isotretinoin and Staphylococcal-Infections

Thirty patients commencing isotretinoin for acne were entered into a double-blind, randomized, placebo-controlled trial to investigate the effect of pulsed intra-nasal mupirocin ointment on Staphylococcus aureus colonization and isotretinoin-related side-effects. In both mupirocin and placebo groups there was an increase in isolation of S. aureus throughout the period of treatment with isotretinoin from the anterior nares, facial skin and lips. However, these increases were significantly less in the mupirocin-treated group. A high proportion of all patients suffered inflammatory side-effects of isotretinoin such as cheilitis and nasal vestibulitis, with their maximum severities being recorded 2 months after starting isotretinoin. In spite of the smaller increase in S. aureus colonization in the mupirocin-treated group no difference was demonstrated in either the incidence of specific S. aureus infections (e.g. furunculosis) or the prevalence of isotretinoin-related inflammatory side-effects. Furthermore, no relationship between the presence of S. aureus and the severity of inflammatory side-effects was shown. Streptococcus species were isolated on four separate occasions from four different patients during the study but their pathogenicity was unclear. These findings suggest that although pulsed intra-nasal mupirocin produces a significant reduction in isotretinoin-related staphylococcal colonization, its routine use cannot be justified on the basis of clinical benefit.

Topics: Acne Vulgaris; Administration, Intranasal; Adolescent; Adult; Double-Blind Method; Drug Administration Schedule; Female; Humans; Isotretinoin; Male; Mupirocin; Nose; Staphylococcal Infections; Staphylococcus aureus

Eighteen patients developed Staphylococcus aureus infection during or shortly after a five-month course of therapy with isotretinoin. Staphylococcus aureus was recovered both from lesions and from the anterior nares. In a prospective study, 4% of control patients treated with isotretinoin alone developed S aureus infection, while none who applied topical antibiotic to the anterior nares developed infection. Control patients had a 64% prevalence of anterior nares colonization with S aureus, compared with 18% in the topical antibiotic group.

Topics: Administration, Topical; Anti-Bacterial Agents; Dermatitis; Humans; Isotretinoin; Ointments; Staphylococcal Infections; Staphylococcus aureus; Tretinoin

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

Isotretinoin is frequently prescribed for the treatment of acne vulgaris. Among the numerous documented adverse effects, most common are xerostomia and cheilitis. Lip abscesses as a consequence of cheilitis present dramatically and may pose a diagnostic challenge.. We present a case of a 15-year-old boy with a severe lip abscess requiring incision and drainage and hospital admission for intravenous antibiotic treatment of methicillin-resistant Staphylococcus aureus. We discuss the pathophysiologic characteristics of isotretinoin therapy and the likely causative role that the medication played in the development of the lip abscess.. Although rare, lip abscesses related to isotretinoin therapy present with substantial morbidity and should be promptly recognized. Misdiagnosis of mucositis and angioedema may delay appropriate therapy.

Topics: Abscess; Acne Vulgaris; Adolescent; Anti-Bacterial Agents; Dermatologic Agents; Drainage; Hospitalization; Humans; Isotretinoin; Lip Diseases; Male; Methicillin-Resistant Staphylococcus aureus; Staphylococcal Infections

Dissecting cellulitis of the scalp is a chronic, relapsing, inflammatory disease of the scalp that results in scarring alopecia. We present a case of a 32-year-old man with recalcitrant disease who is now responding to treatment with isotretinoin. The pathogenesis, clinical presentation, disease associations, and histopathological findings are reviewed. Treatment can be challenging. The literature on medical and surgical therapeutic options is reviewed.

Topics: Adult; Alopecia; Cellulitis; Dermatologic Agents; Humans; Isotretinoin; Male; Methicillin-Resistant Staphylococcus aureus; Scalp Dermatoses; Staphylococcal Infections

Severe scarring acne is frequently treated with isotretinoin. Patients treated with this drug may expect some of the more common complications including mucositis. Less common complications may also occur in a small number of patients. While undergoing treatment, patients may become colonized with Staphylococcus bacteria. However, the incidence of perioral abscess formation in patients taking isotretinoin is not commonly reported and the onset of this adverse event may masquerade as angioedema or severe mucositis.This article presents a case of a significant perioral abscess and discuss the need for prompt recognition as well as treatment of the infection.The case reported is unique due to the extent and severity of the abscess.

Topics: Abscess; Acne Vulgaris; Adolescent; Anti-Bacterial Agents; Cicatrix; Dermatologic Agents; Humans; Isotretinoin; Lip Diseases; Male; Methicillin-Resistant Staphylococcus aureus; Severity of Illness Index; Staphylococcal Infections

Folliculitis decalvans of the scalp is a recurrent, purulent follicular inflammation leading to scarring alopecia. We report on a 27-year-old man with folliculitis decalvans successfully treated with a combination of isotretinoin, corticosteroids, and clindamycin.

Topics: Administration, Oral; Adult; Clindamycin; Dermatologic Agents; Drug Therapy, Combination; Folliculitis; Humans; Isotretinoin; Male; Prednisolone; Scalp Dermatoses; Staphylococcal Infections

Topics: Abscess; Adult; Folliculitis; Humans; Isotretinoin; Male; Scalp Dermatoses; Staphylococcal Infections

Topics: Acne Vulgaris; Administration, Oral; Anti-Bacterial Agents; Drug Resistance, Multiple; Female; France; Gram-Positive Bacterial Infections; Humans; Isotretinoin; Male; Pregnancy; Propionibacterium acnes; Staphylococcal Infections; Staphylococcus epidermidis

Topics: Acne Vulgaris; Adolescent; Adult; Anti-Bacterial Agents; Drug Resistance, Multiple; Female; Gram-Positive Bacterial Infections; Humans; Isotretinoin; Male; Pregnancy; Propionibacterium acnes; Staphylococcal Infections; Staphylococcus epidermidis

Topics: Adult; Cellulitis; Family Health; Humans; Isotretinoin; Male; Scalp Dermatoses; Staphylococcal Infections

A patient with hyperimmunoglobulin E syndrome is described. Recurrent cutaneous staphylococcal abscesses were a prominent feature and had been resistant to treatment with antibiotics and surgical drainage. Following a 4-month course of treatment with isotretinoin, he developed no further abscesses over a 6-month follow-up period. Detailed immunological investigations were undertaken before and after treatment and no change was found to account for his improvement. We consider that the beneficial effects of isotretinoin in this situation are likely to be due to a reduction in sebaceous gland size and activity, rather than to any effect on the underlying disorder.

Topics: Abscess; Adolescent; Humans; Hypergammaglobulinemia; Immunoglobulin E; Isotretinoin; Male; Skin Diseases, Infectious; Staphylococcal Infections; Tretinoin

The use of isotretinoin (13-cis-retinoic acid) in the treatment of numerous dermatologic disorders, as well as the side effects encountered with use of the drug, have increased remarkably since its release. We encountered a case of Staphylococcus aureus endocarditis in a patient with chronic stable aortic insufficiency undergoing therapy with isotretinoin for extensive actinic keratoses. Although significant dysfunction of the immune system has not been demonstrated with isotretinoin, nasal colonization with S aureus has been shown to occur. Changes in skin fragility caused by the drug may provide a portal of entry for the organism. Physicians should be alert for this potential complication in patients with an underlying cardiac valvular lesion; antibiotic prophylaxis may be indicated in this group during isotretinoin therapy.

Topics: Aortic Valve Insufficiency; Endocarditis, Bacterial; Humans; Isomerism; Isotretinoin; Keratosis; Male; Middle Aged; Risk; Skin; Staphylococcal Infections; Staphylococcus aureus; Tretinoin