; Middle Aged; Pityriasis Rubra Pilaris; Tretinoin

Topics: ChAdOx1 nCoV-19; COVID-19; Humans; Isotretinoin; Pityriasis Rubra Pilaris

Topics: Administration, Cutaneous; Administration, Oral; Adolescent; Arm; Betamethasone; Drug Therapy, Combination; Face; Female; Humans; Isotretinoin; Lasers, Dye; Methotrexate; Pityriasis Rubra Pilaris; Skin; Treatment Outcome

Topics: Adolescent; Dermatologic Agents; Diagnosis, Differential; Female; Foot Dermatoses; Humans; Isotretinoin; Pityriasis Rubra Pilaris

Topics: Clobetasol; Dermatologic Agents; Diagnosis, Differential; Eosinophilia; Humans; Hydroxyzine; Isotretinoin; Male; Middle Aged; Pityriasis Rubra Pilaris; Psoriasis; Severity of Illness Index; Skin; Treatment Outcome; Urea

A 3-year-old male presented with progressive pruritic red-orange plaques across most of his body with erythema, desquamation, and fissuring of the hands and feet. He was diagnosed with classic juvenile (type III) pityriasis rubra pilaris (PRP) and treated with oral isotretinoin for 6 months. His skin findings resolved quickly during the treatment period, with residual postinflammatory hypopigmentation resolving within a year. PRP is rare in pediatric patients and standard recommended treatment algorithms for this population are not currently available. Diagnostic and treatment guidelines for PRP are based almost exclusively on case reports or case series, most of which focus on adult patients. The presentation, evaluation, and management of PRP are discussed.

Topics: Administration, Cutaneous; Child, Preschool; Dermatologic Agents; Glucocorticoids; Humans; Isotretinoin; Male; Pityriasis Rubra Pilaris

Pityriasis rubra pilaris (PRP) is an uncommon papulosquamous disorder of unknown etiology. Studies on this condition from our region are lacking.. To describe the clinical and histopathological findings as well as response to treatment of all patients diagnosed with PRP at the American University of Beirut Medical Center between 1995 and 2010 and compare our findings with those published in the literature.. Pityriasis rubra pilaris was diagnosed in 32 patients (16 males, 16 females). Age of onset ranged between 2.5 and 70 years. The majority of patients (n=15) were classified as type I (47%) followed by type III (n=9, 28%) and type IV (n=6, 19%). Based on treatment responses, retinoids appear to be very effective in our population as all patients treated with isotretinoin or acitretin had excellent response. In addition to checkerboard alternating orthokeratosis/parakeratosis, which was observed in 31 cases, interesting features, including the presence of follicular plugging in all 21 cases in which follicles were available for examination, eosinophils in 12 cases, and focal acantholysis in three cases were observed.. Features of patients with PRP in our study are generally comparable to those published in the literature, with minor differences. Microscopically follicular plugging, in addition to checkerboard alternating orthokeratosis/parakeratosis, may serve as clues to PRP diagnosis. The presence of eosinophils and focal acantholysis, observed in a few cases, should not exclude PRP diagnosis.

Topics: Acitretin; Administration, Cutaneous; Adolescent; Adult; Aged; Child; Child, Preschool; Emollients; Eosinophils; Female; Humans; Isotretinoin; Keratolytic Agents; Lebanon; Male; Middle Aged; Nicotinic Acids; Pityriasis Rubra Pilaris; Retrospective Studies; Steroids; Young Adult

Topics: Adult; Child; Female; Humans; Isotretinoin; Keratolytic Agents; Male; Pityriasis Rubra Pilaris

Pityriasis rubra pilaris (PRP) is an uncommon dermatosis in children. Few long-term studies on the treatment and prognosis of PRP in children have been performed.. Our purpose was to retrospectively review the clinical course and treatment of all cases of PRP in children 19 years or younger who were seen at the Mayo Clinic.. The clinical courses of the 30 patients with PRP seen at the Mayo Clinic between 1975 and 1997 were reviewed.. The most common presenting form of PRP in children is the type III juvenile form (Griffiths' criteria). Treatment ranged from topical steroids, tar, and ultraviolet B to systemic retinoids and methotrexate. The best response was obtained with isotretinoin; 5 of 6 patients showed 90% to 100% clearing within 6 months of treatment. Follow-up information was obtained by questionnaire and was available for 83% of patients. Overall, 43% had 90% to 100% resolution of their disease, 23% had a moderate response (30%-90% improvement), and 17% had a poor response (<30% improvement). One patient reported spontaneous resolution. Seventeen percent of those who had total clearing had recurrence of PRP within 1 year.. PRP in children is a noninherited dermatosis with no sex predilection, occurring mainly in the type III classic juvenile form. Retinoids should be considered as first-line treatment for PRP. Recurrence rate, previously thought to be rare, was about 17% in our population.

Topics: Administration, Topical; Adolescent; Adult; Anti-Inflammatory Agents; Child; Child, Preschool; Coal Tar; Female; Glucocorticoids; Humans; Infant; Isotretinoin; Male; Methotrexate; Pityriasis Rubra Pilaris; Retinoids; Retrospective Studies; Ultraviolet Therapy

Pityriasis rubra pilaris (PRP) often has a devastating impact on the lives of patients. Descriptions of its histopathologic features are not uniform. Finding a successful therapy can be challenging.. Our purpose was to examine the histopathologic features and response of patients to our standard therapy of an oral retinoid and concomitant or later addition of low-dose weekly methotrexate.. A retrospective chart review was done on 24 patients with PRP seen from March 1986 to March 1996. Biopsy specimens from 19 patients were reexamined. Telephone follow-up was conducted to determine maintenance of remission.. All patients had the adult acquired form of PRP. Biopsy specimens from nine patients were characterized by prototypical findings of PRP, while the others included both typical and other features. Twenty-two patients were treated with either isotretinoin, 40 mg twice daily, or etretinate, 25 to 75 mg/day. Six patients with more disabling involvement had low-dose weekly methotrexate ranging from 5 to 30 mg started concurrently. Five patients had weekly methotrexate added at a later time. Seventeen patients showed 25% to 75% response after 16 weeks of therapy. All patients whose skin cleared maintained their remission.. Initial oral retinoid plus concurrent or later low-dose weekly methotrexate resulted in 25% to 75% improvement of PRP in 17 of 24 patients after 16 weeks of therapy. Some of the atypical features seen in biopsy specimens emphasize the importance of clinical and histopathologic correlation in establishing the diagnosis.

Topics: Administration, Oral; Adult; Aged; Dermatologic Agents; Drug Administration Schedule; Drug Therapy, Combination; Etretinate; Female; Follow-Up Studies; Humans; Isotretinoin; Male; Methotrexate; Middle Aged; Pityriasis Rubra Pilaris; Retrospective Studies

Treatment of classic pityriasis rubra pilaris, which almost always progresses to a generalized erythroderma with marked, often disabling keratoderma of the palms and soles, remains problematic.. Our purpose was to evaluate the results of treatment in a recent period during which the retinoid group of drugs has been available.. The clinical course of 75 patients with classic pityriasis rubra pilaris seen from 1982 to 1992 was reviewed.. Of 15 patients treated with isotretinoin, 10 had complete and 2 had partial clearing. Of six treated with etretinate, four had clearing. All eight patients treated with methotrexate had a favorable response. Other forms of treatment, including Goeckerman regimen, corticosteroids, vitamin A, and cyclosporine, were ineffective.. Early diagnosis and early treatment with retinoids appear to offer the best chance for clearing of pityriasis rubra pilaris. If retinoids fail or cannot be used, methotrexate should be considered.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Etretinate; Female; Follow-Up Studies; Humans; Isotretinoin; Male; Methotrexate; Middle Aged; Photochemotherapy; Pityriasis Rubra Pilaris; Remission Induction

The side effects of prolonged isotretinoin therapy include progressive calcification of ligamentous and tendon insertions, premature fusion of epiphyses, and modeling abnormalities of long bones. Increased calcification of gastric mucosa has been reported only in animal studies, but not in humans. A case of a child who was treated with isotretinoin for 26 months for a dermatologic disorder and who showed abnormal gastric uptake of 99m-Tc MDP on a bone scan is reported.

Topics: Bone and Bones; Calcinosis; Child; Female; Humans; Isotretinoin; Pityriasis Rubra Pilaris; Radionuclide Imaging; Stomach; Stomach Diseases; Technetium Tc 99m Medronate; Time Factors

We report a retrospective review of 18 patients with pityriasis rubra pilaris treated with isotretinoin or etretinate, or both. Of patients treated with only isotretinoin, 60% have achieved sustained resolution. Of four patients treated with etretinate, three have cleared completely and the other patient has shown substantial improvement. Our data suggest that etretinate may be superior to isotretinoin in the treatment of adult-onset pityriasis rubra pilaris.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Etretinate; Female; Humans; Isotretinoin; Male; Middle Aged; Pityriasis Rubra Pilaris; Retrospective Studies

Five patients with pityriasis rubra pilaris were treated with isotretinoin from September 1982 through 1985. Isotretinoin at an average dose of 1.16 mg/kg/day for 16 to 24 weeks caused complete or almost complete clearing in four of the five patients.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Female; Humans; Isotretinoin; Male; Middle Aged; Pityriasis Rubra Pilaris; Tretinoin; Triamcinolone; Triglycerides

Topics: Adolescent; Adult; Aged; Darier Disease; Female; Humans; Isotretinoin; Male; Middle Aged; Pityriasis Rubra Pilaris; Skin; Skin Diseases, Vesiculobullous; Tretinoin

A new synthetic oral retinoid, 13-cis retinoic acid, is fairly well tolerated in patients and appears to be effective in those with Darier's disease and lamellar ichthyosis. It is less effective in those with pityriasis rubra pilaris. The mechanism of action of 13-cis retinoic acid in disorders of keratinization is unknown at the present time; however, it does not appear to cause lysosomal proliferation in therapeutic doses.

Topics: Adolescent; Adult; Cheilitis; Child; Conjunctivitis; Darier Disease; Dose-Response Relationship, Drug; Evaluation Studies as Topic; Female; Humans; Ichthyosis; Isotretinoin; Male; Middle Aged; Pityriasis Rubra Pilaris; Tretinoin