tretinoin and Skin-Ulcer

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

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

Topics: Adult; Antineoplastic Agents; Biopsy; Diagnosis, Differential; Fever; Genital Diseases, Male; Humans; Induction Chemotherapy; Leukemia, Promyelocytic, Acute; Male; Scrotum; Skin; Skin Ulcer; Tretinoin

Acute promyelocytic leukemia, an aggressive subtype of acute myeloid leukemia, is characterized by the t(15;17) translocation. Standard induction chemotherapy consists of (ATRA) in combination with anthracycline-based chemotherapy with or without the addition of cytarabine. Rare and serious side effects of ATRA have been reported including painful lip and scrotal ulcerations. Of 20 previous reports of genital ulceration, 17 patients had ATRA discontinued and corticosteroids initiated; however, the corticosteroid regimens and duration of therapy were not well described. Herein we present the first known case of a Black male with ATRA-associated scrotal ulcerations who was successfully managed with corticosteroids without cessation of all-trans retinoic acid. We report this case to highlight its rarity and to note that ATRA can be continued in combination with corticosteroids throughout induction.

Topics: Antineoplastic Combined Chemotherapy Protocols; Genital Diseases, Male; Glucocorticoids; Humans; Leukemia, Promyelocytic, Acute; Male; Scrotum; Skin Ulcer; Tretinoin; Young Adult

Acute promyelocytic leukemia (APL) accounts for 10% of acute myelocytic leukemias and is characterized by t(15;17) that produces the PML-RARα (promyelocytic leukemia-retinoic acid receptor α) fusion oncoprotein. The discovery and implementation of all-trans-retinoic acid (ATRA) therapy for APL has led to complete remission rates greater than 90% when coupled with chemotherapy. We report a novel case of ATRA-induced scrotal ulcers in a black man with APL. The differential diagnosis of scrotal ulcerations in immunocompromised patients is lengthy, and misdiagnosis can lead to substantial morbidity and mortality. It is important for dermatologists to be aware of this potential complication of ATRA therapy.

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Cytarabine; Daunorubicin; Drug Eruptions; Humans; Leukemia, Promyelocytic, Acute; Male; Scrotum; Skin Ulcer; Tretinoin

Topics: Adolescent; Antineoplastic Agents; Humans; Leukemia, Promyelocytic, Acute; Male; Scrotum; Skin Ulcer; Treatment Outcome; Tretinoin

All-trans retinoic acid (ATRA) has been shown to improve the outcome in patients with acute promyelocytic leukemia compared with chemotherapy alone, but it is associated with adverse effects. We report the development of scrotal ulcer in a patient with acute promyleocytic leukemia (APL) within 10 days of treatment with ATRA at a dose of 40 mg orally twice daily. The ulcer did not respond to antibiotic treatment and healed shortly after withholding ATRA. The biopsy showed inflammation only, and other microbiological workup was negative.

Topics: Administration, Oral; Adult; Antineoplastic Agents; Genital Diseases, Male; Humans; Leukemia, Promyelocytic, Acute; Male; Scrotum; Skin Ulcer; Tretinoin

All-trans retinoic acid (ATRA) is effective in approximately 90% of the cases of acute promyelocytic leukemia (APL) with a low incidence of adverse effects. We report a patient with APL who developed skin ulcers of the scrotum concomitant with high fever during treatment that included ATRA. Severe fever was promptly alleviated with discontinuation of ATRA, while the ulcers improved gradually over 3 months. As the clinical features are similar to those of Sweet's syndrome, we should be aware of the possibility that this rare adverse effect may occur in the treatment with ATRA.

Topics: Adult; Antineoplastic Agents; Biopsy, Needle; Bone Marrow; Follow-Up Studies; Humans; Leukemia, Promyelocytic, Acute; Male; Scrotum; Skin Ulcer; Tretinoin

Topics: Administration, Topical; Adrenal Cortex Hormones; Adult; Antineoplastic Agents; Humans; Leukemia, Promyelocytic, Acute; Male; Scrotum; Skin Ulcer; Tretinoin

All-trans retinoic acid (ATRA) induces complete remission (CR) in most cases of acute promyelocytic leukemia (APL). Toxicity of ATRA has been shown to be mild and consist of headache, dry skin, dermatitis, gastrointestinal disorders, and hypertriglyceridemia. We report three patients with APL treated with ATRA in combination with chemotherapy, who developed scrotum exfoliative dermatitis with ulceration. Their age was 33 years (range, 25 to 37). All three cases developed scrotum erosions, and many small ulcers after 9 to 17 days of ATRA treatment. The scrotum exfoliative dermatitis with ulceration occurred repeatedly, but gradually resolved in about 8 weeks time. They developed no dryness of the lip or skin apart from the scrotum. All three cases continued to receive 45 mg/m2 of ATRA daily throughout induction therapy, and achieved CR. We suspected the scrotum exfoliative dermatitis with ulceration to be a side effect of ATRA. The scrotum lesions, which have been already reported may be common in patients receiving ATRA.

Topics: Adult; Antineoplastic Agents; Dermatitis, Exfoliative; Humans; Leukemia, Promyelocytic, Acute; Male; Scrotum; Skin Ulcer; Tretinoin

Topics: Acne Vulgaris; Adolescent; Cyclophosphamide; Granulomatosis with Polyangiitis; Humans; Isotretinoin; Lung; Male; Necrosis; Prednisone; Skin; Skin Ulcer; Tretinoin