isotretinoin and Vasculitis

We present a patient in whom a combination of perinuclear antineutrophil cytoplasmic antibody-positive vasculitis, oligoarthritis, tendinitis, and myositis was considered to be associated with isotretinoin use. Discontinuation of the drug resulted in complete clinical and biochemical remission (normalization of perinuclear antineutrophil cytoplasmic antibody titer). Although we were unable to prove causality, no other underlying cause for the patient's course was found. We report this occurrence to bring it to the attention of physicians prescribing isotretinoin.

Topics: Acne Vulgaris; Adolescent; Anti-Inflammatory Agents, Non-Steroidal; Antibodies, Antineutrophil Cytoplasmic; Arthritis; Dermatologic Agents; Diagnosis, Differential; Humans; Isotretinoin; Magnetic Resonance Imaging; Male; Myositis; Skin; Tendinopathy; Vasculitis; Withholding Treatment

Acne fulminans is a severe form of acne vulgaris accompanied by systemic symptoms. A 17-year-old Chinese boy presented with an outbreak of necrotic lesions on his face eight days after the onset of palpable purpura, arthralgia, fever, abdominal pain, and proteinuria. He was successfully treated with oral prednisolone and isotretinoin. Vasculitis-like symptoms are rarely reported in acne fulminans; therefore, the physician needs to maintain awareness of this uncommon presentation.

Topics: Acne Vulgaris; Adolescent; Arthralgia; Fever; Humans; IgA Vasculitis; Isotretinoin; Male; Prednisolone; Purpura; Treatment Outcome; Vasculitis

Various dermatologic manifestations are observed in the different lupus subsets. Lupus lesions are characterized by a dermo-epidermal dermatitis. Other lesions, vascular or non vascular, are essentially present in association with systemic lupus erythematosus. Acute, subacute and chronic lupus erythematosus are distinguishable according to their clinical aspects, pathological features and evolution. Acute lesions are either localized to the midface or widespread. Subacute lesions may be annular or psoriasiform. Chronic lupus erythematosus includes localized or widespread discoid lupus, lupus tumidus, chilblain lupus and panniculitis. Therapy of cutaneous lupus is mainly based on antimalarials and avoidance of sun irradiation. In refractory cutaneous lupus, no universal guidelines are currently available. Except for acrosyndromes and urticaria-like lesions, vascular lesions may be due to vasculitis or thrombosis. An accurate diagnosis is absolutely necessary since therapy is different in thrombosis and vasculitis. Non vascular and non lupus lesions are numerous, some of them require special treatment such as dapsone for bullous lupus.

Topics: Acitretin; Adrenal Cortex Hormones; Adult; Antimalarials; Clinical Trials as Topic; Dapsone; Dermatologic Agents; Diagnosis, Differential; Drug Combinations; Female; Glucosamine; Humans; Hydroxychloroquine; Immunosuppressive Agents; Infant, Newborn; Isotretinoin; Keratolytic Agents; Lupus Erythematosus, Cutaneous; Lupus Erythematosus, Discoid; Male; Middle Aged; Skin; Sulfasalazine; Thalidomide; Thrombosis; Ultraviolet Therapy; Vasculitis

A 19 year old man with severe acne conglobata and ulcerated pyoderma gangraenosum-like skin lesions on the face was first treated with isotretinoin (Roaccutan((R))), then immunosuppressively with prednisolone, diaminodiphenylsulfone (Dapson-Fatol((R))) and mycophenolate mofetil (Cellcept((R))). Under a daily maintenance dose of immunosuppressive treatment with 2.5 mg prednisolone and 1 g mycophenolate mofetil, weakness, muscle and joint aches appeared. Due to proteinuria, haematuria and an elevated antineutrophil cytoplasmic antibody (cANCA) and the histological detection of a leukocytoclastic vasculitis, the diagnosis of cANCA positive vasculitis of the skin and kidneys was established. Therapy with cyclophosphamide (Endoxan((R))) along with prednisolone was effective. An exact classification of this disease process was not possible.

Topics: Acne Vulgaris; Adult; Antibodies, Antineutrophil Cytoplasmic; Cyclophosphamide; Diagnosis, Differential; Drug Therapy, Combination; Endothelium, Vascular; Facial Dermatoses; Humans; Immunosuppressive Agents; Isotretinoin; Kidney; Male; Neutrophils; Prednisolone; Pyoderma Gangrenosum; Vasculitis

The adverse effects of retinoids on bones and joints are being increasingly documented. A case is reported in which isotretinoin was considered responsible for polyarteritis-like vasculitis. Perinuclear antineutrophil cytoplasmic antibodies were present in titers that correlated with clinical and laboratory test abnormalities.

Topics: Acne Vulgaris; Adolescent; Antibodies, Antineutrophil Cytoplasmic; Diagnosis, Differential; Humans; Isotretinoin; Male; Polyarteritis Nodosa; Vasculitis

Topics: Humans; Isotretinoin; Time Factors; Vasculitis

Topics: Adolescent; Adult; Aged; Etretinate; Granulomatosis with Polyangiitis; Humans; Immune Complex Diseases; Isotretinoin; Male; Middle Aged; Product Surveillance, Postmarketing; Vasculitis; Vasculitis, Leukocytoclastic, Cutaneous

Topics: Adolescent; Humans; Isotretinoin; Male; Time Factors; Vasculitis

Topics: Adolescent; Biopsy; Granulomatosis with Polyangiitis; Humans; Isotretinoin; Kidney; Kidney Failure, Chronic; Lung; Male; Tretinoin; Vasculitis