tretinoin and Dermatitis--Seborrheic

Topics: Acne Vulgaris; Androgen Antagonists; Androgens; Benzoyl Peroxide; Cyproterone; Cyproterone Acetate; Dermatitis, Seborrheic; Drug Combinations; Erythromycin; Ethinyl Estradiol; Female; Humans; Isotretinoin; Male; Propionibacterium acnes; Sebum; Tetracycline; Tretinoin

A follow-up was done on the patients of the German multicenter study with severe conglobate acne who had been treated with different dosages of 13-cis-retinoic acid. Eighty-seven patients were monitored from 12 to 21 months. Optimal long-term therapeutic effects were obtained with an initial dose of 1.0 mg/kg body weight, for 3 months, followed by another 3-month-treatment period with 0.2 mg/kg body weight. Six months after the termination of therapy 96% of the patients were still in remission and 81% after 12 months. Comparative figures for the administration of doses were 84% as opposed to 47% (0.5----0.2 mg/kg body wt.) and 74% as opposed to 37% (0.2----0.2 mg/kg body wt.), respectively. It is suggested from the present data that a high initial dosage of 13-cis-retinoic acid be chosen in order to obtain optimal long-term therapeutic effects. Transiently elevated lipid levels as well as other tolerable side effects return to normal within 3 months at the latest after discontinuation of treatment.

Topics: Acne Vulgaris; Adolescent; Adult; Clinical Trials as Topic; Dermatitis, Seborrheic; Follow-Up Studies; Humans; Isomerism; Isotretinoin; Mucous Membrane; Recurrence; Skin; Time Factors; Tretinoin; Xerostomia

Successful treatment of acne conglobata with 13-cis-retinoic acid (isotretinoin, Ro 4-3780) has already been reported in this journal [25, 36]. The aim of the present study was to treat severe forms of papulopustular acne, unresponsive to conventional therapy, with low doses of 13-cis-retinoic acid to obtain good results with few side effects. A total of 191 patients from 14 departments of dermatology in the Federal Republic of Germany received 13-cis-retinoic acid under open randomized conditions in parallel dose groups of 0.05, 0.1, and 0.2 mg/kg body weight for 20 weeks in order to establish efficacy and tolerance. All inflammatory and non-inflammatory skin lesions were counted. The intensity of seborrhea was graded by using a scale. Adverse effects as well as laboratory values were registered. After 20 weeks of treatment a 79% (0.05 mg), 80% (0.1 mg), and 84% (0.2 mg) decrease in the number of inflammatory skin lesions was seen. Fourteen patients in the lowest dose group were considered to be dropouts. The decrease in non-inflammatory skin lesions was less marked and amounted to between 49% and 69%. A significant reduction of seborrhea could be observed in all patients. The main side effect was dryness of the skin and mucous membranes, which was, however, of low intensity. The elevation of triglyceride and cholesterol levels reported with higher doses of 13-cis-acid, especially in patients with high-risk factors, were not encountered in this study.

Topics: Acne Vulgaris; Administration, Oral; Adolescent; Adult; Clinical Trials as Topic; Dermatitis, Seborrheic; Dose-Response Relationship, Drug; Female; Humans; Isotretinoin; Male; Tretinoin

Results of the isotretinoin (13-cis-retinoic acid, Ro 4-3780) German Cooperative Study Group, with 198 acne conglobata patients being treated in 19 departments are reported. For the first 12 weeks (phase I) there was an open assignment to 0.2, 0.5 or 1.0 mg/kilogram bodyweight (kg bw). This was followed by further 12 weeks (phase II). If there was at least a two-third improvement of lesions, the 0.2 mg/kg bw was continued, and the 0.5 mg/kg bw dose lowered to 0.2 mg/kg bw. If there was no such improvement, the dose was elevated to 0.5 and 1.0 mg/kg bw respectively. The initial high dose group of 1.0 mg/kg bw was divided after twelve weeks into 0.2 mg/kg bw maintenance therapy, or no therapy at all. Non-inflammatory and inflammatory acne lesions from the entire body were counted. Seborrhea was graded on a four scale (0 to 3+). Subjective side effects were registered. Laboratory data included hematological profile with differential counts, creatinin, SGOT, SGPT, alkaline phosphatase, total bilirubin, serum cholesterol and serum triglycerides, and urine analysis. For statistical analysis 171 patients were available, 27 dropped out of the study, mostly for reasons unrelated to the drug. At least 75 per cent improvement was seen, in the 0.2 mg/kg bw group in 73.7 and 59.5 per cent respectively; in the 0.5 mg/kg bw group in 72.5 and 61.2 per cent respectively; and in the 1.0 mg/kg bw group in 85.4 and 92 per cent respectively (phase I t12 and phase II t24 values, respectively). Sebum suppression was dose-related. Subjective side effects were fairly well dose-related, particularly those of skin and mucous membranes. Myalgia was rare. There was a dose-related elevation of triglycerides and cholesterol, but not significant for the means of each group. Single patients did show significant elevation of blood lipids. All other laboratory parameters did not change significantly. Isotretinoin is presently the most effective drug to control severe forms of acne, leading to long lasting remissions.

Topics: Acne Vulgaris; Administration, Oral; Clinical Trials as Topic; Dermatitis, Seborrheic; Female; Germany, West; Humans; Isotretinoin; Male; Time Factors; Tretinoin

A methyl salicylate-buffered, croton oil-containing 50% salicylic acid ointment peel, following pretreatment with topical tretinoin and localized 20% trichloroacetic acid, is extremely effective for removal of lentigines, pigmented keratoses, and actinically damaged skin from the dorsum of the hands and forearms. The ease of application, uniform results, decreased risk of scarring, and one-time application of this peel, in comparison with other methods used for treatment of these aging-skin changes, warrants consideration by the dermatologic surgeon.

Topics: Aged; Bandages; Chemexfoliation; Dermatitis, Seborrheic; Female; Forearm; Hand Dermatoses; Humans; Keratosis; Lentigo; Ointments; Pigmentation Disorders; Salicylates; Salicylic Acid; Tretinoin; Trichloroacetic Acid

Topics: Acne Vulgaris; Administration, Cutaneous; Anti-Bacterial Agents; Dermatitis, Seborrheic; Humans; Hydrocortisone; Tretinoin

The clinical and bacteriological findings are reported in 13 patients with gram-negative folliculitis before, during, and after treatment with isotretinoin (13-cis-retinoic acid). Patients were treated for 14-36 weeks with a daily dose of 0.5-1.5 mg isotretinoin/kg body weight. Inflammatory lesions were counted before and during weeks 2, 4, 8, 12, 16, 20, 24, 28, and 30 of therapy and again up to 172 weeks after cessation of treatment. In all patients there was an impressive improvement in clinical symptoms, especially a decrease in seborrhea and inflammatory lesions. Simultaneously, the gram-negative bacteria disappeared from the facial skin. Full clinical bacteriological remission was achieved in 9 patients within a period of up to 43 months, with minor recurrences of the disease in the remaining 4 patients.

Topics: Adolescent; Adult; Bacterial Infections; Dermatitis, Seborrheic; Female; Folliculitis; Gram-Negative Bacteria; Humans; Isotretinoin; Male; Time Factors; Tretinoin

The efficacy and safety of isotretinoin in the treatment of idiopathic seborrhea in dogs were examined. Isotretinoin was judged effective in only 1 of 8 dogs. Side effects included mild conjunctivitis, transient erythematous rash, and increased serum cholesterol and triglyceride concentrations.

Topics: Animals; Conjunctivitis; Dermatitis, Seborrheic; Dog Diseases; Dogs; Female; Isotretinoin; Male; Pruritus; Tretinoin

Castrated rats submitted to androgenic stimulation present hyperseborrhea with an increase in foamy cells associated with an increase in cutaneous lipids and a change in the number of epidermal cell layers. 13-cis-retinoic acid and aromatic retinoid (Ro 10-9359) were given orally during 17 days (10 mg/kg) to castrated rats which had received a testosterone implant. Cyproterone acetate was chosen as the antiandrogenic drug; it was given at doses of 10 mg/kg i.m. once every other day. As opposed to cyproterone acetate, the two substances studied had no effect on the seminal vesicle and ventral prostate. 13-cis-retinoic acid and retinoic aromatic acid increased the total number of epidermal layers: In the case of 13-cis-retinoic acid, the increase involves especially the nonnucleated cell layers, whereas with retinoid aromatic acid it involves the nucleated cell layer. The number of sebaceous glands is not changed by either products, on the other hand, the number of foamy cells is considerably decreased and the weight of cutaneous lipids is decreased as well.

Topics: Animals; Dermatitis, Seborrheic; Etretinate; Foam Cells; Isotretinoin; Lipid Metabolism; Male; Rats; Rats, Inbred Strains; Sebaceous Glands; Skin; Tretinoin

A spayed Cocker Spaniel with idiopathic chronic generalized seborrhea responded poorly to treatment, consisting of medicated baths and intermittent use of lincomycin and triamcinolone acetate, over a 5 1/2-year period. At 7 years of age, the animal became refractory to triamcinolone injections. Oral vitamin A therapy was not beneficial, but oral use of 13-cis-retinoic acid (Accutane: Roche), at 0.25 mg/kg BID, resulted in recovery within a month.

Topics: Animals; Dermatitis, Seborrheic; Dog Diseases; Dogs; Isotretinoin; Tretinoin

Acne vulgaris is one of the most widespread of all diseases and is frequently the object of treatment in general and specialist medical practice. New insights into the pathophysiology of acne show that the most important therapeutic principle is suppression of the propionibacteria in the pilosebaceous duct since these bacteria have a key role in the genesis of the comedo and of inflammatory acne efflorescences. Experimental findings are shown which prove the value of a local treatment with antibiotics and ethanol-containing masks. The second therapeutic principle is "keratolytic" therapy. Retinoic acid, benzoyl peroxide and salicylic acid are in the forefront here. The third therapeutic principle is the reduction of seborrhea. Benzoyl peroxide is especially suitable for local treatment. Differential diagnosis of acne vulgaris and additional possibilities of treatment in problem cases are dealt with.

Topics: Acne Vulgaris; Adolescent; Adult; Androgen Antagonists; Anti-Bacterial Agents; Dermatitis, Seborrheic; Diagnosis, Differential; Humans; Tretinoin

The administration of anti-androgens brings favourable results especially in such skin diseases showing unsatisfactory therapeutic results, i.e. all severe forms of acne, seborrhoea, androgenic alopecia and hirsutism. Exact knowledge of the oestrogen and gestagen effect is essential. Also of fundamental importance is the observation and consideration of side effects besides the contraceptive efficacy and therapeutic results in dermatology.

Topics: Acne Vulgaris; Alopecia; Androgen Antagonists; Contraceptives, Oral; Contraceptives, Oral, Hormonal; Dermatitis, Seborrheic; Female; Hirsutism; Humans; Hypertrichosis; Skin Diseases; Tetracycline; Tretinoin

Sodium sulfacetamide, penetrating antibacterial, in combination with hydrocortisone and sulfur, has enjoyed twenty years of remarkable safety, with outstanding efficacy and patient acceptance, in the prescription treatment of pustular acne and severe, refractory seborrheic dermatitis. Recently, this combination has been reported to be highly effective concomitant therapy for perioral dermatitis. Almost paradoxically, it achieves these desired goals without the excessive erythema and discomforting irritation associated with retinoic acid and benzoyl peroxide.

Topics: Acne Vulgaris; Administration, Topical; Anti-Inflammatory Agents; Benzoyl Peroxide; Dermatitis, Seborrheic; Drug Combinations; Humans; Hydrocortisone; Rosacea; Sulfacetamide; Sulfur; Tretinoin