isotretinoin and Synovitis

We describe the case of a 21-year-old woman who developed biopsy proven seronegative oligoarthritis in association with isotretinoin treatment for acne vulgaris. Elevated levels of antinuclear antibody accompanied joint disease and resolution occurred over a 6-month period. Isotretinoin, an orally active derivative of vitamin A, has been associated with reported arthritis, arthralgia, myalgia, vasculitis and skeletal and soft tissue calcification. We review the literature and discuss the possible association between isotretinoin and immune dysfunction. The etiology of arthritis associated with vitamin A analog treatment remains obscure.

Topics: Acne Vulgaris; Administration, Oral; Adult; Antibodies, Antinuclear; Arthritis; Female; Humans; Isotretinoin; Synovitis

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