tretinoin and Scleroderma--Localized

Systemic sclerosis and morphea are connective tissue diseases characterized by tightening, thickening, and hardening of the skin, leading to significant morbidity. Unfortunately, current treatment options have limited efficacy for many patients. Cutaneous manifestations of these diseases arise from excess collagen deposition and fibrosis in the skin, through pathogenic mechanisms which have yet to be extensively detailed at the causal immune and cellular levels. Research elucidating the mechanism of action of retinoic acid on collagen production in the skin and case series highlighting the success of retinoic acid on the skin manifestations of systemic sclerosis and on morphea demonstrate its promise as a treatment. Herein they will briefly review the treatment options for both systemic sclerosis and morphea, and will discuss the potential of retinoic acid as a therapy and the supporting evidence from the literature, highlighting the previously published basic science and clinical studies investigating the role of retinoic acid in the treatment of sclerotic skin diseases.

Topics: Dermatologic Agents; Humans; Scleroderma, Localized; Scleroderma, Systemic; Skin; Treatment Outcome; Tretinoin

Localized morphoea is an uncommon sclerosing skin disorder. Prognosis is usually good but it may lead to contractures, perturbed limb growth, atrophy, pigmentary changes and cosmetic disturbance. We describe a case of morphoea that developed in one breast in a 9-year-old white female. Treatment comprised topical ammonium lactate 12% cream and tretinoin 0.025% cream but no topical corticosteroids were prescribed. One year later she was noted to have bilateral symmetrical breast development and, although signs of morphoea were still present in one breast, the plaque had softened and there was no breast deformity. It is important to remember that most cases of morphoea improve spontaneously, although a number of possible therapeutic options may be indicated in some patients.

Topics: Breast; Breast Diseases; Child; Drug Therapy, Combination; Female; Humans; Keratolytic Agents; Lactates; Quaternary Ammonium Compounds; Scleroderma, Localized; Tretinoin

Topics: Aged; Female; Ficusin; Humans; Keratolytic Agents; Middle Aged; Photosensitizing Agents; PUVA Therapy; Scleroderma, Localized; Tretinoin

Four patients with systemic scleroderma (SSc), 4 patients with morphea, and 4 patients with hypertrophic scar were treated with topical tocoretinate for 6 months to 3 years and studied clinically and histopathologically. Clinically, all of the lesions responded to this therapy. The stiffness of the skin lesions, glossy appearance of the lesions, and telangiectasia improved. Histopathologically, the proliferated collagen fibers decreased in thickness, and the inter-fiber spaces increased. Immunoreactive tenascin-C expressed in the proliferated deep dermal fibers of the SSc and hypertrophic scar lesions was markedly decreased compared with the level before the topical tocoretinate therapy. Topical tocoretinate has been used for the treatment of ulcers; it is also a potent treatment for sclerotic skin diseases.

Topics: Administration, Topical; Adolescent; Adult; Aged; Child; Child, Preschool; Cicatrix, Hypertrophic; Drug Combinations; Female; Humans; Middle Aged; Scleroderma, Localized; Scleroderma, Systemic; Skin; Tretinoin; Vitamin E

We report on a 56-year-old male patient suffering from scleromyxedema, who was successfully treated with isotretinoin (13-cis retinoic acid, Roaccutan). After 10 months therapy, we observed considerable reduction of the cutaneous infiltration and the skin thickening; the papular eruptions had almost completely disappeared. The mobility of the joints, however, could only be slightly improved.

Topics: Drug Administration Schedule; Humans; Isotretinoin; Male; Middle Aged; Myxedema; Scleroderma, Localized; Skin; Tretinoin