tretinoin and Lupus-Erythematosus--Discoid

Topics: Alopecia; Antirheumatic Agents; Biopsy; Diagnosis, Differential; Drug Administration Routes; Humans; Hydroxychloroquine; Keratolytic Agents; Lupus Erythematosus, Discoid; Male; Middle Aged; Scalp Dermatoses; Skin; Treatment Outcome; Tretinoin

Discoid lupus erythematosus (DLE), the most common lupus erythematosus (LE)-specific chronic manifestation of the skin, is often resistant to therapy. Atrophy, scarring, and pigmentation are often observed. In this study, we report two cases of DLE that were successfully treated with tocoretinate, a compound containing a mixture of retinoic acid and tocopherol. Atrophy and pigmentation improved in both cases. The mechanism of action of tocoretinate is discussed.

Topics: Adult; Anti-Inflammatory Agents, Non-Steroidal; Antiphospholipid Syndrome; Aspirin; Dermatologic Agents; Drug Combinations; Female; Humans; Lupus Erythematosus, Discoid; Male; Patient Satisfaction; Treatment Outcome; Tretinoin; Vitamin E

Acitretin (etretin [Ro-10-1670]) is the major metabolite of etretinate with a much shorter elimination half-life. The drug was used in the treatment of 20 patients who had cutaneous lupus erythematosus. All patients responded to treatment, but in five, the result was unsatisfactory. In 15 patients, an excellent (total clearing) or good response (marked reduction of all lesions) was seen. In seven of them, acitretin was superior to previous therapy with antimalarials and/or systemic corticosteroids. In particular, five of six patients with subacute cutaneous lupus erythematosus showed complete clearing of their lesions, usually within two to four weeks. Side effects were the same as with etretinate. It is concluded that acitretin is a highly effective and well-tolerated drug in the treatment of cutaneous lupus erythematosus.

Topics: Acitretin; Adult; Aged; Alopecia Areata; Antibodies, Antinuclear; Cholesterol; Drug Administration Schedule; Drug Evaluation; Female; Humans; Lupus Erythematosus, Cutaneous; Lupus Erythematosus, Discoid; Male; Middle Aged; Pilot Projects; Tretinoin; Triglycerides

A patient with systemic lupus erythematosus had the additional finding of hypertrophic lupus erythematosus. The lesions cleared with an 11-week course of isotretinoin alone. She has remained without recurrence for 9 months. This is the first reported case of total resolution of hypertrophic lupus erythematosus with a short course of isotretinoin.

Topics: Adult; Diagnosis, Differential; Female; Humans; Isotretinoin; Lupus Erythematosus, Discoid; Lupus Erythematosus, Systemic; 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

Eight of ten patients with chronic or subacute cutaneous lupus erythematosus completed 16 weeks of oral isotretinoin therapy (80 mg/day). All eight patients noted an excellent clinical response without significant side effects. (Two patients did not return to initial two-week follow-up.) Peripheral blood B- and T-cell counts were unaffected by therapy. Therapy was associated with resolution of routine histopathologic abnormalities, conversion of abnormal lesional direct immunofluorescence microscopy to normal, normalization of the epidermis on electron microscopy, and reduction of all T cells near the dermoepidermal junction without change in ratio of T-helper/inducer cells to T-suppressor/cytotoxic cells. Isotretinoin is a clinically effective short-term therapy for chronic or possibly for subacute cutaneous lupus erythematosus. The primary mechanism of action remains unestablished.

Topics: Administration, Oral; Adult; Basement Membrane; Chronic Disease; Complement C3; Drug Evaluation; Female; Fibrin; Fluorescent Antibody Technique; Humans; Immunoglobulin G; Isotretinoin; Lupus Erythematosus, Discoid; Lymphocytes; Male; Middle Aged; Skin; Tretinoin