tretinoin and Granuloma

Dermal dendrocytes represent a population of resident cells of the dermis identified recently by virtue of the immunohistochemical expression of the coagulation factor XIIIa (fXIIIa). These dendritic cells of bone-marrow origin bear particular histoenzymatic and immunohistochemical features, some of which are shared with antigen-presenting cells; however, they are clearly distinct from epidermal Langerhans cells. Dermal dendrocytes could act as macrophages, antigen-presenting cells or participate in the homeostasis of macromolecules of the dermis. These cells give rise to some cutaneous tumours and seem involved in inflammatory dermatoses where they act by means of cytokine production; they could even represent targets of HIV infection. Future functional studies will hopefully lead to a better understanding of their precise role in normal and diseased skin, which remains presently partly speculative.

Topics: Acquired Immunodeficiency Syndrome; Cytokines; Dermatitis; Granuloma; Histiocytoma, Benign Fibrous; HLA-DR Antigens; Humans; Sarcoma, Kaposi; Skin; Skin Neoplasms; Skin Physiological Phenomena; Transglutaminases; Tretinoin; Ultraviolet Rays; Vasculitis, Leukocytoclastic, Cutaneous

Three male patients with severe nodulocystic acne were treated with oral isotretinoin in a dosage of 0.5 to 1.0 mg/kg/day. A flare of their disease developed, characterized by an inflammatory, hemorrhagic, pyogenic, granuloma-like response of previously crusted acne lesions. This reaction occurred between the sixth and ninth weeks of treatment and was confined entirely to the chest and back. The severity of the reaction prompted the administration of oral prednisone and, in two cases, the discontinuation of isotretinoin therapy. In one patient, pyoderma gangrenosum developed on the thigh. The exact incidence of this pyogenic, granuloma-like reaction to isotretinoin is unknown, although we have seen it in three of 66 patients with nodulocystic acne treated with this drug. The cause of the reaction is unknown, but it may be due to the increased skin fragility and vascular proliferation known to be induced by isotretinoin.

Topics: Acne Vulgaris; Administration, Oral; Adult; Double-Blind Method; Drug Eruptions; Granuloma; Hemorrhage; Humans; Isotretinoin; Male; Pyoderma; Skin Ulcer; Tretinoin

Topics: Administration, Topical; Granuloma; Humans; Prognosis; Risk Assessment; Tretinoin; Vitamin A

Topics: Drug Eruptions; Erythema; Granuloma; Humans; Male; Middle Aged; Minoxidil; Scalp Dermatoses; Tretinoin

A case of excess granulation tissues in a patient treated with isotretinoin by a severe cystic acne is reported. Other cases described in the literature are reviewed.

Topics: Acne Vulgaris; Adolescent; Granulation Tissue; Granuloma; Humans; Isotretinoin; Male; Skin Diseases; Tretinoin

Four weeks after the introduction of a therapeutic regimen with 80 mg 13-cis-retinoic acid/day, a 16-year-old male patient developed oozing hypergranulation with vulnerable masses within acne lesions. These local symptoms were accompanied by fever, fatigue, weight loss, polyarthralgia and myalgia, similar to acne fulminans. In spite of these unusual reactions treatment was continued. Local steroid ointments were additionally applied. Within a short period of time regression of granulations and normalization of the general health condition was observed. After 4 months, therapy was discontinued. The patient's acne had totally healed and did not relapse within an observation period of 2 years.

Topics: Acne Vulgaris; Administration, Topical; Adolescent; Granulation Tissue; Granuloma; Humans; Isotretinoin; Male; Skin Diseases; Tretinoin; Wound Healing

This paper reports on the association of two uncommon side effects of isotretinoin therapy for cystic acne: paronychia and excess granulation tissue in the nail sulci. An explanation for these side effects is suggested, but the exact pathogenesis remains obscure.

Topics: Acne Vulgaris; Adult; Female; Granuloma; Humans; Isotretinoin; Nail Diseases; Paronychia; Tretinoin

We studied the effects of oral administration of the retinoid, 4-hydroxyphenyl retinamide (4-HPR), on group A streptococcal cell wall-induced polyarthritis in the rat, a model characterized initially by exudative inflammation of peripheral joints followed by chronic proliferative/erosive synovitis. Experimental arthritis was induced in female LEW/N rats by i.p. injection of streptococcal cell walls in saline (15 micrograms/g body weight). Depending upon the experiment, continuous daily oral administration of the retinoid was begun either 14 days prior to induction of the disease, at the time of cell wall administration and/or 11 days and 31 days after cell wall injection. Dosage was either 1 or 2 mmol 4-HPR/kg of chow. During the course of the disease, severity of clinical illness was assessed by determination of clinical severity index, by histological or radiologic examination, and by measurement of production in vitro of collagenase and prostaglandin E2 by excised synovial tissue. In rats fed the retinoid prior to cell wall injection, both the acute and the chronic responses were suppressed. In rats given the retinoid at the time of cell wall injection, the acute inflammatory response was only partially suppressed on the diet containing 2 mmol 4-HPR/kg chow, but the chronic disease was impressively inhibited in a dose dependent manner. Similarly, in animals with established disease, the drug was also effective; however, the more advanced the illness, the less effective the drug. Clinical observations were paralleled by the histological, radiographical and biochemical analyses. Treated animals showed far less synovial proliferation and joint destruction, and synovial tissues taken from these rats produced lesser amounts of collagenase and prostaglandin E2. No significant toxicity of the retinoid was noted. We conclude that oral administration of 4-HPR suppresses, in a dose and time dependent manner, both the acute and chronic stages of streptococcal cell wall-induced arthritis in rats without apparent significant toxicity. Our data suggest that studies of the effects of this retinoid on patients with chronic inflammatory synovitis are warranted.

Topics: Animals; Arthritis; Cell Wall; Dinoprostone; Disease Models, Animal; Female; Fenretinide; Granuloma; Liver Diseases; Microbial Collagenase; Prostaglandins E; Rats; Rats, Inbred Lew; Streptococcus pyogenes; Tretinoin

Disseminated granuloma annulare is often a chronic disorder that may prove refractory to treatment and lead to prolonged cosmetic disfigurement. In a patient with disseminated granuloma annulare that was unresponsive to multiple therapeutic regimens, administration of isotretinoin resulted in rapid clearing of nearly all lesions. To our knowledge this is the first reported case in which this agent was used to treat disseminated granuloma annulare.

Topics: Female; Granuloma; Humans; Isotretinoin; Middle Aged; Skin; Skin Diseases; Tretinoin

Topics: Adrenal Cortex Hormones; Granuloma; Humans; Isotretinoin; Occlusive Dressings; Tretinoin

Topics: Acne Vulgaris; Adolescent; Granuloma; Humans; Isotretinoin; Male; Time Factors; Tretinoin

Topics: Acne Vulgaris; Adolescent; Chronic Disease; Follow-Up Studies; Granuloma; Humans; Isotretinoin; Male; Skin Diseases; Tretinoin

Topics: Adolescent; Drug Eruptions; Granuloma; Humans; Isotretinoin; Male; Tretinoin

Topics: Adolescent; Granuloma; Humans; Isomerism; Isotretinoin; Male; Paronychia; Skin Diseases; Tretinoin

In our clinical trials of isotretinoin therapy for cystic acne and etretinate treatment of psoriasis, eight patients had growth of excessive granulation tissue. The granulation tissue was found in resolving acne lesions in one patient taking isotretinoin. Among the psoriatic patients taking etretinate, the granulation tissue usually was seen adjacent to nail plates. In two patients, the side effect caused them to stop retinoid therapy. The tissue response did not appear to be related to the daily or cumulative retinoid dose.

Topics: Acne Vulgaris; Adolescent; Adult; Aged; Granulation Tissue; Granuloma; Humans; Isotretinoin; Male; Middle Aged; Psoriasis; Skin Diseases; Tretinoin

Multiple granulomata pyogenica are usually satellites of a primary lesion recently treated unsuccessfully. Disseminated pyogenic granulomas are very uncommon. In our case report, we describe a young man with six granulomata pyogenica over the chest, after treating his acne with tetracycline and vitamin A acid. In the discussion, we include infection, trauma and vitamin A acid as factors which can induce the vascular tumor in the region of a vascular dysplasia.

Topics: Acne Vulgaris; Adult; Granuloma; Humans; Male; Tetracycline; Tretinoin; Vitamin A

The effect of side-chain length of desmethylretinoic acid on granuloma formation induced by implantation of cotton pellets was studied. As in the homologous series of retinoic acid studies, compounds with side chains shorter than retinoic acid were not active while compounds with side chains as long or longer than retinoic acid were active. The compound with a chain two carbons longer than retinoic acid was the most active. The hydroxyproline and hexosamine contents of the granuloma were analyzed. The mechanisms of action of these active compounds on wound healing are discussed.

Topics: Animals; Chemical Phenomena; Chemistry; Gossypium; Granuloma; Hexosamines; Hydroxyproline; Rats; Tretinoin; Vinyl Compounds; Vitamin A