isotretinoin and Skin-Ulcer

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

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

Background /Aim: Acne fulminans is a rare form of acne vulgaris with acute clinical deterioration including systemic signs. Etiopathogenesis and management remain largely unknown. Our aim is to assess the efficacy of a combined therapeutic regimen of systemic isotretinoin and prednisolone following the recent concepts of acne pathogenesis and drug kinetics.. A prospective case series was recruited over 15 years. Isotretinoin 0.5 mg/kg bw/d (0.25-0-0.25) and prednisolone 30 mg/d (10-10-10) were administered concomitantly with prednisolone being tapered after that time. The overall efficacy was evaluated at month 1 and every month thereafter. Daily drug doses were split to reduce the risk for adverse effects.. 26 patients (20 male, 77%) at a mean age of 19 years and a history of acne vulgaris of 3.2 years presented acutely necrotic and ulcerating skin papules (100%), fever (45%), arthralgia (38.5%), leukocytosis (88.5%) and elevated erythrocyte sedimentation rate (100%). After one month of treatment resolution of systemic signs was achieved in all patients and a >50% skin lesion improvement in 17 patients (65%).. The concomitant administration of isotretinoin (0.5 mg/kg bw/d, 0.25-0-0.25) and prednisolone 30 mg/d (10-10-10) is able to resolve systemic signs and markedly improve skin lesions in 65% of the patients at one month.

Topics: Acne Vulgaris; Adolescent; Adult; Arthralgia; Drug Therapy, Combination; Female; Fever; Humans; Isotretinoin; Leukocytosis; Male; Necrosis; Prednisolone; Prospective Studies; Skin; Skin Ulcer; Young Adult

Acne fulminans is an uncommon and debilitating disease that presents as an acute eruption of nodular and ulcerative acne lesions in association with systemic symptoms. It occurs commonly during treatment of severe acne (eg, acne conglobata) with isotretinoin in young adolescent male patients. Isotretinoin and doxycycline also can potentially induce development of neutrophilic dermatoses in patients with severe acne lesions, which are characterized by the acute appearance of painful ulcerative papulonodules accompanied by systemic symptoms including fever and leukocytosis. We report a challenging case of a 13-year-old adolescent boy who acutely developed hundreds of ulcerative plaques as well as systemic symptoms after being treated with doxycycline and isotretinoin for acne conglobata. He was treated with prednisone, dapsone, and colchicine and had to switch to cyclosporine to achieve relief from his condition.

Topics: Acne Conglobata; Adolescent; Colchicine; Cyclosporine; Dapsone; Dermatologic Agents; Doxycycline; Humans; Isotretinoin; Male; Neutrophils; Prednisone; Skin Ulcer

Hidradenitis suppurativa (HS) may be associated with face and back lesions which are considered as acne.. To describe the skin lesions of a group of patients with HS.. Twelve patients were selected from a series of 648 patients on the basis of their specific skin lesions.. The patients (mostly male) had typical hidradenitis. On their face or back they had one or several of the following skin lesions which are not seen in acne: hypertrophic rope-like bridged scars, raised plaques with multiple carbuncle-like openings or with ulcerations, 'worm-eaten scars' and coalescent nodules with round ulcerations. All patients had deep round scars. Several had a pilonidal cyst or large epidermal cysts. Isotretinoin had been used by 7 patients with no effect.. Some HS patients have specific lesions of the face and back which are not acne and have to be treated differently.

Topics: Acne Vulgaris; Adult; Back; Cicatrix; Clindamycin; Dermatologic Agents; Epidermal Cyst; Face; Female; Hidradenitis Suppurativa; Humans; Isotretinoin; Male; Middle Aged; Pilonidal Sinus; Rifampin; Skin Ulcer; Treatment Outcome; Young Adult

A 16-year-old male developed numerous pyogenic granuloma like-lesions across his neck, chest and back after 6 weeks isotretinoin therapy for cystic acne. The isotretinoin was ceased and he was commenced on oral steroids. After 6 weeks, the lesions were almost completely healed. However, due to worsening comedonal acne, the patient was commenced on topical tretinoin cream 0.05% twice daily to his chest. He was reviewed 2 weeks later and, surprisingly, 2 new pyogenic granuloma-like lesions had developed on his chest. These lesions persisted until the topical tretinoin was ceased 3 months later.

Topics: Acne Vulgaris; Adolescent; Drug Eruptions; Granuloma, Pyogenic; Humans; Isotretinoin; Keratolytic Agents; Male; Skin Ulcer

Topics: Acne Vulgaris; Adolescent; Cyclophosphamide; Granulomatosis with Polyangiitis; Humans; Isotretinoin; Lung; Male; Necrosis; Prednisone; Skin; Skin Ulcer; Tretinoin