tretinoin and Folliculitis

Topics: Baths; Calcinosis; Cat-Scratch Disease; Child; Diabetes Mellitus, Type 1; Folliculitis; Foot Dermatoses; Herpes Simplex; Humans; Hyperhidrosis; Isomerism; Isotretinoin; Joint Diseases; Lyme Disease; Skin Diseases; Tinea; Tretinoin

In the one year since isotretinoin has been available in the United States for the treatment of severe, recalcitrant, nodulocystic acne, there has been extensive clinical verification of the reports of its dramatic efficacy in the treatment of this troublesome disease. Proper selection of patients, as well as treatment with adequate doses of drug for 3 to 5 months, will most often result in significant clinical improvement or total clearing. Although dosages of less than 1 mg/kg/day may produce a nearly equivalent degree of improvement with somewhat fewer or less severe side effects, the recommended daily dose remains 1 mg/kg/day because lower dosages are associated with more frequent relapses. In severe cases, the daily dosage may be increased to 2 mg/kg/day. Teratogenicity, elevation of serum triglycerides, liver function abnormalities, pancreatitis, and pseudotumor cerebri may all be associated with isotretinoin therapy and require close monitoring of the patient.

Topics: Abnormalities, Drug-Induced; Acne Vulgaris; Adolescent; Adult; Animals; Central Nervous System; Chemical and Drug Induced Liver Injury; Folliculitis; Humans; Isotretinoin; Middle Aged; Mucous Membrane; Musculoskeletal System; Rats; Skin Diseases; Sweat Gland Diseases; Tretinoin

Pseudofolliculitis barbae is a condition in which a foreign body inflammatory reaction surrounds an ingrown hair. Shaving is the major cause, especially in persons with wavy or curly hair. Among black men who shave, the disease is of particular concern because of both social pressures and limited medical understanding concerning its treatment. The pathogenesis of the disease as well as treatment modalities are presented. General measures, as well as specific techniques involving use of electric clippers, chemical depilatories, manual razors, and complete epilation are discussed. Adjuvant measures are presented such as antibiotics and, in very special cases, retinoic acid.

Topics: Administration, Topical; Anti-Bacterial Agents; Combined Modality Therapy; Folliculitis; Hair Removal; Humans; Hygiene; Male; Tretinoin

Good to excellent clinical results have been obtained in the treatment of severe inflammatory acne (acne conglobata, acne fulminans, and acne conglobata with hidradenitis and dissecting cellulitis of the scalp) with orally administered isotretinoin (13-cis-retinoic acid). Similar promising results have been obtained in patients with severe rosacea and gram-negative folliculitis. Isotretinoin probably has multiple modes of action, including (1) inhibition of sebaceous gland activity, (2) inhibition of the growth of Propionibacterium acnes within the follicle, although the retinoid is not antibacterial, (3) inhibition of inflammation, and (4) alteration of the pattern of keratinization within the follicle, as demonstrated by light and ultrastructural studies.

Topics: Acne Vulgaris; Adolescent; Adult; Clinical Trials as Topic; Enterobacteriaceae Infections; Female; Folliculitis; Humans; Isomerism; Isotretinoin; Male; Rosacea; Skin; Tretinoin

We report the case of a 24-year-old man who presented with pustules, atrophic scars, and alopecia on the scalp, along with follicular keratotic papules on the cheeks, chest, abdomen, back, lateral upper arms, thighs, and axillae, of 6 years' duration. A diagnosis of folliculitis spinulosa decalvans (FSD) was made based on the clinical manifestation and histopathological findings. Dental examination also revealed dental anomalies and a fissured tongue, which are not known to be related to FSD. We provide an overview of the characteristic findings of FSD as well as a review of previously reported cases.

Topics: Adult; Alopecia; Anti-Infective Agents; Clarithromycin; Dermatologic Agents; Diagnosis, Differential; Folliculitis; Fusidic Acid; Humans; Keratosis; Male; Metronidazole; Scalp; Scalp Dermatoses; Skin; Treatment Outcome; Tretinoin

Perifolliculitis capitis abscedens et suffodiens (PCAS) is rare chronic, suppurative and inflammatory scalp disease. Its aetiology and pathogenesis is not completely understood. The treatment is usually difficult and often disappointing. We report a case of 29-year-old male who presented with tender, fluctuant nodules and abscesses, with draining pus and patchy alopecia on his scalp for 3 years. A skin biopsy from scalp lesions revealed features that are characteristic of perifolliculitis. Initially, the patient was treated with periodic incision and drainage of the scalp abscesses. The answer was very poor. When admitted to our department, isotretinoin was started at daily dose of 30 mg, because initially his cholesterol and triglyceride levels were mildly increased. When dose was reduced to 10 mg the levels of cholesterol and triglyceride remained normal. A response to treatment was excellent and rapid. The treatment of PCAS represents usually difficulties and frustration for both the patient and the physician. A long course of isotretinoin can be considered as one of the most effective treatment for PCAS.

Topics: Administration, Topical; Adult; Alopecia; Folliculitis; Humans; Keratolytic Agents; Male; Scalp Dermatoses; Tretinoin

Topics: Adult; Eczema; Folliculitis; Humans; Isotretinoin; Male; Tretinoin

Topics: Adult; Female; Folliculitis; Humans; Isotretinoin; Malassezia; Tretinoin

A 20-year old man with steatocystoma multiplex and pseudofolliculitis barbae was treated unsuccessfully with oral isotretinoin. Consistent with findings from previous reports, treatment with isotretinoin should be reserved for patients with steatocystoma multiplex suppurativum.

Topics: Adult; Epidermal Cyst; Folliculitis; Humans; Isomerism; Isotretinoin; Male; Skin Diseases; 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

Isotretinoin has been found to be effective in the treatment of Gram-negative folliculitis. We investigated the direct in vitro antibacterial activity of isotretinoin against Gram-negative species. The concentrations of isotretinoin tested were two and ten times greater than the maximal levels attained in the sera of patients receiving oral isotretinoin. Regardless of the inoculum size, each organism tested grew as well in isotretinoin-containing media as it did in the control medium. These findings suggest that the efficacy of isotretinoin in patients with Gram-negative folliculitis is due to mechanisms other than direct antimicrobial action.

Topics: Bacterial Infections; Folliculitis; Gram-Negative Bacteria; Humans; In Vitro Techniques; Isotretinoin; Tretinoin

Topics: Adult; Folliculitis; Humans; Isotretinoin; Male; Scalp Dermatoses; Tretinoin

Thirty-two patients with gram-negative folliculitis were treated with 0.47 to 1.0 mg/kg/day of isotretinoin. Serial microbiologic evaluations demonstrated rapid clearing of the face and nasal mucosa of gram-negative rods. The clinical response was rapid, complete, and induced prolonged remissions. Twenty-six of thirty-two patients developed Staphylococcus aureus nasal carriage by the end of the 20-week treatment course. Isotretinoin has decided advantages over previously reported therapies for gram-negative folliculitis.

Topics: Acne Vulgaris; Bacterial Infections; Folliculitis; Gram-Negative Bacteria; Humans; Isomerism; Isotretinoin; Tretinoin

Topics: Acne Vulgaris; Anti-Inflammatory Agents; Bromine; Dermatitis Herpetiformis; Diagnosis, Differential; Folliculitis; Halogens; Humans; Iodine; Potassium Iodide; Tretinoin

Topics: Folliculitis; Humans; Isotretinoin; Tretinoin

Topics: Acne Vulgaris; Adolescent; Adult; Anti-Inflammatory Agents; Female; Folliculitis; Humans; Isotretinoin; Male; Rosacea; Skin Diseases; Tretinoin

Topics: Bacterial Infections; Folliculitis; Humans; Isotretinoin; Tretinoin

A 51-year-old man with a 10-year history of psoriasis presented with coexistent perforating folliculitis. Several perforating lesions were located within psoriatic plaques. This case is instructive from several viewpoints: (1) it is the second case to appear in the literature, to our knowledge, describing the coexistence of these two conditions; (2) several of the larger lesions resolved during topical therapy with retinoic acid; (3) it demonstrates the histologic difficulties encountered in attempting to classify the major perforating diseases. Possible mechanisms for the development of perforating disease in this patient are discussed, as are the reasons for its apparent response to topical therapy.

Topics: Administration, Topical; Biopsy; Darier Disease; Diagnosis, Differential; Folliculitis; Humans; Male; Middle Aged; Psoriasis; Skin; Tretinoin

A fifty-nine year old man is reported herein with a hyperkeratotic papular eruption that clinically and histologically was compatible with Kyrle's disease (hyperkeratosis follicularis et parafollicularis in cutem penetrans). Treatment with tretinoin (topical vitamine A acid) resulted in a severe inflammatory reactions in the lesions which persisted for four monthes and did not prevent a mild recurrence of the disease. The clinical and histologic differential diagnosis is reviewed perforating folliculitis, reactive perforating collagenosis, and elastosis perforans serpiginosa. The close similarity between Kyrle's disease and perforating folliculitis often makes absolute diagnosis very difficult.

Topics: Collagen Diseases; Darier Disease; Diagnosis, Differential; Drug Eruptions; Elastic Tissue; Folliculitis; Humans; Male; Middle Aged; Recurrence; Tretinoin

Three cases of pseudofolliculitis are described in black American women, bringing the total number of cases described in the literature to five. Pseudofolliculitis pubis, pseudofolliculitis axillae, and pseudofolliculitis faciale (for women with facial involvement) are new diagnoses we propose to add to the nomenclature. Topical retinoic acid may be the treatment of choice. It appears that this is not a rare disease in black women.

Topics: Adolescent; Adult; Black People; Female; Folliculitis; Hair Removal; Humans; Hypertrichosis; Tretinoin