isotretinoin and Pyoderma

Topics: Acne Vulgaris; Administration, Oral; Adult; Anti-Bacterial Agents; Female; Folliculitis; Humans; Hyperandrogenism; Isotretinoin; Keratolytic Agents; Male; Pyoderma; Sex Factors

Three male patients with severe nodulocystic acne were treated with oral isotretinoin in a dosage of 0.5 to 1.0 mg/kg/day. A flare of their disease developed, characterized by an inflammatory, hemorrhagic, pyogenic, granuloma-like response of previously crusted acne lesions. This reaction occurred between the sixth and ninth weeks of treatment and was confined entirely to the chest and back. The severity of the reaction prompted the administration of oral prednisone and, in two cases, the discontinuation of isotretinoin therapy. In one patient, pyoderma gangrenosum developed on the thigh. The exact incidence of this pyogenic, granuloma-like reaction to isotretinoin is unknown, although we have seen it in three of 66 patients with nodulocystic acne treated with this drug. The cause of the reaction is unknown, but it may be due to the increased skin fragility and vascular proliferation known to be induced by isotretinoin.

Topics: Acne Vulgaris; Administration, Oral; Adult; Double-Blind Method; Drug Eruptions; Granuloma; Hemorrhage; Humans; Isotretinoin; Male; Pyoderma; Skin Ulcer; Tretinoin

Topics: Animals; Chloramphenicol; Dog Diseases; Dogs; Drug Resistance, Multiple, Bacterial; Female; Isotretinoin; Photosensitivity Disorders; Pyoderma; Skin; Staphylococcal Infections; Staphylococcus

Pyoderma faciale is a rare cutaneous disorder that predominantly affects women in their 20s and 30s and is characterized by the rapid appearance of coalescing nodules and draining sinuses, combined with livid erythema on the face. We describe a 40-year-old woman who presented with localized pyoderma faciale that worsened during treatment with oral and topical antibiotics and corticosteroids. Subsequent treatment with isotretinoin for 5 months resulted in dramatic and sustained improvement.

Topics: Adult; Dermatologic Agents; Female; Humans; Isotretinoin; Pyoderma; Rosacea

Pyoderma faciale is an inflammatory disease that until now was believed to occur only in women. Bacterial pathogens have not been found in most cases, and those found included only gram-positive microorganisms. We present 2 cases consistent with pyoderma faciale--one of them a 17-year-old adolescent boy--in which gram-negative bacteria were found. Enterobacter cloacae was found in one patient, and Klebsiella oxytoca was found in the other. Needle aspiration is the technique of choice in looking for pathogens in this disease.

Topics: Adolescent; Anti-Infective Agents; Ciprofloxacin; Cloxacillin; Drainage; Enterobacter cloacae; Facial Dermatoses; Female; Gram-Negative Bacterial Infections; Humans; Isotretinoin; Klebsiella oxytoca; Male; Needles; Penicillins; Pyoderma; Staphylococcus aureus

Topics: Adult; Anti-Bacterial Agents; Citrobacter; Enterobacteriaceae Infections; Folliculitis; Humans; Isotretinoin; Male; Pyoderma; Recurrence; Staphylococcal Skin Infections

The explosive onset of fluctuant facial papulonodules, usually in young women, is characteristic of pyoderma faciale. This disorder is neither a true pyoderma nor a variant of acne, but rather a severe form of rosacea. The most effective therapeutic modality appears to be isotretinoin, especially if preceded by a brief course of oral corticosteroids or a short interval of application of potent topical corticosteroids. Despite our concern about the potential adverse effects of systemic retinoids on underlying inflammatory bowel disease, isotretinoin was given to a patient with refractory pyoderma faciale. Response was dramatic, and no ill effects were encountered.

Topics: Adult; Colitis, Ulcerative; Facial Dermatoses; Female; Humans; Isotretinoin; Keratolytic Agents; Pyoderma; Rosacea; Terminology as Topic

Topics: Adult; Colitis, Ulcerative; Facial Dermatoses; Female; Humans; Isotretinoin; Keratolytic Agents; Pyoderma

Medical records of 30 dogs with histologically confirmed sebaceous adenitis that were treated with isotretinoin or etretinate were reviewed. Akitas and Standard Poodles were overrepresented, compared with the general hospital population. Thirteen dogs had concurrent pyoderma. The retinoids were administered for a minimum of 2 months. Dosage for the 13 dogs treated with isotretinoin only ranged from 0.8 to 3.5 mg/kg of body weight/d (mean, 1.4 mg/kg/d). Dosage for the 10 dogs treated with etretinate only ranged from 0.7 to 1.8 mg/kg/d (mean, 1.1 mg/kg/d). Two dogs were first given isotretinoin (mean dosage, 1.5 mg/kg/d) and, when they did not respond, were subsequently given etretinate (mean dosage, 0.85 mg/kg/d). Five dogs were first given etretinate (mean dosage, 1 mg/kg/d) and, when they did not respond, were subsequently given isotretinoin (mean dosage, 1.6 mg/kg/d). For the 20 dogs treated with isotretinoin, 1 was lost to follow-up; 9 of the remaining 19 had a successful outcome (> 50% reduction in severity of scaling and extent of alopecia, compared with pretreatment appearance). For the 17 dogs treated with etretinate, 9 had a successful outcome. Outcome could not be predicted on the basis of clinical signs or histologic findings, and a prognosis could not be determined on the basis of whether sebaceous glands were evident histologically.

Topics: Alopecia; Animals; Biopsy; Dog Diseases; Dogs; Etretinate; Female; Follow-Up Studies; Inflammation; Isotretinoin; Male; Pyoderma; Retrospective Studies; Sebaceous Glands; Skin; Skin Diseases; Treatment Outcome

A male patient with severe cystic acne was treated with 13-cis-retinoic acid in a dosage of 1 mg/kg/day. Early flare-up of his acne and multiple pyogenic-like lesions on his face appeared during the second week of isotretinoin treatment. Histologic study of the lesions revealed granulation tissue. Possible etiologies for this phenomenon are discussed.

Topics: Acne Vulgaris; Adolescent; Facial Dermatoses; Granuloma; Humans; Isotretinoin; Male; Pyoderma

A 19-year-old man with severe acne developed extensive scalp folliculitis and later superficial pyoderma gangrenosum following treatment with isotretinoin. A cyclical neutropenia was noted and bone marrow findings suggested myelodysplasia. We believe that isotretinoin was implicated in the development of overt symptoms in this patient whose haematological condition was previously asymptomatic.

Topics: Abdominal Pain; Acne Vulgaris; Adult; Folliculitis; Humans; Isotretinoin; Male; Prednisolone; Pyoderma; Skin

Topics: Adult; Facial Dermatoses; Female; Humans; Isotretinoin; Pyoderma; Tretinoin

Malignant pyoderma is a destructive, ulcerating skin disease that occurs chiefly in young adults. Only eight cases of this rare disease have been reported. The head and neck have been involved in all cases, and a predilection for the periauricular region has been noted in several of the cases. Although the disease is progressive and chronic, responses to high-dose systemic corticosteroids have been noted, but usually a flare is associated with a reduction in dose. An additional case is described in which therapy with isotretinoin and sulfapyridine led to complete remission.

Topics: Adolescent; Adult; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Isomerism; Isotretinoin; Male; Middle Aged; Pyoderma; Sulfanilamides; Sulfapyridine; Time Factors; Tretinoin

Topics: Adolescent; Humans; Isomerism; Isotretinoin; Male; Pyoderma; Skin Diseases, Infectious; Tretinoin