minocycline and Skin-Diseases--Vascular

Minocycline is an oral antibiotic widely used for the long-term treatment of acne vulgaris. Unusual side effects of this medication include two overlapping autoimmune syndromes: drug-induced lupus and autoimmune hepatitis. In addition, in a few patients livedo reticularis or subcutaneous nodules have developed in association with arthritis and serum perinuclear antineutrophil cytoplasmic antibodies (P-ANCA) during long-term minocycline therapy. We report the cases of two young women receiving long-term minocycline therapy (>3 years) in whom P-ANCA-positive cutaneous polyarteritis nodosa developed. Both patients presented with a violaceous reticulated pattern on the lower extremities. Histologic examination of biopsy specimens from a reticulated area and a subcutaneous nodule showed necrotizing vasculitis of medium-sized arteries in the deep dermis, consistent with the diagnosis of polyarteritis nodosa. The cutaneous lesions rapidly resolved on discontinuation of minocycline and initiation of prednisone therapy. A high index of suspicion and testing for antineutrophil cytoplasmic antibody in addition to the standard antinuclear antibody panel can facilitate diagnosis of minocycline-related autoimmune disorders.

Topics: Acne Vulgaris; Adult; Anti-Bacterial Agents; Antibodies, Antineutrophil Cytoplasmic; Drug Eruptions; Female; Humans; Leg Dermatoses; Minocycline; Polyarteritis Nodosa; Skin Diseases, Vascular

Topics: Adult; Calcitriol; Diagnostic Errors; Follow-Up Studies; Hand Dermatoses; Humans; Hyperpigmentation; Male; Minocycline; Papilloma; Regional Blood Flow; Skin; Skin Diseases, Vascular; Skin Neoplasms; Treatment Failure

To describe a novel iatrogenic immunological reaction produced by minocycline.. The clinical course and laboratory results of three women who presented with similar rheumatological manifestations after a prolonged exposure to minocycline are described. All three presented a unique reaction manifested by fever, arthritis/arthralgia and livedo reticularis during treatment with minocycline for acne vulgaris. The clinical syndrome was associated with high titre of serum perinuclear anticytoplasmatic antibodies (p-ANCA) and antimyeloperoxidase antibody (anti-MPO). Symptoms resolved after stopping the drug and recurred promptly after rechallenge in all three patients.. Minocycline, which is widely used in the treatment of acne, often without adequate supervision, may induce arthritis and livedo vasculitis associated with anti-MPO.

Topics: Acne Vulgaris; Adult; Anti-Bacterial Agents; Antibodies, Antineutrophil Cytoplasmic; Arthritis; Autoantibodies; Biomarkers; Female; Fever; Humans; Minocycline; Peroxidase; Skin Diseases, Vascular