isotretinoin and Skin-Diseases

While isotretinoin has been the gold-standard of therapy for severe acne since its approval in 1982, its anti-inflammatory properties makes it a potentially applicable and versatile therapy for a wide variety of dermatologic conditions yet to be explored. This systematic review comprehensively recounts the success of oral isotretinoin in non-acne cutaneous diseases and provide insight into future directions of isotretinoin utility. A systematic literature review was performed using PubMed. Search terms included "isotretinoin" OR "accutane" AND "skin" OR "dermatology" OR "hair" OR "nails" OR "rosacea" OR "psoriasis" OR "pityriasis rubra pilaris" OR "condyloma acuminata" OR "granuloma annulare" OR "darier's disease" OR "non-melanoma skin cancer" OR "frontal fibrosing alopecia" OR "cutaneous lupus erythematosus" OR "hidradenitis suppurativa" OR "photodamaged skin" OR "skin aging" OR "wart" OR "flat warts" OR "plane warts" OR "lichen planus" OR "dissecting cellulitis" OR "folliculitis decalvans" OR "sebaceous hyperplasia" OR "cutaneous t-cell lymphoma" OR "mycosis fungoides." A total of 169 studies discuss the use of oral isotretinoin for 16 non-acne dermatologic conditions, the most common being non-melanoma skin cancers (0.2-8.2 mg/kg/day), cutaneous T-cell lymphomas (0.5-2 mg/kg/day), and rosacea (0.22-1 mg/kg/day). Inflammatory conditions such as rosacea, granuloma annulare, and hidradenitis suppurativa benefit from lower oral isotretinoin dosage of 0.3-1 mg/kg/day, whereas, hyperkeratotic diseases such as psoriasis and pityriasis rubra pilaris, consistently respond better to higher dosages of up to 2-4 mg/kg/day for lesion clearance. Recurrence of disease following discontinuation of isotretinoin have been reported for rosacea, psoriasis, granuloma annulare, Darier's disease, dissecting cellulitis, and non-melanoma skin cancers. Disease exacerbation was reported in some patients with hidradenitis suppurativa. Off-label isotretinoin is an effective treatment choice for dermatological conditions beyond acne. Further prospective, randomized human trials are needed to clarify when and how to prescribe off-label isotretinoin for maximum efficacy and safety.

Topics: Administration, Oral; Dermatologic Agents; Dose-Response Relationship, Drug; Humans; Isotretinoin; Off-Label Use; Skin Diseases; Treatment Outcome

Over the past 20 years, evidence has emerged indicating oral isotretinoin could be considered a potential treatment for photoaged skin. In this review, we provide a succinct overview of the available evidence and provide commentary on the current and future directions for utilizing oral isotretinoin as a potential treatment for photoaging.. We prepared a review protocol and searched the PubMed and Cochrane databases for relevant literature published between January 1982 and April 2020. Using a defined keyword search, a total of 23 papers were initially identified by the main author. Two authors independently reviewed each of the 23 articles, and 6 articles were deemed relevant to this study.. Of the six studies included in this review, three were randomized clinical trials, one was a nonrandomized clinical trial and two were prospective cohort studies. All studies were conducted between 2000 and 2015. Across all 6 studies, 251 patients were recruited, with a mean of 42 patients per study. Four studies were in favor of isotretinoin to improve photoaged skin, 1 study showed no benefit, and 1 study showed no benefit when compared to topical tretinoin treatment. Of the studies available, many were hampered by methodological challenges.. Oral isotretinoin may be useful for treating photoaging but there is currently insufficient evidence to support its use. In comparison with other established anti-photoaging treatments, it is not clear whether the potential benefits of oral isotretinoin outweigh the potential risks.

Topics: Dermatologic Agents; Humans; Isotretinoin; Prospective Studies; Randomized Controlled Trials as Topic; Skin Aging; Skin Diseases

Over the last year there has been major publications related to therapeutic trials in infectious dermatology, not only with regard to Herpes zoster subunit vaccine but also for the treatment of uncomplicated abscesses or scabies. In addition, biological treatments continue to be on the forefront, not only in the treatment of psoriasis but also in other chronic inflammatory dermatologic diseases such as atopic dermatitis and hidradenitis suppurativa, two diseases that significantly impact quality of life and for which there are to date, few therapeutic alternatives in moderate to severe forms. In addition, the treatment of cyclin-resistant papulopustular rosacea was also the subject of a large French controlled randomized controlled trial that could modify our therapeutic approach by the use of isotretinoin. Finally, the prevention of rashes induced by erlotinib with oral doxycyline is also part of this 2016 "what's new in dermatological therapeutics".

Topics: Adalimumab; Anti-Bacterial Agents; Anti-Inflammatory Agents; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Dermatologic Agents; Dermatology; Erlotinib Hydrochloride; Herpes Zoster Vaccine; Humans; Interleukin 1 Receptor Antagonist Protein; Isotretinoin; Piperidines; Protein Kinase Inhibitors; Pyrimidines; Pyrroles; Skin Diseases; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Administration, Cutaneous; Dermatologic Agents; Humans; Isotretinoin; Keratosis; Laser Therapy; Nicotinic Acids; Randomized Controlled Trials as Topic; Skin Aging; Skin Diseases; Sunlight; Tretinoin

Based on the review of the medical publications, this article summarizes the main advances in the field of pediatric dermatology which occurred during the last year. The main results concern psoriasis, atopic dermatitis, acne and hemangiomas. A particular attention was given to genodermatoses.

Topics: Attention; Child; Depression; Dermatologic Agents; Dermatology; Etanercept; Eye Diseases; Humans; Immunoglobulin G; Immunosuppressive Agents; Isotretinoin; Mutation; Propranolol; Proto-Oncogene Proteins c-akt; Receptors, Tumor Necrosis Factor; Severity of Illness Index; Skin Diseases; Skin Neoplasms; Vasodilator Agents; Vitamin D

Several good-quality randomised trials brought useful information on how to manage severe skin infections and develop anti-staphylococcus strategies. Trials on common warts did not bring any valuable solution. Rituximab and omalizumab have seen their indications becoming more precise or broadened. Meta-analyses have been particularly numerous, but most of the time with no decisive conclusion, since this methodology presents strong limitations for studying safety data. Most important work has been rather directed toward analysing safety data rather than efficacy. Among the most important results, are those from a retrospective cohort of patients taking isotretinoin: suicidal risk has to be linked to severe acne itself, rather than to the drug.

Topics: Abscess; Adalimumab; Anti-Bacterial Agents; Antibodies, Anti-Idiotypic; Antibodies, Monoclonal, Humanized; Antibodies, Monoclonal, Murine-Derived; Cicatrix; Dermatologic Agents; Dermatology; Humans; Immunologic Factors; Immunosuppressive Agents; Isotretinoin; Methicillin-Resistant Staphylococcus aureus; Methotrexate; Omalizumab; Papillomavirus Vaccines; Rituximab; Sirolimus; Skin Diseases; Transforming Growth Factor beta3

Although neuromuscular adverse effects represent significant clinical manifestations of hypervitaminosis A syndrome, surprisingly little attention has been paid to the potential neuromuscular toxicity of vitamin A derivatives (retinoids). Since isotretinoin and acitretin are currently the two most commonly used oral retinoids in systemic dermatotherapy, this review focuses exclusively on their neuromuscular adverse effects and proposes a neuromuscular algorithm for appropriate monitoring of patients treated with these two compounds. The most frequent CNS adverse effect associated with oral isotretinoin is headache, either as an independent adverse effect or as part of benign intracranial hypertension, which is additionally characterized by nausea and visual changes. Isolated cases of stiff-person-like syndrome, epileptic seizures and generalized muscle stiffness syndrome, possibly or probably related to oral treatment with isotretinoin, have also been reported. In addition, oral isotretinoin has reportedly been associated with muscular adverse effects that most frequently manifest as myalgia and stiffness and, in rare cases, as true myopathy or rhabdomyolysis. Creatine phosphokinase, a specific marker of muscle destruction, has been found to be elevated, occasionally by up to 100 times the normal value (with or without muscular symptoms and signs), in a variable percentage of patients receiving isotretinoin treatment and particularly in those undergoing vigorous physical exercise. Oral acitretin has been found to cause peripheral nerve dysfunction, particularly of sensory fibres, which in rare cases leads to clinically evident sensory disturbances. Less clear is the causal relationship between acitretin and benign intracranial hypertension or myopathy, whereas an isolated case of cranial nerve IV (oculomotor) palsy and a further case of thrombotic stroke during treatment with oral acitretin have been reported. Systemic diseases with involvement of nervous and/or muscle tissue and neuromuscular disorders should be regarded as exclusion criteria for initiation of oral retinoid therapy. Additionally, intense physical exercise and concurrent treatment with neurotoxic or myotoxic drugs should be avoided during treatment with oral retinoids. In order to minimize the potential risk of neuromuscular adverse effects, a neuromuscular algorithm is suggested that may be useful for monitoring patients taking oral retinoids.

Topics: Acitretin; Administration, Oral; Biomarkers; Creatine Kinase; Dermatologic Agents; Drug Monitoring; Exercise; Humans; Hypervitaminosis A; Isotretinoin; Neuromuscular Diseases; Practice Guidelines as Topic; Skin Diseases

Acne vulgaris is a nearly universal phenomenon among adolescents in the western world and continues to remain problematic for a significant proportion of adults. During adolescence, emotional and physical changes must be successfully integrated into the emerging sense of self, and skin disorders such as acne, which alter that self-image, may engender distressing feelings of embarrassment, shame, and disgust. While most patients eventually achieve spontaneous remission, approximately one quarter of teenagers will show evidence of permanent acne scarring by 18 years of age. This article reviews current information regarding the pathophysiology, clinical manifestations, differential diagnosis, and therapy of the adolescent patient who has acne, and emphasizes recent advances in acne management.

Topics: Acne Vulgaris; Anti-Bacterial Agents; Benzoyl Peroxide; Contraceptives, Oral; Dermatologic Agents; Diagnosis, Differential; Humans; Isotretinoin; Phototherapy; Retinoids; Skin Diseases

The most widely used retinoids include topical tretinoin (Retin-A), adapalene (Differin), topical tazarotene (Tazorac), isotretinoin (Accutane), and acitretin (Soriatane). This article will review new uses and developments in tazarotene (its failure to secure FDA approval in oral form for psoriasis), adapalene (its new 0.3% gel form and use in rosacea), alitretinoin (its use in photoaging), bexarotene (its use for psoriasis and chronic hand dermatitis), isotretinoin (the IPledge program, its use for neuroblastoma and branded formulation pharmacological superiority to generics), and retinoic acid metabolism-blocking agents (RAMBAs) (liarazole use for ichthyosis and psoriasis).

Topics: Adapalene; Humans; Isotretinoin; Keratolytic Agents; Naphthalenes; Nicotinic Acids; Retinoids; Skin Diseases; Tretinoin

Photodamage describes skin changes such as fine and coarse wrinkles, roughness, freckles and pigmentation changes that occur as a result of prolonged exposure to the sun. Many treatments are available to reverse the damage, but it is unclear which work and at what cost in terms of unwanted side effects.. To assess the effects of topically applied treatments, tablet treatments, laser and surgical procedures for photodamaged skin.. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, Issue 1 2002, MEDLINE (1966-June 2002), EMBASE (1974-June 2002), Health Periodicals (1976-June 2002). We checked references of articles and communicated with authors and the pharmaceutical industry.. Randomised controlled trials which compared drug or surgical interventions with no treatment, placebo or another drug, in adults with mild, moderate or severe photodamage of the face or forearms.. Two reviewers independently extracted data and assessed trial quality.. Thirty studies of variable quality were included. Eight trials showed that topical tretinoin cream, in concentrations of 0.02% or higher, was superior to placebo for participants with mild to severe photodamage on the face and forearms (although losses to follow-up were relatively high in most studies). For example, the relative risk of improvement for 0.05% tretinoin cream, compared to placebo (three studies), at 24 weeks, was 1.73 (95% confidence interval 1.39 to 2.14). This effect was not seen for 0.001% topical tretinoin (one study) or 0.01% (three studies). A dose-response relationship was evident for both effectiveness and skin irritation. One small within-patient study showed benefit from topical ascorbic acid compared with placebo. Tazarotene (0.01% to 0.1%) and isotretinoin (0.1%) both showed significant improvement over placebo for moderate photodamage (one study each). There is limited evidence (one trial), to show that the effectiveness of 0.05% tretinoin, is equivalent to the effects of 0.05% and 0.1% tazarotene. One small study showed greater improvement in upper lip wrinkles with CO2 laser technique compared to Baker's phenol chemical peel, at 6 months. Three small RCTs comparing CO2 laser with dermabrasion found no difference in wrinkle score at 4 to 6 months, suggesting that both methods are equally efficacious, but more erythema was reported with the laser. The effectiveness of other interventions such as hydroxy acids and natural polysaccharides was not clear.. There is conclusive evidence that topical tretinoin improves the appearance of mild to moderate photodamage on the face and forearms, in the short term. However erythema, scaling/dryness, burning/stinging and irritation may be experienced initially. There is limited evidence that tazarotene and isotretinoin benefit patients with moderate photodamage on the face: both are associated with skin irritation and erythema. The effectiveness of other interventions remains uncertain.

Topics: Administration, Cutaneous; Dermatologic Agents; Humans; Isotretinoin; Keratosis; Laser Therapy; Nicotinic Acids; Randomized Controlled Trials as Topic; Skin Aging; Skin Diseases; Sunlight; Tretinoin

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

Retinoids have been in sharp focus ever since their introduction 30 years ago. They include any drug (s) that bind to retinoid receptors and elicit a biological response. Enormous information on the subject seems to embroil the recent literature. Practically it is impossible to clearly comprehend the undercurrents. The meticulously dispensing text envisages surmounting the perspective reader's predicaments. Accordingly, retinoids and their related facets namely retinoid receptors, classification, mode of action, and the pharmacological diversity have been precisely defined. Commonly used systemic retinoids too have been given a substantial fresh look along with their monitoring. Overall, adverse effects and relative and absolute contraindications have been scrupulously incorporated. Human immuno deficiency virus (HIV) and isoretinoid for acne, in particular, have been highlighted. Micronized isotretinoin formulations have also been taken care so also commonly used topical retinoids. Tretinoin and their newer formulation have also been accounted for along with tretinoin polymer cream. Adapalene, a new chemical entity possessing a unique physico-chemical activity similar to that of tretinoin has also been dealt with. Newer retinoids are likely to be a subject of intrigue. A focus on future potentials of retinoids is its special ingredient. The inclusion of details of rexinoid the most recent introduction in their purview is likely to invoke interest to further consolidate its reckoning in future. All in all the text of the paper should provide an insight into the current rumbling around retinoids.

Topics: Acne Vulgaris; Adapalene; Administration, Cutaneous; Administration, Oral; Chemistry, Pharmaceutical; Humans; Isotretinoin; Naphthalenes; Psoriasis; Receptors, Retinoic Acid; Retinoids; Skin Diseases; Tretinoin

Systemic retinoids represent a growing armamentarium in the treatment of a wide range of skin disorders and malignancies. Although these drugs can have substantial toxicities, their wise use can result in safe and efficacious therapy that can alter dramatically the lives of individuals with severe skin disorders.

Topics: Acne Vulgaris; Anticarcinogenic Agents; Humans; Isotretinoin; Psoriasis; Retinoids; Skin Diseases; Skin Neoplasms

Upon completion of this article, the reader should be able to: 1. Identify the dermatologic drugs with the highest risk of teratogenicity. 2. List the essential information to be obtained from a woman with childbearing potential being considered for treatment with a teratogenic dermatologic agent. 3. Discuss management principles for administration of teratogenic agents to women with childbearing potential. Dermatologic agents can be highly teratogenic, and the gynecologist must be aware of the issues involved in prescribing them. Prescribers should be aware of the risks and ensure that patients taking teratogens do not become pregnant during the course of therapy (or until the drug has been cleared from the body). This can involve taking menstrual and sexual histories and counseling the patient about sexual behavior and contraception.

Topics: Adult; Congenital Abnormalities; Contraceptive Agents, Female; Contraindications; Dermatologic Agents; Female; Humans; Isotretinoin; Pregnancy; Risk Factors; Sexual Behavior; Skin Diseases; Teratogens

Isotretinoin (13-cis-retinoic acid) is a retinoid that has been used over the past 2 decades to treat a wide variety of dermatologic conditions, some with great success. Although it is beneficial in many skin conditions, the side effects and toxicities of oral retinoids require careful monitoring by experienced physicians. The clinical applications of oral retinoids continue to expand both within and beyond the field of dermatology.

Topics: Acne Vulgaris; Administration, Oral; Adult; Aged; Aging; Dermatologic Agents; Humans; Isotretinoin; Middle Aged; Psoriasis; Skin Diseases; Skin Neoplasms

A case of acquired perforating dermatosis associated with diabetic nephropathy is described. The case is unusual in that the dermatosis first developed approximately 1 year after renal transplantation rather than at a time when renal function was more severely impaired or during haemodialysis. There was a partial response to treatment with isotretinoin but the use of this drug was limited by the development of hyperlipidaemia. The relevant literature is reviewed.

Topics: Adult; Diabetes Mellitus, Type 1; Diabetic Nephropathies; Humans; Hyperlipidemias; Isotretinoin; Keratolytic Agents; Kidney Failure, Chronic; Male; Skin Diseases

The retinoids provide an important new way of treating dermatologic disorders. They have also proved to have a role in the prevention of new lesion formation. New retinoids, of which adapalene is one, have recently been synthesized in order to obtain similar or better efficacy while reducing skin irritation potential. These new molecules are currently under clinical investigation. Preliminary results are encouraging. In the near future, an expanded range of topical retinoids should be available.

Topics: Adapalene; Administration, Cutaneous; Animals; Anti-Inflammatory Agents, Non-Steroidal; Humans; Isotretinoin; Mice; Models, Biological; Naphthalenes; Psoriasis; Retinoids; Skin Aging; Skin Diseases; Tretinoin

We report a case of acne fulminans occurring during treatment with 13-cis-retinoic acid for cystic acne. Continuing the treatment with 13-cis-retinoic acid without systemic steroid eventually cleared the systemic manifestations and skin lesions. We review the literature and discuss its pathogenesis.

Topics: Acne Vulgaris; Adolescent; Cysts; Humans; Isotretinoin; Male; Skin Diseases

The retinoids, a group of compounds consisting of vitamin A and its derivatives, have been the subject of intense investigation over the past 30 years. These molecules have shown beneficial effects in the areas of acne, psoriasis, neoplastic processes and, most recently, reversal of extrinsically aged skin. Additional retinoids are currently under development. Adverse reactions to these drugs include mucocutaneous irritation, hyperlipidemia, and profound teratogenicity. Appropriate patient selection is imperative before beginning therapy with these medications. An overview of retinoid metabolism and the currently available compounds is presented. The newest class of retinoids, the arotinoids, is also discussed.

Topics: Abnormalities, Drug-Induced; Etretinate; Female; Humans; Isotretinoin; Pregnancy; Retinoids; Skin Diseases; Tretinoin

The synthetic retinoids, the vitamin-D-derivatives etretinate and isotretinoin, have substantially enlarged the therapeutic arsenal in dermatology. They are primarily used in severe cases of acne and cornification disorders. In the majority of cases, long-term treatment is necessary. Certain side effects in the skeletal system can occur, e.g., osteoporosis, premature epiphyseal closure, and changes similar to DISH (diffuse idiopathic skeletal hyperostosis). We discuss the reports in the literature and our own observations in 31 patients treated at the Westphalian Wilhelms University in Muenster, as well as at the Technical University in Munich. In 3 out of 31 patients treated by retinoids on a long-term basis, skeletal changes were found radiologically as a result of the retinoid medication.

Topics: Adolescent; Adult; Calcinosis; Child; Etretinate; Female; Humans; Hyperostosis, Diffuse Idiopathic Skeletal; Isotretinoin; Male; Middle Aged; Osteoporosis; Radiography; Skin Diseases; Spinal Osteophytosis; Time Factors; Tretinoin

In addition to well-accepted indications, etretinate has a beneficial effect in a variety of other dermatoses such as the hyperkeratotic eczema of the palms and soles, prurigo nodularis, and other nonpsoriatic, sterile, pustular eruptions. Due to its influence on dermal inflammatory processes and immunomodulation of the tissue response, etretinate is effective in cutaneous lupus erythematosus, certain bullous disorders like pemphigus herpetiformis, the persistent variant of Grover's disease, dermatitis herpetiformis, and bullous pemphigoid. Isotretinoin is reported to be effective in cutaneous sarcoidosis, disseminated granuloma annulare, systemic sclerosis and tumors of the cutaneous appendages. New synthetic retinoids have been developed. Etretin, the main metabolite of etretinate, was shown to be effective and to have a short elimination half-life of approximately equal to 50 h. Arotinoid ethyl ester and arotinoid-free carboxylic acid are effective in minimal doses 500-fold lower than etretinate. Arotinoid ethyl ester was shown not to increase serum lipids. Arotinoid ethyl sulfone is the first retinoid without bone toxicity in animal experiments. Motretinide is the ethylamide of tretinoin and is reported to be effective in the local treatment of acne. Some of the new polyaromatic retinoids appear to have sebosuppressive, antikeratinizing and/or anti--inflammatory effects via topical application.

Topics: Administration, Cutaneous; Etretinate; Humans; Isotretinoin; Retinoids; Skin Diseases; Tretinoin

Topics: Adult; Benzoates; Bowen's Disease; Carcinoma, Basal Cell; Child; Etretinate; Female; Humans; Isotretinoin; Male; Precancerous Conditions; Psoriasis; Retinoids; Skin Diseases; Skin Neoplasms; Tretinoin; Xeroderma Pigmentosum

Topics: Acitretin; Administration, Oral; Benzoates; Eczema; Etretinate; Humans; Isotretinoin; Psoriasis; Retinoids; Skin Diseases; Skin Diseases, Vesiculobullous; Tretinoin

The potential of vitamin A, or retinol, in the treatment of a variety of skin diseases has long been recognized, but because of serious toxic effects this substance generally could not be used. The recent development and marketing of two relatively non-toxic synthetic analogues, which are known as retinoids, has made it possible to treat some of the diseases that are resistant to standard forms of therapy. Isotretinoin is very effective in cystic and conglobate acne, while etretinate is especially useful in the more severe forms of psoriasis. Good results have also been obtained in other disorders of keratinization. Vitamin A and its derivatives apparently have an antineoplastic effect as well and may come to be used in both the prevention and the treatment of epithelial cancer. In many of these diseases the retinoids act by enhancing the normal differentiation and proliferation of epidermal tissues, but the exact mechanisms are not well understood. Their influence on the intracellular polyamines that control the synthesis of nucleic acids and proteins may be an important factor. Although the retinoids have few serious systemic effects, they are teratogenic, and because they persist in the body their use in women of childbearing potential is limited.

Topics: Acne Vulgaris; Bone Diseases; Chemical and Drug Induced Liver Injury; Etretinate; Female; Humans; Isomerism; Isotretinoin; Keratosis; Kinetics; Psoriasis; Skin Diseases; Skin Neoplasms; Tretinoin; Triglycerides; Vitamin A

Topics: Adolescent; Adult; Aged; Child; Drug Administration Schedule; Etretinate; Female; Humans; Isotretinoin; Retinoids; Skin Diseases; Tretinoin; Vitamin A; Vitamin A Deficiency

The retinoids are synthetic derivatives of vitamin A. Isotretinoin (13-cis-retinoic acid) is now being widely used in the United States for severe acne and etretinate is available in Europe and other countries for psoriasis. These drugs are also effective for a number of other skin diseases. This is an attempt to review basic knowledge of retinoids with which the practicing dermatologist should be familiar, to review the current status of studies, and to speculate on the present and future roles of these drugs in dermatology.

Topics: Acne Vulgaris; Etretinate; Humans; Inflammation; Isotretinoin; Keratins; Psoriasis; Retinoids; Sebum; Skin Diseases; Skin Neoplasms; Sweat Gland Diseases; Tretinoin; Vitamin A

Isotretinoin is a new orally active retinoic acid derivative for the treatment of severe refractory nodulocystic acne. The pharmacological profile of isotretinoin suggests that it acts primarily by reducing sebaceous gland size and sebum production, and as a result alters skin surface lipid composition. Bacterial skin microflora is reduced, probably as a result of altered sebaceous factors. Isotretinoin 1 to 2 mg/kg/day for 3 to 4 months produces 60 to 95% clearance of inflammatory lesions in patients with severe, recalcitrant nodulocystic acne, with evidence of continued healing and prolonged remissions in many patients after treatment withdrawal. Doses as low as 0.1 mg/kg/day have also proven successful in the clearance of lesions; however, with such low doses the duration of remission after discontinuation of therapy is usually shorter. Encouraging results have also been seen in small numbers of patients with rosacea, Gram-negative folliculitis, Darier's disease, ichthyosis and pityriasis rubra pilaris, the response in keratinising disorders resembling that with the related drug etretinate. While long term follow-up studies in these patients have not been reported, prolonged remission after withdrawal of isotretinoin in disorders of keratinisation is unlikely, as with other drugs used in these conditions. Isotretinoin is only partially effective in psoriasis, in contrast to etretinate which is very effective in psoriasis but ineffective in severe acne. Some encouraging results have also been reported with isotretinoin in patients with squamous and basal cell carcinomas, but isotretinoin has proven unsuccessful in non-squamous cell epithelial and non-epithelial cancer. Side effects affecting the mucocutaneous system occur in nearly all patients receiving isotretinoin, but rarely lead to drug withdrawal. Raised serum triglyceride levels are also commonly reported. The possibility of long term spinal or skeletal bone toxicity may restrict the use of isotretinoin in severe disorders of keratinisation requiring prolonged administration. Isotretinoin is strictly contraindicated in women of childbearing potential due to its severe teratogenic properties, unless an effective form of contraception is used. Thus, isotretinoin offers an effective advance on the treatment options available in a difficult therapeutic area - those patients with severe, nodulocystic acne not responding to 'traditional' therapy.

Topics: Acne Vulgaris; Animals; Anti-Inflammatory Agents; Carcinogens; Cell Differentiation; Cell Division; Humans; Immunity; Isotretinoin; Kinetics; Mutagens; Psoriasis; Rosacea; Sebaceous Glands; Skin; Skin Absorption; Skin Diseases; Skin Neoplasms; Teratogens; Tissue Distribution; Tretinoin

Topics: Baths; Calcinosis; Cat-Scratch Disease; Child; Diabetes Mellitus, Type 1; Folliculitis; Foot Dermatoses; Herpes Simplex; Humans; Hyperhidrosis; Isomerism; Isotretinoin; Joint Diseases; Lyme Disease; Skin Diseases; Tinea; Tretinoin

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

Oral retinoids obviously influence dermal components such as cutaneous capillaries and dermal inflammatory cells in addition to their well-known action on keratinizing epithelia. On this basis, they act as an anti-inflammatory drug. In particular, they reduce the elevated skin temperature, inhibit the motility of neutrophils and eosinophils and their migration into the epidermis, decrease DNA synthesis of human lymphocytes by blocking their response to lectins and stimulate Langerhans cells, monocytes and macrophages in various in vitro and in vivo models. These data indicate that oral retinoids may not only normalize disorders of keratinization but also exert distinct therapeutic effects on various skin diseases with dermal inflammatory involvement regardless of their particular aetiology. In some respects, retinoids resemble corticosteroids, acting as a modified hormone. Preliminary clinical experiences with oral retinoid treatment in skin diseases such as cutaneous disseminated LE, bullous pemphigoid, Duhring's disease, pemphigus, Behçet's disease and necrotizing vasculitis with eosinophilia support these data. Monotherapy or combined administration of oral retinoids with corticosteroids in low doses seems therapeutically beneficial in these disorders.

Topics: Acitretin; Administration, Oral; Animals; Anti-Inflammatory Agents; Etretinate; Granulocytes; Humans; Isotretinoin; Leukocyte Count; Lymphocytes; Macrophages; Mice; Psoriasis; Skin Diseases; Skin Temperature; Tretinoin

In the one year since isotretinoin has been available in the United States for the treatment of severe, recalcitrant, nodulocystic acne, there has been extensive clinical verification of the reports of its dramatic efficacy in the treatment of this troublesome disease. Proper selection of patients, as well as treatment with adequate doses of drug for 3 to 5 months, will most often result in significant clinical improvement or total clearing. Although dosages of less than 1 mg/kg/day may produce a nearly equivalent degree of improvement with somewhat fewer or less severe side effects, the recommended daily dose remains 1 mg/kg/day because lower dosages are associated with more frequent relapses. In severe cases, the daily dosage may be increased to 2 mg/kg/day. Teratogenicity, elevation of serum triglycerides, liver function abnormalities, pancreatitis, and pseudotumor cerebri may all be associated with isotretinoin therapy and require close monitoring of the patient.

Topics: Abnormalities, Drug-Induced; Acne Vulgaris; Adolescent; Adult; Animals; Central Nervous System; Chemical and Drug Induced Liver Injury; Folliculitis; Humans; Isotretinoin; Middle Aged; Mucous Membrane; Musculoskeletal System; Rats; Skin Diseases; Sweat Gland Diseases; Tretinoin

The synthetic retinoids are a new class of drugs which are highly effective in the treatment of a broad spectrum of dermatologic disease. In this report 15 patients with chronic disorders of keratinization and one patient with severe cystic acne were treated with oral isotretinoin. The degree of clinical response and duration of post-treatment remission varied with the different disorders. Acute side effects were predominantly limited to the skin and mucous membranes and were reversible after discontinuation of treatment in these patients. Acute retinoid toxicity and the potential for developing chronic toxicity are reviewed. In an attempt to facilitate the monitoring of dermatologic patients treated with oral synthetic retinoids, we present our current guidelines for the use of these agents.

Topics: Acne Vulgaris; Adolescent; Animals; Bone Diseases; Child; Child, Preschool; Etretinate; Humans; Isomerism; Isotretinoin; Joint Diseases; Keratosis; Mice; Psoriasis; Skin Diseases; Tretinoin

Topics: Animals; Antineoplastic Agents; Cell Division; Chemical Phenomena; Chemistry; Humans; Neoplasms; Ornithine Decarboxylase Inhibitors; Phenotype; Skin; Skin Diseases; Tretinoin; Vitamin A

Topics: Breast Neoplasms; Etretinate; Humans; Isomerism; Isotretinoin; Skin Diseases; Skin Neoplasms; Tretinoin

Over the past 20 years, evidence has emerged indicating oral isotretinoin could be considered a potential treatment for photoaged skin. In this review, we provide a succinct overview of the available evidence and provide commentary on the current and future directions for utilizing oral isotretinoin as a potential treatment for photoaging.. We prepared a review protocol and searched the PubMed and Cochrane databases for relevant literature published between January 1982 and April 2020. Using a defined keyword search, a total of 23 papers were initially identified by the main author. Two authors independently reviewed each of the 23 articles, and 6 articles were deemed relevant to this study.. Of the six studies included in this review, three were randomized clinical trials, one was a nonrandomized clinical trial and two were prospective cohort studies. All studies were conducted between 2000 and 2015. Across all 6 studies, 251 patients were recruited, with a mean of 42 patients per study. Four studies were in favor of isotretinoin to improve photoaged skin, 1 study showed no benefit, and 1 study showed no benefit when compared to topical tretinoin treatment. Of the studies available, many were hampered by methodological challenges.. Oral isotretinoin may be useful for treating photoaging but there is currently insufficient evidence to support its use. In comparison with other established anti-photoaging treatments, it is not clear whether the potential benefits of oral isotretinoin outweigh the potential risks.

Topics: Dermatologic Agents; Humans; Isotretinoin; Prospective Studies; Randomized Controlled Trials as Topic; Skin Aging; Skin Diseases

To investigate dry eye development in the patients receiving systemic retinoic acid therapy and to compare effectiveness of Autologous Serum (AS) and preservative free artificial tear (PFAT) in the patients with dry eye disease.. This prospective, crossover, double blind study was conducted on patients who have dry eyes due to systemic isotretinoin treatment for different indications. Patients detected as having dry eye during systemic isotretinoin treatment were included to our study. At baseline, 1 and 2 month of study, detailed ocular examination, best corrected visual acuity measurement, intraocular pressure measurement, and Tear Break-up Time (TBUT) and Schirmer Test (ST) without topical anesthesia were performed. We compared the efficacy of AS and PFAT. To accomplish crossover after the first month, treatment given to each patient was switched to the other treatment. Statistical analysis was measured using SPSS version 20.0. p values of < 0.05 were considered as statistically significant.. At the end of the first month, there was a significant improvement for the TBUT test in both AS and PFAT groups compared to baseline (respectively p < 0.001, p < 0.001). TBUT was found to be significantly higher in the AS group compared to the PFAT group at the end of the first month (p < 0.001). At the end of the second month, TBUT was found to be significantly higher in the AS group compared to the PFAT group at the posttreatment time (p < 0.001). There was a significant OSDI score decreasing in both groups compared to that reported previously at the end of the first and second months (respectively p < 0.001, p < 0.001). OSDI score decreasing was more significant in the AS group compared to the PFAT group at both time points (respectively p < 0.001, p < 0.001).. AS may be an effective alternative to PFAT in the treatment of dry eye developed during isotretinoin use.

Topics: Adult; Cross-Over Studies; Dermatologic Agents; Double-Blind Method; Dry Eye Syndromes; Female; Follow-Up Studies; Humans; Isotretinoin; Lubricant Eye Drops; Male; Ophthalmic Solutions; Prospective Studies; Serum; Skin Diseases; Tears; Time Factors; Treatment Outcome

The combination of interferon alfa (IFNalpha) and isotretinoin has shown a direct antiproliferative effect on human melanoma cell lines, but it remained unclear whether this combination is more effective than IFNalpha alone in patients with metastatic melanoma. We evaluated safety and efficacy of IFNalpha and isotretinoin compared with IFNalpha alone as adjuvant treatment in patients with primary malignant melanoma stage IIA and IIB.. In a prospective, randomized, double-blind, placebo-controlled trial, 407 melanoma patients in stage IIA (301 patients) and IIB (106 patients) were randomly assigned to either IFNalpha and isotretinoin (isotretinoin group; 206 patients) or IFNalpha and placebo (placebo group; 201 patients) after excision of the primary tumor. IFNalpha was administered three times a week at a dose of 3 million units subcutaneously for 24 months. Isotretinoin at a dose of 20 mg for patients < or = 73 kg, 30 mg for patients greater than 73 kg, or placebo daily for 24 months.. A scheduled interim analysis revealed no significant differences in survival rates, with the isotretinoin group and the placebo group showing 5-year disease-free survival rates of 55% (95% CI, 46% to 65%) and 67% (95% CI, 59% to 75%), respectively, and overall 5-year survival rates of 76% (95% CI, 67% to 84%) and 81% (95% CI, 74% to 88%), respectively. The trial was stopped for futility.. The addition of isotretinoin to an adjuvant treatment of low-dose IFNalpha in patients with stage IIA and IIB melanoma had no significant effect on disease-free or overall survival and is therefore not recommended.

Topics: Adolescent; Adult; Aged; Antineoplastic Agents; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Chemotherapy, Adjuvant; Disease-Free Survival; Double-Blind Method; Europe; Female; Head and Neck Neoplasms; Humans; Hyperlipidemias; Interferon-alpha; Isotretinoin; Male; Melanoma; Middle Aged; Multivariate Analysis; Neoplasm Staging; Prognosis; Prospective Studies; Quality of Life; Skin Diseases; Treatment Outcome

13 cis Retinoic acid (isotretinoin) is a retinoid with preclinical evidence of anti-prostate cancer activity. This phase II, cross-over, randomized study of advanced, predominantly androgen-dependent prostate cancer patients was designed to assess primarily the effect on prostate-specific antigen (PSA) decline and toxicity of adding isotretinoin to hormonal therapy and, secondarily, the potential antitumor activity of the combination.. Thirty-seven D0 to D2 patients were randomized soon after initiating luteinizing hormone-releasing hormone agonist with antiandrogen treatment to add (arm 1) or not (arm 2) isotretinoin from weeks 1 to 12. After cross-over on week 13, patients in arm 1 discontinued while patients in arm 2 added isotretinoin from weeks 14 to 25. Observation on hormonal therapy alone continued until week 49.. Baseline and randomization median PSA for 30 assessable patients were, respectively, 34 and 18.2 ng/mL for arm 1 and 31 and 13.4 ng/mL for arm 2. Median PSA at week 13 was 0.5 ng/mL (range, < 0.05 to 136 ng/mL) for arm 1 and 0.7 ng/mL (range, < 0.05 to 4.4 ng/mL) for arm 2; at week 25, 0.1 ng/mL (range, < 0.05 to 121 ng/mL) and 0.4 ng/mL (range, < 0.05 to 3.1 ng/mL), respectively. At week 49, arm 1 had median PSA of 0.1 ng/mL (range, < 0.05 to 345 ng/mL) and arm 2, 0.3 ng/mL (range, < 0.05 to 8.8 ng/mL); seven of 15 and three of 15 patients, respectively, had undetectable PSA levels (P =.12). Frequent isotretinoin-related toxicity included grade 1 cheilitis (76%), skin dryness (43%), and elevated triglycerides (50%).. Isotretinoin does not impair PSA decline or add significant toxicity to hormonal therapy. An adequately powered, randomized study would be required to determine whether the combination is superior to standard hormonal treatment.

Topics: Administration, Oral; Aged; Androgen Antagonists; Antineoplastic Agents; Antineoplastic Agents, Hormonal; Combined Modality Therapy; Cross-Over Studies; Humans; Injections, Subcutaneous; Isotretinoin; Male; Middle Aged; Prostate-Specific Antigen; Prostatic Neoplasms; Skin Diseases; Treatment Outcome; Triglycerides

One hundred and seventy-five children with Stage 3 or 4 neuroblastoma who had obtained a good response to conventional therapy were randomly allocated to 13-Cis retinoic acid at a dose of 0.75 mg/kg/day or placebo for up to 4 years. Toxicity was mild but no advantage in event-free survival was shown for the children receiving retinoic acid.

Topics: Adolescent; Adult; Antineoplastic Agents, Alkylating; Cheilitis; Child; Child, Preschool; Dose-Response Relationship, Drug; Double-Blind Method; Follow-Up Studies; Humans; Infant; Isotretinoin; Melphalan; Neoplasm Staging; Neoplasm, Residual; Neuroblastoma; Skin Diseases; Survival Analysis; Survival Rate; Treatment Outcome

The objective of the study was to assess the extent of systemic exposure of retinoic acid metabolites after excessive application of 0.1% isotretinoin cream in patients with photodamaged skin. This was a single-center, open-label, noncomparative, multiple-dose study of isotretinoin cream. Eighteen female patients with photodamaged skin received a 10 g topical application of isotretinoin cream once daily to a surface area of approximately 2,300 cm2 for 42 days. The patients were not allowed to have high vitamin A-containing foods, vitamin A supplements, or concomitant medications during the entire study period. Plasma levels of four retinoic acids (isotretinoin, tretinoin, 4-oxo-isotretinoin, and 4-oxo-tretinoin) were evaluated after 42 days of isotretinoin application and compared with baseline (pretreatment) levels. The mean area under the curve (AUC) in plasma increased by 48% (+/-SE 9.2) and 77% (+/-13) from the 24-hour pretreatment baseline level for isotretinoin and 4-oxo-isotretinoin, respectively, after treatment with excessive amounts of isotretinoin cream, suggesting systemic absorption of isotretinoin cream. This increase in systemic exposure of retinoic acids was less than that reported earlier after the U.S. recommended daily allowance of 5,000 i.u. of vitamin A supplementation (isotretinoin 141 +/- 19% and 4-oxo-isotretinoin 171 +/- 27%). The minimal systemic availability of isotretinoin cream compared with the U.S. recommended daily allowance for vitamin A supplements provides reasonable evidence for lack of its potential teratogenic risk.

Topics: Administration, Cutaneous; Adult; Area Under Curve; Female; Humans; Isotretinoin; Keratolytic Agents; Middle Aged; Skin Absorption; Skin Diseases; Teratogens

Topics: Acne Vulgaris; Acute Disease; Adult; Clinical Trials as Topic; Depression; Female; Headache; Humans; Isotretinoin; Male; Middle Aged; Skin Diseases

Etretinate and isotretinoin were compared with respect to their clinical effects and changes in serum lipoprotein concentrations. Sixteen patients with hyperkeratotic and pustular disorders of hands and feet (mainly palmoplantar pustulosis) underwent a double-blind cross-over study. The daily doses of etretinate and isotretinoin were 50 and 40 mg, respectively. Each drug was given for 2 months with a 2-month intermission. The clinical score was reduced both by isotretinoin (P less than 0.05) and etretinate (P less than 0.001). Both drugs affected the lipoprotein concentrations. Isotretinoin increased the cholesterol concentration in low-density lipoprotein (LDL) by 20% and the triglyceride concentration in very low-density lipoprotein (VLDL) by 35%, but decreased the high-density lipoprotein cholesterol by 12%. Etretinate elevated LDL-cholesterol by 10%. These changes had reverted to normal 8 weeks after the end of treatment. The data suggest that in the diseases studied, etretinate is preferable to isotretinoin with regard to both clinical effect and serum lipid side-effects.

Topics: Adult; Aged; Clinical Trials as Topic; Double-Blind Method; Etretinate; Female; Humans; Hyperlipoproteinemias; Isotretinoin; Lipoproteins; Male; Middle Aged; Skin Diseases; Tretinoin

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

Orally administered retinoids are synthetic derivatives of vitamin A. This new group of drugs (not yet available for general use in the United States) has been effective in experimental trials for treatment of a wide range of skin diseases. The current status of two of these drugs, isotretinoin (13-cis-retinoic acid) and etretinate (Ro 10-9359), is herein reviewed.

Topics: Acne Vulgaris; Administration, Oral; Child; Clinical Trials as Topic; Facial Dermatoses; Female; Humans; Isomerism; Isotretinoin; Keratins; Keratitis; Neoplasms; Psoriasis; Skin Diseases; Tretinoin; Xerostomia

Topics: Clinical Trials as Topic; Humans; Isomerism; Isotretinoin; Keratins; Skin Diseases; Tretinoin

Topics: Abnormalities, Drug-Induced; Australia; Clinical Trials as Topic; Etretinate; Female; Humans; Isotretinoin; Neoplasms; Pregnancy; Skin Diseases; Tretinoin; Vitamin A

Topics: Dermatology; Humans; Isotretinoin; Skin Diseases; Telemedicine

Topics: Dermatology; Humans; Isotretinoin; Patient Outcome Assessment; Patient Satisfaction; Personal Satisfaction; Qualitative Research; Skin Diseases

An immunocompetent patient with extensive and recalcitrant common warts that was orally treated with isotretinoin (1 mg/kg/day) is reported. His lesions revealed a complete remission after 6 weeks of treatment, which was well tolerated. The patient has presently completed a 23-month follow-up and shows no evidence of relapse of his skin lesions. In view of these remarkable therapeutic results, further randomized controlled clinical studies in large numbers of patients are now warranted, which will definitely determine whether monotherapy with oral isotretinoin at a dose of 1 mg/kg/day may be regarded as a highly effective and well-tolerated therapeutic modality for extensive and recalcitrant common warts in both immunocompetent and immunocompromised patients.

Topics: Administration, Oral; Adult; Dermatologic Agents; Humans; Immunocompromised Host; Isotretinoin; Male; Remission Induction; Skin Diseases; Time Factors; Warts

The purpose of this prospective study was to investigate whether mid-term treatment with oral isotretinoin may impact peripheral nerve function.. In this study, we included 28 patients with no apparent neurological or neurophysiological findings. The patients received treatment with oral isotretinoin for papulopustular or nodulocystic acne. The patients with normal findings in the first examination were given 1 mg/kg/day oral isotretinoin. Neurological examinations and electroneurographic studies were performed before and 6 months after the onset of isotretinoin treatment.. Clinical examinations and electroneurographic evaluations prior to treatment revealed no abnormalities in any of the patients. However, 20 patients (72%) displayed one or more abnormal values in the tested parameters after treatment. Although the mean amplitudes of compound muscle action potential of the ulnar and median nerves did not vary, significant decreases were observed in the mean sensory conduction velocities of median, ulnar, sural, medial plantar, medial dorsal cutaneous, and dorsal sural nerves 6 months after the onset of treatment.. Systemic use of isotretinoin may cause electroneurographic changes. Probable electroneurographic alterations may be detected at a much earlier period via dorsal sural nerve tracing when electrophysiological methods used in routine clinical practice cannot detect these changes.. A prospektív vizsgálat célja az volt, hogy feltárja, befolyásolja-e a közepes időtartamú orális isotretinoin­kezelés a perifériás idegműködést.. A vizsgálatba 28 olyan beteget vontunk be, akinél nem állt fenn neurológiai vagy neurofiziológiai rend­ellenesség. A betegek papulopustularis vagy nodulocysticus acne kezelésére orális isotretinoinkezelésben részesültek. Azok a betegek, akik az első vizsgálat során normális neurológiai és elektroneurográfiás eredményt produkáltak, 1 mg/kg/nap isotretinoint kaptak. A neurológiai és elekt­ro­neurográfiás vizsgálatokat az isotretinoinkezelés megkezdése előtt és a terápiakezdés után hat hónappal végeztük.. A kezelés indulása előtt végzett klinikai és elektroneurográfiás vizsgálatok egyik beteg esetén sem mutattak rendellenességet. A terápiakezdés után hat hónappal végzett vizsgálatok 20 beteg (72%) esetében tártak fel abnormális értékeket: habár a kombinált akcióspotenciál amplitúdójának mediánja a n. ulnaris és medianus által beidegzett izmokon nem változott, szignifikánsan csökkent a n. medianus, ulnaris, suralis, medialis plantaris, medialis dorsalis cutaneus és dorsalis suralis szenzoros vezetési sebessége.. Az orális isotretinoinkezelés elektroneurográfiás eltéréseket okozhat. Az eltérések a dorsalis suralis idegen elektroneurográfiás vizsgálatokkal jóval hamarabb kimutathatók, mint rutin klinikai módszerekkel.

Topics: Acne Vulgaris; Administration, Oral; Dermatologic Agents; Drug Administration Schedule; Humans; Isotretinoin; Neural Conduction; Peripheral Nerves; Prospective Studies; Skin Diseases; Sural Nerve

Currently, the isotretinoin (13-cis-retinoic acid) package insert contains language advising the discontinuation of isotretinoin for 6 months before performing cosmetic procedures, including waxing, dermabrasion, chemical peels, laser procedures, or incisional and excisional cold-steel surgery. It is common practice to follow this standard because of concerns regarding reports of sporadic adverse events and increased risk of scarring.. To develop expert consensus regarding the safety of skin procedures, including resurfacing, energy device treatments, and incisional and excisional procedures, in the setting of concurrent or recent isotretinoin use.. The American Society for Dermatologic Surgery authorized a task force of content experts to review the evidence and provide guidance. First, data were extracted from the literature. This was followed by a clinical question review, a consensus Delphi process, and validation of the results by peer review.. The task force concluded that there is insufficient evidence to justify delaying treatment with superficial chemical peels and nonablative lasers, including hair removal lasers and lights, vascular lasers, and nonablative fractional devices for patients currently or recently exposed to isotretinoin. Superficial and focal dermabrasion may also be safe when performed by a well-trained clinician.

Topics: Chemexfoliation; Cicatrix; Dermabrasion; Dermatologic Agents; Dermatologic Surgical Procedures; Humans; Isotretinoin; Laser Therapy; Patient Safety; Skin Diseases

Topics: Humans; Isotretinoin; Male; Nicotinic Acids; Penicillamine; Skin Diseases; Triamcinolone Acetonide

Low-dose isotretinoin is used to reduce side effects albeit higher relapse. This study aimed to determine the efficacy and safety of fixed-dose 10 mg daily isotretinoin for the treatment of acne.. This prospective study was performed between 2011 and 2015. All 150 patients were given 10 mg daily isotretinoin until a cumulative dose of 90-110 mg/kg.. The mean age was 26.6 years with 64.7% moderate acne, 29.3% severe, and 6% very severe. The mean cumulative dose was 98.8 ± 6.05 mg/kg. All 150 patients had total clearance with a mean time to clearance of 24.0 weeks. Patients with severe/very severe acne had higher cumulative dosage (102.1 vs. 97.0, P < 0.001) and longer duration to clearance (32.9 weeks vs. 19.1 weeks, P < 0.001). Mild relapse was seen in 4%. The mean time to relapse was 32.3 weeks. Lip dryness was the commonest side effects (100%). Mild transient elevation of liver enzymes was detected in 3.3% and a slight increase of serum lipid in 2.7% with no treatment discontinuation.. Fixed-dose 10 mg daily treatment with isotretinoin until a cumulative dose of 90-110 mg/kg is safe with low relapse rate.

Topics: Acne Vulgaris; Adult; Dermatologic Agents; Female; Humans; Isotretinoin; Lipids; Liver; Malaysia; Male; Prospective Studies; Recurrence; Skin Diseases

Isotretinoin is approved by the US Food and Drug Administration for the treatment of severe recalcitrant nodular acne. Mucocutaneous toxicity is the most commonly observed side effect of isotretinoin use. Because atrophy and skin fragility may occur while taking isotretinoin, most warnings recommend avoidance of cosmetic procedures, such as dermabrasion, laser treatments, waxing, and chemical peels. We report a case of isotretinoin-induced skin fragility in a 16-year-old adolescent boy who presented with an unusual amount of skin erosions and excoriations on his face during wrestling season. We propose that it may be prudent to advise athletes who are involved in contact sports that skin fragility and increased erosions may occur during or after their course of treatment with isotretinoin.

Topics: Acne Vulgaris; Adolescent; Athletic Injuries; Dermatologic Agents; Humans; Isotretinoin; Male; Skin Diseases; Wrestling

Folliculosebaceous cystic hamartoma (FSCH) is a relatively recently described malformation with follicular and sebaceous components and a particular type of stroma with adipocytes. We conducted an anatomo-clinical study in order to clarify the clinical and histological characteristics of FSCH.. We included all cases of FSCH diagnosed between 1985 and February 2011 at our dermatopathology laboratory. Clinical information was obtained from medical records and requests for histological examination.. We studied 25 cases of FSCH in 25 patients of mean age 51 years. The sex ratio was 1.3. The mean disease duration was 9 years. Lesions were described mainly as flesh-colored, occasionally pedunculated nodules and were found primarily on the face (60%). The diagnosis of FSCH had never been mentioned by the clinician. Histological examination revealed in all cases one or more follicular cystic structures surrounded by sebaceous glands in a stroma containing adipocytes. A number of variants were identified, such as the presence of a mucinous stroma, a neuroid component with protein S 100 expression, and rudimentary hair follicles in adjacent dermis. One case involved a proliferating cyst while another was on the scalp in the area of pre-existing radiodermatitis. Only one relapse was noted, 5 years after the initial excision.. FSCH is a benign, underdiagnosed lesion, localized on the face, particularly on the nose. It is dome-shaped or pedunculated and grows slowly. Differential diagnoses include nevus lipomatosus superficialis and "sebaceous" trichofolliculoma. FSCH can be readily identified by the presence of adipocytes and a fibrous stroma. One case was unique in its appearance of a large pedunculated nodule with a proliferating cyst. Prior to the invidualization of this entity, such cases were interpreted as nevus lipomatosus superficialis or "sebaceous" trichofolliculoma, although their histological appearance was inconsistent with such a diagnosis.

Topics: Acitretin; Adipocytes; Adolescent; Adult; Aged; Aged, 80 and over; Combined Modality Therapy; Diagnosis, Differential; Epidermal Cyst; Facial Dermatoses; Female; Follicular Cyst; Hair Follicle; Hamartoma; Humans; Isotretinoin; Lasers, Gas; Male; Middle Aged; Neoplasms, Basal Cell; Radiodermatitis; Retrospective Studies; Skin Diseases; Skin Neoplasms; Stromal Cells; Young Adult

Topics: Dermatologic Agents; Humans; Inflammatory Bowel Diseases; Isotretinoin; Psoriasis; Skin Diseases; Skin Neoplasms

Topics: Antifungal Agents; Dermatologic Agents; Drug and Narcotic Control; Health Services Accessibility; Humans; Internet; Isotretinoin; Naphthalenes; Prescription Drugs; Self Medication; Skin Diseases; Terbinafine; United States

Topics: Dermatologic Agents; Dermatology; Humans; Internet; Isotretinoin; Naphthalenes; Prescription Drugs; Skin Diseases; Terbinafine

Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a clinically heterogeneous entity, encompassing a variety of debilitating conditions that have in common inflammation of the skeletal system and skin. To date, there is a paucity of documented efficacious treatment options. We report a 48-year-old man with skeletal and cutaneous signs and symptoms who improved dramatically after treatment with a combination of isotretinoin and pamidronate. This report provides an alternative treatment regimen for SAPHO that addresses the possible underlying pathophysiology of this likely underdiagnosed syndrome.

Topics: Acneiform Eruptions; Diphosphonates; Drug Therapy, Combination; Humans; Hyperostosis; Isotretinoin; Male; Middle Aged; Osteitis; Pamidronate; Psoriasis; Skin Diseases; Syndrome; Synovitis

Nodular amyloidosis is a primary cutaneous amyloidosis characterized by the deposition of amyloid L-type fibril proteins in the dermis. Clinical history and routine histology may not be sufficient to differentiate nodular amyloidosis from colloid milium. We present a case of a 45-year-old man with nodular amyloidosis, whose diagnosis was confirmed by the characteristic appearance of filaments on electron microscopy.

Topics: Acne Vulgaris; Amyloidosis; Dermatologic Agents; Diagnosis, Differential; Face; Facial Dermatoses; Humans; Isotretinoin; Male; Microscopy, Electron, Transmission; Middle Aged; Skin Diseases

An 8 year old boy presented with fever of unknown origin in whom the diagnosis of liver abscess was made. He also had palmoplantar keratoderma and premature loss of teeth, consistent with the diagnosis of Papillon Lefevre syndrome.

Topics: Amikacin; Anti-Bacterial Agents; Cefotaxime; Child; Dermatologic Agents; Humans; Isotretinoin; Liver Abscess; Male; Papillon-Lefevre Disease; Periodontitis; Skin Diseases; Sulbactam

Topics: Abnormalities, Multiple; Adolescent; Hair Diseases; Humans; Isotretinoin; Male; Skin Diseases; Syndrome; Treatment Outcome

Accumulating evidence over the past decade indicates that synthetic retinoids may be capable of affecting both growth and differentiation of nervous tissue. Our aim was to substantiate possible side-effects of oral isotretinoin therapy on peripheral nerve functions, both neurologically and neurophysiologically. We performed neurological examination and electroneuromyographic studies on 18 patients with various skin diseases before, at the third month, and at the end of isotretinoin treatment. Abnormal neurophysiological findings in this study point towards a typical distal, length-dependent and predominantly sensory polyneuropathy. Clinicians should be aware of possible neurological sensorial symptoms during isotretinoin therapy. In our opinion, electroneuromyographic investigation should be performed on all patients reporting symptoms (e.g. paresthesia, numbness, sensory loss) before and during oral isotretinoin treatment. The precise clinical significance of the isotretinoin-induced neurophysiological alterations reported here remains to be determined in further studies.

Topics: Administration, Oral; Adolescent; Adult; Dermatologic Agents; Female; Humans; Isotretinoin; Male; Middle Aged; Neural Conduction; Neurologic Examination; Peripheral Nerves; Skin Diseases

Topics: Abnormalities, Drug-Induced; Acne Vulgaris; Adverse Drug Reaction Reporting Systems; Contraindications; Cost-Benefit Analysis; Drug and Narcotic Control; Drug Approval; Female; Fetus; Guidelines as Topic; History, 20th Century; History, 21st Century; Humans; Isotretinoin; Legislation, Pharmacy; Male; Maternal-Fetal Exchange; Pharmaceutical Services; Pregnancy; Reproductive Behavior; Risk Management; Skin Diseases; Social Control Policies; United States; United States Food and Drug Administration

Angiolymphoid hyperplasia with eosinophilia (ALHE) is a benign but potentially disfiguring vascular lesion. It is usually characterized by dermal and subcutaneous nodules, primarily in the head and neck region. Spontaneous regression is common, but persistent or recurrent lesions may require treatment. Several treatments have been reported but surgery is the most efficient one.. We report a 32-year-old man presenting with multiple nodules on the cheeks, preauricular region and the scalp and who received treatment with isotretinoin (0.5 mg/kg/day) for 1 year with complete resolution of one of his scalp nodules. The rest of the lesions remained stable and were treated with surgical excision without recurrence.. Isotretinoin may play a role in the treatment of ALHE due to its antiangiogenic properties via a reduction of vascular endothelial growth factor (VEGF) production by keratinocytes.

Topics: Adult; Castleman Disease; Dermatologic Agents; Dose-Response Relationship, Drug; Eosinophilia; Follow-Up Studies; Humans; Isotretinoin; Male; Skin Diseases

Topics: Eye Diseases; Histiocytosis, Sinus; Humans; Isotretinoin; Laryngeal Diseases; Male; Middle Aged; Skin Diseases

Dermal angiomatosis of the breast is an extremely rare disorder of unknown origin characterized by increased angiomatosis and ulceration. We report a case of a young woman whose disorder responded to isotretinoin. Our findings have potential relevance to the treatment of skin disorders in which ulceration is a prominent feature.

Topics: Adult; Angiomatosis; Breast; Dermatologic Agents; Diagnosis, Differential; Female; Humans; Isotretinoin; Skin Diseases

Eosinophilic folliculitis (EF) is a chronic, intensely pruritic condition of unknown pathogenesis that causes marked morbidity in those HIV patients whom it affects. There is a wide differential diagnosis of itchy skin conditions in HIV which are amenable to different treatments. It is therefore essential to take a biopsy of each suspected case and examine multiple sections of the biopsy to confirm or refute a diagnosis of EF. Treatment of EF can be difficult but we hope that by suggesting a rational approach to this and considering possible therapeutic options more patients may be helped with this troublesome dermatosis.

Topics: Administration, Topical; Anti-Infective Agents; Anti-Inflammatory Agents; Antifungal Agents; Eosinophilia; Folliculitis; Glucocorticoids; Histamine H1 Antagonists; HIV Infections; Humans; Insecticides; Isotretinoin; Itraconazole; Keratolytic Agents; Metronidazole; Permethrin; Pyrethrins; Skin Diseases; Ultraviolet Therapy

Topics: Aged; Extremities; Female; Humans; Isotretinoin; Keratoacanthoma; Keratolytic Agents; Skin Diseases

Topics: Acne Vulgaris; Administration, Topical; Anti-Inflammatory Agents; Dermatology; Drug Therapy, Combination; Forecasting; Glucocorticoids; Humans; Isotretinoin; Keratolytic Agents; Prospective Studies; Retinoids; Retrospective Studies; Skin Diseases; Tretinoin

A 27-year-old male patient presented with scaly erythema and crusts on the scalp. Since birth, he suffered from dry skin and inflammation of the eyelids. Scarring alopecia was noticed in some regions of his scalp. Folliculitis spinulosa decalvans was diagnosed. Therapy with isotretinoin and topical corticosteroids was without effect. In contrast, 100 mg of Dapsone per day led to resolution of the inflammatory signs. This enabled him to cover the disfiguring scarring alopecia with a permanent hairpiece. His condition has been stable after 18 months without the enlargement of the scarred alopecic areas.

Topics: Adrenal Cortex Hormones; Adult; Alopecia; Anti-Inflammatory Agents, Non-Steroidal; Blepharitis; Cicatrix; Dapsone; Erythema; Folliculitis; Follow-Up Studies; Humans; Isotretinoin; Keratolytic Agents; Male; Scalp Dermatoses; Skin Diseases; Treatment Outcome

We report a 31-year-old female patient with cutaneous sarcoidosis, who showed a complete remission of her single system skin disease after an 8-month therapy with oral isotretinoin (1 mg/kg/day). At 15-month follow-up, the patient still remained free of recurrence and visceral involvement.

Topics: Administration, Oral; Adult; Female; Follow-Up Studies; Humans; Isotretinoin; Keratolytic Agents; Remission Induction; Sarcoidosis; Skin Diseases

Topics: Acquired Immunodeficiency Syndrome; Adult; Humans; Isotretinoin; Keratolytic Agents; Male; Mucinoses; Skin Diseases

In dermatology Isotretinoin has been used for 16 years in cases of serious clinical forms of acne resistant to common therapy. This paper presents actual knowledge on pharmacokinetics of isotretinoin, mechanisms of its action, side effects, the newest clinical indications for its application in acne therapy and other possible indications in the contemporary dermatology.

Topics: Humans; Isotretinoin; Keratolytic Agents; Skin Diseases

We describe a 75-year-old man demonstrating the florid clinical features of actinic granuloma of O'Brien. This rare disfiguring condition is believed to result from a granulomatous reaction of the dermis to solar-induced elastosis and is poorly responsive to topical steroids. Twelve weeks' treatment with isotretinoin prevented the development of new granulomata and produced almost complete resolution of established lesions.

Topics: Aged; Facial Dermatoses; Granuloma; Humans; Isotretinoin; Keratolytic Agents; Male; Neck; Skin Diseases

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

This is a case report of four patients of the same family with pachyderma. Their clinical findings are discussed in regard of a review of the literature. Also, because there are few data on effective treatment, their dramatic improvement with isotretinoin is of significant interest.

Topics: Adult; Aged; Female; Humans; Hypertension; Hypertriglyceridemia; Isotretinoin; Male; Osteoarthropathy, Primary Hypertrophic; Pedigree; Scalp Dermatoses; Skin Diseases

Elastosis perforans serpiginosa (EPS) and the elastotic changes of pseudoxanthoma elasticum (PXE) are rare but well-recognized side-effects of long-term penicillamine therapy. A 42-year old female patient who developed both of these cutaneous side-effects following treatment with high-dose penicillamine for Wilson's disease is described; near-complete resolution of the EPS, but not the PXE was achieved by treatment with isotretinoin (0.5 mg/kg/day) for 6 weeks, despite continuation of the penicillamine.

Topics: Adult; Elastic Tissue; Female; Hepatolenticular Degeneration; Humans; Isotretinoin; Penicillamine; Pseudoxanthoma Elasticum; Skin Diseases

Topics: Adolescent; Child; Etretinate; Humans; Isotretinoin; Pediatrics; Practice Guidelines as Topic; Skin Diseases; Societies, Medical; United States

The serum levels of muscle-specific serum carbonic anhydrase III (S-CAIII) and myoglobin (S-Myo) were analyzed in various male dermatological patients of the same age. The mean levels of S-CAIII and S-Myo were essentially similar in patients with acne, psoriasis vulgaris, atopic eczema and tinea, suggesting that common dermatological diseases do not affect the serum levels of the muscle markers. Increased levels of S-CAIII, which is specific for skeletal muscle cells, were found in the acne patients who had been treated with isotretinoin. However, when S-CAIII and S-Myo were studied in 24 patients (16 males, 8 females) before and during isotretinoin treatment, no constant increases in these markers could be observed. When individual patients were followed for several months, transient increases or decreases could be observed. The changes in S-CAIII, or S-Myo, did not correlate with the dose of isotretinoin, nor with the duration of the treatment. The results suggest that systemic isotretinoin does not specifically affect skeletal or myocardial muscles. The increases in these markers observed in the course of dermatological diseases and isotretinoin treatment are obviously due to other factors, such as exercise.

Topics: Adolescent; Adult; Carbonic Anhydrases; Female; Follow-Up Studies; Humans; Isotretinoin; Male; Muscles; Myoglobin; Skin Diseases

Topics: Abnormalities, Drug-Induced; Abortion, Spontaneous; Etretinate; Female; Humans; Isotretinoin; Pregnancy; Pregnancy Complications; Pregnancy Trimester, First; Retinoids; Skin Diseases

The treatment of scleromyxedema has been largely ineffective. We report improvement of scleromyxedema with myopathy after treatment with isotretinoin, 40 mg twice a day. We review other therapeutic modalities used for this disorder and discuss properties of isotretinoin that may have contributed to the favorable response.

Topics: Adult; Facial Dermatoses; Hand Dermatoses; Humans; Isotretinoin; Male; Muscular Diseases; Myxedema; Skin Diseases

Topics: Administration, Oral; Adult; Aged; Aged, 80 and over; Facial Dermatoses; Female; Humans; Isotretinoin; Keratoacanthoma; Male; Middle Aged; Recurrence; Skin Diseases

We evaluated the effects of long- and short-term isotretinoin therapy on the skeletons of patients. Eight patients who were treated with isotretinoin for disorders of keratinization received frequent radiographic evaluations for 4 to 9 years. Seven patients developed multiple hyperostoses at the spine and extremities. Hyperostoses increased in size and number over the course of therapy, although relatively few sites were symptomatic. Hyperostoses typically developed first in the spine and later in the extremities, where both bilaterally symmetric and asymmetric involvement was observed. After 5 years of therapy one patient did not develop hyperostosis. In a group of nine patients who received a relatively high dose of isotretinoin in 1982 for the treatment of acne, two patients developed tiny, asymptomatic hyperostoses. One patient had hyperostoses 1 year after isotretinoin therapy, which remained unchanged 3 years later, whereas the other patient had one hyperostosis 4 years after therapy had been stopped. Although we suspect that these hyperostoses were retinoid induced, they should not be of concern for the patient needing routine isotretinoin therapy for the treatment of cystic acne.

Topics: Acne Vulgaris; Adolescent; Adult; Bone Diseases; Child; Female; Follow-Up Studies; Humans; Ichthyosis; Isomerism; Isotretinoin; Male; Radiography; Skin Diseases; Spinal Diseases; Time Factors; Tretinoin

Topics: Child; Etretinate; Humans; Isotretinoin; Retinoids; Skin Diseases; Teratogens; Tretinoin

Scleromyxedema is a rare type of papular mucinosis that exhibits a generalized lichenoid pattern. A wide variety of clinical manifestations can occur in patients with this disease. Cutaneous involvement is characteristic, but neurologic, cardiovascular, renal, neoplastic, and other systemic manifestations have been described. A monoclonal gammopathy may be present. Many treatment modalities have been used in the past for scleromyxedema. None, however, have shown consistently favorable results. This report concerns the cases of three patients with scleromyxedema who were treated with isotretinoin.

Topics: Adult; Aged; Biopsy; Female; Humans; Hypergammaglobulinemia; Immunoglobulin G; Isotretinoin; Male; Mucins; Nervous System Diseases; Prednisone; Skin Diseases

A patient with steatocystoma multiplex was treated with 0.75 mg per kg per day of oral isotretinoin. After one month of minimal improvement the patient discontinued therapy. Over the next two months he noted some shrinkage of his pre-existing lesions, which persisted for a follow-up period of six months. Isotretinoin may show a beneficial response in some cases of steatocystoma multiplex even after use of the drug is discontinued. Isotretinoin is known to have effects beyond its treatment period that are related to its long serum half-life. A small number of patients with steatocystoma multiplex have been treated with isotretinoin, with varied responses. This is the first case of a patient who discontinued therapy before a response occurred and then showed a response later.

Topics: Adolescent; Epidermal Cyst; Humans; Isotretinoin; Male; Skin; Skin Diseases; Time Factors

Topics: Acne Vulgaris; Etretinate; Humans; Isotretinoin; Keratins; Papillon-Lefevre Disease; Skin Diseases; Tretinoin

Thirty patients, 13 female and 17 male, have been followed from 3 months to 22 years (mean, 81 months; median, 63 months) and special studies have been performed on a proportion of these in order to try to predict malignant evolution. Age at onset was from 20 to 70 years (mean, 43 years; median, 42 years). Duration of disease was from 1 to 30 years (mean, 119 months; median 161 months). Seven patients also had parapsoriasis en plaque or plaque-stage mycosis fungoides at the time of diagnosis and one patient had erythroderma. None of the 22 uncomplicated lymphomatoid papulosis patients developed malignant cutaneous lymphoma during the period of observation, while the remaining 8 patients who had concurrent parapsoriasis en plaque, mycosis fungoides, or erythroderma did not deteriorate further. Single-cell deoxyribonucleic acid (DNA) measurements on the dermal infiltrate were done in 13 patients and were abnormal in 7 patients. Two of these had greatly abnormal DNA histograms and at the same time an abnormal clinical presentation with multiple nodules and tumors. The remaining five patients had DNA histograms that indicated a potential for malignancy. Monoclonal antibody studies were performed on skin biopsy specimens of 10 patients. The dermal infiltrate was dominated by T-helper lymphocytes and some Hodgkin and Reed-Sternberg cells could be detected by the antibodies Ki-1, Ki-24, and Ki-27. Human T-lymphotropic virus type I (HTLV-I) antibodies were found in 3 of 18 patients examined. Treatment with psoralens plus ultraviolet A (PUVA) was effective (partial or complete remission) in six patients but they relapsed at cessation of therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Antibodies, Monoclonal; Antibodies, Viral; Deltaretrovirus; Deltaretrovirus Antibodies; DNA; Female; Follow-Up Studies; Humans; Isotretinoin; Male; Methotrexate; Middle Aged; Precancerous Conditions; PUVA Therapy; Skin Diseases; Skin Neoplasms; Tretinoin

The effect of oral isotretinoin (13-cis-retinoic acid) on in vivo chemotactic responses was studied longitudinally in 7 patients with cystic acne. As measured in a microchamber chemotaxis assay, both monocyte and neutrophil chemotaxis were inhibited 98% (p less than 0.001) during isotretinoin treatment. In vivo chemotactic responses returned to normal within 2 months of cessation of treatment. Biopsies of skin chamber sites from patients on isotretinoin showed no significant dermal or epidermal leukocytic accumulation in response to autologous zymosan-activated serum, whereas chambers from controls showed extensive neutrophilic infiltrates even in the epidermis. In contrast, in vitro chemotactic responses of neutrophils and monocytes from patients on isotretinoin were not diminished. Sera and plasma from patients on isotretinoin contained no inhibitors of chemotaxis, and activated sera from these patients were excellent attractants for normal monocytes. We postulate that isotretinoin produces significant anti-inflammatory effects by inhibition of monocyte and neutrophil chemotaxis across intact biologic barriers in vivo.

Topics: Acne Vulgaris; Chemotaxis; Chemotaxis, Leukocyte; Cysts; Humans; Isotretinoin; Monocytes; Neutrophils; Skin Diseases; Tretinoin

A case of excess granulation tissues in a patient treated with isotretinoin by a severe cystic acne is reported. Other cases described in the literature are reviewed.

Topics: Acne Vulgaris; Adolescent; Granulation Tissue; Granuloma; Humans; Isotretinoin; Male; Skin Diseases; Tretinoin

Using the sebum-absorbent tape technique, we have disclosed five different patterns of follicular sebum excretion rate (SER). These are the infantile, pubertal, acne, adult and aging patterns, distinguished by different densities of active sebaceous follicles, by distinct levels of follicular SER and by the relative stability in time of the overall SER.

Topics: Acne Vulgaris; Adolescent; Adult; Aged; Aged, 80 and over; Aging; Benzoyl Peroxide; Child; Child, Preschool; Cytodiagnosis; Hair; Humans; Image Processing, Computer-Assisted; Infant; Isotretinoin; Middle Aged; Sebaceous Glands; Sebum; Skin Diseases; Tretinoin

We report the case of a young man with extreme sebaceous gland hyperplasia that occurred in a diffuse pattern of aggregated papular lesions involving the entire face, neck and upper chest, together with marked seborrhoea oleosa. Oral therapy with 13-cis-retinoic acid (isotretinoin) resulted in remarkable improvement within a few weeks. Parallels from our case are drawn to familial sebaceous hyperplasia, reported by Dypre et al. in 1980 [6], and to a case of a young man with severe sebaceous gland hyperplasia and facial seborrhoea, reported by de Villez et al. in 1982. We suggest that these types of seboglandular proliferative disorders be classified as diffuse (presenile) sebaceous gland hyperplasia in contrast to the well-defined senile circumscribed variant, and that they be regarded as a separate entity.

Topics: Adult; Humans; Hyperplasia; Isotretinoin; Male; Sebaceous Glands; Skin Diseases; Tretinoin

Topics: Cysts; Humans; Isotretinoin; Skin Diseases; Tretinoin

Retinoids are vitamin A derivatives that have therapeutic benefit in the treatment of hyperkeratotic genodermatosis, psoriasis, and acne. Isotretinoin (Accutane), a first-generation retinoid, is used in the treatment of cystic acne. Etretinate (Tegison), a second-generation retinoid, is used in the treatment of severe psoriasis. Third-generation drugs are currently being tested. Side effects and long-term toxicity are of concern. Etretinate in combination with ultraviolet B and psoralen-ultraviolet A (PUVA) is especially beneficial in the treatment of psoriasis.

Topics: Etretinate; Humans; Isotretinoin; Retinoids; Skin Diseases; Tretinoin

A 20-year old man with steatocystoma multiplex and pseudofolliculitis barbae was treated unsuccessfully with oral isotretinoin. Consistent with findings from previous reports, treatment with isotretinoin should be reserved for patients with steatocystoma multiplex suppurativum.

Topics: Adult; Epidermal Cyst; Folliculitis; Humans; Isomerism; Isotretinoin; Male; Skin Diseases; Tretinoin

Four weeks after the introduction of a therapeutic regimen with 80 mg 13-cis-retinoic acid/day, a 16-year-old male patient developed oozing hypergranulation with vulnerable masses within acne lesions. These local symptoms were accompanied by fever, fatigue, weight loss, polyarthralgia and myalgia, similar to acne fulminans. In spite of these unusual reactions treatment was continued. Local steroid ointments were additionally applied. Within a short period of time regression of granulations and normalization of the general health condition was observed. After 4 months, therapy was discontinued. The patient's acne had totally healed and did not relapse within an observation period of 2 years.

Topics: Acne Vulgaris; Administration, Topical; Adolescent; Granulation Tissue; Granuloma; Humans; Isotretinoin; Male; Skin Diseases; Tretinoin; Wound Healing

Topics: Acne Vulgaris; Humans; Isomerism; Isotretinoin; Skin Diseases; Teratogens; Tretinoin

Topics: Adult; Humans; Isotretinoin; Male; Middle Aged; Papillomaviridae; Skin Diseases; Tretinoin; Tumor Virus Infections

A patient with steatocystoma multiplex (SM) with severe inflammation was treated with oral isotretinoin. Inflamed cysts markedly improved with treatment. However, after eight weeks of therapy, many pre-existing cysts rapidly enlarged and new cysts occurred. Therapy was then discontinued. Isotretinoin may have exacerbated or worsened this condition.

Topics: Adult; Cysts; Female; Humans; Isotretinoin; Skin Diseases; Tretinoin

Topics: Abnormalities, Drug-Induced; Etretinate; Female; Humans; Infant, Newborn; Isotretinoin; Pregnancy; Retinoids; Skin Diseases; Teratogens; Tretinoin

Topics: Endocarditis, Bacterial; Epidermis; Humans; Isomerism; Isotretinoin; Retinoids; Risk; Skin; Skin Diseases; 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

A patient with multiple keratoacanthomas was successfully treated with oral isotretinoin. The treatment resulted in clearing of existing keratoacanthomas and prevented the development of new lesions. An induction dose of 1.5 mg/kg/day was necessary to initiate the response. This is the third report of successful treatment of multiple keratoacanthomas with isotretinoin.

Topics: Administration, Oral; Adult; Humans; Isotretinoin; Keratoacanthoma; Male; Skin; Skin Diseases; Tretinoin

Topics: Etretinate; Humans; Isotretinoin; Killer Cells, Natural; Skin Diseases; Tretinoin

A total of 261 adverse ocular reactions occurred in 237 patients who received isotretinoin, a commonly used drug in the treatment of severe cystic acne. Blepharoconjunctivitis, subjective complaints of dry eyes, blurred vision, contact lens intolerance, and photodermatitis are reversible side effects. More serious ocular adverse reactions include papilledema, pseudotumor cerebri, and white or gray subepithelial corneal opacities; all of these are reversible if the drug is discontinued. Reported cases of decreased dark adaptation are under investigation. Isotretinoin is contraindicated in pregnancy because of the many reported congenital abnormalities after maternal use (including microphthalmos, orbital hypertelorism, and optic nerve hypoplasia).

Topics: Acne Vulgaris; Cataract; Conjunctivitis; Cysts; Eye; Eye Diseases; Eyelid Diseases; Humans; Inflammation; Isotretinoin; Photosensitivity Disorders; Skin Diseases; Tretinoin; Vision Disorders

Hyperplasia of sebaceous glands is a common cause of papulonodular facial lesions that occur in middle-aged and older patients. Recently, several cases of premature sebaceous gland hyperplasia have been reported. In these patients the lesions had persisted despite vigorous attempts at therapy. We present a case of premature sebaceous gland hyperplasia that was successfully treated with isotretinoin.

Topics: Adult; Dermatologic Agents; Humans; Hyperplasia; Isotretinoin; Male; Sebaceous Glands; Skin Diseases; Tretinoin

The neutrophil function and plasma leukotactic activity of a patient with Sweet's syndrome and cystonodular acne were evaluated during a 2 1/2-year period. These studies demonstrated that chemotaxis was frequently slightly increased, especially during an exacerbation of Sweet's syndrome, but showed some decrease during isotretinoin therapy. Other functions, such as phagocytosis, metabolic activation, and bacterial killing, also were slightly increased. In addition, the patient's serum contained a heat-stable, nonlipid chemoattractant that was present at all times except during a course of isotretinoin. Although his symptoms responded to aspirin, the plasma continued to show this chemoattractant. These findings are consistent with the hypothesis that excess chemoattractant in Sweet's syndrome attracts neutrophils, which then mediate an inflammatory response. In addition, aspirin may be used to control Sweet's syndrome symptoms, although it does not suppress the plasma chemoattractant.

Topics: Adult; Aspirin; Chemotaxis, Leukocyte; Dialysis; Hot Temperature; Humans; Isotretinoin; Leukocytosis; Male; N-Formylmethionine Leucyl-Phenylalanine; Neutrophils; Pentose Phosphate Pathway; Phagocytosis; Plasma; Skin Diseases; Syndrome; Tretinoin; Zymosan

Grover's disease (transient acantholytic dermatosis; TAD), a disorder of unknown etiology, may resemble Darier's disease and frequently resists conventional therapies. The lesions can be extensive and pruritus can be a prominent feature. Four patients with Grover's disease were treated with isotretinoin. Three patients with relatively acute disease responded with remissions of up to 10 months after treatment. One patient with disease of 8 months' duration obtained partial relief but experienced a relapse when medication was stopped.

Topics: Acantholysis; Female; Humans; Isotretinoin; Male; Middle Aged; Skin Diseases; Tretinoin

Topics: Etretinate; Humans; Isotretinoin; Psoriasis; PUVA Therapy; Retinoids; Skin Diseases; Tretinoin

Disseminated granuloma annulare is often a chronic disorder that may prove refractory to treatment and lead to prolonged cosmetic disfigurement. In a patient with disseminated granuloma annulare that was unresponsive to multiple therapeutic regimens, administration of isotretinoin resulted in rapid clearing of nearly all lesions. To our knowledge this is the first reported case in which this agent was used to treat disseminated granuloma annulare.

Topics: Female; Granuloma; Humans; Isotretinoin; Middle Aged; Skin; Skin Diseases; Tretinoin

Topics: Child; Humans; Isotretinoin; Male; Skin Diseases; Syndrome; Tretinoin

Peripheral blood natural killer (NK) cell activity was screened in patients with non-malignant disorders of the skin who took oral etretinate or 13-cis-retinoic acid for up to 11 months. Compared to pretreatment values, the basic NK activity rose during the first 2 months of treatment, but thereafter returned to starting values. Interferon reactivity (IFN-alpha, IFN-gamma) was essentially unaltered by the treatment. It is concluded that moderate oral retinoid doses cause a mild, transient stimulation of this natural immune surveillance system in man.

Topics: Administration, Oral; Adult; Aged; Etretinate; Female; Humans; Isotretinoin; Killer Cells, Natural; Male; Middle Aged; Skin Diseases; Stimulation, Chemical; Tretinoin

Isotretinoin is remarkably effective in the treatment of severe cystic acne, however, many complications have been observed during treatment and new toxic effects have been reported. Hypertriglyceridemia associated with decreases in high density lipoprotein (HDL) cholesterol has occurred in 25 percent of patients and requires monitoring during treatment. Painful erosions with granulation tissue recently have been reported in patients with severe acne. Other complications have included corneal opacities, pseudotumor cerebri, hypercalcemia, photosensitivity reactions, abnormal liver function tests, and skeletal hyperostosis. Isotretinoin is teratogenic and should be avoided during pregnancy. With the increasing acceptance and use of isotretinoin for cystic acne, as well as related disorders (inflammatory papulopustular acne with scarring, gram-negative folliculitis, and acne rosacea), a reevaluation of isotretinoin aimed at reducing complications is in order. Patient selection criteria and guidelines directed at reducing these complications are presented.

Topics: Acne Vulgaris; Female; Humans; Isotretinoin; Mucous Membrane; Pregnancy; Skin Diseases; Teratogens; Tretinoin; Triglycerides

Topics: Acne Vulgaris; Adolescent; Chronic Disease; Follow-Up Studies; Granuloma; Humans; Isotretinoin; Male; Skin Diseases; Tretinoin

Topics: Acne Vulgaris; Humans; Isotretinoin; Retinoids; Skin Diseases; Tretinoin

Topics: Animals; Etretinate; Humans; Isotretinoin; Mice; Rabbits; Rats; Retinoids; Skin Diseases; Tretinoin

Topics: Adolescent; Granuloma; Humans; Isomerism; Isotretinoin; Male; Paronychia; Skin Diseases; Tretinoin

Frequent symptoms of back and neck stiffness led to a radiographic investigation of the vertebral spine in patients receiving synthetic retinoids, isotretinoin and etretinate. X-ray examination of fifty patients with various skin disorders who received retinoids for at least 2 years were compared with seventy-two age- and sex-matched untreated patients. Differences in frequencies of defined abnormalities, which included anterior spinal ligament calcification and presence of osteophyte at two or more vertebral levels in the absence of joint space narrowing, were determined for treated and untreated patients. When the entire group of treated patients was compared with the entire group of those untreated, no statistically significant differences were observed. When only patients with basal cell nevus syndrome ( BCNS ) or basal cell carcinoma (BCC) who had never received retinoid were compared with those who received isotretinoin, the frequency of the defined abnormalities was significantly higher in the treated group (P less than 0.01). This study suggests that the ingestion of isotretinoin at mean total dose of 150,060 mg for an average of 2.9 years is associated with a statistically significant increase in developing an associated ossifying diathesis in patients with BCNS or BCC, when compared with matched, untreated controls.

Topics: Adult; Calcinosis; Dose-Response Relationship, Drug; Etretinate; Female; Humans; Isotretinoin; Male; Middle Aged; Radiography; Skin Diseases; Spinal Diseases; Spinal Osteophytosis; Spine; Tretinoin

The effects of four retinoids, all-trans-retinoic acid (RA), 13-cis-retinoic acid (13-cis-RA), aromatic retinoid, and arotinoid ethyl ester ( arotinoid ) were examined on the skin of the rhino mouse. Rhino mouse skin is characterized by the presence of keratin-containing utricles attached to the epidermis, and subcutaneous cysts, both of which are derived from hair follicles. The utricles were examined in horizontal sheets of epidermis, and in vertical histologic sections. After applications of 0.1 ml of 0.1% RA, 0.1% 13-cis-RA, 0.1% aromatic retinoid, or 0.001% arotinoid in acetone to the dorsal skin for 5 days a week for 2 weeks, there was a reduction of utricle diameter to 45%, 52%, 30%, and 31% of acetone-treated controls, respectively. Histologic examination of the epidermis revealed that a dose-dependent hyperplasia and thickening of the epidermis and the stratum granulosum was induced by the retinoids when given at subtoxic doses, being most marked after arotinoid or RA. The thickness of the walls of the utricles also increased with increasing dose of retinoid, paralleling the changes in the epidermis. After doses of 0.1% RA and 0.001% arotinoid , the utricles resembled the hair follicles of hairless mice. Hyperplasia of the epidermis appears to be a primary effect of retinoids or rhino mouse skin. Hyperproliferation of the utricle wall is accompanied by a reduction in the size of the utricle lumen, preceding eventual differentiation of the utricles to normal-looking pilar units.

Topics: Animals; Benzoates; Dermatologic Agents; Etretinate; Isomerism; Isotretinoin; Keratolytic Agents; Mice; Mice, Mutant Strains; Retinoids; Skin; Skin Diseases; Tretinoin

Two cases of diffuse multiple lesions of sebaceous hyperplasia of the face are reported. The results of both medical and surgical therapies had been unsatisfactory. The patients were treated with low dose systemic isotretinoin (13-cis-retinoic acid) which resulted in complete clearing in one case and substantial clearing in the second. We suggest that in those patients cosmetically bothered by diffuse multiple lesions of sebaceous hyperplasia, for which other therapies are unsuccessful or unamenable to the patient, isotretinoin offers a safe, rational therapeutic option.

Topics: Aged; Facial Dermatoses; Humans; Hyperplasia; Isotretinoin; Male; Middle Aged; Sebaceous Glands; Skin Diseases; Tretinoin

An 83-year-old woman with multiple squamous cell carcinomas and keratoacanthomas of the legs was treated with orally administered isotretinoin (13 cis-retinoic acid). Complete regression of the tumors was noted during the initial six-month treatment period. In the subsequent 36 months, four new cutaneous tumors were excised. There have been no recurrences of lesions that regressed while the patient was receiving retinoid therapy.

Topics: Administration, Oral; Aged; Carcinoma, Squamous Cell; Female; Humans; Isotretinoin; Keratoacanthoma; Leg; Skin Diseases; Skin Neoplasms; Tretinoin

A patient with steatocystoma multiplex with multiple ruptured draining cysts and abscesses was treated with a twenty-week course of isotretinoin. Abscesses involuted and inflamed cysts shrank. The remission persisted for ten weeks after discontinuing therapy; subsequently cysts and abscesses occurred in multiple sites.

Topics: Adult; Epidermal Cyst; Humans; Isotretinoin; Male; Skin Diseases; Tretinoin

Topics: Chemical Phenomena; Chemistry; Humans; Isotretinoin; Neoplasms; Precancerous Conditions; Retinaldehyde; Skin Diseases; Tretinoin; Vitamin A; Vitamin A Deficiency

13-cis-Retinoic acid (Accutane) is an effective new agent for the treatment of severe cystic acne. The most encouraging feature associated with use of this drug is the persistence of remissions even after administration has been discontinued. The cutaneous side effects are mild to moderate and are usually well tolerated. Careful monitoring of the serum lipids is necessary. In 4 of our 10 patients, the levels of triglycerides became elevated. Of these four patients, three had lowering of the high-density lipoprotein fraction. In three of our most severely affected patients, nonhealing erosions with heaped-up granulation tissue developed at the sites of large acne cysts, which healed promptly after therapy was completed. For the present, we emphasize that use of Accutane should be reserved for severe acne that is unresponsive to conventional treatment; in such cases, careful clinical and laboratory monitoring is imperative.

Topics: Acne Vulgaris; Adolescent; Adult; Animals; Humans; Isotretinoin; Male; Rabbits; Rats; Skin Diseases; Tretinoin; Triglycerides

In our clinical trials of isotretinoin therapy for cystic acne and etretinate treatment of psoriasis, eight patients had growth of excessive granulation tissue. The granulation tissue was found in resolving acne lesions in one patient taking isotretinoin. Among the psoriatic patients taking etretinate, the granulation tissue usually was seen adjacent to nail plates. In two patients, the side effect caused them to stop retinoid therapy. The tissue response did not appear to be related to the daily or cumulative retinoid dose.

Topics: Acne Vulgaris; Adolescent; Adult; Aged; Granulation Tissue; Granuloma; Humans; Isotretinoin; Male; Middle Aged; Psoriasis; Skin Diseases; Tretinoin

The naturally occurring retinoids (vitamin A alcohol = retinol and all-trans-retinoic acid) have been largely replaced by synthetic retinoids in recent years as systemic drugs for use in dermatology. At the present time, two synthetic retinoids are commercially available: etretinate (Tigason) and isotretinoin (Accutane). These compounds-which have a more favourable therapeutic index than the naturally occurring retinoids-ushered in a new era of dermatological therapy by their potent antikeratinizing, antiseborrhoeic (only isotretinoin) and antineoplastic action. The broadest indications for the use of these retinoids are psoriasis (etretinate) and cystic acne (isotretinoin), whereas the most dramatic effects are encountered in a number of severe ichthyosiform disorders. Another important, although at present not clearly defined role of the retinoids is in the prophylaxis of skin tumours.

Topics: Acne Vulgaris; Etretinate; Humans; Ichthyosis; Isotretinoin; Psoriasis; Retinoids; Skin Diseases; Skin Neoplasms; Tretinoin

A patient with chronic cutaneous and pulmonary sarcoidosis, unresponsive to oral corticosteroid therapy, was treated with isotretinoin. The patient's cutaneous manifestations of sarcoidosis showed consistent improvement during the course of retinoid therapy. The lesions that responded earliest either resolved or showed the greatest reduction in size. The patient's WBC count increased and her angiotensin-converting enzyme level decreased during the first two months of isotretinoin therapy; both returned to pretreatment levels during the third month of therapy. Pulmonary function tests were unchanged after four months of treatment. Isotretinoin may be a useful therapeutic agent for cutaneous sarcoidosis. However, the possibility of spontaneous remission of the disease during the course of therapy cannot be excluded.

Topics: Adult; Female; Humans; Isotretinoin; Sarcoidosis; Skin; Skin Diseases; Time Factors; Tretinoin

Topics: Etretinate; Humans; Isotretinoin; Keratosis; Psoriasis; Skin; Skin Diseases; Tretinoin

Topics: Acne Vulgaris; Humans; Isotretinoin; Keratins; Psoriasis; Skin Diseases; Skin Neoplasms; Tretinoin; Vitamin A

Topics: Acne Vulgaris; Adolescent; Adult; Anti-Inflammatory Agents; Female; Folliculitis; Humans; Isotretinoin; Male; Rosacea; Skin Diseases; Tretinoin

Retinoids possess regulatory influences on growth and differentiation of epithelial tissues. They induce a population of keratinozytes with normal pattern of differentiation, they have antiproliferative properties, and they show antineoplastic effects by inhibition of malignant transformation of cells in vitro. Also the dermis undergoes distinct alterations under oral administration of retinoids. By stimulating T-lymphocytes and by inhibition of neutrophil migration retinoids seem to develop immunmodulating and antiinflammatory effects. The aromatic retinoid Etretinate is therapeutically used in severe forms of psoriasis and in various genodermatoses with disorders of keratinization as for example ichthyosis, dyskeratosis follicularis Darier, and pityriasis rubra pilaris.

Topics: Acne Vulgaris; Administration, Oral; Etretinate; Humans; Isomerism; Isotretinoin; Psoriasis; Rosacea; Skin Diseases; Tretinoin

Topics: Acne Vulgaris; Adult; Cysts; Female; Humans; Isotretinoin; Male; Skin; Skin Diseases; Tretinoin

Topics: Female; Humans; Hyperplasia; Isotretinoin; Middle Aged; Sebaceous Glands; Skin Diseases; Tretinoin

Topics: Etretinate; Humans; Isotretinoin; Skin Diseases; Tretinoin

Topics: Acne Vulgaris; Animals; Cocarcinogenesis; Etretinate; Humans; Immunity; Isomerism; Isotretinoin; Keratosis; Polyamines; Psoriasis; Skin; Skin Diseases; Teratogens; Tretinoin; Triglycerides; Vitamin A

The origin and frequency of skin fragility, a frequent side effect of oral synthetic retinoids, was studied in ten patients receiving isotretinoin (13-cis-retinoic acid) for disorders of keratinization and in hairless mice treated with isotretinoin and the aromatic retinoid, etretinate (RO 10-9359). Clinical skin fragility occurred in eight of ten patients, and experimental friction blisters could be induced by pencil eraser abrasion in nine of nine patients and in the hairless mice. Light and electron microscopy of friction blisters showed fraying or loss of the stratum corneum and outer layers of the viable epidermis, loss of desmosomes and tonofilaments, and intracellular and intercellular deposits of amorphous material that did not stain with stains for mucin. The skin fragility produced by oral synthetic retinoids is epidermal in origin, since (1) retinoids induce profound disruption of epidermal morphologic appearance, (2) an intraepidermal split is produced by experimental friction blisters, and (3) urinary hydroxyproline excretion in patients receiving retinoids, a measure of collagen catabolism, was not increased.

Topics: Adolescent; Adult; Animals; Blister; Child; Etretinate; Female; Humans; Hydroxyproline; Isomerism; Isotretinoin; Lectins; Male; Mice; Mice, Hairless; Skin; Skin Diseases; Tretinoin; Water Loss, Insensible

Ten patients with disorders of keratinization were treated with oral isotretinoin (13-cis-retinoic acid) on an investigational protocol to test the efficacy, safety, and optimal dosage schedule for using the drug in these rare disorders. Elevations of serum triglyceride levels above the highest normal levels developed in seven of the ten patients, while they maintained normal levels of serum cholesterol. This effect was found to be dose and/or time related and reversible. Moderate elevations of serum triglyceride levels have not been clearly established as a risk factor for the development of coronary artery disease. High levels, however, may precipitate acute pancreatitis. For this reason, the conditions of patients receiving retinoids must be carefully monitored for triglyceride abnormalities throughout their courses of treatment.

Topics: Administration, Oral; Adolescent; Adult; Child; Cholesterol; Darier Disease; Female; Humans; Isotretinoin; Keratins; Keratosis; Male; Middle Aged; Skin; Skin Diseases; Tretinoin; Triglycerides

Topics: Adult; Anti-Bacterial Agents; Aspirin; Child; Cimetidine; Cyclophosphamide; Dipyridamole; Female; Humans; Infant; Isotretinoin; Pruritus; Skin Diseases; Tretinoin; Ultraviolet Therapy