tretinoin and Mycoses

The use of biological drugs in psoriasis is replacing traditional therapies due to their specific mechanism and limited side effects. However, the use of Interleukin 17 inhibitors and the modification of its cytokine pathway could favor the risk of fungal infections. All-trans retinoic acid is an active metabolite of vitamin A with anti-inflammatory and immunoregulatory properties through its capacity to stimulate both innate and adaptive immunity and to its effects on proliferation, differentiation and apoptosis in a variety of immune cells. Furthermore, it has been recently discovered that All-trans retinoic acid has a direct fungistatic effect against Candida and Aspergillus Fumigatus. On the basis of these new insights, in the current review, we suggest that the evaluation of serum level of All-trans retinoic acid or vitamin A should be considered as a predictive marker for the development of fungal infections among psoriatic patients treated with Interleukin 17 inhibitors. In clinical practice, vitamin A test could be added in the routine hospital diagnostic management for a better selection of psoriatic patients eligible to Interleukin 17 inhibitors.

Topics: Antibodies, Monoclonal, Humanized; Biomarkers; Candidiasis; Cytokines; Dermatomycoses; Humans; Interleukin-17; Mycoses; Patient Selection; Predictive Value of Tests; Psoriasis; Risk; Signal Transduction; Tretinoin; Vitamin A

A number of cytochrome P450s are targets for compounds that are clinically used or under clinical evaluation for treatment of patients with mycotic infections, such as dermatophytosis, superficial and systemic candidiasis, cryptococcosis and aspergillosis, with skin diseases, such as psoriasis or ichthyosis, and other retinoid-sensitive malignancies, e.g., neuro-ectodermal glioma. Some of the P450 inhibitors are candidates for the treatment of hirsutism or prostate cancer, others are potent inhibitors of the P450 isomerase involved in the synthesis of thromboxane A2, a potent platelet aggregation inducer and vasoconstrictor.

Topics: Androgens; Animals; Antifungal Agents; Candidiasis; Cytochrome P-450 Enzyme Inhibitors; Cytochrome P-450 Enzyme System; Drugs, Investigational; Enzyme Inhibitors; Humans; Models, Molecular; Mycoses; Sterols; Structure-Activity Relationship; Thromboxanes; Tretinoin

A 13-month-old child with lamellar ichthyosis and numerous cutaneous and systemic infections died following an abrupt episode of severe hypotension. Postmortem examination revealed white matter vacuolation in the brain stem tegmentum and cerebellar hemispheres similar to that seen in toxicity from hexachlorophene, to which our patient was not exposed. The patient had been treated with many commonly used medications, including 13-cis-retinoic acid, a relatively new drug with apparent therapeutic benefit in hyperkeratotic dermatoses. This had been given systemically during the patient's last week of life. Possible relationships between the white matter lesions and extrinsic toxic agents are discussed.

Topics: Anti-Bacterial Agents; Anti-Infective Agents; Bacterial Infections; Brain Stem; Central Nervous System Diseases; Cerebral Ventricles; Drug Therapy, Combination; Female; Humans; Ichthyosis; Infant; Isotretinoin; Mycoses; Myelin Sheath; Skin Diseases, Infectious; Tretinoin; Vacuoles

Topics: Adrenal Cortex Hormones; Candidiasis, Oral; Humans; Levamisole; Levodopa; Mouth Diseases; Mycoses; Tretinoin; Virus Diseases; Vitamin A