tretinoin and Exostoses

We describe a patient with severe pityriasis rubra pilaris in whom extensive extraspinal hyperostoses developed after 13 years of oral retinoid treatment. The most prominent abnormality was a bridging exostosis between the left acetabulum and collum. X-ray examinations of the spine during retinoid therapy showed no abnormalities. During oral retinoid treatment, it is important to ask the patient on a regular basis about any skeletal pains or mobility restriction. Normal spinal x-ray results are no guarantee that a patient is free of hyperostoses. Discontinuation of acitretin therapy resulted in a severe exacerbation of the patient's pityriasis rubra pilaris after 2 weeks. The clinical response to administration of azathioprine was clearly inferior to that of acitretin. However, low-dose oral methotrexate therapy appeared to be a good alternative in this patient, with a clinical result comparable to acitretin and no side effects after 6 months of therapy.

Topics: Acetabulum; Acitretin; Adolescent; Adult; Azathioprine; Child; Etretinate; Exostoses; Femur Neck; Follow-Up Studies; Humans; Hyperostosis; Male; Methotrexate; Pityriasis Rubra Pilaris; Retinoids; Tretinoin

Skeletal abnormalities have been reported on numerous occasions in patients who have received high doses of vitamin A and its derivatives. Recently, a new derivative, isotretinoin (Accutane, Hoffman-LaRoche, Inc.), has become available for the treatment of cystic acne. Ninety-six patients treated for a minimum of four months with low doses of this drug at two University centers have shown overall good to excellent clinical responses. However, ten of these patients have developed small pointed excrescences on the anterior margins of cervical, thoracic, or lumbar vertebral bodies. The findings are of unknown clinical significance but show some similarities to the spinal findings in DISH syndrome. Follow-up studies will be obtained, but, at the present time, the drug still can be recommended for patients who have severe cystic acne because of the excellent clinical response.

Topics: Acne Vulgaris; Adolescent; Adult; Exostoses; Female; Humans; Isotretinoin; Male; Radiography; Spinal Diseases; Tretinoin

Topics: Abnormalities, Drug-Induced; Acne Vulgaris; Animals; Exostoses; Female; Humans; Isotretinoin; Lipids; Pregnancy; Tretinoin

Eight patients with disorders of keratinization (six with ichthyosis, one with Darier's disease, and one with palmar-plantar keratoderma) were treated with isotretinoin for 9 months (1 patient) to 1 year (7 patients). The patients ranged from 5 to 26 years of age. The average isotretinoin dose was 2 mg/kg/day (range, 1.0-2.9 mg/kg/day). Radiographic skeletal surveys were performed prior to therapy, and after 6 months and 1 year of therapy. After 1 year of isotretinoin treatment, six of the eight patients had small but unequivocal skeletal hyperostoses. Five of the patients had multiple hyperostoses. While only two patients were judged to have hyperostoses after 6 months of isotretinoin therapy during prospective evaluation, retrospective comparison with the radiographs obtained after 1 year revealed skeletal hyperostoses after 6 months of treatment in an additional three patients. Between 6 months and 1 year of therapy, some of the hyperostoses remained unchanged while others had progressed. In three patients, hyperostoses were seen at 12 months that were not detectable at 6 months. Based on this prospective study of skeletal changes during isotretinoin therapy, we recommend that patients taking high doses of isotretinoin for long periods be monitored radiographically.

Topics: Adolescent; Adult; Bone and Bones; Child; Child, Preschool; Exostoses; Female; Humans; Isotretinoin; Keratosis; Male; Prospective Studies; Radiography; Retrospective Studies; Time Factors; Tretinoin

Topics: Acne Vulgaris; Exostoses; Humans; Isotretinoin; Tretinoin; United States; United States Food and Drug Administration

Topics: Acne Vulgaris; Dehydroepiandrosterone; Dexamethasone; Exostoses; Female; Humans; Isotretinoin; Tretinoin

Topics: Adolescent; Adult; Exostoses; Female; Humans; Ichthyosis; Isotretinoin; Long-Term Care; Male; Tretinoin