tretinoin and Keratosis

Topics: Acanthoma; Administration, Topical; Adolescent; Biopsy, Needle; Combined Modality Therapy; Cryotherapy; Dermatologic Surgical Procedures; Diagnosis, Differential; Eczema; Female; Humans; Immunohistochemistry; Keratosis; Nipples; Pruritus; Rare Diseases; Skin Neoplasms; Treatment Outcome; Tretinoin

Topics: Administration, Cutaneous; Dermatologic Agents; Humans; Isotretinoin; Keratosis; Laser Therapy; Nicotinic Acids; Randomized Controlled Trials as Topic; Skin Aging; Skin Diseases; Sunlight; Tretinoin

Topics: Child; Female; Humans; Keratolytic Agents; Keratosis; Tretinoin

Photodamage describes skin changes such as fine and coarse wrinkles, roughness, freckles and pigmentation changes that occur as a result of prolonged exposure to the sun. Many treatments are available to reverse the damage, but it is unclear which work and at what cost in terms of unwanted side effects.. To assess the effects of topically applied treatments, tablet treatments, laser and surgical procedures for photodamaged skin.. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, Issue 1 2002, MEDLINE (1966-June 2002), EMBASE (1974-June 2002), Health Periodicals (1976-June 2002). We checked references of articles and communicated with authors and the pharmaceutical industry.. Randomised controlled trials which compared drug or surgical interventions with no treatment, placebo or another drug, in adults with mild, moderate or severe photodamage of the face or forearms.. Two reviewers independently extracted data and assessed trial quality.. Thirty studies of variable quality were included. Eight trials showed that topical tretinoin cream, in concentrations of 0.02% or higher, was superior to placebo for participants with mild to severe photodamage on the face and forearms (although losses to follow-up were relatively high in most studies). For example, the relative risk of improvement for 0.05% tretinoin cream, compared to placebo (three studies), at 24 weeks, was 1.73 (95% confidence interval 1.39 to 2.14). This effect was not seen for 0.001% topical tretinoin (one study) or 0.01% (three studies). A dose-response relationship was evident for both effectiveness and skin irritation. One small within-patient study showed benefit from topical ascorbic acid compared with placebo. Tazarotene (0.01% to 0.1%) and isotretinoin (0.1%) both showed significant improvement over placebo for moderate photodamage (one study each). There is limited evidence (one trial), to show that the effectiveness of 0.05% tretinoin, is equivalent to the effects of 0.05% and 0.1% tazarotene. One small study showed greater improvement in upper lip wrinkles with CO2 laser technique compared to Baker's phenol chemical peel, at 6 months. Three small RCTs comparing CO2 laser with dermabrasion found no difference in wrinkle score at 4 to 6 months, suggesting that both methods are equally efficacious, but more erythema was reported with the laser. The effectiveness of other interventions such as hydroxy acids and natural polysaccharides was not clear.. There is conclusive evidence that topical tretinoin improves the appearance of mild to moderate photodamage on the face and forearms, in the short term. However erythema, scaling/dryness, burning/stinging and irritation may be experienced initially. There is limited evidence that tazarotene and isotretinoin benefit patients with moderate photodamage on the face: both are associated with skin irritation and erythema. The effectiveness of other interventions remains uncertain.

Topics: Administration, Cutaneous; Dermatologic Agents; Humans; Isotretinoin; Keratosis; Laser Therapy; Nicotinic Acids; Randomized Controlled Trials as Topic; Skin Aging; Skin Diseases; Sunlight; Tretinoin

Extensive well-controlled clinical studies performed over the past 5 years have demonstrated a consistent, dose-dependent, statistically significant improvement in the appearance of photodamaged skin after 3-6 months of daily treatment with topical 0.001-0.1% tretinoin cream. Clinical changes included decreases in surface roughness, irregular pigmentation, fine and coarse wrinkling, and sallowness. Actinic keratoses have also been reported to decrease in size and number. Blinded analysis of biopsies from more than 500 subjects showed that there was compaction of the stratum corneum, an increase in the number of granular layers, thickening of the epidermis and a decrease in epidermal melanin. There were no detectable histological changes in any dermal parameters. The specific cellular mechanisms by which retinoic acid (RA) exerts its beneficial effect on photodamaged skin are currently the subject of intensive investigation. It is well established that RA enters the nucleus where it binds to an RA receptor (RAR), and that the RA-RAR complex then binds to specific RA response elements in the DNA, modulating the expression of target genes. It is thus likely that RA improves at least some aspects of photoageing by modifying cellular differentiation programmes, as retinoids have been shown to do during embryogenesis, in malignantly transformed cells and in skin affected by certain dermatoses.

Topics: Dose-Response Relationship, Drug; Humans; Keratosis; Skin; Skin Aging; Skin Neoplasms; Skin Pigmentation; Sunlight; Tretinoin

Topical tretinoin is an effective therapy for the treatment of photodamaged skin. Clinically, patients experience decreased wrinkling, improved texture, and pinkening of sallow skin. However, the changes induced by topical tretinoin extend beyond simple cosmesis. Microscopic, ultrastructural, and biochemical alterations indicate that topical tretinoin is a significant medical therapy. Its successful use requires the guidance of an experienced physician.

Topics: Cosmetics; Humans; Keratosis; Photosensitivity Disorders; Skin Aging; Tretinoin

A patient with erythrokeratodermia variabilis (Mendes da Costa's disease) is presented, and the clinical and histological response to acitretin is described. An initial dose of 35 mg of acitretin and a maintenance dose of 25-35 mg resulted in a pronounced and sustained improvement. Further reduction of the dosage resulted in a relapse within a few days. At the histological level the extensive hyperkeratosis and the moderate dermal inflammatory infiltrate decreased during treatment with acitretin. In comparison with the other retinoids available so far, acitretin is the derivative of first choice in the treatment of erythrokeratodermia variabilis Mendes da Costa.

Topics: Acitretin; Adolescent; Erythema; Female; Humans; Keratosis; Tretinoin

The effect of 0.1% tretinoin cream for the treatment of photoageing was studied in a double-blind, placebo-controlled trial. All patients applied tretinoin cream to one forearm and the vehicle cream to the other, and half of the patients also applied tretinoin cream to the face and the other half used the vehicle cream. Tretinoin treatment produced an improvement in the signs of extrinsic ageing compared with the vehicle-treated areas. Fine wrinkling was improved most, although coarse wrinkling, brown spots, tactile roughness and overall skin colour also showed clear improvement. The majority of lentigines and sun-induced freckles showed some reduction in coloration with extended treatment. It is important when using tretinoin that the treatment procedure is carefully explained to the patients and that they are warned about a retinoid reaction. It should be stressed that improvement is gradual and that regular application of the cream must continue even after improvement has been achieved. Patients should be assured that there is no evidence of carcinogenicity in humans. Although no teratogenic effects of tretinoin have been reported when applied topically, it is not advisable to use the cream when trying to conceive or when pregnant.

Topics: Administration, Topical; Double-Blind Method; Humans; Keratosis; Randomized Controlled Trials as Topic; Skin Aging; Tretinoin; Ultraviolet Rays

Quantitative techniques for assessing the effects of tretinoin on photo-aged skin mainly involve humans, although hairless mice were used in initial studies. Ideally techniques should be non-invasive but occasionally biopsies have to be taken, especially when studying the effects of tretinoin on different skin compartments. Characteristic features of photo-aged skin, including the development of fine and coarse wrinkles, skin discoloration, rosy cheeks and telangiectasis, have been assessed subjectively using a visual analogue scale. Effects of tretinoin on wrinkle depth have been measured non-invasively by quantifying contours of silicone rubber replicas using either a mechanical tracking device or an optical technique employing an image-analysing computer. Changes in skin colour have been measured using an erythema meter and the stimulatory effect of tretinoin on blood flow has been established by laser doppler flowmetry. Skin thickness has been measured non-invasively using pulsed A-scan ultrasound which showed that tropical tretinoin increased thickness. Biopsies have also been used but no changes in the thickness of the dermal repair zone have been noted in humans, in contrast to the situation in hairless mice. Epidermal dysplasia has been measured by a visual analogue scale or by objective image analysis.

Topics: Humans; Keratosis; Skin Aging; Tretinoin; Ultraviolet Rays

Topics: Acne Vulgaris; Administration, Topical; Humans; Keratosis; Pigmentation Disorders; Skin; Skin Neoplasms; Tretinoin

Hereditary disorders of keratinization may be a considerable handicap. Oral treatment with retinoids has been shown to be effective in many of these diseases. In the group of ichthyoses, the best results can be obtained in the various types of nonbullous congenital ichthyosis (erythrodermic autosomal recessive lamellar ichthyosis, nonerythrodermic autosomal recessive lamellar ichthyosis, autosomal dominant lamellar ichthyosis). It should be borne in mind, however, that retinoid therapy alone cannot lead to a complete response of these forms of ichthyosis and that this treatment cannot replace an appropriate topical treatment. During continuous treatment with etretinate a reduction of the dosis to 0.5 mg/kg is often necessary. Etretinate treatment of bullous congenital ichthyosiform erythroderma is more difficult, and it is advisable to begin with a low dosis of 0.25-0.5 mg/kg. The epidermolytic form of palmoplantar keratoderma is in our opinion no indication for retinoid treatment which seems to result inevitably in large erosions. Good or excellent results have been seen in other forms of palmoplantar keratoderma including mal de Meleda, Papillon-Lefèvre syndrome, erythrokeratodermia variabilis, verrucous epidermal nevi, Darier disease and pityriasis rubra pilaris. In patients with Darier disease it is wise to begin with a relatively low dosage of 0.5 mg/kg and to adjust the dosage to the further course of the disease. The same is true for the ichthyosis seen in the Netherton syndrome, which may be either a diffuse hyperkeratosis or ichthyosis linearis circumflexa. In view of the fact that any inherited keratinization disorder requires long-term treatment, the risk of bone toxicity should be carefully weighed against the benefit of this therapy. The results so far obtained indicate that the effect of etretin is comparable to that of etretinate in the treatment of inherited keratinization disorders. Intermittent therapy should be tried whenever possible. A combination therapy seems reasonable in pityriasis rubra pilaris of the adult type. We have seen good results by combination with PUVA treatment. Autosomal dominant ichthyosis vulgaris and X-linked recessive ichthyosis are inappropriate to treat with oral retinoid therapy because these diseases are too mild. Papillomatous epidermal nevi should also be excluded because they do not respond to the drug. Hailey-Hailey disease may even be worsened by this treatment. According to our experience, oral retinoid

Topics: Acitretin; Adult; Etretinate; Humans; Ichthyosis; Keratoderma, Palmoplantar; Keratosis; Pityriasis; Tretinoin

Acne vulgaris is a common skin disorder. Although it is most prevalent in the second decade of life, its beginnings are heralded by increased activity of the sebaceous glands and faulty follicular keratinization, which are already evident in mid to late childhood. The subsequent and increasing proliferation of the follicular anaerobic diphtheroid microflora contribute further as an important pathogenic factor in the generation of inflammatory lesions. Treatments of acne, therefore, are aimed at reducing the follicular anaerobic bacteria, counteracting the follicular hyperkeratosis, and inhibiting the activity of sebaceous glands.

Topics: Acne Vulgaris; Adolescent; Anti-Bacterial Agents; Anti-Infective Agents, Local; Bacterial Infections; Benzoyl Peroxide; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Isomerism; Isotretinoin; Keratosis; Male; Propionibacterium acnes; Sebaceous Glands; Sebum; Tretinoin; Triamcinolone Acetonide

The potential of vitamin A, or retinol, in the treatment of a variety of skin diseases has long been recognized, but because of serious toxic effects this substance generally could not be used. The recent development and marketing of two relatively non-toxic synthetic analogues, which are known as retinoids, has made it possible to treat some of the diseases that are resistant to standard forms of therapy. Isotretinoin is very effective in cystic and conglobate acne, while etretinate is especially useful in the more severe forms of psoriasis. Good results have also been obtained in other disorders of keratinization. Vitamin A and its derivatives apparently have an antineoplastic effect as well and may come to be used in both the prevention and the treatment of epithelial cancer. In many of these diseases the retinoids act by enhancing the normal differentiation and proliferation of epidermal tissues, but the exact mechanisms are not well understood. Their influence on the intracellular polyamines that control the synthesis of nucleic acids and proteins may be an important factor. Although the retinoids have few serious systemic effects, they are teratogenic, and because they persist in the body their use in women of childbearing potential is limited.

Topics: Acne Vulgaris; Bone Diseases; Chemical and Drug Induced Liver Injury; Etretinate; Female; Humans; Isomerism; Isotretinoin; Keratosis; Kinetics; Psoriasis; Skin Diseases; Skin Neoplasms; Tretinoin; Triglycerides; Vitamin A

The synthetic retinoids are a new class of drugs which are highly effective in the treatment of a broad spectrum of dermatologic disease. In this report 15 patients with chronic disorders of keratinization and one patient with severe cystic acne were treated with oral isotretinoin. The degree of clinical response and duration of post-treatment remission varied with the different disorders. Acute side effects were predominantly limited to the skin and mucous membranes and were reversible after discontinuation of treatment in these patients. Acute retinoid toxicity and the potential for developing chronic toxicity are reviewed. In an attempt to facilitate the monitoring of dermatologic patients treated with oral synthetic retinoids, we present our current guidelines for the use of these agents.

Topics: Acne Vulgaris; Adolescent; Animals; Bone Diseases; Child; Child, Preschool; Etretinate; Humans; Isomerism; Isotretinoin; Joint Diseases; Keratosis; Mice; Psoriasis; Skin Diseases; Tretinoin

Topical vitamin A acid (VAA) has various mechanisms of action which may be responsible for its therapeutic success in many different disorders. Although the absorption, metabolism, and excretion of VAA are not completely understood, VAA appears to remain mainly on the skin surface. The question of carcinogenicity is unresolved, and more research is needed to clarify this problem. This article reviews the literature regarding the therapeutic uses of VAA and summarizes various investigators' experiences with VAA.

Topics: Acne Vulgaris; Animals; Callosities; Cocarcinogenesis; Fox-Fordyce Disease; Humans; Ichthyosis; Keloid; Keratoacanthoma; Keratosis; Lichen Planus; Melanoma; Melanosis; Molluscum Contagiosum; Nevus; Psoriasis; Skin Absorption; Skin Diseases; Skin Neoplasms; Tretinoin

We sought to determine the interobserver reliability of the histopathologic diagnosis of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) (keratinocyte carcinomas) in the setting of a Department of Veteran Affairs multicenter chemoprevention study.. Interobserver concordance was assessed by blinded review of histopathologic slides by study dermatopathologists.. Overall interobserver agreement between the two dermatopathogists was kappa = 0.69 (95% confidence interval [CI] 0.67-0.69). The dermatopathologists' interobserver agreement was highest for basal cell carcinoma at kappa = 0.88 (95% CI 0.84-0.91) and for a diagnostic category in the SCC-actinic keratosis spectrum at kappa = 0.80 (95% CI 0.73-0.86). The largest disagreements between the two reference dermatopathologists were regarding the categories of invasive SCC at kappa = 0.62 (95% CI 0.52-0.72), SCC in situ at kappa = 0.42 (95% CI 0.29-0.56), and actinic keratosis at kappa = 0.51 (95% CI 0.40-0.62). Agreement between the local pathologists and central reference dermatopathologists were similar to the agreement between the central dermatopathologists. The morphea subtype of basal cell carcinoma was the only reliably diagnosed subtype (kappa = 0.79, 95% CI 0.51-1.00), and tumor depth was reliably measured.. A limitation of this study was the use of only two reference dermatopathologists.. Because of the impact on physician decision making and patient care, researchers and clinicians need to be aware of reliability of histopathology results, particularly pertaining to the SCC and actinic keratosis spectrum.

Topics: Biopsy; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Ear Neoplasms; Facial Neoplasms; Humans; Keratinocytes; Keratolytic Agents; Keratosis; Neoplasm Invasiveness; Observer Variation; Photosensitivity Disorders; Reproducibility of Results; Tretinoin

Topics: Adult; Aged; Calcitriol; Dermatologic Agents; Double-Blind Method; Drug Therapy, Combination; Humans; Keratosis; Kidney Transplantation; Middle Aged; Sunlight; Treatment Failure; Tretinoin

Photodamaged skin typically displays lentigines, actinic keratoses, wrinkles, and textural alteration. Chemical peeling has been used to treat these, but few controlled studies have been performed to determine its efficacy.. Our purpose was to compare the efficacy of a medium-depth chemical peel with and without tretinoin before and after treatment.. Sixteen men with actinic damage including actinic keratoses were treated with a 40% trichloroacetic acid(TCA) chemical peel. Half were pretreated for 6 weeks with topical tretinoin; they also used tretinoin after the peel. Photographs were obtained at baseline and at 6 weeks and 6 months after treatment. Changes in specific features were rated by a panel of three examiners.. Some improvement was noted in all patients. More rapid and even frosting was observed in the patients pretreated with tretinoin. Solar lentigines, actinic keratoses, and skin texture were the features of photoaging most affected; wrinkles were least affected. No statistically significant difference was found between patients treated with TCA and tretinoin (before and after peel) and those with TCA alone.. A medium-depth chemical peel with 40% TCA alone produced moderate improvement in some manifestations of actinic damage but had little effect on wrinkles. Treatment with tretinoin before and after TCA did not significantly enhance the efficacy of the peel.

Topics: Administration, Cutaneous; Bacteria; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Chemexfoliation; Follow-Up Studies; Humans; Keratolytic Agents; Keratosis; Lentigo; Male; Patient Satisfaction; Photography; Premedication; Sebum; Skin; Skin Aging; Skin Neoplasms; Tretinoin; Trichloroacetic Acid

Topics: Adolescent; Adult; Aged; Child; Female; Humans; Immunosuppression Therapy; Keratosis; Male; Middle Aged; Transplantation; Tretinoin

We conducted a double-blind, placebo-controlled, prospective, randomized study to assess the effects of tretinoin pretreatment on healing after trichloroacetic acid (TCA) chemical peel. Sixteen male patients (mean age, 67 years) with actinically damaged skin were treated daily with 0.1% tretinoin and placebo creams to the left and right halves of the face and the left and right forearms and hands, respectively, for 14 days prior to the 35% TCA peel. We subjectively noted that during the peel, "frosting" was more pronounced and uniform and occurred earlier in tretinoin-pretreated skin in 94% of the patients. Healed skin was measured planimetrically, and the healed area was determined with point stereology. Regardless of pretreatment, the face healed twice as fast as the forearm or hand. In all regions, the mean area healed was significantly greater in skin that had been pretreated with tretinoin. The differences between tretinoin and placebo, respectively, in healed skin were maximal after 5 days for the face (68% vs 52%), after 11 days for the forearms (72% vs 24%), and after 9 days for the hands (61% vs 29%). After 7 days, 75% of the tretinoin-pretreated hemifaces were completely healed, as opposed to 31% of the placebo-pretreated hemifaces. By visual inspection, we could not appreciate a cosmetic difference between tretinoin- and placebo-pretreated skin 2 weeks and 3 months after the TCA peel. We conclude that 0.1% tretinoin pretreatment for 2 weeks prior to the TCA peel will significantly speed healing, which may result in greater patient satisfaction. Patients presently being treated with tretinoin who later undergo a TCA peel might be expected to have similar results.

Topics: Aged; Aged, 80 and over; Chemexfoliation; Double-Blind Method; Facial Dermatoses; Forearm; Hand Dermatoses; Humans; Keratosis; Male; Middle Aged; Placebos; Premedication; Prospective Studies; Skin; Tretinoin; Trichloroacetic Acid; Wound Healing

In a double-blind, randomized, within-patient comparative study, the efficacy and tolerability of Ro 14-9706 (an arotinoid methyl sulfone) in the treatment of actinic keratoses was compared with that of tretinoin (all-trans-retinoic acid). A total of 25 patients with more than three lesions on each side of the face completed the study. All patients applied each agent twice daily for 16 weeks as a 0.05% cream to opposite sides of the face. The number of actinic keratoses in each treatment area was counted before treatment and at weekly intervals. The mean percent decrease in the number of actinic keratoses was 37.8% for areas treated with Ro 14-9706 and 30.3% for areas treated with tretinoin. Each of these decreases was significantly different from baseline (p less than 0.01), but not from each other. Ro 14-9706 was better tolerated; local inflammation was slight or absent in most patients, whereas tretinoin caused severe erythema in 50% and severe scaling in 23% of patients.

Topics: Administration, Cutaneous; Aged; Aged, 80 and over; Double-Blind Method; Facial Dermatoses; Female; Humans; Keratosis; Male; Middle Aged; Naphthalenes; Ointments; Retinoids; Sulfones; Tretinoin

The effect of 0.1% tretinoin cream for the treatment of photoageing was studied in a double-blind, placebo-controlled trial. All patients applied tretinoin cream to one forearm and the vehicle cream to the other, and half of the patients also applied tretinoin cream to the face and the other half used the vehicle cream. Tretinoin treatment produced an improvement in the signs of extrinsic ageing compared with the vehicle-treated areas. Fine wrinkling was improved most, although coarse wrinkling, brown spots, tactile roughness and overall skin colour also showed clear improvement. The majority of lentigines and sun-induced freckles showed some reduction in coloration with extended treatment. It is important when using tretinoin that the treatment procedure is carefully explained to the patients and that they are warned about a retinoid reaction. It should be stressed that improvement is gradual and that regular application of the cream must continue even after improvement has been achieved. Patients should be assured that there is no evidence of carcinogenicity in humans. Although no teratogenic effects of tretinoin have been reported when applied topically, it is not advisable to use the cream when trying to conceive or when pregnant.

Topics: Administration, Topical; Double-Blind Method; Humans; Keratosis; Randomized Controlled Trials as Topic; Skin Aging; Tretinoin; Ultraviolet Rays

In a randomized double-blind controlled study, 19 patients applied 5% 5-fluorouracil (5-FU) cream to actinic keratoses (AK) on each arm twice daily, followed by nightly application of 0.05% tretinoin cream to one arm, and a control cream to the other arm until discomfort precluded further applications. After 3 months, the number of residual AK was compared to pre-treatment values. The tretinoin-treated arms had 15.7 +/- 6.1 AK before treatment and 3.4 +/- 2.6 AK following therapy. The control arms had 15.3 +/- 6.9 AK before therapy and 4.2 +/- 2.5 lesions afterwards. Using a one-tailed paired t-test, the difference in response was statistically significant (0.03 less than P less than 0.04). It was concluded that daily application of 0.05% tretinoin cream appeared to enhance the efficacy of topical 5-FU in destruction of AK of the arms and may represent a useful treatment modality.

Topics: Arm; Clinical Trials as Topic; Double-Blind Method; Drug Therapy, Combination; Fluorouracil; Humans; Keratosis; Random Allocation; Tretinoin

In several studies between 1962 and 1978, topical tretinoin was proved capable of producing complete regression of actinic keratosis and basal cell carcinoma. But because its efficacy is not comparable to that of other modalities, topical tretinoin is currently used only as an adjunct to topical 5-fluorouracil in the treatment of actinic keratosis. One recent report found topical tretinoin ineffective in the chemoprevention of actinic keratosis. Although the oral synthetic retinoids isotretinoin and etretinate have been used in the prevention and treatment of cutaneous malignancy, the potential exists for chronic toxicity from the prolonged systemic therapy that appears necessary for maintaining the chemopreventive effect. For this reason, it may be appropriate to study further the preventive as well as therapeutic effects of topical tretinoin and other retinoids for actinic keratosis and skin cancer. If they prove safe and effective, the use of topical retinoids in the prevention and treatment of cutaneous tumors may be the most significant clinical application of these drugs.

Topics: Carcinoma, Basal Cell; Clinical Trials as Topic; Etretinate; Humans; Isotretinoin; Keratosis; Photosensitivity Disorders; Skin Neoplasms; Tretinoin; Urinary Bladder Neoplasms

Topics: Clinical Trials as Topic; Humans; Ichthyosis; Isotretinoin; Keratosis; Pityriasis Rubra Pilaris; Skin Diseases; Tretinoin

50 patients with actinic keratosis were studied over four months of treatment with either etretinate ('Tigason') or placebo. Each treatment was given for two months and the order of administration was randomised. The clinical response to treatment was assessed by direct measurement and photographs of the lesions at monthly intervals. Of the 44 patients who completed treatment with etretinate 37 had a complete or partial response. Of the 42 patients who completed treatment on placebo only 2 showed a complete or partial response. The response to treatment occurred within the first month of therapy and was maintained even when the dose was reduced because of toxicity.

Topics: Aged; Clinical Trials as Topic; Double-Blind Method; Etretinate; Female; Humans; Keratosis; Male; Middle Aged; Random Allocation; Tretinoin

In four medical centers, 40 patients with keratinizing dermatoses were treated with topical tretinoin (vitamin A acid) 0.1% cream and salicylic acid 2% cream in a short-term, double-blind study. Tretinoin was the more effective treatment for several of the keratinizing dermatoses with the exception of palmar-plantar hyperkeratosis, for which it was not effective in the concentration and method of application used. The most striking clinical responses occurred in patients with lamellar ichthyosis and ichthyosis vulgaris. Local adverse reactions-chiefly pruritus, erythema, burning, excoriation, and irritation-were not severe and could be controlled by modification of the treatment regimen.

Topics: Administration, Topical; Adolescent; Adult; Aged; Child; Child, Preschool; Double-Blind Method; Drug Evaluation; Female; Humans; Ichthyosis; Keratosis; Male; Middle Aged; Salicylates; Tretinoin; Vitamin A

We report the successful treatment of multiple facial milia with manual extraction and tretinoin in a child with orofaciodigital syndrome type 1. Treatment with topical medications may be insufficient in individuals with orofaciodigital syndrome type 1, and pitted scarring is often a sequala. This case demonstrates that manual extraction is well tolerated and effective in the treatment of multiple milia. In addition, clinicians need to be aware of this rare genetic condition, which commonly presents de novo and can lead to significant morbidity if untreated.

Topics: Drainage; Face; Female; Humans; Infant; Keratosis; Orofaciodigital Syndromes; Tretinoin

Milia are multiple, small, benign keratin-filled superficial epidermoid cysts which are classified as primary when they occur spontaneously or secondary when they result from skin trauma or disease. Multiple eruptive milia (MEM) refer to a condition characterized by a sudden eruption of a large number of milia. MEM may be familial, occur as part of a genodermatosis, or occur spontaneously when they are termed idiopathic. Idiopathic MEM are an exceedingly rare disease. We present the case of a 70-year-old Nigerian woman with idiopathic MEM.

Topics: Administration, Topical; Aged; Biopsy; Epidermal Cyst; Female; Humans; Keratolytic Agents; Keratosis; Lost to Follow-Up; Tretinoin

Topics: Acute Generalized Exanthematous Pustulosis; Aged; Diagnosis, Differential; Humans; Keratolytic Agents; Keratosis; Male; Mycosis Fungoides; Neoplasm Staging; Skin Neoplasms; Tretinoin

Vemurafenib is a selected BRAF kinase inhibitor approved for treating metastatic or unresectable melanoma, which has numerous cutaneous side effects unfortunately, including three previously reported cases of asymptomatic areola and/or nipple hyperkeratosis. We present the first case of painful bilateral nipple hyperkeratosis secondary to vemurafenib in an 84-year-old woman. She was successfully treated with tretinoin 0.05% cream that allowed her to comfortably continue treatment. With increased awareness of this condition, we found a second case of asymptomatic nipple hyperkeratosis secondary to vemurafenib in our clinic. As this medication gains acceptance for treatment of metastatic melanoma, it is imperative that dermatologists are aware of this potentially uncomfortable side effect that can result in decreased compliance and impaired quality of life.

Topics: Aged, 80 and over; Antineoplastic Agents; Female; Humans; Indoles; Keratosis; Melanoma; Nipples; Protein Kinase Inhibitors; Proto-Oncogene Proteins B-raf; Quality of Life; Skin Neoplasms; Sulfonamides; Tretinoin; Vemurafenib

Acitretin has been used off-label for years to treat chronic hand eczema, but acitretin is less often prescribed as alitretinoïne was approved. This study evaluates both retinoids in a daily practice cohort of patients with severe chronic hand eczema in terms of drug survival and reasons for discontinuation. Patients using alitretinoin or acitretin between 01-01-1994 and 01-08-2015 were included in this retrospective daily practice study and analyzed by Kaplan-Meier drug survival curves. Potential determinants were analyzed by Cox regression analyses. Ninety-five patients were treated with alitretinoin and 109 patients with acitretin. The main reasons for discontinuation were adverse events and cleared hand eczema, 29.5 and 27.4% in alitretinoin versus 43.1 and 23.9% in acitretin. Patients with hyperkeratotic hand eczema had most often a good effect of treatment: 68.3% in alitretinoin and 50.7% in acitretin treatment. The drug survival rates of alitretinoin and acitretin after 12, 24, 36, and 52 weeks were 69.3, 45.1, 19.6, 7.0% and 74.3, 45.5, 33.8, 23.2%, respectively. Alitretinoin and acitretin are effective treatment options for patients with hand eczema. However, both treatments were more effective in patients with hyperkeratotic hand eczema. Fewer patients discontinued alitretinoin compared with acitretin due to adverse events.

Topics: Acitretin; Adult; Aged; Alitretinoin; Chronic Disease; Dermatologic Agents; Eczema; Female; Hand Dermatoses; Humans; Kaplan-Meier Estimate; Keratosis; Male; Middle Aged; Proportional Hazards Models; Remission Induction; Retrospective Studies; Severity of Illness Index; Time Factors; Treatment Outcome; Tretinoin

Milia en plaque is a rare, benign, localized, entity typically seen in adults after the third decade of life. Although there have been a few cases described in children, we describe the first case in a newborn.

Topics: Humans; Infant, Newborn; Keratolytic Agents; Keratosis; Male; 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

Milia are benign, superficial keratinaceous cysts that present as fine, small white papules. Milia en plaque is a rare, challenging-to-treat variant most often seen in the posterior auricular region. A total of 9 cases of milia en plaque have been reported in the pediatric literature to date. We report a case of milia en plaque of the nose in a 7-year-old boy, a novel site of involvement in the pediatric population, and successful treatment with the use of topical tretinoin. Topical retinoids offer an effective treatment option for the management of milia en plaque in the pediatric population.

Topics: Administration, Topical; Child; Dermoscopy; Drug Administration Schedule; Humans; Keratosis; Male; Miliaria; Nose Diseases; Treatment Outcome; Tretinoin

A 5 1/2-year-old boy revealed symmetric erythematous plaques on both arms and legs as well as in the face. Additionally, contractions of several digital joints were noted. We diagnosed a progressive symmetric erythrokeratoderma and initiated a topical therapy with tretinoin. Here we discuss the etiology, differential diagnoses, and therapeutic options of this rare disorder of keratinization.

Topics: Administration, Topical; Child, Preschool; Darier Disease; Dermatitis, Exfoliative; Diagnosis, Differential; Disease Progression; Follow-Up Studies; Humans; Keratoderma, Palmoplantar; Keratosis; Male; Tretinoin

Topics: Acute Disease; Adult; Dermatologic Agents; Female; Graft vs Host Disease; Hematopoietic Stem Cell Transplantation; Humans; Keratosis; Leukemia, Myeloid; Nipples; Treatment Outcome; Tretinoin

Topics: Adolescent; Female; Humans; Keratolytic Agents; Keratosis; Ointments; Pigmentation Disorders; Salicylic Acid; Treatment Outcome; Tretinoin

Retinoids are a fascinating class of compounds that exert control over cellular function from the time of conception to death. They play a critical role in such vital processes as fetal morphogenesis, cellular differentiation and apoptosis. Over the years synthetic retinoids have provided dermatologists with a spectrum of medications that have profound therapeutic effects on a variety of recalcitrant skin disorders. Moreover, retinoids are an expanding component of the treatment arsenal against hematologic and solid malignancies. Retinoids are poised to offer exciting new therapeutic options in the field of endocrinology for the treatment of diabetes and lipid disorders. Researchers and clinicians are only beginning to unveil the therapeutic potential of this class of medications. The development of new retinoid compounds targeting specific receptors promises a wealth of new therapies for the new millennium.

Topics: Acne Vulgaris; Humans; Keratosis; Leukemia, Promyelocytic, Acute; Lymphoma, T-Cell, Cutaneous; Psoriasis; Skin Neoplasms; Treatment Outcome; Tretinoin; Vitamin A

To assess the reliability of counts of actinic keratoses (AKs) and the effect of a brief joint discussion of discrepancies on that reliability.. Seven dermatologists independently counted AKs on the face and ears before and after a brief joint discussion of discrepancies.. A volunteer sample of 9 patients from the ongoing VA (Department of Veterans Affairs) Topical Tretinoin Chemoprevention (VATTC) Trial. All participating individuals are veterans and have had 2 or more keratinocyte carcinomas (basal or squamous cell carcinoma) in the 5 years before enrollment in the study.. Standard deviation of estimates of the Poisson regression parameter for the dermatologists.. Substantial variation was found among the dermatologists in their AK counts. The SD of the parameter estimates for the dermatologists decreased from 0.45 to 0.24 after the brief joint discussion, a 47% decrease (P =.076). The variation attributable to the dermatologists also decreased substantially (chi(2)(6) decrease, 94 to 12).. Actinic keratoses are common, and there is a continuous spectrum of lesions that ranges from sun-damaged skin to squamous cell carcinoma in situ. Clinical distinguishing features may be difficult to delineate precisely. Counts of AK are commonly performed, but appear to be unreliable, even when performed by experienced dermatologists. Joint discussion of discrepancies may enhance the reliability of these counts, although substantial variation remains. Research that relied on these counts must be reevaluated in light of the marked variation among expert observers. Future studies should consider measures to assess and enhance reliability.

Topics: Aged; Aged, 80 and over; Humans; Keratolytic Agents; Keratosis; Middle Aged; Photosensitivity Disorders; Randomized Controlled Trials as Topic; Reproducibility of Results; Tretinoin

To investigate the treatment efficient of viaminati on the laryngeal keratosis.. All 16 cases of laryngeal keratosis took viaminati.. 15 cases were recovered. 1 case was developed cancer.. Viaminati is effective in treating laryngeal keratosis and has not obvious side-effect.

Topics: Adult; Female; Humans; Keratolytic Agents; Keratosis; Laryngeal Diseases; Laryngeal Neoplasms; Male; Middle Aged; Precancerous Conditions; Tretinoin

All-trans-retinoic acid (RA) regulates epithelial differentiation and growth through activation of specific nuclear RA receptors (RARs). Because high-rate metabolism largely impairs the biological efficacy of RA, we have sought for compounds capable of inhibiting the metabolic breakdown of the retinoid. This study identifies R115866 as a novel inhibitor of the cytochrome P450 (CYP)-mediated metabolism of RA. In vitro, nanomolar concentrations of R115866 inhibited the conversion of RA by CYP26, a RA-inducible RA metabolizing enzyme. In vivo, oral administration of R115866 (2.5 mg/kg) to rats induced marked and transient increases of endogenous RA levels in plasma, skin, fat, kidney, and testis. Consistent with its ability to enhance endogenous RA content in tissues, R115866 was found to exert retinoidal activities. Like RA, the title compound: 1) inhibited vaginal keratinization in estrogen-stimulated rats; 2) induced epidermal hyperplasia in mouse ear skin; 3) transformed mouse tail epidermis from a para- to an orthokeratotic skin type; and 4) up-regulated the CYP26 mRNA expression in rat liver. Furthermore, we found that the keratinization-suppressive and CYP26-inducing activities of R115866 could be reversed by concomitant administration of the RAR antagonist, AGN193109. Our data characterize R115866 as a potent, orally active inhibitor of RA metabolism, capable of enhancing RA levels and displaying retinoidal actions. These activities are reversed by RAR antagonism, supporting the idea that the actions of R115866 result from increased availability of endogenous RA and improved RAR triggering.

Topics: Animals; Aromatase Inhibitors; Benzothiazoles; Cytochrome P-450 Enzyme Inhibitors; Cytochrome P-450 Enzyme System; Enzyme Inhibitors; Epidermis; Female; Humans; Hyperplasia; Keratosis; Male; Mice; Ovariectomy; Rats; Rats, Wistar; Retinoids; Reverse Transcriptase Polymerase Chain Reaction; RNA, Messenger; Thiazoles; Tissue Distribution; Tretinoin; Triazoles; Vagina

Nevoid hyperkeratosis of the nipple and areola is a rare dermatosis with unknown etiology, (Perez-Izquierdo JM, Vilata JJ, Sanchez JL, et al. Retinoic acid treatment of nipple hyperkeratosis. Arch Dermatol 1990;126:687-688). Only 40 cases have been reported until 1997 (Alpsoy E, Yilmaz E, Aykol A. Hyperkeratosis of the nipple: report of two cases. J Dermatol 1997;24:43-45). The disease has a benign course and may only be a cosmetic problem. Different modalities have been used in the treatment of NHNA. In our case treatment with topical retinoic acid induced an acceptable response.

Topics: Administration, Cutaneous; Adult; Breast Diseases; Female; Humans; Hyperpigmentation; Keratins; Keratolytic Agents; Keratosis; Nipples; Tretinoin; Warts

Topics: Administration, Cutaneous; Adult; Breast Diseases; Female; Humans; Hyperpigmentation; Keratolytic Agents; Keratosis; Nipples; Tretinoin

Topics: Antimetabolites, Antineoplastic; Drug Therapy, Combination; Etretinate; Fluorouracil; Humans; Keratolytic Agents; Keratosis; Masoprocol; Neoplasms, Radiation-Induced; Retinoids; Skin Neoplasms; Tretinoin

Hyperkeratosis of the nipple and areola is a rare condition; its characteristic properties are verrucous thickening and brownish discoloration of the nipples and areola. The nevoid form of the disease is extremely rare, usually seen in women in the second or third decade of life. The nipple is seldom affected alone. We report two cases of the nevoid form of hyperkeratosis of the nipple. In both female patients, lesions developed after puberty and were confined to both nipples alone. One of the patients' lesions became darker and more verrucous during pregnancy, making breast feeding impossible.

Topics: Adolescent; Adult; Breast Diseases; Breast Feeding; Female; Humans; Hyperpigmentation; Keratolytic Agents; Keratosis; Nipples; Pregnancy; Pregnancy Complications; Tretinoin; Warts

To explore the role of retinoids in epidermal development, we recently targeted expression of a dominant-negative, retinoic acid receptor mutant (RAR alpha403) in the epidermis of transgenic mice and observed an unexpected loss of barrier function. In this paper, we demonstrate that transgenic mice expressing the RAR alpha403 transgene show attenuated responsiveness to topical application of all-trans retinoic acid, in agreement with our previous in vitro data. We also show that the vitamin D3 receptor is unaffected in its ability to transactivate in the presence of the dominant-negative RAR alpha403 transgene, indicating that the RAR alpha403 is unlikely to be functioning through a global sequestration of retinoid X receptors. Additionally, we show that the disruption of epidermal barrier function results in a dramatic 4 C drop in mean body surface temperature, probably accounting for the extremely high incidence of neonatal mortality in severely phenotypic pups. Some severely affected pups do survive and show a pronounced hyperkeratosis at postpartum day 4, consistent with previously documented effects of vitamin A deficiency. Biochemical analysis of the severely phenotypic neonates indicates elevated phospholipids and glycosylceramides in the stratum comeum, which results from altered lipid processing. Taken together with previous studies, these data provide strong evidence linking the retinoid-signaling pathway with modulation of lipid processing required for formation of epidermal barrier function.

Topics: Administration, Topical; Animals; Animals, Newborn; Body Temperature; Ceramides; Epidermis; Fluorescent Dyes; Keratosis; Lipid Metabolism; Mice; Mice, Transgenic; Oxazines; Phospholipids; Receptors, Calcitriol; Receptors, Retinoic Acid; Retinoic Acid Receptor alpha; Retinoid X Receptors; Retinoids; Signal Transduction; Skin; Transcription Factors; Transgenes; Tretinoin

Topics: Acanthosis Nigricans; Adult; Disease Progression; Edema; Fingers; Foot Deformities, Congenital; Hand Deformities, Congenital; Humans; Keratoderma, Palmoplantar; Keratosis; Lip; Male; Mouth; Mouth Mucosa; Nose; Toes; Tretinoin

The precise pathologic processes of comedo formation in acne are not well understood. Retention hyperkeratosis may play an important role. To evaluate the effects of three topical comedolytics, 20% azelaic acid, 0.1% tretinoin and 5% benzoyl peroxide, on the retention hyperkeratosis of experimentally induced comedones (EIC), an ultrastructural study was done. After formation of EIC with 50% oleic acid in paraffin oil on the external ears of rabbits, each comedolytic was applied for 4 weeks. Biopsies were taken every week and, using a Hitachi H-600 transmission electron microscope, morphologic observations were done in the upper portion of the follicular epithelium. In EIC, after application of each comedolytic, the markedly thinned horny layer was loosely adhered by extremely few desmosomes and desmosomal bodies. The number and size of tonofilaments and keratohyaline granules decreased, but the number of variable sized Odland bodies increased in the upper epidermis. These findings appeared 1 week after application of either azelaic acid or benzoyl peroxide, and 3 weeks after application of tretinoin. For the first 2 weeks of tretinoin application, EIC showed rather compact hyperkeratosis with more desmosomes and desmosomal bodies than before. Azelaic acid tretinoin and benzoyl peroxide increased the number of Odland bodies, and the horny cells became less adhesive. This lysis of retention hyperkeratosis resulted in comedolysis. During 4 weeks of treatment with these three comedolytics, only tretinoin normalized the keratinization process.

Topics: Acne Vulgaris; Animals; Benzoyl Peroxide; Dermatologic Agents; Dicarboxylic Acids; Disease Models, Animal; Epithelial Cells; Epithelium; Evaluation Studies as Topic; Keratolytic Agents; Keratosis; Rabbits; Tretinoin

Topics: Administration, Topical; Animals; Cell Division; DNA; Female; Keratosis; Lactones; Mice; Ornithine Decarboxylase Inhibitors; Skin; Structure-Activity Relationship; Tretinoin

Topical tretinoin is a well-established treatment for acne, with a low incidence of reported adverse effects, most of which are local skin reactions. The retinoid has limited absorption through the skin, so that even with repeated applications plasma concentrations do not exceed normal endogenous levels. In mice, lifetime treatment with topical tretinoin improved skin texture and did not have any tumorigenic effects. Data from multicentre clinical trials have shown that 0.05% tretinoin emollient cream reduced fine wrinkling, surface roughness and mottled hyperpigmentation caused by photodamage. Improvement of these clinical signs was maintained after 12 months of daily tretinoin therapy, and regressed slowly after cessation of therapy. However, maintenance of the visible effects of topical tretinoin was reported after continued therapy with once or three times weekly applications of tretinoin emollient cream. Data from multicentre studies suggested that 0.1% tretinoin cream has a potential role in the treatment of solar keratoses. It is concluded that the application of tretinoin to photodamaged skin used in conjunction with sunscreens and judicious sun exposure is an effective regimen to treat the damaging cutaneous effects of chronic sun exposure.

Topics: Administration, Topical; Animals; Humans; Keratosis; Mice; Neoplasms, Radiation-Induced; Skin Absorption; Skin Aging; Sunlight; Time Factors; Tretinoin; Ultraviolet Rays

Lesional and perilesional skin samples from a 57-year-old man who had hyperkeratosis lenticularis perstans (HLP) (Flegel's disease) were studied by light and electron microscopic examination. Keratohyalin granules were diminished at the center of a fully-developed lesion. In contrast, keratohyalin appeared normal and membrane-coating granules were found in reduced numbers at the edges of the HLP lesion and were easily detected in normal numbers in clinically normal, perilesional skin. The inflammatory infiltrate in the HLP lesion was composed of small lymphocytes, which often displayed nuclei with deep infoldings resembling Sézary cells, and larger histiocytic cells, many of which were in close contact with the lymphocytes. Peripheral blood mononuclear cells did not show an abnormal ultrastructural appearance. Treatment with topical 5-fluorouracil cream led to the disappearance of the HLP lesions, whereas topical tretinoin was ineffective.

Topics: Administration, Cutaneous; Fluorouracil; Foot Dermatoses; Humans; Keratosis; Leg Dermatoses; Male; Middle Aged; Skin; 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

The purpose of this open, noncomparative study with acitretin (Ro 10-1670) was to evaluate the clinical response of patients with various nonpsoriatic disorders of keratinization and to establish for these patients the optimal dosage for both efficacy and tolerance. Thirty-three patients (21 adults and 12 children or adolescents) with ichthyoses, palmoplantar hyperkeratosis, or Darier's disease were treated for a period of 4 months. Most patients showed marked improvement or remission. The results obtained in congenital ichthyosiform erythroderma, lamellar ichthyosis, and Papillon-Lefèvre syndrome were judged as better than those usually reported with etretinate. The side effects observed in our patients were similar to those reported with etretinate, with the exception of scaling of palms and soles, which had an incidence and severity greater than expected with etretinate. The optimal acitretin dosage providing the best efficacy with minimal undesirable effects varied from patient to patient. The mean daily dose (+/- SD) was 27 +/- 11 mg in adults and 0.7 +/- 0.2 mg/kg in children or adolescents.

Topics: Acitretin; Adolescent; Adult; Child; Child, Preschool; Drug Tolerance; Female; Humans; Ichthyosiform Erythroderma, Congenital; Keratoderma, Palmoplantar; Keratosis; Male; Middle Aged; Remission Induction; Tretinoin

The introduction of the oral retinoid etretinate in the past decade has proved to be a major advance in the treatment of disorders of keratinization. During the past few years a new retinoid acitretin has been investigated in clinical trials. Acitretin has a half-life time of 2 days, versus 100 days for etretinate. Acitretin has therefore a great advantage with respect to the teratogenic potential of retinoids. The period of contraception after cessation of acitretin therapy is only two months, compared with two years for etretinate. From December 1989, etretinate has been replaced by acitretin in The Netherlands. In the Department of Dermatology of the University Hospital of Nijmegen, 36 patients with various disorders of keratinization were treated with acitretin. In this communication therapeutic results of acitretin therapy are reported. Clinical efficacy and side effects of acitretin are similar to those observed with etretinate.

Topics: Acitretin; Humans; Keratosis; Tretinoin

Topics: Adult; Breast; Female; Humans; Keratosis; Nipples; Tretinoin

Topics: Acitretin; Adult; Dermatitis, Exfoliative; Diagnosis, Differential; Etretinate; Female; Humans; Ichthyosis; Keratosis; Optic Atrophy; Pedigree; Tretinoin

Topics: Erythema; Humans; Keratosis; New York; North Carolina; Sunlight; Tretinoin

Topics: Administration, Cutaneous; Adult; Biopsy; Diagnosis, Differential; Humans; Keratosis; Male; Tretinoin

The skeletal changes associated with systemic retinoid therapy reflect the influence of retinoids on differentiating systems. Although skin is usually the intended target, treatment with retinoids often results in abnormalities of ossification and calcification. The effects of retinoids on bone may be profound and include progressive calcification of ligaments and tendon insertions, premature fusion of epiphyses, modeling abnormalities of long bones, and perhaps osteoporosis. Although it has been known since 1933 that vitamin A cause bone abnormalities, the mechanism of this effect has been elusive. Recent work suggests a possible relationship of the retinoids with several cytokines, which results in enhanced maturation of the preosteoclast. The increasing number of significant bone changes, including posterior lumbar vertebral osteophytosis, make skeletal toxicity the principle risk factor of chronic systemic retinoid therapy.

Topics: Drug Administration Schedule; Etretinate; Humans; Isotretinoin; Keratosis; Ossification, Heterotopic; Radiography; Spinal Osteophytosis; Tretinoin

During the last 10 years we treated 39 children with severe keratinization disorders with the aromatic retinoid etretinate. Six of these children were followed-up for 8-9 years. Mucocutaneous serum enzymatic and lipid side effects of etretinate were mild, transient and well tolerated. Osseous side effects were present after 4-6 years in all our 6 patients on prolonged retinoid therapy. Asymptomatic osseous neoformation and osseous reabsorption in the absence of calcium, phosphate, and alkaline phosphatase serum alterations have been observed. The growth and development curves and the sexual development of our patients (with exception of a patient with Rud's syndrome) have been normal. Osteoporosis and slender diaphysis were often present at initiation of therapy. On the basis of our findings and recent reports of the literature we suggest restricting retinoid therapy of keratinizing disorders in children to conditions severe enough to be physically, psychologically or socially incapacitating. In an attempt to reduce the risk of chronic toxicity and possibly to allow regression of initial bone alterations, intermittent therapy and combination therapy are recommended.

Topics: Adolescent; Bone Diseases; Child; Drug Administration Schedule; Drug Therapy, Combination; Etretinate; Female; Humans; Isotretinoin; Keratosis; Male; Tretinoin

A state of pure vitamin A deficiency, without any clinical manifestations, rapidly induces a stimulation of ornithine decarboxylase (ODC) activity and some oesophageal mucosal abnormalities (hyperkeratosis, dyskeratosis, cytonuclear abnormalities) in rats treated with N-nitrosobenzylmethylamine (NBMA). Retinol deficient rats fed with retinoïc acid (all-trans) show a mucosal ODC induction, but no morphological lesion. The association of retinoïc acid + retinol, as does retinol alone, prevents simultaneously histological lesions and enzymatic induction. In the liver of vitamin A deficient rats treated with NBMA, a stimulation of the ODC system, without any macroscopical lesions, has been observed.

Topics: Animals; Dimethylnitrosamine; Enzyme Induction; Esophageal Neoplasms; Keratosis; Neoplasms, Experimental; Ornithine Decarboxylase; Rats; Tretinoin; Vitamin A; Vitamin A Deficiency

A 30-year-old woman with erythrokeratodermia variabilis was treated with oral isotretinoin for four months. Clinical and light and electron microscopic observations were made before and after treatment. A characteristic electron microscopic feature was subnormal numbers of keratinosomes within the stratum granulosum of hyperkeratotic plaques. Isotretinoin therapy resulted in almost complete clinical clearing of these plaques and restoration of normal numbers of epidermal keratinosomes. In addition, distinctive dyskeratotic cells containing clumped tonofilaments were observed within the stratum granulosum by electron microscopy. These cells persisted after retinoid treatment.

Topics: Adult; Biopsy; Epidermal Cells; Erythema; Female; Humans; Isotretinoin; Keratins; Keratoderma, Palmoplantar; Keratosis; Microscopy, Electron; Skin; Time Factors; Tretinoin

We describe a patient with a distinct verrucous variant of chronic discoid lupus erythematosus manifested by skin lesions resembling keratoacanthomas. The diagnosis of keratotic lupus was confirmed by characteristic immunofluorescence and ultrastructural findings and by an initial response to antimalarial therapy. Combination therapy with isotretinoin and hydroxychloroquine resulted in control of her previously refractory skin lesions, and the isotretinoin apparently played a key role in this improvement.

Topics: Aged; Biopsy; Drug Therapy, Combination; Female; Humans; Hydroxychloroquine; Isomerism; Isotretinoin; Keratosis; Lupus Erythematosus, Discoid; Skin; Tretinoin

The use of isotretinoin (13-cis-retinoic acid) in the treatment of numerous dermatologic disorders, as well as the side effects encountered with use of the drug, have increased remarkably since its release. We encountered a case of Staphylococcus aureus endocarditis in a patient with chronic stable aortic insufficiency undergoing therapy with isotretinoin for extensive actinic keratoses. Although significant dysfunction of the immune system has not been demonstrated with isotretinoin, nasal colonization with S aureus has been shown to occur. Changes in skin fragility caused by the drug may provide a portal of entry for the organism. Physicians should be alert for this potential complication in patients with an underlying cardiac valvular lesion; antibiotic prophylaxis may be indicated in this group during isotretinoin therapy.

Topics: Aortic Valve Insufficiency; Endocarditis, Bacterial; Humans; Isomerism; Isotretinoin; Keratosis; Male; Middle Aged; Risk; Skin; Staphylococcal Infections; Staphylococcus aureus; Tretinoin

Topics: Humans; Isotretinoin; Keratosis; Tretinoin

A mother and daughter with epidermolytic hyperkeratosis were treated with two different synthetic retinoids at different times. Both patients exhibited the previously unreported side effect of increased curliness of scalp hair. Light microscopic examination revealed pili torti during the administration of isotretinoin. Both patients also experienced a better therapeutic response to and more hair loss with etretinate than with isotretinoin.

Topics: Adolescent; Adult; Female; Hair; Hair Diseases; Humans; Isotretinoin; Keratosis; Tretinoin

The authors have studied--in the plasma--the changes of zinc, retinol binding protein (RBP), retinol and retinoic acid with reference to the dermatological status of fifty chronically haemodialysed renal insufficiency patients divided into four subgroups (normal skin, dry skin, dry skin with keratosis, and only keratosis). The results of these groups were compared to those of thirty healthy subjects. The values of these variables do not show any significant difference in function of the dermatological subgroups; but, despite the considerable rise in the retinol binding protein and retinol levels in comparison with the controls (haemodialysis patients: RBP = 11.77 +/- 2.83 mumol X l(-1), retinol = 7 +/- 2.57 mumol X l(-1); controls; RBP = 2.76 +/- 0.62 mumol X l(-1), retinol = 2.16 +/- 0.53 mumol X l(-1] the electromicroscopic examination of skin biopsy samples from some of the patients did not reveal any sign of hypervitaminosis A in the lesions.

Topics: Humans; Hypervitaminosis A; Keratosis; Renal Dialysis; Retinol-Binding Proteins; Retinol-Binding Proteins, Plasma; Skin; Skin Diseases; Tretinoin; Vitamin A; Zinc

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

Two patients, a father and son, with pachyonychia congenita were treated with orally administered isotretinoin because the extreme deformity and discomfort associated with their massive keratoderma interfered with their work and school, respectively. While clinical benefits could not be sustained, electron microscopic findings compatible with suppression of abnormal keratinization were observed. In addition, skin biopsy samples were analyzed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis, and the gels were then subjected to a lectin overlay technique with concanavalin A labeled with iodine 125. The distribution of specific glycoproteins was found to be different for lesional as against normal epidermis. The procedure was repeated after oral treatment with isotretinoin. The labeled glycoprotein pattern of the lesional epidermis was clearly distinguishable from both the pretreatment lesional and the normal epidermis; it was mostly intermediate between the two. The normal epidermis was virtually unaffected by the retinoid treatment.

Topics: Adult; Child; Glycoproteins; Humans; Isotretinoin; Keratosis; Male; Microscopy, Electron; Nail Diseases; Skin; Tretinoin

Prolonged therapy with retinoid drugs (chemically similar to vitamin A) often results in skeletal hyperostoses, similar to those seen in idiopathic skeletal hyperostosis. Eight patients, aged 5-26 years, with dermatologic disorders were treated with 13-cis-retinoic acid. Skeletal surveys were obtained before and during treatment. In 1 year, six of the eight patients had developed such skeletal hyperostoses in both axial and appendicular regions. The cervical spine was the most common site of involvement. None of the children demonstrated accelerated skeletal maturation. Two of the patients had mild musculoskeletal discomfort during this period. The findings indicate that high-dose 13-cis-retinoic acid therapy may cause skeletal hyperostoses, requiring radiographic monitoring during prolonged periods of treatment. An implication of these observations, relating to the etiology of idiopathic skeletal hyperostosis, is discussed.

Topics: Adolescent; Adult; Bone Diseases, Developmental; Child; Child, Preschool; Female; Humans; Isotretinoin; Keratosis; Male; Prospective Studies; Radiography; Spine; Time Factors; Tretinoin

Topics: Etretinate; Female; Humans; Keratosis; Male; Middle Aged; Tretinoin

Ro12-7554, a chlorinated derivative of etretinate, was evaluated in an open study. 16 patients, 13 suffering from severe psoriasis and 3 from congenital disorders of keratinization previously treated with etretinate, received Ro 12-7554 at a mean daily dosage of 12.3 mg/day. Ro 12-7554 was very similar to etretinate in terms of clinical efficacy and overall safety.

Topics: Adult; Dermatitis, Exfoliative; Drug Evaluation; Etretinate; Female; Humans; Keratosis; Male; Middle Aged; Psoriasis; Skin Diseases, Vesiculobullous; Tretinoin

Topics: Etretinate; Humans; Isotretinoin; Keratosis; Psoriasis; Skin; Skin Diseases; Tretinoin

Topics: Administration, Oral; Child; Etretinate; Humans; Keratosis; Skin Diseases; Tretinoin

Case report of a patient with keratosis lichenoides chronica and good response to a combined therapy with retinoids and photochemotherapy.

Topics: Chronic Disease; Humans; Keratosis; Male; Middle Aged; PUVA Therapy; Skin; Tretinoin

Topics: Administration, Oral; Aged; Epidermis; Etretinate; Female; Headache; Humans; Keratosis; Microscopy, Electron; Tretinoin

Topics: Administration, Oral; Adult; Etretinate; Female; Humans; Keratosis; Male; Middle Aged; Tretinoin

A boy with epidermolytic hyperkeratosis was treated systemically for 4 1/2 years with 13-cis-retinoic acid. At the age of 10 1/2 years, he developed pain in his right knee and radiographic evidence of partial closure of the proximal epiphysis of the right tibia. Similar radiographic changes have been described in individuals ingesting excessive amounts of vitamin A.

Topics: Bone Diseases; Child; Epiphyses; Humans; Isotretinoin; Keratosis; Male; Tibia; Tretinoin

Therapeutic benefits from aromatic retinoid have been described in the treatment of a variety of dermatological disorders. Stress is given on some of them which coexist with ungual abnormalities and the results are reported. These diseases include psoriasis, acropustulosis, keratosis lichenoides chronica. Drug-induced modifications of the epidermal structures of the nail apparatus are emphasized: fragility with onychorrhexis and onychoschizia is the commonest finding. Onychomadesis and nail shedding can be seen. Onycholysis is rare. Painful paronychia which is sometimes accompanied by granulation tissue and ingrowing nails is the most interesting alteration due to this synthetic retinoid and as yet unexplained.

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Etretinate; Female; Humans; Keratosis; Lichen Planus; Male; Middle Aged; Nails; Nails, Malformed; Psoriasis; Tretinoin

Topics: Aged; Carcinoma, Squamous Cell; Etretinate; Humans; Keratosis; Lung Neoplasms; Male; Paraneoplastic Syndromes; Skin; Tretinoin

Topics: Acne Vulgaris; Animals; Cocarcinogenesis; Etretinate; Humans; Immunity; Isomerism; Isotretinoin; Keratosis; Polyamines; Psoriasis; Skin; Skin Diseases; Teratogens; Tretinoin; Triglycerides; Vitamin A

Twenty patients with disabling disorders of keratinization were treated with Tigason (etretinate, Ro 10-9359), an oral aromatic retinoid, and the clinical responses and the effects on the skin were monitored. Most patients showed a considerable clinical improvement within 4 weeks. Side effects, such as cheilitis, were common but mostly transient or minor. In the skin there was a decrease in glucose-6-phosphate dehydrogenase activity within the granular cell layer of the epidermis, and an increase in mean epidermal thickness and mean corneocyte area. However, there was little apparent effect on epidermal proliferation or on histological and ultrastructural appearances. These findings suggest that the drug acts at a late stage of epidermal differentiation.

Topics: Drug Administration Schedule; Etretinate; Humans; Keratosis; Pityriasis Rubra Pilaris; Tretinoin

Ten patients with disorders of keratinization were treated with oral isotretinoin (13-cis-retinoic acid) on an investigational protocol to test the efficacy, safety, and optimal dosage schedule for using the drug in these rare disorders. Elevations of serum triglyceride levels above the highest normal levels developed in seven of the ten patients, while they maintained normal levels of serum cholesterol. This effect was found to be dose and/or time related and reversible. Moderate elevations of serum triglyceride levels have not been clearly established as a risk factor for the development of coronary artery disease. High levels, however, may precipitate acute pancreatitis. For this reason, the conditions of patients receiving retinoids must be carefully monitored for triglyceride abnormalities throughout their courses of treatment.

Topics: Administration, Oral; Adolescent; Adult; Child; Cholesterol; Darier Disease; Female; Humans; Isotretinoin; Keratins; Keratosis; Male; Middle Aged; Skin; Skin Diseases; Tretinoin; Triglycerides

8 children with lamellar ichthyosis, 1 with epidermolytic hyperkeratosis and 5 with symmetrical progressive erythrokeratoderma were treated with a new aromatic retinoid (Ro 10-9359). Clinical improvement was dramatic. The children acquired an appearance never obtained before with other managements. The treatment had to be maintained to prevent recurrence. The tolerance to the drug was good. The side-effects were minimal and tended to disappear after several months of treatment. Our results suggest that because of its efficacy, good tolerance and easy administration, the oral retinoid Ro 10-9359 is at present the treatment of choice for the great ichthyotic disorders of children.

Topics: Child; Child, Preschool; Dermatitis, Exfoliative; Etretinate; Female; Humans; Ichthyosis; Infant; Keratosis; Male; Skin Diseases, Vesiculobullous; Tretinoin

Sixty-four male and female Syrian hamsters, 3 months of age and weighing 90 to 120 grams, were divided into four equal experimental groups. In animals of Groups 1 and 2 the left buccal pouch was painted three times weekly with a 0.5% solution of DMBA in heavy mineral oil. Group 2 animals also received 10 mg. of 13-cis-retinoic acid in peanut oil administered orally twice a week by pipette. Carcinogen retinoid were administered on alternate days. Group 3 animals served as controls, receiving only 13-cis-retinoic acid. Group 4 animals served as untreated controls. Four animals in each group (two males and two females) were killed at 10, 12, 14, and 16 weeks. The Group 2 animals, which received 13-cis-retinoic acid, exhibited a significant delay in DMBA carcinogenesis of buccal pouch mucosa, as studied both grossly and histologically. Both groups eventually demonstrated well-differentiated epidermoid carcinomas, but the tumors were smaller in the DMBA-retinoid animals.

Topics: Animals; Carcinoma, Papillary; Carcinoma, Squamous Cell; Cheek; Cricetinae; Female; Isotretinoin; Keratosis; Leukoplakia, Oral; Male; Mesocricetus; Mouth Mucosa; Mouth Neoplasms; Neoplasms, Experimental; Tretinoin

The need for safe and effective topical treatments is underlined by several clinical trials over the years treating miscellaneous dermatosis with many and heterologous drugs, sometimes on a simple empirical basis. In a recent study Robinson and Kligman claimed to have obtained satisfactory results treating several cases of actinic keratosis with an alternate regimen of retinoic acid and 5-FU. We wish to report an open-label pilot study using a simple and readily accessible combination of commercially formulated and available agents as 0,05% retinoic acid cream and 5% 5-FU cream over two groups of patients. Treatment consisted of bid application of sparing amounts of an equal parts combination of retinoic acid and 5-FU. The first group consisted of 7 patients affected by skin diseases associated with an altered epidermal keratinization (actinic keratosis, Darier's disease, seborrheic keratosis, phrynoderma and epidermodysplasia verruciformis). The patients were followed up for a period of 15 to 60 days and, as it might be expected, the results were quite good. The second group, on the contrary, consisted of 6 patients affected mainly by dermatosis involving the corium (LED, milium, colloid pseudomilium). The patients were followed up for the same period of time as the first group was, but the results were much less rewarding. Only a partial resolution of the process, which was followed soon after by a relapse, was noted. Finally we believe that this modified regimen of equal parts of retinoic acid and 5-FU has to be recommended in the topical treatment of the above mentioned dermatosis associated with an altered keratinization.

Topics: Drug Combinations; Fluorouracil; Humans; Keratosis; Ointments; Radiation Injuries; Skin Diseases; Syndrome; Tretinoin

Linear porokeratosis is a rare variant of porokeratosis of Mibelli and usually occurs in childhood. A 15-year-old boy is presented with typical clinical lesions of linear porokeratosis on the extensor surface of the right arm exhibiting the classical histopathologic criteria of the disease. Treatment with an oral aromatic retinoid resulted in a remission of the lesion.

Topics: Administration, Oral; Adolescent; Etretinate; Foot Dermatoses; Hand Dermatoses; Humans; Keratosis; Male; Syndrome; Tretinoin

2 patients with widespread porokeratosis Mibelli (PM) were treated orally with RO 10-9359. The dose was 75 mg/day for 10 days, then 50 mg/day for 3 weeks. The drug produced a good improvement of condition with no serious side effect. Ultrastructural examination of a healed lesion showed the presence of a fine granular substance in the intercellular space of the spinous layer, most likely produced by keratinocytes; ultrastructural cellular alterations of PM were still evident and the lesion recurred after suspension of treatment.

Topics: Aged; Etretinate; Foot Dermatoses; Hand Dermatoses; Humans; Keratosis; Male; Middle Aged; Skin; Syndrome; Tretinoin

Topics: Abdomen; Adult; Breast Diseases; Humans; Keratosis; Male; Middle Aged; Nipples; Tretinoin; Umbilicus

Topics: Administration, Oral; Etretinate; Female; Humans; Keratosis; Middle Aged; Pruritus; Tretinoin

Treatment with an oral aromatic all-trans retinoid (Ro 10-9359) resulted in clearing of the skin lesions in five patients with ichthyosis, four patients with Darier's disease and one patient with linear porokeratosis. No response to treatment was achieved in two patients with disseminated superficial actinic porokeratosis. Known side effects of retinoid treatment occurred in all patients in different intensity but disappeared when treatment was discontinued. Due to side effects (pruritus) treatment had to be discontinued only in one patient with Darier's disease and preexisting diabetes.

Topics: Administration, Oral; Adolescent; Adult; Child; Child, Preschool; Darier Disease; Etretinate; Female; Humans; Ichthyosis; Keratosis; Male; Middle Aged; Tretinoin

Topics: Adolescent; Adult; Child; Child, Preschool; Etretinate; Female; Humans; Keratosis; Male; Middle Aged; Tretinoin

Beneficial effects of oral retinoids in prophylaxis of epithelial neoplasias have been demonstrated by experimental works. In this study oral retinoid (RO 10-9359) was used in human dermatosis with high frequency of cutaneous malignancies: xeroderma pigmentosum with or without malignant neoplasias, Mibelli's porokeratosis with multifocal malignant degeneration, basal cell naevus syndrome with basal cell carcinomas, familial epithelioma of Ferguson-Smith and actinic keratosis. This work started in december 1977. Visible epitheliomas have been treated before trial. Initial dose of retinoid was 1 mg/kg daily, decreased depending on individual tolerance. Results were appreciated by comparising number of epitheliomas observed in years preceding retinoid therapy and number of them appearing during treatment; in two familial cases (basal cell naevus syndrom in twins and xeroderma pigmentosum in two brothers) comparison was made between treated and untreated patients. First results are very promising: an excellent response on solar keratosis is noted; epitheliomas occurrence seems actually to be prevented or delayed by oral retinoid therapy. Of course more numerous cases, a longer time, periods without treatment are necessary to confirm these interesting first results. On the other hand drug is not with this dose active on already constituted carcinomas.

Topics: Adolescent; Basal Cell Nevus Syndrome; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Child; Etretinate; Female; Humans; Keratosis; Male; Precancerous Conditions; Skin Diseases; Skin Neoplasms; Tretinoin; Xeroderma Pigmentosum

The ever increasing expenditures in health service urgently call for a critical revision of the therapy habitually practiced so far. This also includes the complete utilization of ambulatory therapeutic approaches. Moreover, after many years of clinical practice, the dermatologist in general practice should not forego the manifold therapeutic methods in which he had been trained and by the application of which he has gained particular experience. The dermatologist's small office consisting of a desk and couch must be a matter of the past once and for all. It is just the dermatologist who has the opportunity to try many forms of clinical treatment in general practice.

Topics: Family Practice; Humans; Keratosis; Methotrexate; Methoxsalen; Patient Care Team; Photochemotherapy; Psoriasis; Skin Diseases; Tretinoin

Blepharoconjunctivitis developed as a side-effect of treatment of patients with basal cell carcinomas, keratinizing dermatoses, and cystic acne with oral 13-cis-retinoic acid. Forty-two of the 97 dermatologic patients had signs and symptoms of blepharoconjunctivitis that were dose related and abated one week after discontinuation of the medication. About half of the patients had a history of similar symptoms prior to treatment. Staphylococcus aureus was present in eye cultures of 73% to 79% of the patients, whether symptomatic or not. Patients whose clinical appearance was that of staphylococcal blepharoconjunctivitis and whose cultures grew S aureus were successfully treated with topical erythromycin ointment to the lids even while being treated with the 13-cis-retinoic acid.

Topics: Acne Vulgaris; Blepharitis; Carcinoma, Basal Cell; Conjunctivitis; Erythromycin; Eyelid Diseases; Humans; Keratosis; Skin Diseases; Skin Neoplasms; Staphylococcal Infections; Tretinoin

The clinical and histologic features of lifelong reactive perforating collagenosis in a twenty-five year old woman are presented. Experimentally induced lesions showed the expected evolution and regression, although total time for the experimental lesion to develop and regress was shorter than the time necessary for those occurring spontaneously. Therapeutic trials with a wide variety of topical and systemic medications were without benefit, with the exception of tretinoin cream (0.1 percent), which was regularly effective in reducing the total number of lesions present.

Topics: Administration, Topical; Adult; Collagen Diseases; Erythema; Female; Humans; Keratosis; Skin; Tretinoin; Vitamin A

Identical twins with mal de Meleda, a rare genodermatosis, displayed the characteristic "glove and sock" hyperkeratosis, hyperhidrosis, and malodor. Their parents, who are first cousins, are unaffected and originated from Calabria, Italy, which is not far from Meleda (Mljet). The disorder is probably transmitted as an autosomal recessive trait. Previous therapy with grenz rays, topical preparations of adrenocorticosteroids, lactic acid, retinoic acid, and bland emollients had been unsuccessful. One of the twins was treated with 13-cis retinoic acid taken by mouth for 16 weeks with dramatic improvement. The major adverse effect was cheilitis, which did not force discontinuation of the treatment.

Topics: Adolescent; Diseases in Twins; Female; Humans; Keratosis; Skin; Tretinoin; Vitamin A

15 patients with superficial basaliomas or premalignant epithelial neoplastic disorders (actinic keratosis, leukoplakia, Bowen's disease) were treated locally over three weeks with retinoic acid (RA) alone or in combination with 5-fluorouracil (5-FU). In 11 cases the lesions disappeared clinically, however, only 5 patients proved to be cured by histological examination. 4 of them were treated with RA combined with 5-FU. There was a decrease of the 3H-index after the first week and an increase after the third week of treatment. These findings suggest, that RA inhibits the proliferation of neoplastic keratinocytes and stimulates the proliferation of normal epidermal cells. Retinoic acid, therefore, has an inhibitory effect on epithelial neoplasias, particularly in combination with 5-FU. Since local therapy with RA and 5-FU is not sufficient for routine clinical purposes in all cases, their use should be restricted to selected patients.

Topics: Aged; Carcinoma, Basal Cell; Drug Therapy, Combination; Female; Fluorouracil; Humans; Keratosis; Leukoplakia; Light; Lip Neoplasms; Male; Middle Aged; Mouth Neoplasms; Neoplasms, Radiation-Induced; Precancerous Conditions; Scalp; Skin Neoplasms; Thorax; Tretinoin; Vitamin A

Oral retinoic acid successfully and rapidly helped two patients with erythrokeratoderma variabilis. Treatment had to be maintained to prevent recurrence and no side effects have been observed so far.

Topics: Administration, Oral; Adolescent; Adult; Dermatitis, Exfoliative; Female; Humans; Keratosis; Time Factors; Tretinoin; Vitamin A

Topics: Administration, Topical; Adult; Drug Evaluation; Female; Foot Dermatoses; Hand Dermatoses; Humans; Keratosis; Syndrome; Tretinoin; Vitamin A

Topics: Administration, Oral; Adolescent; Adult; Aged; Child; Darier Disease; Female; Humans; Ichthyosis; Keratoderma, Palmoplantar; Keratosis; Leukoplakia; Male; Middle Aged; Pityriasis Rubra Pilaris; Psoriasis; Skin Neoplasms; Tretinoin; Vitamin A

In contrast to solar keratoses of the face, twice daily application of 5% 5-fluorouracil cream was found to be incapable of destroying such lesions situated on the forearms and hands. Twice daily application of 0-1% retinoic acid was also ineffective. Combined use of these agents eradicated keratoses in all twenty subjects with numerous keratoses of the forearms; in only two was the treatment ineffective for keratoses of the hands.

Topics: Adult; Aged; Drug Therapy, Combination; Female; Fluorouracil; Humans; Keratosis; Male; Middle Aged; Sunlight; Tretinoin; Vitamin A

Topics: Keratosis; Keratosis, Actinic; Tretinoin; Vitamin A