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Sample records for isotretinoin

  1. Isotretinoin (Accutane) and Pregnancy

    MedlinePlus

    ... an increased risk for miscarriage or infant death? YES. The risk for having a miscarriage may be ... Can taking isotretinoin during pregnancy cause birth defects? YES. Isotretinoin causes a pattern of birth defects in ...

  2. Isotretinoin updates.

    PubMed

    On, Shelbi C Jim; Zeichner, Joshua

    2013-01-01

    Acne vulgaris is a chronic inflammatory disease of pilosebaceous follicles commonly affecting adolescents and young adults. This disease has a profound psychological impact on affected individuals and treatment has been shown to significantly improve both self-esteem and quality of life. Isotretinoin is an effective medication used primarily in severe cystic acne patients. Over the past 30 years, this medication has revolutionized the treatment of acne. However, despite its popularity there are numerous side effects associated with its use. Most of its side effects are predictable and dose dependent, which has led to the development of variable dose regimens. Unfortunately, rare but significant side effects (e.g., depression, inflammatory bowel disease) do occur and necessitate careful monitoring to improve clinical outcomes and minimize potential adverse events.

  3. Improving bioavailability with a novel isotretinoin formulation (isotretinoin-Lidose).

    PubMed

    Tan, Jerry; Knezevic, Sanja

    2013-01-01

    Current practice guidelines recommend administration of oral isotretinoin with high-fat meals, which may pose issues with patient compliance. Isotretinoin-Lidose (Epuris™), approved by Health Canada in November 2012 and scheduled for commercial release June 2013, is based on novel lipid encapsulation technology (Lidose®) to enclose isotretinoin, thereby increasing drug absorption during fasted states. An open label, single dose randomized crossover study demonstrated pharmacokinetic bioequivalence of isotretinoin-Lidose to standard isotretinoin formulations during fed states, with significantly greater absorption during fasting. Isotretinoin-Lidose, may lead to more consistent plasma levels of isotretinoin during variable dietary conditions, providing the potential for enhanced patient outcomes.

  4. [Isotretinoin and adolescent depression].

    PubMed

    Misery, L; Feton-Danou, N; Consoli, A; Chastaing, M; Consoli, S; Schollhammer, M

    2012-02-01

    Isotretinoin, indicated in France in the treatment of severe acne (e.g. nodular acne, acne conglobata or acne likely to result in permanent scarring) resistant to adequate cure by standard systemic antibiotic therapy and topical treatments, has on occasion been suspected of being associated with suicide. A study involving collective reflection on this issue is presented herein. The Psychodermatology Group of the French Dermatology Society, made up of dermatologists, psychiatrists, paediatric psychiatrists, psychoanalysts and clinical psychologists, met several times and views were exchanged by e-mail. The first two authors drafted the present article, which was then re-read, modified and approved by the members of the Psychodermatology Group, in particular by the co-authors. The article was then modified at the request of the proofreaders of the Annales de Dermatologie and re-read once more by members of the Psychodermatology Group. Psychological disturbances, including depression and other suicidal tendencies, are extremely common during adolescence and are clearly increased by acne, particularly where it is severe. Isotretinoin does not appear to increase this risk. Routine screening should be performed for psychological disturbance in adolescents, particularly among those presenting acne. Prescription of isotretinoin is not contraindicated in subjects presenting depression. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

  5. Premature ventricular contractions associated with isotretinoin use*

    PubMed Central

    Alan, Sevil; Ünal, Betül; Yildirim, Aytül

    2016-01-01

    Isotretinoin has been considered a unique drug for acne treatment. However, it is associated with numerous adverse effects. Isotretinoin can trigger premature ventricular contractions. This report describes a 33-year-old-woman who presented with palpitations for 1 week while undergoing 1-month isotretinoin treatment for mild-moderate facial acne. An electrocardiogram and Holter monitoring showed premature ventricular contractions during isotretinoin (Roaccutane, Roche) treatment. Isotretinoin-related premature ventricular contractions were strongly suggested in this case due to the existence of documented premature ventricular contractions on electrocardiograms and the disappearance of these premature ventricular contractions two weeks after termination of the treatment To the authors' knowledge, there has been 1 reported case of premature ventricular contractions linked to isotretinoin use; this report describes a second such case. PMID:28099609

  6. Presumed isotretinoin-induced extraocular myopathy

    PubMed Central

    Alam, Md. Shahid; Agarwal, Swati

    2016-01-01

    Isotretinoin a synthetic analogue of vitamin A is primarily used for cystic acne not responding to conventional treatment. Several ocular side effects including blurring of vision, decreased dark adaptation, corneal opacities and meibomian gland atrophy have been reported with prolonged use of isotretinoin. There have been reports of muscular damage caused by isotretinoin. Extra ocular myopathy as an adverse effect of long term used of isotretinoin has never been mentioned in literature. We report a case of a young male who presented to us with complaints of diplopia after using isotretinoin for a prolonged period. He was diagnosed as a case of presumed isotretinoin extraocular myopathy after imaging and other blood investigations. PMID:28163542

  7. Coping with the isotretinoin registry.

    PubMed

    Baldwin, Hilary E

    2006-01-01

    The isotretinoin registry has arrived. It has a lofty goal of preventing all isotretinoin pregnancies. How we got to this point and what the registry means to prescribers and patients have many dermatologists confused and concerned. Will it be burdensome, will it preclude the use in most offices of this most important drug? Will it breed a new group of "isotretinologists" who are willing to take on the challenge? This article endeavors to answer these questions and to put most concerns at rest. The new system seems ultimately to have few changes compared to the risk management program we are already (technically) following. The difference is that compliance with all the rules will be monitored and mandatory. The system seems user friendly, is accessible to the computer-savvy as well as those of us still addicted to telephone, and may well turn out to be much fuss made over minimal hassle. What is clear is that this is likely our last chance to save this wonderful drug from oblivion. It is time for dermatologists to step to the plate and do what is in the best interest of their patients.

  8. Sebaceous hyperplasia: systemic treatment with isotretinoin*

    PubMed Central

    Tagliolatto, Sandra; Santos, Octavio de Oliveira; Alchorne, Maurício Mota de Avelar; Enokihara, Mauro Yoshiaki

    2015-01-01

    The study aimed to verify the therapeutic action of isotretinoin in the treatment of sebaceous hyperplasia. During two months, 20 patients with sebaceous hyperplasia took isotretinoin at a dosage of 1mg/kg per day. Their skin lesions were counted and photographed before and after treatment and re-evaluated two years later. The average number of sebaceous hyperplasia lesions before treatment was 24 per patient. At the end of two months of therapy, the number of lesions decreased to 2 per patient. The statistically analyzed data showed a reduction in the number of lesions following isotretinoin use (p < 0.05). Two years after the end of the treatment, the average number of sebaceous hyperplasia lesions was 4 per patient. There were no severe side effects. Thus, the data analysis suggests that isotretinoin is a safe and effective drug for treating the disease under study. PMID:25830991

  9. Sebaceous hyperplasia: systemic treatment with isotretinoin.

    PubMed

    Tagliolatto, Sandra; Santos Neto, Octavio de Oliveira; Alchorne, Maurício Mota de Avelar; Enokihara, Mauro Yoshiaki

    2015-01-01

    The study aimed to verify the therapeutic action of isotretinoin in the treatment of sebaceous hyperplasia. During two months, 20 patients with sebaceous hyperplasia took isotretinoin at a dosage of 1mg/kg per day. Their skin lesions were counted and photographed before and after treatment and re-evaluated two years later. The average number of sebaceous hyperplasia lesions before treatment was 24 per patient. At the end of two months of therapy, the number of lesions decreased to 2 per patient. The statistically analyzed data showed a reduction in the number of lesions following isotretinoin use (p < 0.05). Two years after the end of the treatment, the average number of sebaceous hyperplasia lesions was 4 per patient. There were no severe side effects. Thus, the data analysis suggests that isotretinoin is a safe and effective drug for treating the disease under study.

  10. Isotretinoin for acne and rosacea.

    PubMed

    Watson, Kendra D; Miest, Rachel Y; Tollefson, Megha M

    2016-06-01

    Isotretinoin is a revolutionary medicine for the treatment of acne vulgaris, with new studies showing evidence of excellent clinical outcomes in treating rosacea. After 30 years of clinical experience, new insights are being gained into dosing strategies, recurrence prevention, and dose-related side effects. Previous controversial associations with inflammatory bowel diseases and mood disorders have hampered the use of this medication in some clinical situations, with new evidence disproving these claims. The teratogenicity of this medication mandates iPLEDGE compliance with government regulations. Clinicians should be knowledgeable about this medication including its side effects, teratogenicity, and its controversies in order to adequately counsel patients, dissuade fears, and obtain the best clinical outcome when treating acne and rosacea.

  11. A Case Report of Isotretinoin-induced Manic Psychosis

    PubMed Central

    Lucca, Jisha M; Varghese, Niphy Annie; Ramesh, Madhan; Ram, Dushad

    2016-01-01

    Isotretinoin, an oral vitamin A derivative, used to treat severe treatment-resistant acne. Psychiatric side effects of isotretinoin particularly depression and suicidal thoughts have been well documented. We report a case of isotretinoin-induced manic psychosis in a young female without a family history and history of mental illness. PMID:26955128

  12. Isotretinoin

    MedlinePlus

    ... activities you used to enjoy, poor performance at school or work, sleeping more than usual, difficulty falling asleep or staying asleep, irritability, anger, aggression, changes in appetite or weight, difficulty concentrating, withdrawing ...

  13. Managing nonteratogenic adverse reactions to isotretinoin treatment for acne vulgaris.

    PubMed

    Reilly, Bridget K; Ritsema, Tamara S

    2015-07-01

    Isotretinoin is the strongest, most effective oral treatment for patients with severe acne vulgaris, with remission rates of 89% and higher. Because of its potency, isotretinoin causes many adverse reactions. This article reviews common and severe adverse reactions to isotretinoin and how providers can best manage these reactions. Because of inconclusive research on the correlation between isotretinoin and depression and irritable bowel syndrome, providers should ask patients about symptoms monthly. Prescribing micronized isotretinoin and starting at the lowest dose with gradual upward titration also can help reduce the incidence of adverse reactions.

  14. Non-acne dermatologic indications for systemic isotretinoin.

    PubMed

    Akyol, Melih; Ozçelik, Sedat

    2005-01-01

    Systemic isotretinoin has been used to treat severe acne vulgaris for 20 years. However, isotretinoin also represents a potentially useful choice of drugs in many dermatologic diseases other than acne vulgaris. Diseases such as psoriasis, pityriasis rubra pilaris, condylomata acuminata, skin cancers, rosacea, hidradenitis suppurativa, granuloma annulare, lupus erythematosus and lichen planus have been shown to respond to the immunomodulatory, anti-inflammatory and antitumor activities of the drug. Isotretinoin also helps prevent skin cancers such as basal cell carcinoma or squamous cell carcinoma. A combination of systemic isotretinoin and interferon-alpha-2a may provide a more potent effect than isotretinoin alone in the prevention and treatment of skin cancers.Systemic isotretinoin may be considered as an alternative drug in some dermatologic diseases unresponsive to conventional treatment modalities. However, randomized clinical trials aimed at determining the role of systemic isotretinoin therapy in dermatologic diseases other than acne vulgaris are required.

  15. Treatment of condylomata acuminata with oral isotretinoin.

    PubMed

    Tsambaos, D; Georgiou, S; Monastirli, A; Sakkis, T; Sagriotis, A; Goerz, G

    1997-11-01

    The aim of our study was to evaluate the efficacy and safety of oral isotretinoin in the treatment of condylomata acuminata. A total of 56 male patients with a history of condylomata acuminata refractory to at least 1 standard therapeutic regimen was treated orally with isotretinoin (1 mg./kg. daily) during a 3-month period. At the end of treatment 21 of the 53 evaluated patients (39.6%) had complete response, 7 (13.2%) had partial response and 25 (47.1%) had no response. A statistically significant inverse relationship was found between age and area of treated lesions and response to medication. Two complete responders (9.5%) revealed recurrence during the 1-year followup. Oral isotretinoin may be regarded as an effective, fairly well tolerated and noninvasive alternative form of therapy for immature and small condylomata acuminata.

  16. Isotretinoin and FoxO1

    PubMed Central

    2011-01-01

    Oral isotretinoin (13-cis retinoic acid) is the most effective drug in the treatment of acne and restores all major pathogenetic factors of acne vulgaris. isotretinoin is regarded as a prodrug which after isomerizisation to all-trans-retinoic acid (ATRA) induces apoptosis in cells cultured from human sebaceous glands, meibomian glands, neuroblastoma cells, hypothalamic cells, hippocampus cells, Dalton's lymphoma ascites cells, B16F-10 melanoma cells, and neuronal crest cells and others. By means of translational research this paper provides substantial indirect evidence for isotretinoin's mode of action by upregulation of forkhead box class O (FoxO) transcription factors. FoxOs play a pivotal role in the regulation of androgen receptor transactivation, insulin/insulin like growth factor-1 (IGF-1)-signaling, peroxisome proliferator-activated receptor-γ (PPArγ)- and liver X receptor-α (LXrα)-mediated lipogenesis, β-catenin signaling, cell proliferation, apoptosis, reactive oxygene homeostasis, innate and acquired immunity, stem cell homeostasis, as well as anti-cancer effects. An accumulating body of evidence suggests that the therapeutic, adverse, teratogenic and chemopreventive effecs of isotretinoin are all mediated by upregulation of FoxO-mediated gene transcription. These FoxO-driven transcriptional changes of the second response of retinoic acid receptor (RAR)-mediated signaling counterbalance gene expression of acne due to increased growth factor signaling with downregulated nuclear FoxO proteins. The proposed isotretinoin→ATRA→RAR→FoxO interaction offers intriguing new insights into the mode of isotretinoin action and explains most therapeutic, adverse and teratogenic effects of isotretinoin in the treatment of acne by a common mode of FoxO-mediated transcriptional regulation. PMID:22110774

  17. Objective Assessment of Isotretinoin-Associated Cheilitis: Isotretinoin Cheilitis Grading Scale

    PubMed Central

    Ornelas, Jennifer; Rosamilia, Lorraine; Larsen, Larissa; Foolad, Negar; Wang, Quinlu; Li, Chin-Shang; Sivamani, Raja K.

    2016-01-01

    Importance Isotretinoin remains an effective treatment for severe acne. Despite its effectiveness, it includes many side effects, of which cheilitis is the most common. Objective To develop an objective grading scale for assessment of isotretinoin-associated cheilitis, Design Cross-sectional clinical grading study. Setting UC Davis Dermatology clinic. Participants Subjects were older than 18 years old and actively treated with oral isotretinoin. Exposures Oral Isotretinoin. Main outcomes and Measures We developed an isotretinoin cheilitis grading scale (ICGS) incorporating the following four characteristics: erythema, scale/crust, fissures, and inflammation of the commissures. Three board-certified dermatologists independently graded photographs of the subjects. Results The Kendall’s coefficient of concordance (KCC) for the ICGS was 0.88 (p<0.0001). The Kendall’s coefficient was ≥ 0.72 (p<0.0001) for each of the four characteristics included in the grading scale. An image-based measurement for lip roughness statistically significantly correlated with the lip scale/crusting assessment (r = 0.52, p <0.05). Conclusion and Relevance The ICGS is reproducible and relatively simple to use. It can be incorporated as an objective tool to aid in the assessment of isotretinoin associated cheilitis. PMID:26395167

  18. The use of isotretinoin in acne

    PubMed Central

    2009-01-01

    Systemic isotretinoin remains the most efficacious treatment for severe acne as well as many cases of more moderate disease that are unresponsive to other treatment modalities. The current chapter outlines the mechanisms behind the excellent efficacy, describes how to optimize treatment, reviews the recommended guidelines for monitoring and summarizes adverse effects. PMID:20436884

  19. [Isotretinoin: compliance with recommendations in childbearing women].

    PubMed

    Bensouda-Grimaldi, L; Jonville-Béra, A-P; Mouret, E; Elefant, E; Dhellot, H; Delmas, C; Gouin, T; Coste, P; Autret-Leca, E

    2005-05-01

    The aim of this survey is to ascertain if the incidence of isotretinoin exposed pregnancies was reduced by the late recommendations of prescription and issue (AMM modification on 06/08/2001 and 25/09/2001). All isotretinoin exposed pregnancies registered by the French Regional Drug Monitoring Centres, the Information Centre for Teratogenic Agents and Roche (Roaccutane), Pierre Fabre (Curacné Gé) and Expanscience (Procuta Gé) laboratories, from January 1st, 1999 to December 31st, 2002, were analysed. Enforcement of the strengthening of isotretinoin prescription recommendations was analysed on a sample of 68 prescriptions from 45 pharmacies throughout France. In 4 years, 103 isotretinoin exposed pregnancies (Roaccutane 97 p. 100, Curacné(R) Gé 3 p. 100) during teratogenic risk period, were registered. Pregnancy started less than one month after isotretinoin stopping (37 p. 100), during the treatment (43 p. 100), or was in progress when the treatment was initiated (20 p. 100). The reason of the 22 lacking contraception was known 12 times, i.e. an absence of prescription (6 times), a refusal to take a prescribed contraception (3 times) and a self-medication (3 times). Among the 71 pregnancies whose contraceptive status is known, 48 p. 100 could had been avoided if recommendations had been followed (pregnancies due to a premature stopping or an absence of contraception). The issue of pregnancies is a voluntary termination in 60 cases (87 p. 100). Malformations frequency is 25 p. 100. Incidence of isotretinoin exposed pregnancies remained stable, 0.26/1000 treated women (vs 0.34 after 2001's AMM modifications). Of 68 prescriptions studied, 23 (24 p. 100) carried all the legal warnings, which is close to the previous survey's results. Contraception was in accordance with the recommendations in 78 p. 100 of cases and women learned and applied information given in 38 p. 100 of cases. At last, only 6 patients (9 p. 100) have both a correctly written prescription, a

  20. Facial edema induced by isotretinoin use: a case and a review of the side effects of isotretinoin.

    PubMed

    Scheinfeld, Noah; Bangalore, Sripal

    2006-05-01

    Isotretinoin (13-cis-retinoic acid) is a retinoid that is used to treat cystic acne, comedonal acne, and other diseases. For the treatment of acne, isotretinoin is dosed at 0.5 to 2 mg/kg daily for 5 months with a target total dose of approximately 120 mg/kg. Its most common side effects are mucocutaneous and ocular in nature (ie, cheilitis, ocular sicca, and decreased dark adaptation). It can also cause xerosis. Patients should be made aware of these side effects before taking isotretinoin and also that utilization of moisturizers and eye drops can help to mitigate such side effects. Sometimes, however, the dose of isotretinoin needs to be decreased to reduce the induction of side effects. Isotretinoin's most significant side effect is the induction of birth defects if a fetus is exposed to isotretinoin, which is pregnancy category X. Isotretinoin should be used with 2 forms of birth control by fecund women. It can rarely increase serum levels of triglycerides, which can, if very elevated, be related to the development of pancreatitis and xanthomas. Isotretinoin's well-documented but rarer side effects include intracranial hypertension. It can induce bony changes. A review of the literature demonstrates that isotretinoin is not linked to depression and suicide. Facial swelling has been linked to isotretinoin use in 3 previous case reports. We note herein the first case of facial swelling that occurred in an acne patient being treated with isotretinoin who at the time the swelling developed had no cysts, comedones, pustules, or evidence of bacterial infection. Possible reasons for the patient's facial swelling include some type of retinoid induced angioedema, exacerbation of inflammation by isotretinoin, and isotretinoin induced capillary leak syndrome.

  1. Pityriasis rosea-like eruption induced by isotretinoin.

    PubMed

    Gürel, Gülhan; Şahin, Sevinç; Çölgeçen, Emine

    2017-04-19

    Pityriasis rosea is a common, self-limited and inflammatory skin disease. The etiology is not clearly known. Viral agents, autoimmunity, psychogenic factors and drugs have all been suggested as risk factors. Isotretinoin is usually used in the treatment of resistant, nodulocytic acne. We present a case of pityriasis rosea-like eruption induced by isotretinoin. To our knowledge, this is the second clinical case of pityriasis rosea-like eruption induced by isotretinoin.

  2. Occurrence of pregnancy and pregnancy outcomes during isotretinoin therapy

    PubMed Central

    Henry, David; Dormuth, Colin; Winquist, Brandace; Carney, Greg; Bugden, Shawn; Teare, Gary; Lévesque, Linda E.; Bérard, Anick; Paterson, J. Michael; Platt, Robert W.

    2016-01-01

    Background: Isotretinoin, a teratogen, is widely used to treat cystic acne. Although the risks of pregnancy during isotretinoin therapy are well recognized, there are doubts about the level of adherence with the pregnancy prevention program in Canada. Our objective was to evaluate the effectiveness of the Canadian pregnancy prevention program in 4 provinces: British Columbia, Saskatchewan, Manitoba and Ontario. Methods: Using administrative data, we identified 4 historical cohorts of female users of isotretinoin (aged 12–48 yr) for the period 1996 to 2011. We defined pregnancy using International Statistical Classification of Diseases and billing codes. One definition included only cases with documented pregnancy outcomes (high-specificity definition); the other definition also included individuals recorded as receiving prenatal care (high-sensitivity definition). We studied new courses of isotretinoin and detected pregnancies in 2 time windows: during isotretinoin treatment only and up to 42 weeks after treatment. Live births were followed for 1 year to identify congenital malformations. Results: A total of 59 271 female patients received 102 308 courses of isotretinoin. Between 24.3% and 32.9% of participants received prescriptions for oral contraceptives while they were taking isotretinoin, compared with 28.3% to 35.9% in the 12 months before isotretinoin was started. According to the high-specificity definition of pregnancy, there were 186 pregnancies during isotretinoin treatment (3.1/1000 isotretinoin users), compared with 367 (6.2/1000 users) according to the high-sensitivity definition. By 42 weeks after treatment, there were 1473 pregnancies (24.9/1000 users), according to the high-specificity definition. Of these, 1331 (90.4%) terminated spontaneously or were terminated by medical intervention. Among the 118 live births were 11 (9.3%) cases of congenital malformation. Pregnancy rates during isotretinoin treatment remained constant between 1996 and 2011

  3. Congenital neuroblastoma in a neonate with isotretinoin embryopathy.

    PubMed

    Aguilar, Shiley; Louis, Chrystal; Hicks, John; Zage, Peter; Russell, Heidi

    2014-03-01

    We describe a neonate with isotretinoin embryopathy and an incidental finding of congenital neuroblastoma. Diffuse liver metastases led to the decision to provide oncologic therapy followed by tumor resection. Despite the possible need for chronic care related to the comorbidities of the isotretinoin embryopathy and oncologic management, the patient remains disease-free. Because of the uncertain etiology of neuroblastoma, it remains unclear whether exposure to isotretinoin during embryogenesis and fetal development had an oncogenic effect on this patient.

  4. Affective psychosis following Accutane (isotretinoin) treatment.

    PubMed

    Barak, Yoram; Wohl, Yonit; Greenberg, Yifa; Bar Dayan, Yosefa; Friedman, Tali; Shoval, Gideon; Knobler, Haim Y

    2005-01-01

    Isotretinoin (Accutane) ranks in the top 10 of the US Food and Drug Administration's database of drugs associated with reports of depression and suicide attempts. However, this association is still controversial because up to 5.6% of patients with moderate acne may have pre-existing suicidal ideations, improvement of acne often reduces associated depression, and isotretinoin users are reportedly no more likely than those taking antibiotics for acne to have depression or commit suicide. We describe a series of cases of manic psychosis that developed in a 1-year period (2003) in association with isotretinoin treatment and resulted in suicidality and progression to long-standing psychosis. Cases were drawn from 500 soldiers who had been evaluated in a military specialists dermatology clinic for severe acne. Data were summarized from medical records of five severe acne patients treated by isotretinion during their compulsory military service. Data from their draft board examinations and service records, as well as repeated clinical assessments by certified psychiatrists at the Israel Defense Forces (IDF) Mental Health Department clinic, were evaluated. Five young adults developed manic psychosis within a mean of 7.6 months of exposure to isotretinoin. In three cases, this was accompanied by a suicide attempt, and in three cases, psychosis lasted for longer than 6 months. Either a personal history of obsessive-compulsive disorder, neurological insult or family history of a major psychiatric illness were present in all cases. The present case-series is suggestive of an increase in the likelihood of an association between exposure to isotretinion and manic psychosis. Associated risk factors were both family and personal history of psychiatric morbidity. Further studies are needed to establish our findings.

  5. Ovarian stimulation under the effect of isotretinoin.

    PubMed

    Cozzolino, Mauro; Domingo, Javier; Soares, Sérgio Reis

    2017-09-23

    Isotretinoin (13-cis-retinoic acid) is a pharmaceutical vitamin A analog that is frequently used in the treatment of severe cystic acne, many women at reproductive age being exposed to this substance. This drug has a clearly documented teratogenicity and data from rodents and humans indicate that a direct aggression to ovarian follicles also occurs. Here we report the case of a 29-year-old woman with breast cancer referred for emergency preservation of reproductive potential that used isotretinoin up to the day before the initiation of ovarian stimulation. Ultrasound scan showed an antral follicle count of 17 and 13 follicles on the right and the left ovary, respectively, and her antimüllerian hormone levels were 4.03 ng/ml. Standard ovarian stimulation for oocyte vitrification in oncological patients was initiated during the luteal phase and final estradiol levels were 49 pg/ml. Three mature oocytes were obtained. Other four oocytes were retrieved in the germinal vesicle and metaphase I developmental stage, all of which matured in vitro in the following 30 h and were also vitrified. Response to ovarian stimulation, both in terms of the number of mature oocytes obtained and serum sex steroids production were in the lower range of what is observed in patients with a similar clinical profile. These findings suggest that isotretinoin impairs follicular-oocyte maturation.

  6. Acute myocardial infarction in a young woman on isotretinoin treatment.

    PubMed

    Lorenzo, Natalia; Antuña, Paula; Dominguez, Lourdes; Rivero, Fernando; Bastante, Teresa; Alfonso, Fernando

    2015-02-15

    The use of isotretinoin has been associated with mild changes in the metabolic profile of adolescents. In very rare cases, a possible association with myocardial infarction, stroke and thromboembolic events has been reported. In this report we describe the potential association of isotretinoin with the occurrence of an acute myocardial infarction in a very young girl. OCT provided unique visualization of the culprit lesion.

  7. Comparative Study of Oral Isotretinoin Versus Oral Isotretinoin + 20% Salicylic Acid Peel in the Treatment of Active Acne

    PubMed Central

    Kar, Bikash Ranjan; Tripathy, Sanjita; Panda, Maitreyee

    2013-01-01

    Background: Acne is a self limiting condition that often results in scarring and disfigurement disproportionate to its clinical severity. Isotretinoin is considered the gold standard in the medical management of severe form of acne vulgaris. Salicyclic acid (SA) peels, a β- hydroxy acid peel has got sebosuppressive effect and helps in faster resolution of acne with minimal scarring. It also decreases the post inflammatory hyperpigmentation. Combining both the modalities is usually not advocated because of expected excessive dryness and irritation Aims: To compare the efficacy of oral isotretinoin and oral isotretinoin with 20% SA peels in patients with moderate to severe acne. Materials and Methods: 60 consecutive patients with moderate to severe facial acne attending the skin department were randomized in to 2 groups. 1st group received 20mg oral isotretinoin once daily for 16 weeks and 2nd group received 20mg oral isotretinoin once daily along with 20% SA peels every two weeks for 16 weeks. Baseline grading of acne was done with Michelsons Acne severity index (MASI).Right and left sides of the face were scored separately and total score was taken. Severity score was assessed monthly .Clinical photographs were obtained for evaluation every month. Patients were asked to follow up once every 2 weeks or earlier in case of any adverse events. Results: Patients in both the groups revealed a reduction in the number of lesions. The 1st group showed a reduction of approximately 73.4% after receiving 20mg oral isotretinoin for 16 weeks. The 2nd group showed a reduction of approximately 92.5 % after receiving 20mg oral isotretinoin along with 20% SA peel once every 2 weeks for 16 weeks. Conclusion: Both oral isotretinoin and combination of oral isotretinoin with 20% SA peels once every 2 weeks are effective in treating moderate to severe acne but the combination showed significantly better clearance of acne than monotherapy with isotretinoin. PMID:24470716

  8. Isotretinoin exposure and risk of inflammatory bowel disease.

    PubMed

    Rashtak, Shadi; Khaleghi, Shahryar; Pittelkow, Mark R; Larson, Joseph J; Lahr, Brian D; Murray, Joseph A

    2014-12-01

    IMPORTANCE Isotretinoin is the standard treatment for refractory severe nodulocystic acne.A true association between prior isotretinoin use and development of inflammatory bowel disease (IBD) is uncertain. Addressing the reality of this association is important in decision making for both the clinician and the patient when isotretinoin treatment is indicated.OBJECTIVE To assess the risk of IBD mainly in patients with acne with and without isotretinoin exposure.DESIGN, SETTING, AND PARTICIPANTS In this retrospective, single-center study, the electronic medical records of patients who were primarily seeking acne treatment were reviewed for isotretinoin exposure. International Classification of Diseases, Ninth Revision (ICD-9) codes were used to search for IBD diagnosis. participants included 1078 patients from 1995 to 2011,with isotretinoin referenced in their medical records, and who had ongoing local medical care defined as having had a serum sample collected between 2006 to 2011 for any reason while an Olmsted County, Minnesota, resident at the time of serum sample collection.EXPOSURES The exposed group included the patients with confirmed prior isotretinoin exposure (n = 576), and the nonexposed group were defined as patients who never received isotretinoin or received it after the diagnosis of IBD (n = 502).MAIN OUTCOMES AND MEASURES Risk of IBD among isotretinoin-exposed vs non exposed patients.RESULTS Both groups were comparable by race, prior systemic antibiotic use, and systemic tetracycline use. Inflammatory bowel disease developed less frequently in the isotretinoin-exposed group vs the nonexposed group (0.9%vs 2.6%; P = .03; unadjusted odds ratio [OR], 0.33; 95%CI, 0.12-0.93; P = .04). The negative association between isotretinoin exposure and IBD remained after adjusting for sex (OR, 0.28; 95%CI, 0.10-0.80;P = .02) and for sex and non acne indication (OR, 0.28; 95%CI, 0.10-0.79; P = .02).CONCLUSIONS AND RELEVANCE Our study did not show an increased risk

  9. Does isotretinoin therapy of acne cure or cause depression?

    PubMed

    Borovaya, Alena; Olisova, Olga; Ruzicka, Thomas; Sárdy, Miklós

    2013-09-01

    Cosmetic defects in acne may provoke a wide range of mental disorders (depressive, social-phobic, etc.). Isotretinoin is a very effective acne treatment; hence, it usually resolves the associated mental disorders. However, more available data show the possible association of taking isotretinoin and the onset of a depressive syndrome that includes frank depression and even suicidal ideation. The frequency of depressive disorders during isotretinoin treatment varies from 1% to 11% in different studies, and it is unclear whether this is a consequence of isotretinoin therapy. Since it crosses the blood-brain barrier, isotretinoin affects the expression of a broad spectrum of genes in the limbic structures, thus affecting the function of the dopaminergic, serotonergic, and noradrenergic neurons involved in the regulation of mood and emotion. It was suggested that isotretinoin in high concentrations inhibits hippocampal neurogenesis and induces apoptosis of hippocampal cells. However, some studies do not confirm this pathogenic role, and isotretinoin was even reported to have a therapeutic effect in acne-associated depression. In this review, we highlight epidemiological data, the underlying molecular pathogenesis, and the aspects of prevention concerning retinoid-induced depression in acne from the practical point of view of a dermatologist.

  10. Oral Isotretinoin: New Developments Relevant to Clinical Practice.

    PubMed

    Tan, Jerry; Boyal, Sanwarjit; Desai, Karishma; Knezevic, Sanja

    2016-04-01

    Oral isotretinoin is unrivalled in efficacy and remission capability for treatment of acne. In addition to appropriate monitoring and continued vigilance for safety concerns, appropriate dosing to mitigate avoidable dose-dependent adverse effects is the responsibility of prescribers. Low-dose regimens are better tolerated and effective in inducing acne clearance. Although much progress has been made since the advent of isotretinoin, there remain many unanswered questions regarding optimization to maximize response while minimizing the potential for avoidable adverse events. The ongoing availability of isotretinoin is imperative to patients with acne, their caregivers, and physicians.

  11. Isotretinoin and mental health in adolescents: Australian consensus.

    PubMed

    Rowe, Casey; Spelman, Lynda; Oziemski, Margaret; Ryan, Alexander; Manoharan, Shobhan; Wilson, Perry; Daubney, Michael; Scott, James

    2014-05-01

    Acne is a common condition among adolescents and has the potential to negatively impact on the psychological well-being of those who suffer from it. In particular, depression and suicidal ideation are more common in adolescents with acne. Successful treatment of acne can improve the quality of life and reduce levels of anxiety and depression in these individuals. The current treatment of choice for severe or refractive acne is isotretinoin, a retinoid. While the possible causal association between isotretinoin and mental illness remains a controversial topic, a recent systematic review has presented evidence to support this relationship. In light of this evidence, a group of dermatologists and psychiatrists have collaborated to develop these recommendations to aid the safe prescribing of isotretinoin in adolescents. These clinical suggestions are aimed at practitioners in both disciplines to increase awareness of the current evidence in support of the association between isotretinoin and adolescent depression.

  12. [Isotretinoin and exercise: can the two walk together?].

    PubMed

    Dalal, Adam; Ben-Barak, Shira; Zlotogorski, Abraham; Constantini, Naama

    2014-02-01

    Since its introduction in 1982, isotretinoin has revolutionized acne treatment, targeting the underlying mechanism of the disease, with effective and long-lasting results. During the first decade of its marketing, several cases of hyperCKemia and rhabdomyolysis were linked to isotretinon therapy. A special concern was given to the possible triggering of muscle toxicity by vigorous exercise. These potential effects discouraged the prescription of isotretinoin to physically active patients or required them to abstain from exercise during treatment. Common musculoskeletal adverse effects of isotretinoin include muscle or joint pains. HyperCKemia is frequently found in patients receiving treatment for rare cases of rhabdomyolysis. Isotretinoin-associated muscle toxicity is usually detected in asymptomatic patients, even though symptoms can appear without hyperCKemia. A possible synergistic effect of isotretinoin and exercise is plausible, although supported by weak evidence and mediated by an unknown mechanism. There are only two reports of myoglobinuria and no reports of decreased renal function in exercising patient under treatment. In conclusion, we believe that current data should not deter physicians from offering isotretinoin to physically active patients nor require them to abstain from exercise. Physicians must explain to patients the possible side effects of treatment, ask them to refrain from an unusual change in their exercise regimen and advise them to avoid other triggers of rhabdomyolysis. Patients should be aware of possible signs of muscle toxicity and inform their doctors about any relevant symptoms.

  13. Isotretinoin-induced arthritis mimicking both rheumatoid arthritis and axial spondyloarthritis.

    PubMed

    Yilmaz Tasdelen, Ozlem; Yurdakul, Fatma Gul; Duran, Semra; Bodur, Hatice

    2015-05-01

    Isotretinoin is used for the treatment of various acne lesions that are resistant to other treatments. The most frequent rheumatologic side effect of isotretinoin is transient muscle and/or joint pains. Here, we report a case with bilateral wrist and metacarpophalangeal joint arthritis and unilateral sacroiliitis associated with isotretinoin usage to attract attention, particularly from physiatrists, rheumatologists and dermatologists, to this rare adverse effect of isotretinoin.

  14. Predictive markers of response to isotretinoin in female acne.

    PubMed

    Preneau, Sophie; Dessinioti, Clio; Nguyen, Jean-Michel; Katsambas, Andreas; Dreno, Brigitte

    2013-01-01

    Acne vulgaris is a common and chronic disorder of the pilosebaceous unit. Female acne may be a subtype differing from teenager acne. Isotretinoin is the only therapy impacting on all the major acne-related aetiological factors. All clinical studies demonstrating isotretinoin efficacy in acne patients have been performed either in teenagers or in a mixed population of teenagers and adults. To evaluate isotretinoin efficiency and tolerance in a cohort of females with acne, aged 20+ years. Study of 32 women prescribed isotretinoin according to the European recommendations (0.5 mg/kg) in two dermatology departments (France and Greece). The ECLA scale and a global evaluation using the GEA grading were used to evaluate isotretinoin efficacy. The correlation between the clinical response and the different epidemiological factors was determined. Complete response reached 59% on the face, 78% on the trunk and 43% on both the face and trunk. A significant correlation was observed between the facial response and body mass index (p = 0.02), the high-glycemic-load diet (p = 0.0009), tobacco (p = 0.05) and age at acne onset (p = 0.05). Isotretinoin at 0.5mg/kg is effective and well tolerated in mild-to-moderate acne in females over 20 years old and results were similar to those of teenagers and men. We can propose positive predictive markers of response to isotretinoin in female acne, including a low body mass index, low glycemic-load diet, no tobacco, absence of early acne onset and of lesions on the neck.

  15. Mortality in the randomized, controlled lung intergroup trial of isotretinoin.

    PubMed

    Lee, J Jack; Feng, Lei; Reshef, Daniel S; Sabichi, Anita L; Williams, Brendell; Rinsurongkawong, Waree; Wistuba, Ignacio I; Lotan, Reuben; Lippman, Scott M

    2010-06-01

    In 2001, we reported that mortality may have been higher with isotretinoin (30 mg/d for 3 years) than with placebo in the subgroup of current smokers among the 1,166 patients with definitively resected early-stage non-small cell lung cancer who participated in the randomized, controlled Lung Intergroup Trial. We report the overall and cause (cancer, cardiovascular disease, or other)-specific mortality associated with long-term isotretinoin after an extended median follow-up of 6.2 years that included the capture of cause-of-death data from 428 deceased patients. Overall mortality was 36.7% in each of the two trial arms, about two thirds related to cancer and one third to other or unknown causes. Overall and cancer deaths increased in current smokers in the isotretinoin arm during the treatment and the extended follow-up period. No mortality end point increased among never smokers and former smokers taking isotretinoin, and cancer deaths decreased marginally in this combined subgroup. Isotretinoin also increased deaths from cardiovascular disease in current smokers. The present analysis supports the safety of protracted isotretinoin use in the combined group of never smokers and former smokers, which has important public health implications, for example, for treating acne in young people. The increased mortality in current smokers in this study is further evidence of the multifaceted danger of active smoking. The overall indications of this study have public health implications for treating acne in young people and other uses of retinoids in smokers.

  16. Isotretinoin Oil-Based Capsule Formulation Optimization

    PubMed Central

    Tsai, Pi-Ju; Huang, Chi-Te; Lee, Chen-Chou; Li, Chi-Lin; Huang, Yaw-Bin; Tsai, Yi-Hung; Wu, Pao-Chu

    2013-01-01

    The purpose of this study was to develop and optimize an isotretinoin oil-based capsule with specific dissolution pattern. A three-factor-constrained mixture design was used to prepare the systemic model formulations. The independent factors were the components of oil-based capsule including beeswax (X1), hydrogenated coconut oil (X2), and soybean oil (X3). The drug release percentages at 10, 30, 60, and 90 min were selected as responses. The effect of formulation factors including that on responses was inspected by using response surface methodology (RSM). Multiple-response optimization was performed to search for the appropriate formulation with specific release pattern. It was found that the interaction effect of these formulation factors (X1X2, X1X3, and X2X3) showed more potential influence than that of the main factors (X1, X2, and X3). An optimal predicted formulation with Y10 min, Y30 min, Y60 min, and Y90 min release values of 12.3%, 36.7%, 73.6%, and 92.7% at X1, X2, and X3 of 5.75, 15.37, and 78.88, respectively, was developed. The new formulation was prepared and performed by the dissolution test. The similarity factor f2 was 54.8, indicating that the dissolution pattern of the new optimized formulation showed equivalence to the predicted profile. PMID:24068886

  17. [Treatment of acne by isotretinoin (general course)].

    PubMed

    Chivot, Martine

    2002-04-15

    Acne is a chronic disease which evolves under periodic eruptions. Resolution occurs around the late teens. Conventional treatment clears the lesions, but treatment by isotretinoin alone can achieve long remissions indeed definitive clearing. Indications are nodulo-cystic acne and resistant acne to a conventional treatment of at least 3 months duration. This drug is prescribed in cures, a cure is the period during which the patient receives a continuous treatment. The daily dose is computed according to the patient's weight and varies between 0.5 and 1 mg/kg. To prevent relapses, it is recommended to cumulate a dose between 100 and 150 mg/kg. No other topical or systemic treatment is needed. Side effects exist, among which teratogenicity is the most severe. Very strict contraception is necessary for women of child-bearing age. The most important mucocutaneous side effect is dryness and has to be counteracted by emollients. It is recommended that the drug be prescribed by doctors having a fair experience of oral retinoids and a perfect understanding of the teratogenic risk of the drug.

  18. Are we underdosing acne patients with generic isotretinoin?

    PubMed

    Mutizwa, Misha M; Sheinbein, David M

    2013-01-15

    With Roche's withdrawl of Accutane from the U.S. market in 2009, isotretinoin has only been available in its generic form. Many clinicians fail to realize that for approval by the U.S. Food and Drug Administration, a generic medication must have a bioequivalence between 80 percent and 125 percent of that of the innovator product. This potential variability in bioavailability between branded and generic medications is important to keep in mind with isotretinoin, given the implications for achieving a sustained remission in acne patients.

  19. Treatment of an infantile acne with oral isotretinoin.

    PubMed

    Sarazin, F; Dompmartin, A; Nivot, S; Letessier, D; Leroy, D

    2004-01-01

    We report the case of a little girl who presented with a nodulocystic acne which had its onset at the age of 20 months. She had no clinical or biological features of endocrinopathy. The lesions did not respond to conventional antibiotics so she was started on oral isotretinoin. A seven-month treatment period was necessary to achieve remission. The onset of infantile acne is usually around 6 to 16 months and there is a male predominance. The onset is later in females. Oral erythromycin is the first line treatment when topical therapies are inefficacious. Some cystic lesions do not respond to oral antibiotics. In these cases, oral isotretinoin may be effective and the treatment is similar to that of an adult. Clinical and biological tolerance is good with no growth retardation. Lesions may relapse after the withdrawal of isotretinoin but they are less important and easily controlled with topical treatments. Isotretinoin can be used for nodulocystic acne to reduce the risk of scarring.

  20. Isotretinoin therapy for acne vulgaris: results in an Irish population.

    PubMed

    Buckley, D; Rogers, S; Daly, P

    1990-01-01

    The results of treatment of cystic and antibiotic-resistant acne vulgaris in 96 consecutive patients with the oral retinoid isotretinoin (13-cis-retinoic acid; Roacentane) are reported retrospectively. The results show that the drug, while toxic in the short term, is highly effective in clearing acne.

  1. Systemic corticosteroid and isotretinoin treatment in cystic acne.

    PubMed

    Karvonen, S L; Vaalasti, A; Kautiainen, H; Reunala, T

    1993-12-01

    Prednisolone combined with erythromycin was given to 6 patients with cystic acne. The treatment responses were compared to those in 6 patients with cystic acne receiving isotretinoin and erythromycin and also to those in 3 patients with acne fulminans treated with prednisolone and erythromycin. During the first 4 weeks cystic acne showed a clear improvement in 5 out of 6 patients in both treatment groups. A similar improvement occurred in all 3 patients with acne fulminans. When corticosteroid was stopped, 2 out of 5 patients with cystic acne had a relapse and needed isotretinoin for complete control. In the isotretinoin-treated group, one patient with cystic acne needed prednisolone because the acne worsened to an ulcerative form. Slightly elevated liver enzymes, possibly due to erythromycin treatment, were observed in 2 patients with cystic acne and in one patient with acne fulminans. The present results show that prednisolone combined with erythromycin is an effective treatment during the early stages of cystic and febrile acne, but isotretinoin is needed for long-term control.

  2. Asymmetric crying face in a newborn with isotretinoin embryopathy.

    PubMed

    Sarici, Dilek; Akin, Mustafa Ali; Kurtoglu, Selim; Uzum, Kazim; Kiraz, Aslihan

    2013-01-01

    We report a newborn with asymmetric crying face and other anomalies whose mother had taken isotretinoin during the first month of pregnancy. We hypothesize that asymmetric crying face is a finding of retinoic acid embryopathy and results from the intrauterine effects of retinoic acid on the development of the depressor anguli oris muscle or the mandibular branch of the facial nerve.

  3. Changes of psychiatric parameters and their relationships by oral isotretinoin in acne patients.

    PubMed

    Hahm, Bong Jin; Min, Seong Uk; Yoon, Mi Young; Shin, Yong Wook; Kim, Jin Sook; Jung, Jae Yoon; Suh, Dae Hun

    2009-05-01

    Oral isotretinoin is a highly effective agent for the treatment of moderate to severe acne, but ever since oral isotretinoin was introduced as a modality for acne, the relationship between oral isotretinoin therapy and psychiatric problems, especially depression, has been controversial. The purposes of this study were to know the acute effects of oral isotretinoin therapy on psychiatric symptoms and to investigate the relationships among them, which have not been reported in the published work. This cohort study included 38 acne patients who started oral isotretinoin therapy. Individual patients were examined before administering oral isotretinoin and 2 and 8 weeks after commencement. Acne severity was graded using the Leeds revised acne grading system. Acute psychiatric effects of oral isotretinoin were assessed using a questionnaire authorized by two psychiatrists. This questionnaire included assessments of acne-related quality of life (Assessment of the Psychological and Social Effects of Acne [APSEA]), depression (Beck's depression inventory [BDI]), anxiety (Beck's anxiety inventory [BAI]) and psychopathology (Symptomchecklist-90-revised [SCL-90-R]). Acne grading and APSEA showed similar change patterns. Both improved after 8 weeks of oral isotretinoin treatment. On the other hand, the severity of depression decreased after 2 weeks of treatment. A significant correlation was found between BDI and APSEA, but no correlation was found between BDI and acne grade. These results indicate that oral isotretinoin therapy alleviates depressive symptoms. Improvements in depression are directly related to acne-related life quality improvements rather than to improvement in acne grade.

  4. Updated Physician’s Guide to the Off-label Uses of Oral Isotretinoin

    PubMed Central

    Peterson, Nathan; Peterson, Michael

    2014-01-01

    While oral isotretinoin is renowned for its ability to treat acne vulgaris, many of its off-label uses continue to go underappreciated. Since the last review on the unapproved indications of isotretinoin, relevant publications have surfaced with new recommendations. This article attempts to provide physicians with the latest information regarding successful and unsuccessful use of isotretinoin as an effective treatment for dermatological conditions, such as rosacea, psoriasis, pityriasis rubra pilaris, condyloma acuminatum, granuloma annulare, Darier’s disease, systemic cutaneous lupus erythematosus, nonmelanoma skin cancer, and hidradenitis suppurativa. Variations in dosage regimens and isotretinoin viability as an alternative to other standard treatments are also discussed in relation to these conditions. PMID:24765227

  5. Dermatologists' attitudes, prescription, and counseling patterns for isotretinoin: a questionnaire-based study.

    PubMed

    Nagler, Arielle R; Orlow, Seth J

    2015-02-01

    Isotretinoin, the most effective therapy for severe acne, has engendered controversy. These controversies impact dermatologists' opinions of isotretinoin and prescription behaviors. This study was designed to characterize dermatologists' opinions of controversies surrounding isotretinoin, as well as counseling and prescribing practices. A 25-question survey was emailed to 7,013 dermatologists included in a proprietary database (MBD, Inc.) and anonymous responses were collected. 591 board-certified dermatologists participated. Thirty-seven percent of the responding dermatologists believe that isotretinoin may cause psychiatric disturbances. Dermatologists' opinions on this relationship did not significantly impact prescription practices in patients with history of depression (P=0.056) or in patients being treated with an antidepressant (P=0.118). A larger percentage of dermatologists surveyed believe there is a causal relationship between isotretinoin and psychiatric disturbances than isotretinoin and IBD. Of the surveyed dermatologists, 2.7% believe there is a causal association between isotretinoin and inflammatory bowel disease IBD. In addition, physicians with 20 or fewer years of experience, which included 50% of the responding dermatologists, were significantly less likely to have read the patient brochure (P=0.004), and more likely to prescribe isotretinoin to patients who had not failed systemic antibiotics (P=0.015). This questionnaire also may highlight a practice gap, as more recently trained dermatologists appear less likely to require failure of systemic antibiotics prior to initiating isotretinoin.

  6. Paronychia and granulation tissue formation during treatment with isotretinoin*

    PubMed Central

    Figueiras, Daniela de Almeida; Ramos, Ticiana Batista; Marinho, Ayana Karla de Oliveira Ferreira; Bezerra, Milena Soneley Mendonça; Cauas, Renata Cavalcanti

    2016-01-01

    This paper describes the association of two unusual side effects of treatment with isotretinoin for severe acne: paronychia and excess granulation tissue in the nails furrows. We report a case of male patient aged 19 years, who in the course of the 36th week of treatment with isotretinoin for acne grade III showed erythema, edema, excess granulation tissue and onychocryptosis in various nail beds of hands and feet, with no history of trauma associated. A literature review revealed few reports of these adverse events, and two clinical patterns of exuberant granulation tissue has been described: one in periungual location and other in lesions of previous acne. The rarity and lack of knowledge on the best treatment for granuloma-like reactions make this theme a considerable challenge. PMID:27192525

  7. Isotretinoin and acne--a study of relapses.

    PubMed

    Chivot, M; Midoun, H

    1990-01-01

    A study was carried out involving 172 patients with acne which warranted treatment with isotretinoin. Patients were followed up for between 12 and 41 months after discontinuation of treatment and the number of relapses was assessed. 37 patients (21%) relapsed. These relapses were correlated with patients' age, length of disease progression prior to treatment, total dose received, daily dose, duration of treatment and severity of acne. It appeared that only young age and severity of acne influenced the percentage of relapse.

  8. Improvement of cystic fibrosis during treatment with isotretinoin.

    PubMed

    Buckley, Jennifer L; Chastain, Mark A; Rietschel, Robert L

    2006-01-01

    A 15-year-old boy with a history significant for multiple respiratory infections since birth presented for evaluation of acne vulgaris. He was initially prescribed doxycycline, topical tretinoin, and topical clindamycin solution, with the later addition of a benzoyl peroxide preparation to his regimen. The patient returned 6 months later after having been diagnosed with CF (cystic fibrosis) by sweat testing and genetic testing. His skin condition had not responded adequately to prior therapy, so all acne medications were discontinued. The 84-kg patient was started on 80 mg (0.95 mg/kg/d) of isotretinoin (13-cis-retinoic acid) daily. The patient's dose was decreased to 40 mg/d 2 weeks later following an episode of blood in his stool and epistaxis. At the 1- and 2-month follow-up visits, the patient reported improvement in his acne and mentioned that his lung secretions seemed reduced. His acne cleared after 4 months of therapy, so the isotretinoin was discontinued. The patient and his mother noted that no respiratory infections had occurred during the course of therapy. The patient's acne relapsed nearly 2 years later, so isotretinoin was restarted at 60 mg/d. During the next 7 months while on the drug, he experienced no further episodes of epistaxis or bloody stools and his acne had resolved by the end of therapy. The patient and his mother again reported fewer bronchopulmonary secretions and no infections requiring antibiotics during treatment with isotretinoin. This was unusual because he had experienced numerous respiratory infections requiring antibiotics during the prior 2 years. Since discontinuing the drug, the patient has had intermittent pulmonary infections and exacerbations in the symptomatology of his CF.

  9. Efficacy of vitamin E to prevent dermal complications of isotretinoin.

    PubMed

    Goforoushan, Farideh; Azimi, Hamideh; Goldust, Mohamad

    2013-06-01

    Acne treatment depends on whether patents have a mild, moderate, or severe type of acne. The aim of this study was to compare the using of Isotretinoin (Rokutan) with and without oral vitamin E in treating acne. This study was performed on 60 patients on 0.5 mg/kg/day isotretinoin treatment for 6 months. The first group received 800 IU day(-1) Vit E during treatment and the second group recieved 800 Iu day(-1) cod liver oil capsules. All patients were observed for the complications at 1th, 4th and 6th weeks during treatment. Cheilitis was the most common side effect among these patients (69%). Epistaxis was the second side effect in both groups (22%). Other side effects were xerosis, pruritus, epigastric pain and nail fragility. The frequency and the severity of complications were less common at 4th and 6th weeks of treatment. Isotretinoin is a useful and effective drug in treating severe and treatment-resistance acne lesions.

  10. Oral isotretinoin. How can we treat difficult acne patients?

    PubMed

    Leyden, J J

    1997-01-01

    Isotretinoin (Roaccutane/Accutane) therapy (120 mg/kg) normally results in complete clearing of nodulocystic acne followed by prolonged remission, and many patients remain free of disease. Four groups of patients respond poorly or have a high rate of relapse. Preteens and young teenagers show a high rate of relapse and several courses of treatment are usually needed; 14 of 20 under the age of 12 years, 21 of 47 aged 12-14 and 23 of 66 aged 14-16 relapsed within 1 year. Individuals with linear lesions consisting of undermining tracks of follicular epithelium often show only a partial response. These individuals typically have a history of other 'sinus track' disease such as pilonidial sinus and hidradenitis, either themselves or other family members. Hemorrhagic or crusted lesions can be exacerbated by full doses of isotretinoin and patients develop pyrogenic-granuloma-type lesions and even acne-fulminans-like eruptions. Women with adrenal or ovarian syndrome associated with elevated androgens commonly relapse with 6-12 months after isotretinoin therapy.

  11. Isotretinoin-induced acute severe myopathy involving pelvic girdle muscles: A case report

    PubMed Central

    Sameem, Farah; Semira

    2016-01-01

    Oral isotretinoin has been in widespread use for more than three decades. It causes numerous side effects; skin and mucous membrane being commonly involved. Musculoskeletal adverse effects are also known to occur, but pelvic girdle myopathy is rarely reported. We report myopathy involving pelvic girdle muscles in a young male who received oral isotretinoin for folliculitis decalvans. PMID:27721552

  12. Depression and suicidal behavior in acne patients treated with isotretinoin: a systematic review.

    PubMed

    Marqueling, Ann L; Zane, Lee T

    2005-06-01

    Isotretinoin (13-cis retinoic acid) is an effective treatment for severe cystic or recalcitrant acne vulgaris; however, concerns have been raised regarding its potential association with depression and suicidal behavior. We sought to explore the proposed relationship between isotretinoin use and the risk of depression and attempted and completed suicide in patients with acne vulgaris by performing a systematic literature search for studies reporting primary data on depression and suicidal behavior in patients treated with isotretinoin for acne vulgaris. Nine studies met the qualifying criteria for our analysis. Rates of depression among isotretinoin users ranged from 1% to 11% across studies, with similar rates in oral antibiotic control groups. Overall, studies comparing depression before and after treatment did not show a statistically significant increase in depression diagnoses or depressive symptoms. Some, in fact, demonstrated a trend toward fewer or less severe depressive symptoms after isotretinoin therapy. This decrease was particularly evident in patients with pretreatment scores in the moderate or clinical depression range. No correlation between isotretinoin use and suicidal behavior was reported, although only one retrospective study presented data on this topic. Although the current literature does not support a causative association between isotretinoin use and depression, there are important limitations to many of the studies. The available data on suicidal behavior during isotretinoin treatment are insufficient to establish a meaningful causative association.

  13. Depression and suicidal behavior in acne patients treated with isotretinoin: a systematic review.

    PubMed

    Marqueling, Ann L; Zane, Lee T

    2007-12-01

    Isotretinoin (13-cis retinoic acid) is an effective treatment for severe cystic or recalcitrant acne vulgaris; however, concerns have been raised regarding its potential association with depression and suicidal behavior. We sought to explore the proposed relationship between isotretinoin use and the risk of depression and attempted and completed suicide in patients with acne vulgaris by performing a systematic literature search for studies reporting primary data on depression and suicidal behavior in patients treated with isotretinoin for acne vulgaris. Nine studies met the qualifying criteria for our analysis. Rates of depression among isotretinoin users ranged from 1% to 11% across studies, with similar rates in oral antibiotic control groups. Overall, studies comparing depression before and after treatment did not show a statistically significant increase in depression diagnoses or depressive symptoms. Some, in fact, demonstrated a trend toward fewer or less severe depressive symptoms after isotretinoin therapy. This decrease was particularly evident in patients with pretreatment scores in the moderate or clinical depression range. No correlation between isotretinoin use and suicidal behavior was reported, although only one retrospective study presented data on this topic. Although the current literature does not support a causative association between isotretinoin use and depression, there are important limitations to many of the studies. The available data on suicidal behavior during isotretinoin treatment are insufficient to establish a meaningful causative association.

  14. Role of isotretinoin in cancer prevention and management in malignancies associated with xeroderma pigmentosum.

    PubMed

    Zaman, Sajid; Gillani, Jawad A; Nabeela; Khattak, Rauf; Iqbal; ul Ain, Noor; Zanaib; Fayyaz

    2014-01-01

    We report a case of 15 year old female patient of xeroderma pigmentosum with large squamous cell carcinoma on the left side of cheek. She received combination chemotherapy with isotretinoin for a period of 4 months and showed complete clinical remission of tumour. The role of isotretinoin in cancer prevention and management of malignancies associated in xeroderma pigmentosum is also reviewed through literature.

  15. Decreased ovarian reserve in female Sprague-Dawley rats induced by isotretinoin (retinoic acid) exposure.

    PubMed

    Abali, Remzi; Yuksel, Mehmet Aytac; Aktas, Cevat; Celik, Cem; Guzel, Savas; Erfan, Gamze; Sahin, Onder

    2013-08-01

    Isotretinoin is a retinoid widely used for the treatment of severe nodulocystic acne. Although it has broad side effects, there is no well-designed study about its effects on the ovary. This study investigated possible toxic effects of isotretinoin on female gonads. A total of 30 female rats were randomly divided into three equal groups according to the dose of isotretinoin they were administered: 0 mg/kg/day (group 1), 7.5 mg/kg/day (group 2) or 15 mg/kg/day (group 3). Thirty days after the treatment, the effects of isotretinoin on the ovaries were evaluated with serum anti-Müllerian hormone (AMH) concentrations, apoptosis by TUNEL assay and immunohistochemical observations by proliferating cell nuclear antigen (PCNA). The percentage of atretic follicles was calculated for each stage of folliculogenesis. The serum AMH concentrations were found to be lower in both isotretinoin groups. The percentage of atretic follicles in both isotretinoin groups was higher than the control. The number of PCNA-positive granulosa cells was decreased in the isotretinoin groups. The number of ovarian follicles with apoptotic granulosa cells was increased in the experimental groups. These data are the first to identify that exposure of isotretinoin may be responsible for decreased ovarian reserve and toxic effects on rat ovaries.

  16. A practical approach for the use of oral isotretinoin for infantile acne.

    PubMed

    Barnes, Cheryl J; Eichenfield, Lawrence F; Lee, Jungho; Cunningham, Bari B

    2005-01-01

    Infantile acne is a rare occurrence. It is more common in boys and predominately occurs on the cheeks in infants between the ages of 1 and 16 months. Clinically, the lesions range from comedones to inflammatory papulopustules to cysts. Successful therapies include topical tretinoin, benzoyl peroxide and topical and oral erythromycin. For more serious cases, oral isotretinoin (Accutane) has been reported to successfully treat recalcitrant infantile cystic acne. We describe two additional patients with infantile cystic acne treated successfully with oral isotretinoin. The dose of isotretinoin used ranged from 0.2 mg/kg/day to 1.5 mg/kg/day. The treatment duration varied from 5 to 14 months. Careful monthly monitoring is recommended because of the many side effects reported with isotretinoin. Practical tips for the administration of oral isotretinoin in infants are reviewed.

  17. Isotretinoin-induced skin fragility in a teenaged athlete: a case report.

    PubMed

    Pavlis, Michelle B; Lieblich, Lawrence

    2013-07-01

    Isotretinoin is approved by the US Food and Drug Administration for the treatment of severe recalcitrant nodular acne. Mucocutaneous toxicity is the most commonly observed side effect of isotretinoin use. Because atrophy and skin fragility may occur while taking isotretinoin, most warnings recommend avoidance of cosmetic procedures, such as dermabrasion, laser treatments, waxing, and chemical peels. We report a case of isotretinoin-induced skin fragility in a 16-year-old adolescent boy who presented with an unusual amount of skin erosions and excoriations on his face during wrestling season. We propose that it may be prudent to advise athletes who are involved in contact sports that skin fragility and increased erosions may occur during or after their course of treatment with isotretinoin.

  18. A novel patient support program to address isotretinoin adherence: proof-of-concept analysis.

    PubMed

    Eichenfield, Lawrence F; Krakowski, Andrew C

    2015-04-01

    The iPLEDGE protocol for isotretinoin treatment requires multiple steps to be completed within strict timing windows, resulting in many interruptions or discontinuations of treatment. The US Food and Drug Administration has indicated that approximately 40% of isotretinoin prescriptions written over the course of one year of the iPLEDGE program were denied due to failure to comply with iPLEDGE. Insurance restrictions add to the likelihood of prescriptions not being filled. Here, we describe a novel program implemented specifically to assist patients and providers with improving isotretinoin therapy adherence. This innovative isotretinoin support program provides assistance with insurance questions and hurdles, an uninterrupted treatment supply, educational support, reminder communications, and an indigent patient assistance program. Proof-of-concept analysis shows that 17 months after implementation of the program, 93% of prescriptions received have been filled. Utilization of the program appears to improve adherence to an isotretinoin treatment regimen, with fewer interruptions due directly to unfilled prescriptions.

  19. Comparative study of systemic interferon alfa-2a plus isotretinoin versus isotretinoin in the treatment of recurrent condyloma acuminatum in men.

    PubMed

    Cardamakis, E; Kotoulas, I G; Relakis, K; Metalinos, K; Michopoulos, J; Stathopoulos, E; Mantouvalos, H

    1995-05-01

    Purpose of the present study was to evaluate the effectiveness of isotretinoin versus interferon alfa-2a plus isotretinoin in the treatment of recurrent condyloma acuminatum in 86 men. Men were randomly assigned to group A (n = 42) who received isotretinoin 1 mg/kg orally daily until remission was achieved, but not more than 3 months, or to group B (n = 44) who received interferon alfa-2a 3 x 10(5) IU subcutaneously three times weekly until remission was achieved, but not more than 8 weeks, plus isotretinoin in the same dosage as in group A. The reduced duration of treatment to achieve remission was statistically significant in group B (2.18 versus 2.5 months; P < 0.01) and the recurrence rate was less in group B (4 of 44 versus 16 of 42; P < 0.01). The results of this study are encouraging and demonstrated that the combination of isotretinoin plus interferon alfa-2a achieves higher remission rates and a shorter duration of treatment than isotretinoin alone.

  20. Isotretinoin versus placebo in the treatment of cystic acne. A randomized double-blind study.

    PubMed

    Peck, G L; Olsen, T G; Butkus, D; Pandya, M; Arnaud-Battandier, J; Gross, E G; Windhorst, D B; Cheripko, J

    1982-04-01

    Thirty-three patients with treatment-resistant cystic and conglobate acne entered a randomized, double-blind protocol testing the efficacy of isotretinoin versus placebo. There was an overall 57% increase in the number of cystic lesions in seventeen patients who initially received placebo. Sixteen of these seventeen patients then received isotretinoin, with a resultant 98% improvement. The sixteen patients who had been randomly assigned to receive initial therapy with isotretinoin had a 95% improvement. Twenty-seven of the thirty-two patients treated with isotretinoin cleared completely. The average maximum dosage of isotretinoin received by these patients was 1.2 mg/kg/day. Eighteen patients received only one 4-month course of isotretinoin. Fifteen patients received two courses. These included twelve patients with predominantly truncal acne who responded partially to the first course, and three patients who had cleared completely after one course of therapy but had mild relapses after an average of six months off of treatment. All patients are now in remission averaging 38 months in duration. Skin biopsies and quantitative measurement of sebum production during therapy indicated a profound inhibition of sebaceous gland size and function, which may be central to the mechanism of action of isotretinoin in acne.

  1. Isotretinoin Use and the Risk of Inflammatory Bowel Disease: A Population-Based Cohort Study

    PubMed Central

    Alhusayen, Raed O.; Juurlink, David N.; Mamdani, Muhammad M.; Morrow, Richard L.; Shear, Neil H.; Dormuth, Colin R.

    2013-01-01

    Limited evidence suggests that isotretinoin may be associated with inflammatory bowel disease (IBD). To explore this association, we conducted a retrospective population-based cohort study in British Columbia, Canada, among participants who were newly treated with isotretinoin or topical acne medications. The entire population of untreated provincial residents aged 12–29 years served as the reference group. During the 12-year study period, we identified 46,922 participants treated with isotretinoin, 184,824 treated with a topical acne medication, and 1,526,946 untreated individuals. Compared with untreated individuals, we observed no significant association between isotretinoin use and IBD (rate ratio (RR) 1.14; 95% confidence interval (CI) 0.92–1.41). As expected, we found no association with topical acne medications (RR 1.11; 95% CI 0.99–1.24). In prespecified secondary analyses, isotretinoin was associated with IBD among individuals aged 12–19 years (RR 1.39; 95% CI 1.03–1.87) and topical acne medications were associated with ulcerative colitis (RR 1.19; 95% CI 1.00–1.42). Our primary analyses found no association between isotretinoin and IBD. In prespecified secondary analyses, some evidence was found of associations with isotretinoin as well as topical acne medications, suggesting a possible association between IBD and acne itself. Additional research is needed to explore this possibility. PMID:23096714

  2. Isotretinoin increased carotid intima-media thickness in acne patients

    PubMed Central

    Saklamaz, A; Uyar, B; Yalcin, M; Cengiz, H

    2016-01-01

    Background: Isotretinoin (Iso) in acne treatment may cause dyslipidemia and increase in liver enzymes. Moreover, its effect on lipid and glucose metabolism may induce atherosclerotic complications. The aim of this study was to evaluate carotid intima-media thickness (CIMT), osteopontin (OPN), lipid, high sensitive C-reaktive protein (hs-CRP) levels, and insulin resistance (HOMA-IR) in acne patients before and after Iso treatment. Materials: Twenty-one acne patients were treated with Iso (0.5-0.8 mg/kg) for four months. Blood tests for lipid profile, fasting glucose, liver enzymes, OPN, HOMA-IR, hs-CRP and CIMT measurements were performed before and after Iso treatment. Serum levels of OPN and, hs-CRP were measured by ELISA and particle-enhanced turbidimetric immunoassay respectively. Results: Iso treatment significantly increased lipid levels, CIMT (0.60-0.74 mm; p ˂0.001); whereas it non-significantly increased HOMA-IR (0.91-1.87; p =0.70), OPN (4.32-5.44 ng/ml; p =0.27), and hs-CRP (0.08-0.09 mg/dl; p =0.88) levels. There was no correlation between OPN and CIMT (p =0.77). Conclusion: Isotretinoin treatment for four months significantly increased CIMT in acne patients. Hippokratia 2016, 20(1): 14-18 PMID:27895437

  3. Isotretinoin treatment in patients with acne vulgaris: does it impact muscle strength, fatigue, and endurance?

    PubMed

    Yıldızgören, Mustafa Turgut; Rifaioğlu, Emine Nur; Demirkapı, Musa; Ekiz, Timur; Micooğulları, Ahmet; Şen, Tuğba; Turhanoğlu, Ayşe Dicle

    2015-07-01

    The objective of this study was to evaluate the effects of isotretinoin on muscle strength, fatigue, and endurance in patients with acne vulgaris. The study included 27 patients with acne vulgaris who underwent treatment with isotretinoin as well as 26 control patients for comparison. Participants in the treatment group received oral isotretinoin 0.5 mg/kg once daily for 1 month followed by an increased dose of 1 mg/kg once daily for 2 months. Isokinetic measurements were obtained from the hamstrings and quadriceps on the nondominant side of the body at baseline and 3-month follow-up using an isokinetic dynamometer. Results indicated that systemic isotretinoin did not significantly alter muscle strength, fatigue, and endurance.

  4. Effects of isotretinoin on body mass index, serum adiponectin, leptin, and ghrelin levels in acne vulgaris patients

    PubMed Central

    Ayvaz, Havva Hilal; Ozturk, Gulfer; Ergin, Can; Akıs, Havva Kaya; Gonul, Muzeyyen; Arzuhal, Ercan

    2016-01-01

    Introduction Isotretinoin has been successfully used for the treatment of acne vulgaris. Aim To investigate the effects of isotretinoin on body mass index (BMI), to determine whether isotretinoin causes any changes in serum adiponectin, leptin, and ghrelin levels in acne vulgaris patients, and to correlate variables. Material and methods Thirty-two patients were included in this study. Oral isotretinoin was begun at a dose of 0.5–0.6 mg/kg and raised to 0.6–0.75 mg/kg. Pretreatment and posttreatment third-month BMI and adiponectin, leptin, and ghrelin serum levels were measured. Results The pre- and posttreatment BMI values were not significantly different. In addition, serum adiponectin and leptin levels were significantly increased following isotretinoin therapy while serum ghrelin levels were not different. Conclusions Isotretinoin may exert its anti-inflammatory activity by increasing leptin and adiponectin levels. PMID:27605902

  5. Young women taking isotretinoin still conceive. Role of physicians in preventing disaster.

    PubMed Central

    Atanackovic, G.; Koren, G.

    1999-01-01

    QUESTION: One of my adolescent patients was prescribed isotretinoin for severe acne by a dermatologist. I was shocked to discover she does not use any means of contraception. The dermatologist insists he told her about the need for contraception. How can we do better? ANSWER: Clearly this dermatologist, like many of his colleagues, does not comply with the Pregnancy Prevention Program. Until physicians become more aware of this program, babies will continue to be born with embryopathy due to isotretinoin. PMID:10065298

  6. The effect of systemic isotretinoin treatment on skin biophysicalparameters among patients with acne vulgaris.

    PubMed

    Çölgeçen, Emine; Özyurt, Kemal; Ferahbaş Kesikoğlu, Ayten

    2016-12-20

    Systemic isotretinoin has been widely considered an effective and safe medical treatment for severe and refractory acne for nearly 3 decades. However, it also appears to cause undesirable cutaneous side effects. The aim of this study was to prospectively measure biophysical parameters of skin function among patients with acne vulgaris before and after 3 months of isotretinoin therapy, including pH, temperature, sebum content, skin hydration, and transepidermal water loss. The study cohort consisted of 19 patients with acne vulgaris. Noninvasive methods were used to measure the biophysical characteristics of forehead skin. All measurements were repeated following the completion of 3 months of systemic isotretinoin treatment. Biophysical skin parameter measurements after 3 months of isotretinoin therapy revealed a decrease in the severity of seborrhea. However, the skin was dry, indicting a decrease in stratum corneum hydration. An increase in skin temperature was also determined. Treatment with systemic isotretinoin reduces sebum secretion and stratum corneum hydration and increases skin temperature, suggesting that isotretinoin may partially improve the biophysical characteristics of the skin among patients with acne vulgaris.

  7. Apoptosis May Explain the Pharmacological Mode of Action and Adverse Effects of Isotretinoin, Including Teratogenicity.

    PubMed

    Melnik, Bodo C

    2017-02-08

    Isotretinoin (13-cis retinoic acid) is the most effective sebum-suppressive drug for the treatment of severe acne. Its effect depends on sebocyte apoptosis, which results from isotretinoin-induced expression of the apoptotic protein tumour necrosis factor-related apoptosis-inducing ligand, insulin-like growth factor-binding protein-3 and neutrophil gelatinase-associated lipocalin. This review proposes that the pharmacological mode of action of isotretinoin in the treatment of severe acne, acute promyelocytic leukaemia, and neuroblastoma results from apoptosis. Furthermore, apoptosis may be the underlying and unifying mechanism of the adverse effects of isotretinoin on neural crest cells (teratogenicity), hippocampal neurones (depression), epidermal keratinocytes and mucosa cells (mucocutaneous side-effects), hair follicle cells (telogen effluvium), intestinal epithelial cells (inflammatory bowel disease), skeletal muscle cells (myalgia and release of creatine kinase), and hepatocytes (release of transaminases and very low-density lipoproteins). Genetic variants of components of the apoptotic signalling cascade, such as RARA polymorphisms, might explain variations in the magnitude of isotretinoin-induced apoptotic signalling and apparently identify subgroups of patients who experience either stronger adverse effects with isotretinoin therapy or resistance to treatment.

  8. Effects of oral isotretinoin on lipids and liver enzymes in acne patients.

    PubMed

    Kızılyel, Okan; Metin, Mahmut S; Elmas, Ömer F; Çayır, Yasemin; Aktaş, Akın

    2014-11-01

    Isotretinoin has been used to treat severe inflammatory acne that is resistant to antibiotics or topical agents; however, it also may cause alterations in lipids and liver enzymes. In this retrospective study, we evaluated changes in lipids and liver enzymes in 322 acne patients who had been treated with oral isotretinoin at our institution over a 3-year period. Each patient's medical records were evaluated to determine baseline triglyceride (TG), low-density lipoprotein (LDL), high-density lipoprotein (HDL), aspartate aminotransferase (AST), and alanine aminotransferase (ALT) levels compared to levels recorded at 3 and 6 months following initiation of treatment with oral isotretinoin. Overall, statistically significant increases in TG and LDL levels were noted following treatment with isotretinoin (P<.001, respectively), while HDL levels were shown to decrease (P=.016). Although ALT levels also increased, the changes were not statistically significant increases in AST levels also were noted (P=.72). In our study, isotretinoin appeared to have a greater effect on lipids than liver enzymes. Dermatologists should not avoid isotretinoin use for appropriate indications, but close follow-up is important.

  9. Promoting safe use of isotretinoin by increasing contraceptive knowledge.

    PubMed

    Werner, Carly A; Papic, Melissa J; Ferris, Laura K; Schwarz, Eleanor B

    2015-04-01

    Isotretinoin, a known teratogen, is strictly regulated through the iPLEDGE program. However, isotretinoin-exposed pregnancies continue to occur. To evaluate an information sheet's effect on women's contraceptive knowledge. Women aged 18 to 45 years visiting a dermatology practice completed anonymous surveys assessing their knowledge of the typical effectiveness of 8 contraceptive methods before and after reviewing an educational information sheet. Participants categorized each contraceptive as "most effective, >99% effective," "medium effective, 92%-97% effective," or "least effective, <89% effective" or indicated that they had "never heard of" it. All participants were recruited from a single dermatology clinic between April and May 2014. A total of 118 women were approached by consecutive sampling, and surveys were completed by 100 women. Preintervention contraceptive effectiveness knowledge and change in contraceptive effectiveness knowledge after viewing the educational tool. Prior to viewing the contraceptive information sheet, more than half of women overestimated the typical effectiveness of condoms (75%), contraceptive injections (57%), and oral contraceptives (51%). Thirty-four percent had never heard of contraceptive implants, whereas 16% had never heard of an intrauterine contraceptive device (IUD). Participants correctly identified the typical effectiveness of only a mean (SD) of 3.8 (1.9) of the 8 contraceptives that they were asked about. Only 3% of participating women were able to correctly identify the typical effectiveness of all available contraceptives. On average, women spent less than 1 minute reviewing the contraceptive information sheet (mean [SD], 31 [27] seconds). After viewing the educational handout, the proportions of participants able to correctly identify the typical effectiveness of contraceptives increased for almost all methods (subdermal implant, 45% to 78% [P < .001]; IUD, 61% to 83% [P < .001]; injection, 28% to 44% [P =

  10. The effect of isotretinoin on the pharmacokinetics and pharmacodynamics of ethinyl estradiol and norethindrone.

    PubMed

    Hendrix, Craig W; Jackson, Kimberley A; Whitmore, Elizabeth; Guidos, Anita; Kretzer, Ryan; Liss, Catherine M; Shah, Leena P; Khoo, Ko-Chin; McLane, John; Trapnell, Carol Braun

    2004-05-01

    Isotretinoin is a known teratogen, and when it is prescribed to women of childbearing potential, 2 forms of contraception must be used, commonly including hormonal contraception. Although isotretinoin and estradiol are metabolized largely by cytochrome P450 (CYP) 3A4 and glucuronidation, the potential for clinical drug interaction, with subsequent pharmacodynamic impact, has not been evaluated. We enrolled 26 healthy women who were to receive isotretinoin for the treatment of severe, recalcitrant nodular acne and who were taking or planning to take oral contraceptives. The pharmacokinetics of ethinyl estradiol and norethindrone (INN, norethisterone) (the components of Ortho Novum 7/7/7; Ortho-McNeil Pharmaceutical, Inc, Raritan, NJ) and pharmacodynamic assessments of oral contraceptive effectiveness (concentrations of serum progesterone, luteinizing hormone, and follicle-stimulating hormone) were determined on days 6 and 20 of 2 separate oral contraceptive cycles, before and during isotretinoin treatment. The addition of isotretinoin to the oral contraceptive regimen resulted in small and inconsistent, although statistically significant (P <.04), decreases in the concentrations of both ethinyl estradiol (9% decrease in area under the plasma concentration-time curve from time 0 to 24 hours after the dose on day 6) and norethindrone (11% decrease in maximum plasma concentration on day 20). Isotretinoin did not cause any statistically significant increases in pharmacodynamic markers, although a majority of women had increases in these measures. Although there was no correlation between isotretinoin (or metabolite) levels and oral contraceptive levels (P >.05), there was a correlation between progesterone level and oral contraceptive levels (P <.05). Variability was large for both pharmacokinetic measures (median coefficients of variation of 44%-69% [for each time point within a study period]) and pharmacodynamic measures (median coefficients of variation of 64

  11. The antiestrogen 4-hydroxytamoxifen protects against isotretinoin-induced permeability transition and bioenergetic dysfunction of liver mitochondria: comparison with tamoxifen.

    PubMed

    Silva, Filomena S G; Ribeiro, Mariana P C; Santos, Maria S; Rocha-Pereira, Petronila; Santos-Silva, Alice; Custódio, José B A

    2013-08-01

    The combination of isotretinoin (13-cis-retinoic acid) with antiestrogens seems to be a promising strategy for cancer chemotherapy. The aim of the study was to evaluate the effects of isotretinoin alone or in combination with 4-hydroxytamoxifen (OHTAM) and with its prodrug tamoxifen (TAM), on the functions of rat liver mitochondria, i.e., mitochondrial permeability transition (MPT), bioenergetic functions and adenine nucleotide translocase (ANT). Isotretinoin (5 nmol/mg protein) induced the Ca²⁺-dependent MPT pore opening in mitochondria energized with succinate, which was prevented by OHTAM, cyclosporine A, TAM and ANT ligands. When mitochondria were energized with glutamate/malate and in the absence of added Ca²⁺ isotretinoin decreased the state 3 respiration, the ATP levels, the active ANT content and increased the lag phase of the phosphorylation cycle, demonstrating that isotretinoin decreased the mitochondrial phosphorylation efficiency. These changes of isotretinoin in bioenergetic parameters were not significant in the presence of succinate. The effects of isotretinoin at 5 nmol/mg protein on the Ca²⁺-dependent MPT and phosphorylative efficacy may be related with interactions with the ANT. Above 10 nmol/mg protein isotretinoin strongly diminished the active ANT content, decreased the Δψ, inhibited the complex I and induced proton leak through the Fo fraction of complex V. The combination of OHTAM with isotretinoin only induced significant changes in the energy production systems at concentrations ≥5 nmol isotretinoin/mg protein. Therefore, our results suggest that isotretinoin-associated liver toxicity is possibly related with mitochondrial dysfunctions and that the combination with OHTAM may contribute to decrease its toxicity.

  12. Isotretinoin therapy changes the expression of antimicrobial peptides in acne vulgaris.

    PubMed

    Borovaya, Alena; Dombrowski, Yvonne; Zwicker, Stephanie; Olisova, Olga; Ruzicka, Thomas; Wolf, Ronald; Schauber, Jürgen; Sárdy, Miklós

    2014-10-01

    In acne vulgaris, antimicrobial peptides (AMPs) could play a dual role; i.e., protective by acting against Propionibacterium acnes, pro-inflammatory by acting as signalling molecules. The cutaneous expression of 15 different AMPs was investigated in acne patients; furthermore, the impact of isotretinoin therapy on AMP expression was analysed in skin biopsies from 13 patients with acne vulgaris taken before, during and after a 6-month treatment cycle with isotretinoin using quantitative real-time polymerase chain reaction. Cutaneous expression of the AMPs cathelicidin, human β-defensin-2 (HBD-2), lactoferrin, lysozyme, psoriasin (S100A7), koebnerisin (S100A15), and RNase 7 was upregulated in untreated acne vulgaris, whereas α-defensin-1 (HNP-1) was downregulated compared to controls. While relative expression levels of cathelicidin, HBD-2, lactoferrin, psoriasin (S100A7), and koebnerisin (S100A15) decreased during isotretinoin treatment, only those of cathelicidin and koebnerisin returned to normal after 6 months of isotretinoin therapy. The increased expression of lysozyme and RNase 7 remained unaffected by isotretinoin treatment. The levels of granulysin, RANTES (CCL5), perforin, CXCL9, substance P, chromogranin B, and dermcidin were not regulated in untreated acne patients and isotretinoin had no effect on these AMPs. In conclusion, the expression of various AMPs is altered in acne vulgaris. Isotretinoin therapy normalizes the cutaneous production of distinct AMPs while the expression of others is still increased in healing acne. Considering the antimicrobial and pro-inflammatory role of AMPs, these molecules could serve as specific targets for acne therapy and maintenance of clinical remission.

  13. The prevalence of sacroiliitis in patients with acne vulgaris using isotretinoin.

    PubMed

    Baykal Selçuk, Leyla; Aksu Arıca, Deniz; Baykal Şahin, Hanife; Yaylı, Savas; Bahadır, Sevgi

    2017-06-01

    Acne vulgaris is a chronic inflammatory disease affecting the pilosebaceous unit in the skin. Isotretinoin is a synthetic vitamin A derivative regarded as the most effective agent in the treatment of acne. There have recently been increasing reports of adverse effects of isotretinoin on the skeletal system. Our aim in this study was to evaluate the rheumatic side-effects triggered by this drug, and particularly the prevalence of sacroiliitis. A total of 73 patients receiving isotretinoin due to moderate or severe acne vulgaris were included. All patients were questioned about inflammatory low back pain and musculoskeletal pains during the treatment process. Inflammatory low back pain was evaluated using Assessment of Spondyloarthritis International Society (ASAS) criteria. Patients meeting ASAS criteria were evaluated with radiography and when necessary with sacroiliac magnetic resonance. The dose range for isotretinoin was between 0.4 and 0.8 mg/kg/day (mean 0.53 mg/kg/day). Treatment lasted for 6-8 months (mean 6.8 months). Lethargy was determined in 37 (50.7%) patients, myalgia in 31 (42.5%) and low back pain in 36 (49.3%). Mechanical low back pain symptoms were present in 20 of the patients describing low back pain and inflammatory low back pain in 16. Acute sacroiliitis was determined in six patients (8.2%) following a sacroiliac magnetic resonance imaging (MRI). Five (83.3%) of the patients with sacroiliitis were female and one (16.7%) was male. No statistically significant difference was determined between male and female patients in terms of prevalence of sacroiliitis (p = 0.392). The incidence of sacroiliitis in patients using isotretinoin is quite high. Patients using isotretinoin must be questioned about sacroiliitis findings and must be subjected to advanced assessment when necessary. Further studies regarding the development of sacroiliitis under isotretinoin therapy are now needed.

  14. Rosacea treatment with intermediate-dose isotretinoin: follow-up with erythema and sebum measurements.

    PubMed

    Uslu, Meltem; Şavk, Ekin; Karaman, Göksun; Şendur, Neslihan

    2012-01-01

    Isotretinoin is one of the therapeutic options for rosacea. However, the response of erythema to treatment with isotretinoin is usually slow and incomplete with common (0.5-1 mg/kg/day) or low (10 mg/day) doses. This study investigated the efficacy of, and relapse on, 20 mg/day isotretinoin treatment in rosacea, with the aid of instrumental measurement of facial erythema and sebum levels. A 20 mg/day dose of isotretinoin was given for 4 months, and then the dose was tapered off within the following 6 months. A total of 25 patients were included in the study. Papule and pustule counts, erythema index, sebum level, dermatologist's and patient's erythema scores, and dermatologist's sebum scores were significantly lower in the first month of therapy compared with pre-treatment values (p < 0.05). Within a median follow-up of 11 months (95% confidence interval: 8.4-13.5 months) 45% of patients had a relapse. In conclusion, 20 mg/day isotretinoin was rapidly efficient for reducing both inflammatory lesions and erythema in rosacea.

  15. The Role of Isotretinoin Therapy for Cushing's Disease: Results of a Prospective Study

    PubMed Central

    Vilar, Lucio; Albuquerque, José Luciano; Lyra, Ruy; Trovão Diniz, Erik; Rangel Filho, Frederico; Gadelha, Patrícia; Thé, Ana Carolina; Ibiapina, George Robson; Gomes, Barbara Sales; Santos, Vera; Melo da Fonseca, Maíra; Frasão Viana, Karoline; Lopes, Isis Gabriella; Araújo, Douglas; Naves, Luciana

    2016-01-01

    Objective. This prospective open trial aimed to evaluate the efficacy and safety of isotretinoin (13-cis-retinoic acid) in patients with Cushing's disease (CD). Methods. Sixteen patients with CD and persistent or recurrent hypercortisolism after transsphenoidal surgery were given isotretinoin orally for 6–12 months. The drug was started on 20 mg daily and the dosage was increased up to 80 mg daily if needed and tolerated. Clinical, biochemical, and hormonal parameters were evaluated at baseline and monthly for 6–12 months. Results. Of the 16 subjects, 4% (25%) persisted with normal urinary free cortisol (UFC) levels at the end of the study. UFC reductions of up to 52.1% were found in the rest. Only patients with UFC levels below 2.5-fold of the upper limit of normal achieved sustained UFC normalization. Improvements of clinical and biochemical parameters were also noted mostly in responsive patients. Typical isotretinoin side-effects were experienced by 7 patients (43.7%), though they were mild and mostly transient. We also observed that the combination of isotretinoin with cabergoline, in relatively low doses, may occasionally be more effective than either drug alone. Conclusions. Isotretinoin may be an effective and safe therapy for some CD patients, particularly those with mild hypercortisolism. PMID:27034666

  16. Psychological Status and Quality of Life in Acne Patients Treated with Oral Isotretinoin.

    PubMed

    Šimić, Dubravka; Penavić, Jasna Zeljko; Babić, Dragan; Gunarić, Anita

    2017-05-01

    The acne patients are at higher risk of acquiring depresion and anxiety, which can lead to reduced quality of life. Effective treatment of acne can reduce symptoms of anxiety and depression and significantly improve other physiological parameters and quality of life of these patients. The aim of this study was to determine the psychological status and quality of life of acne patients before, during and after the treatment with oral isotretinoin. The prospective study included a total of 127 patients suffering from moderate to severe form of acne. To assess the psychological status and quality of life of studied groups the following standard psychometric questionnaires were performed before, during and after the treatment with oral isotretinoin: Beck Depression Inventory (BDI), Assessments of the Psychological and Social Effects of Acne (APSEA), State Trait Anxiety Inventory (STAI), Measure of Psychological Stress (MPS) and Dermatology Specific Quality of Life (DSQL). Results of the present study indicate that there is no increase in depressive and anxiety symptoms in the patients treated with oral isotretinoin. The psychological status by gender has shown the existence of differences between the genders in all measures of psychological status. Statistically significantly better quality of life was observed after healing than before treatment. The results of our study showed no higher risk of depression and anxiety within the patients with acne treated with oral isotretinoin. Improvement of quality of life after the treatment of acne with oral isotretinoin was confirmed.

  17. Dietary Supplements, Isotretinoin, and Liver Toxicity in Adolescents: A Retrospective Case Series.

    PubMed

    DeKlotz, Cynthia Marie Carver; Roby, Keith D; Friedlander, Sheila Fallon

    2017-10-01

    Isotretinoin is the most effective acne therapy available, but has the potential for a number of adverse side effects, including transaminitis. The iPLEDGE isotretinoin program recommends avoiding some herbals and supplements due to potential side effects. However, little is known about the effects of protein supplements on the liver, particularly in patients taking isotretinoin. We designed a retrospective chart review to evaluate the symptoms, diagnosis, treatment, and outcome of patients on or preparing to take isotretinoin therapy who were concurrently ingesting protein or herbal supplementation and who developed transaminitis. In 100% (8/8) of cases, dietary supplementation was determined to be at least a possible cause of elevated liver transaminases. In 75% (6/8) of cases, dietary supplement appears to be the most likely cause at some point in their evaluation. Most of our patients' elevations in aspartate aminotransferase and/or alanine aminotransferase were likely caused by supplementation with protein, creatine, or herbal extracts, rather than prescribed isotretinoin or tetracycline antibiotics for acne. Hence, dietary supplementation may cause liver function abnormalities. As supplement usage appears common in teenagers, clinicians should consider counseling their patients to avoid these products, particularly when prescribing known hepatotoxic drugs. Copyright © 2017 by the American Academy of Pediatrics.

  18. The relationship between erythrocyte zinc levels and isotretinoin use in acne vulgaris patients.

    PubMed

    Bilgiç, Özlem; Altınyazar, Hilmi Cevdet; Sivrikaya, Abdullah; Ünlü, Ali

    2015-01-01

    Prior studies have demonstrated lower serum zinc levels in acne vulgaris (AV) patients compared with controls. However, no study has investigated the relationship between AV and erythrocyte zinc levels, which is a superior indicator of body zinc levels. Additionally, the potential influence of isotretinoin use on body zinc status remains to be evaluated. In this study, we aimed to determine erythrocyte zinc levels and their relationship with isotretinoin use in AV patients. The enrolled study participants included 106 (68% female) isotretinoin-treated AV patients, 89 (65% female) untreated AV patients and 100 (59% female) healthy volunteers between 18 and 30 years of age. The acne severity of the AV patients who did not receive treatment was assessed using the classification system of the International Consensus Conference on Acne. Erythrocyte zinc levels were analysed by atomic absorption spectroscopy. No significant differences were observed among the three groups with respect to erythrocyte zinc levels. In addition, erythrocyte zinc levels did not vary according to the severity of AV, nor according to the duration of isotretinoin use. This study suggests that no relationships exist among zinc status, AV and isotretinoin use. However, given the relationship between vitamin A and zinc, and the fact that previous studies have indicated low serum zinc levels in AV patients, prospective studies are required to corroborate our data.

  19. The frequency of hematuria in acne vulgaris patients during isotretinoin treatment.

    PubMed

    Yesilkaya, Burcu; Alli, Nuran; Artuz, R Ferda; Ulu, Ezgi; Kartal, Demet; Cinar, S Levent

    2017-03-01

    Systemic isotretinoin (13-cis-retinoic acid) is effective in the treatment of acne vulgaris. The most common side effects are mucocutaneous ones. Hematuria seen secondary to isotretinoin treatment is thought to be due to mucosal dryness in the urinary system. This study aims to determine the frequency of hematuria in acne vulgaris patients during isotretinoin treatment. Eighty-eight subjects aged 16-32 years were included in the study group and 52 subjects were in the control group. The subjects were treated for 6 months and were monitored monthly by complete urine analyzes. They were also examined each month in terms of cheilitis, xerosis, epistaxis, rectal bleeding, fatigue, myalgia, weight loss, dry eye, conjunctivitis, headache, dysuria and pollakiuria. In the study group, 15 subjects (17%) had hematuria at least once during the study, and in the control group, four subjects (7.7%) had hematuria. The difference was not statistically significant (p = 0.118). Among the subjects who had hematuria, 11 of them (73.3%) were female and four of them (33.3%) were male in the study group while all the subjects with hematuria in the control group were female. Hematuria and gender did not show a statistically significant correlation. Hematuria was observed in 17% of the study group; this frequency rate was not different from that of the normal population. In subjects having isotretinoin treatment, if all the other reasons or disorders are excluded, one must keep in mind that hematuria may be due to isotretinoin use.

  20. The effects of isotretinoin on the ovarian reserve of females with acne.

    PubMed

    Sikar Aktürk, Aysun; Abalı, Remzi; Yüksel, Mehmet Aytaç; Güzel, Eda Çelik; Güzel, Savaş; Kıran, Rebiay

    2014-01-01

    There are some side effects of isotretinoin in many organs. However, a study investigating the effects of isotretinoin on the human ovarian reserve has not been reported previously. The study was conducted to investigate possible effects of isotretinoin on ovarian reserve. Serum anti-Müllerian hormone (AMH) levels were measured at the beginning and at the end of isotretinoin treatment in 22 patients with acne and in 22 women without. The mean AMH level before treatment was 5.77 ng/mL in the study group and 3.79 ng/mL in the control group (p = 0.008). Following treatment, the mean AMH level was 4.69 ng/mL in the study group. This mean AMH level after treatment was statistically lower than the AMH level before treatment (p = 0.012). There was no significant difference between the mean AMH level at the end of treatment and that of the control group (p = 0.20). The high level of pre-treatment AMH levels could be an evidence of hyperandrogenism in women with acne, even if they are not identified as having polycystic ovary syndrome (PCOS) or hyperandrogenism. Decrease in AMH levels following exposure to isotretinoin may suggest that it has a detrimental effect on the ovaries.

  1. The role of isotretinoin in acne therapy: why not as first-line therapy? facts and controversies.

    PubMed

    Rigopoulos, Dimitris; Larios, George; Katsambas, Andreas D

    2010-01-01

    Acne is one of the most prevalent diseases in dermatology: Millions of people worldwide experience this distressing condition. To determine the appropriate therapeutic strategy, there is a strong need for a standardized classification system of acne. The exact molecular mechanism of action of isotretinoin is not completely understood; however, oral isotretinoin targets simultaneously at all major mechanisms of acne pathogenesis. Various mass media reports about the risk of teratogenicity and depression from isotretinoin usage as well as the creation of intense prevention programs have created an obstacle to the use of the most active available drug against acne, presenting isotretinoin as a very dangerous regimen. According to recommendations of several international experts, which we share, oral isotretinoin may be prescribed not only to patients with severe disease but indications should be broadened to also include patients with less severe forms of acne, especially in cases with scarring, significant psychologic stress, or failure to respond to conventional therapy.

  2. A case of isotretinoin-induced purpura annularis telangiectodes of Majocchi and review of substance-induced pigmented purpuric dermatosis.

    PubMed

    Kaplan, Rachel; Meehan, Shane A; Leger, Marie

    2014-02-01

    IMPORTANCE Medications as well as chemical and food exposures have been causally linked to the development of pigmented purpuric dermatosis (PPD). We describe herein what is to our knowledge the first reported case of isotretinoin-induced PPD. OBSERVATIONS A woman in her 30s presented with purpura annularis telangiectodes of Majocchi on the lower extremities 2 months after initiating isotretinoin for the treatment of refractory nodulocystic acne. CONCLUSIONS AND RELEVANCE We believe isotretinoin was the most likely causative agent in this case because the lesions began after initiation of isotretinoin treatment and resolved shortly after its termination, and the pathologic findings were consistent with other described cases of drug-induced PPD. The lesions have continued to fade, and no new lesions have developed in a 3-month follow-up period. Drug-induced PPD is distinct from idiopathic PPD, and it is important to consider isotretinoin as a potential inciting agent.

  3. Congenital microtia in a neonate due to maternal isotretinoin exposure 1 month before pregnancy: Case Report.

    PubMed

    Shirazi, Mahboobeh; Abbariki, Ezzat; Pirjani, Reihaneh; Akhavan, Setareh; Dastgerdy, Ebrahim

    2015-06-01

    Isotretinoin is a drug used for treating severe cystic/nodular acne. Severe malformations have been documented in neonates whose mothers had taken isotretinoin during pregnancy. Women who became pregnant one cycle after completing therapy are believed to be at teratogenic risk not higher than baseline. We describe the case of a newborn whose mother had taken the drug for 4 weeks. The woman then had contraception for 4 weeks (after the drug treatment had finished), and became pregnant after that period. The newborn had isolated bilateral microtia due to suspected isotretinoin exposure. His mother also had a history of urine tract infection in the second week of pregnancy that was treated with cephalexin. The parents were not from a consanguineous marriage and had no family history of congenital malformations. To reduce the risk, effective contraception should be continued in fertile women more than 1 month after completing therapy.

  4. Trypanocidal Effect of Isotretinoin through the Inhibition of Polyamine and Amino Acid Transporters in Trypanosoma cruzi

    PubMed Central

    Reigada, Chantal; Valera-Vera, Edward A.; Sayé, Melisa; Errasti, Andrea E.; Avila, Carla C.; Miranda, Mariana R.; Pereira, Claudio A.

    2017-01-01

    Polyamines are essential compounds to all living organisms and in the specific case of Trypanosoma cruzi, the causative agent of Chagas disease, they are exclusively obtained through transport processes since this parasite is auxotrophic for polyamines. Previous works reported that retinol acetate inhibits Leishmania growth and decreases its intracellular polyamine concentration. The present work describes a combined strategy of drug repositioning by virtual screening followed by in vitro assays to find drugs able to inhibit TcPAT12, the only polyamine transporter described in T. cruzi. After a screening of 3000 FDA-approved drugs, 7 retinoids with medical use were retrieved and used for molecular docking assays with TcPAT12. From the docked molecules, isotretinoin, a well-known drug used for acne treatment, showed the best interaction score with TcPAT12 and was selected for further in vitro studies. Isotretinoin inhibited the polyamine transport, as well as other amino acid transporters from the same protein family (TcAAAP), with calculated IC50 values in the range of 4.6–10.3 μM. It also showed a strong inhibition of trypomastigote burst from infected cells, with calculated IC50 of 130 nM (SI = 920) being significantly less effective on the epimastigote stage (IC50 = 30.6 μM). The effect of isotretinoin on the parasites plasma membrane permeability and on mammalian cell viability was tested, and no change was observed. Autophagosomes and apoptotic bodies were detected as part of the mechanisms of isotretinoin-induced death indicating that the inhibition of transporters by isotretinoin causes nutrient starvation that triggers autophagic and apoptotic processes. In conclusion, isotretinoin is a promising trypanocidal drug since it is a multi-target inhibitor of essential metabolites transporters, in addition to being an FDA-approved drug largely used in humans, which could reduce significantly the requirements for its possible application in the treatment of

  5. Trypanocidal Effect of Isotretinoin through the Inhibition of Polyamine and Amino Acid Transporters in Trypanosoma cruzi.

    PubMed

    Reigada, Chantal; Valera-Vera, Edward A; Sayé, Melisa; Errasti, Andrea E; Avila, Carla C; Miranda, Mariana R; Pereira, Claudio A

    2017-03-01

    Polyamines are essential compounds to all living organisms and in the specific case of Trypanosoma cruzi, the causative agent of Chagas disease, they are exclusively obtained through transport processes since this parasite is auxotrophic for polyamines. Previous works reported that retinol acetate inhibits Leishmania growth and decreases its intracellular polyamine concentration. The present work describes a combined strategy of drug repositioning by virtual screening followed by in vitro assays to find drugs able to inhibit TcPAT12, the only polyamine transporter described in T. cruzi. After a screening of 3000 FDA-approved drugs, 7 retinoids with medical use were retrieved and used for molecular docking assays with TcPAT12. From the docked molecules, isotretinoin, a well-known drug used for acne treatment, showed the best interaction score with TcPAT12 and was selected for further in vitro studies. Isotretinoin inhibited the polyamine transport, as well as other amino acid transporters from the same protein family (TcAAAP), with calculated IC50 values in the range of 4.6-10.3 μM. It also showed a strong inhibition of trypomastigote burst from infected cells, with calculated IC50 of 130 nM (SI = 920) being significantly less effective on the epimastigote stage (IC50 = 30.6 μM). The effect of isotretinoin on the parasites plasma membrane permeability and on mammalian cell viability was tested, and no change was observed. Autophagosomes and apoptotic bodies were detected as part of the mechanisms of isotretinoin-induced death indicating that the inhibition of transporters by isotretinoin causes nutrient starvation that triggers autophagic and apoptotic processes. In conclusion, isotretinoin is a promising trypanocidal drug since it is a multi-target inhibitor of essential metabolites transporters, in addition to being an FDA-approved drug largely used in humans, which could reduce significantly the requirements for its possible application in the treatment of

  6. Isotretinoin and lymecycline treatments modify the skin microbiota in acne.

    PubMed

    Kelhälä, Hanna-Leena; Aho, Velma T E; Fyhrquist, Nanna; Pereira, Pedro A B; Kubin, Minna E; Paulin, Lars; Palatsi, Riitta; Auvinen, Petri; Tasanen, Kaisa; Lauerma, Antti

    2017-06-21

    Oral retinoids and tetracyclines have a major role in acne treatment. Here, we report for the first time the effect of isotretinoin and lymecycline therapy on the skin microbiota in cheek, back and armpit swab samples of acne vulgaris patients using 16S ribosomal RNA (16S rRNA) gene amplicon sequencing. Propionibacterium acnes was the most common in sebaceous areas of healthy and untreated acne skin and more abundant in back than cheek samples. Five taxa, including a Streptococcus taxon, differed significantly between the cheek samples of healthy controls and acne patients, and acne severity was positively correlated with the abundance of Propionibacterium. Both treatments reduced clinical acne grades and the abundance of Propionibacterium, while the abundance of several other taxa was significantly higher in treated cheek samples compared with untreated ones. Less variation was observed in back samples and none in armpit samples. There were no differences in alpha diversity between control and acne patients in any of the sampled skin areas, but the diversity of the microbiota on the cheek and the back was significantly increased after acne treatments. This study provides insight into the skin microbiota in acne and how it is modulated by systemic acne treatment. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  7. Isotretinoin and inflammatory bowel disease: trial lawyer misuse of science and FDA warnings.

    PubMed

    Tenner, Scott

    2014-04-01

    Based on the Food and Drug Administration Adverse Event Reporting System (FAERS), the FDA and Hoffman La Roche issued warnings of a possible causal association between isotretinoin and inflammatory bowel disease. While scientists studied the association, trial lawyers used the courts to award large sums of money to plaintiffs despite the absence of clear scientific evidence of a causal effect. In this Issue of the Journal, a well-designed, large pharmaco-epidemiologic study shows no association. The story of isotretinoin highlights the problems that occur when the FAERS is used in litigation prior to further study and scientific analysis.

  8. Bilateral nasal bone osteophytosis associated with short-term oral isotretinoin therapy for cystic acne vulgaris.

    PubMed

    Novick, N L; Lawson, W; Schwartz, I S

    1984-10-01

    Bilateral 2.5 and 3.0 mm nasal bone osteophytes developed five weeks following the initiation of oral isotretinoin therapy (50 mg daily) for severe cystic acne vulgaris in a healthy 30-year-old white woman who had undergone uneventful rhinoplasty 12 years earlier. Histologically mature bone fragments were removed at surgery. Vitamin A and its analogs have been reported to cause hyperostosis of the vertebrae and long bones, but no known reports link them to nasal bone changes. Clinically significant nasal bone osteophytosis may be another adverse reaction to oral isotretinoin therapy.

  9. Effects of isotretinoin on the thyroid gland and thyroid function tests in acne patients: A preliminary study.

    PubMed

    Uyar, Belkiz; Solak, Aynur; Saklamaz, Ali; Akyildiz, Muhittin; Genc, Berhan; Gökduman, Ayse

    2016-01-01

    Isotretinoin is widely used in the treatment of acne. We investigated the effects of isotretinoin on thyroid function tests and thyroid volume in acne patients. In this prospective study, a total of 104 acne patients were included. Sixty-six patients were treated with isotretinoin for at least 4 months. Thirty eight patients were included in the control group. The levels of thyroid stimulating hormone, free triiodothyronine, free thyroxine, antithyroglobulin and antithyroid peroxidase antibodies were measured and a thyroid ultrasound was performed in all the subjects before treatment and 4 months after treatment. A "p" value of < 0.05 was considered significant. In the isotretinoin-treated group, thyroid stimulating hormone levels increased significantly during isotretinoin treatment (P = 0.018). Free triiodothyronine, free thyroxine, anti-thyroid peroxidase levels and thyroid volume decreased significantly during treatment (P = 0.016, P= 0.012, P= 0.006, P = 0.020 respectively). The major limitation of this study is the lack of follow-up data after the cessation of isotretinoin therapy in acne patients. Patients treated with isotretinoin should be monitored with thyroid function tests.

  10. Assessing the availability of the teratogenic drug isotretinoin outside the pregnancy prevention programme: a survey of e-pharmacies†

    PubMed Central

    Lagan, Briege M; Dolk, Helen; White, Bronagh; Uges, Donald R A; Sinclair, M

    2014-01-01

    Purpose The increase in online purchasing of medications raises safety concerns regarding teratogenic drugs. The use of the teratogenic drug ‘isotretinoin’ for women of childbearing age requires strict adherence to the Pregnancy Prevention Programme (PPP), a risk minimisation measure imposed on prescribers and users. We sought to determine how readily consumers can purchase isotretinoin online and the associated safety procedures and information. Methods A descriptive cross-sectional survey was conducted of 50 e-pharmacies identified from commonly used search engines. E-pharmacy characteristics and isotretinoin PPP specific criteria were evaluated. Purchases of isotretinoin from seven e-pharmacies not bearing authentication logos and not requiring a prescription were assessed for PPP policy adherence, purchasing procedures and compound quality. Results Forty-three (86%) of the e-pharmacies did not have an authentication seal/logo. Isotretinoin could be purchased from 42 sites without a valid prescription. Information on isotretinoin causing birth defects was lacking in 25 of the 50 sites, on not taking isotretinoin in pregnancy in 24 sites and not taking isotretinoin if planning or at risk of a pregnancy in 33 sites. Of the eight attempted purchases, seven arrived, all without any patient information leaflet. All were verified as isotretinoin. Conclusion The Internet provides a loophole for purchasing of medications known to cause congenital abnormalities, which needs to be addressed by medicines regulatory agencies worldwide. The current PPP for isotretinoin may be failing to protect mothers and babies from preventable harm—clinicians need to be aware of this, and the public needs to be educated about the potential risks. PMID:24493556

  11. The use of isotretinoin in low doses and unconventional treatment regimens in different types of acne: a literature review

    PubMed Central

    Dziankowska-Bartkowiak, Bożena; Gerlicz-Kowalczuk, Zofia; Wozniacka, Anna

    2017-01-01

    High effectiveness of isotretinoin treatment for severe types of acne resistant to antibiotics has been widely recognized. However, the recommended doses in conventional therapy, according to consensus of the Polish Dermatological Society, may cause serious adverse effects. Thus, research into less stressful, alternative treatment regimens with the use of low doses of isotretinoin has been carried out. The aim of the paper was to review the selected papers where authors present the results of their studies on different regimens with the use of isotretinoin in low doses in patients with acne, evaluate their efficacy, patient satisfaction, frequency of adverse effects, recurrences and also treatment costs. PMID:28261025

  12. Nano-lipoidal carriers of isotretinoin with anti-aging potential: formulation, characterization and biochemical evaluation.

    PubMed

    Raza, Kaisar; Singh, Bhupinder; Singla, Nitish; Negi, Poonam; Singal, Parteek; Katare, Om Prakash

    2013-05-01

    Treatment of photoaging includes non-prescription cosmeceuticals and prescription products, retinoids. Isotretinoin, an established anti-acne retinoid, is also reported to delay the aging process. However, the drug is reported to be an irritant on skin. The present study endeavors to explore the potential of a novel set of biocompatible nano-structured systems of isotretinoin in the treatment of photoaging. Nano-lipoidal carriers (NLCs) of isotretinoin were developed, characterized and investigated in vivo for anti-aging potential in Laca mice vis-à-vis the marketed products of retinoids. The anti-aging efficacy of NLCs was measured in terms of visual and redox-biochemical parameters in ultraviolet (UV)-irradiated mice. Visual observations revealed that there was no significant change (p < 0.05) w.r.t. erythema, skin sagging and wrinkles in the skin of the animals treated with NLCs formulation compared to the marketed product(s). The malondialdehyde levels were found to be significantly reduced, whereas glutathione levels were increased with the application of NLCs vis-à-vis control and test formulations. The NLCs were able to maintain the normal redox-balance of UV-irradiated skin, and were better tolerated by the animals. The study ratifies enhancement in the efficacy of isotretinoin against photoaging and improved skin biocompatibility after its encasement in novel topical dosage forms.

  13. Tolerance to systemic isotretinoin therapy in two patients using highly wettable contact lenses.

    PubMed

    Arman, Ayşegül; Demirseren, D Deniz; Akoglu, Gulsen

    2014-01-01

    Purpose. Numerous ocular side effects have been reported with the use of systemic isotretinoin therapy. Herein, we presented two contact lens user patients who did not have contact lens intolerance during systemic isotretinoin therapy. Methods. 25-year-old male and 20-year-old female patients with severe acne vulgaris who were using highly wettable silicone hydrogel contact lenses which increase tear film stability were examined. Tear film function tests including Schirmer tests and tear break up time (TBUT) test and ocular surface staining with fluorescein were done. Subjective ocular complaints were scored with ocular surface disease index (OSDI) questionnaire. Patients were followed up monthly and examinations were repeated at each visit. Results. Both patients completed the therapy after a cumulative dose of 140 mg/kg isotretinoin in 6 months. The OSDI score and tear film function tests before and after treatment were all within normal limits. Discussion. Highly wettable contact lenses that provide increase in the tear film stability may be used during systemic retinoid therapy under close followups. Although isotretinoin affects ocular glands, the differences between tolerances to this retinoid therapy need to be investigated in larger patient groups using contact lenses.

  14. Tolerance to Systemic Isotretinoin Therapy in Two Patients Using Highly Wettable Contact Lenses

    PubMed Central

    Arman, Ayşegül; Demirseren, D. Deniz

    2014-01-01

    Purpose. Numerous ocular side effects have been reported with the use of systemic isotretinoin therapy. Herein, we presented two contact lens user patients who did not have contact lens intolerance during systemic isotretinoin therapy. Methods. 25-year-old male and 20-year-old female patients with severe acne vulgaris who were using highly wettable silicone hydrogel contact lenses which increase tear film stability were examined. Tear film function tests including Schirmer tests and tear break up time (TBUT) test and ocular surface staining with fluorescein were done. Subjective ocular complaints were scored with ocular surface disease index (OSDI) questionnaire. Patients were followed up monthly and examinations were repeated at each visit. Results. Both patients completed the therapy after a cumulative dose of 140 mg/kg isotretinoin in 6 months. The OSDI score and tear film function tests before and after treatment were all within normal limits. Discussion. Highly wettable contact lenses that provide increase in the tear film stability may be used during systemic retinoid therapy under close followups. Although isotretinoin affects ocular glands, the differences between tolerances to this retinoid therapy need to be investigated in larger patient groups using contact lenses. PMID:24707422

  15. Arthropathy associated with cystic acne, hidradenitis suppurativa, and perifolliculitis capitis abscedens et suffodiens: treatment with isotretinoin.

    PubMed

    Libow, L F; Friar, D A

    1999-08-01

    A patient with arthropathy associated with cystic acne, hidradenitis suppurativa, and perifolliculitis capitis abscedens et suffodiens who showed a dramatic response to isotretinoin is described. This, to our knowledge, is the first report documenting effective treatment of this condition, whose nosologic position with respect to other spondyloarthropathies associated with cutaneous disease is considered.

  16. Isotretinoin versus minocycline in cystic acne: a study of lipid metabolism.

    PubMed

    Pigatto, P D; Finzi, A F; Altomare, G F; Polenghi, M M; Vergani, C; Vigotti, G

    1986-01-01

    We have recently reported that patients with severe nodular cystic acne have much lower levels of HDL-cholesterol, apolipoprotein A and hepatic lipoprotein lipase than healthy controls or subjects with acne vulgaris. Since isotretinoin is very effective in the treatment of the nodular cystic acne but has been shown to increase blood lipid levels, we decided to compare its clinical effectiveness and its effects on lipid metabolism with those of minocycline in patients with nodular cystic acne. After 20 weeks, the number and mean diameter of the cysts were definitely decreased in both groups, but the improvement was more striking in the isotretinoin-treated group. At the end of the treatment, the HDL-C and hepatic lipoprotein lipase levels in this group were increased toward normal, but not in the minocycline-treated group. Our study showed a significant remission in the acne of patients treated with isotretinoin but not in that of the minocycline-treated patients. Furthermore isotretinoin can also correct the altered lipid metabolism in these patients.

  17. Pro-inflammatory cytokines in patients with various kinds of acne treated with isotretinoin

    PubMed Central

    Brzezińska-Wcisło, Ligia

    2014-01-01

    Introduction Acne vulgaris is the most frequently diagnosed dermatosis in patients aged between 11 and 30. It is believed that it affects about 80% of persons in this age group or even, taking into account lesions of low intensity, 100% of young people. The role of cytokines in the pathogenesis of acne is not fully known. The TLR2 receptors play a role in the aetiology of acne. Stimulation of TLR2 by Propionibacterium acnes makes the IL-8 and IL-12 concentrations increase. Aim The aim of this work was to determine IL-1β, IL-1α, IL-8 and TNF-α levels in patients’ sera used to test response to TLR2 stimulation. A decrease in the levels of the above mentioned cytokines together with a decrease in sebum production were defined as an indication of efficient treatment with isotretinoin. Material and methods The tests were performed in 155 patients treated for different clinical forms of acne with an oral isotretinoin preparation in the Dermatology Clinic of the Silesian Medical University in Katowice in 2009–2011 – I group and the patients treated with oral isotretinoin 2 and 5 years ago – II group. The control group consisted of 40 healthy individuals. Conclusions Measurements of IL-1α, IL-1β and TNF-α sera concentrations could be assessed in parallel to the improvement of the clinical condition and can constitute a good indication of the efficiency of the isotretinoin treatment. PMID:24683393

  18. Case reports: minocycline-induced hyperpigmentation resolves during oral isotretinoin therapy.

    PubMed

    Soung, Jennifer; Cohen, Justine; Phelps, Robert; Cohen, Steven R

    2007-12-01

    Although disfiguring hyperpigmentation is a well-defined complication of minocycline therapy, modalities to reverse the phenomenon are unpredictable. We report a case of minocycline-induced, blue-black pigmentation in a 23-year-old Hispanic man, which resolved after treatment with oral isotretinoin for acne vulgaris.

  19. 75 FR 39024 - Determination That ACCUTANE (Isotretinoin) Capsules, 10 Milligrams, 20 Milligrams, and 40...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-07

    ... Administration (FDA) is announcing its determination that ACCUTANE (isotretinoin) Capsules, 10 milligrams (mg), 20 mg, and 40 mg, were not withdrawn from sale for reasons of safety or effectiveness. This...) Capsules, 10 mg, 20 mg, and 40 mg, are the subject of NDA 18-662, held by Hoffman-La Roche, Inc....

  20. Short-term isotretinoin-induced elkonyxis and median nail dystrophy.

    PubMed

    Alli, Nuran; Dogan, Sibel

    2016-03-01

    Elkonyxis and median nail distrophy are very rare nail fold disorders due to the damage in nail matrix and proximal nail fold. Herein, we report a patient with both elkonyxis and median nail distrophy occured two months into a treatment course of isotretinoin that is to our knowledge for the first time.

  1. [Exposure to isotretinoin during pregnancy in France: 25 years of follow-up].

    PubMed

    Rouzès, Agnès; Jonville-Béra, Annie-Pierre

    2014-01-01

    Because of its teratogenicity, isotretinoin is contraindicated in pregnant women and also among women of childbearing age in the absence of effective contraception. The objective of this work is to summarize the results of studies assessing the effects of regulatory measures successively implemented in France since 1996 to prevent foetal exposure to isotretinoin. The five pharmacovigilance studies have shown persistence of pregnancies exposed to isotretinoin, with an estimated incidence in the latter study, between 0.32 and 0.95 per 1000 treated women of childbearing age. The strengthening of the prevention plan of pregnancies, established in France in March 2010, seems to have resulted in a decrease in the incidence of pregnancies exposed, but this trend needs to be confirmed. However, these pregnancies are almost preventable, because most of them are explained by the non-compliance with the conditions of prescribing and dispensing. Then it seems mandatory to not deliver oral isotretinoin if it is not prescribed in accordance with the prescription laid down by the authorities.

  2. Evaluation of thyroid function tests of acne vulgaris patients treated with systemic isotretinoin.

    PubMed

    Yıldırım, Neslihan; Doğan, Sibel; Atakan, Nilgün

    2017-03-01

    Isotretinoin is a systemic retinoid used to treat acne and it binds receptors which are the member of steroid-thyroid hormone superfamily. Certain types of retinoids may cause abnormalities in serum thyroid function tests (sTFTs) by suppressing thyroid stimulating hormone (TSH). However, it is uncertain whether systemic isotretinoin has any effect on sTFTs. The aim of the study was to find out if there is any alteration in sTFTs of patients with acne vulgaris treated with systemic isotretinoin. A total of 51 patients (male/female: 22/29) with severe acne vulgaris treated with a total dose of 120 mg/kg isotretinoin were included into the study prospectively. Serum free T3 (fT3), free T4 (fT4) and TSH levels were measured at baseline, 3rd and 6th months of treatment. Mean serum TSH levels at baseline, 3rd and 6th months of treatment were 1.57 ± 0.67, 2.07 ± 0.88 and 2.25 ± 0.86 uIU/mL, respectively. Mean serum TSH levels increased significantly following isotretinoin therapy (p < 0.01, p = 0.007 and p < 0.01, respectively). Mean serum fT3 levels at baseline, 3rd and 6th months of treatment were 3.59 ± 0.57, 3.19 ± 0.45 and 3.09 ± 0.61 pmol/L, respectively. Mean serum fT4 levels at baseline, 3rd and 6th months of treatment were 1.21 ± 0.19, 1.09 ± 0.16 and 1.11 ± 0.19 pmol/L, respectively. Mean serum fT3 and fT4 levels decreased significantly at 3rd and 6th months compared to baseline levels (p < 0.01 and p < 0.01, p < 0.01 and p = 0.001, respectively). Systemic isotretinoin therapy causes significant alterations in sTFTs. Dose dependent or long-term effects of systemic isotretinoin on sTFTs needs further evaluation.

  3. Dose response of retinol and isotretinoin in the prevention of nonmelanoma skin cancer recurrence.

    PubMed

    Clouser, Mary C; Roe, Denise J; Foote, Janet A; Harris, Robin B; Alberts, David S

    2010-01-01

    Using data from a randomized, double blind, study of the efficacy of retinol or isotretinoin vs. placebo on recurrence of nonmelanoma skin cancer in high-risk subjects, a reanalysis of the original intent to treat analysis was performed in a dose-response format. Cox proportional hazards models describe the relationship between dose quartiles of isotretinoin and retinol use and time to first occurrence of squamous cell carcinoma (SCC) or basal cell carcinoma (BCC) in crude and adjusted models. Neither the isotretinoin nor retinol models showed any significance at any quartile for reduction in first BCC or SCC occurrence. Crude and adjusted retinol models show a statistically significant increase in risk of developing an SCC in the first quartile, whereas only the crude model shows a statistically significant increase in risk in the first quartile of the isotretinoin model. For retinol and SCC, hazard ratios (HRs) for the first quartile were as follows: HR = 2.92, 95% confidence interval (CI) = 1.67-5.10 crude; HR = 1.95, 95% CI = 1.00-3.80 adjusted. For isotretinoin and SCC, HRs for the first quartile were as follows: HR = 2.38, 95% CI = 1.35-4.19 crude; HR = 1.69, 95% CI = 0.87-3.31 adjusted. Test for trend was not significant in any of the models. These analyses confirm the results of the original intent to treat analyses and raise an interesting question related to the potential for increased risk for patients in the first quartile of retinol dose.

  4. Inter-relationships between isotretinoin treatment and psychiatric disorders: Depression, bipolar disorder, anxiety, psychosis and suicide risks

    PubMed Central

    Ludot, Maude; Mouchabac, Stephane; Ferreri, Florian

    2015-01-01

    Isotretinoin (Accutane) is a treatment for severe acne that is resistant to other forms of treatment, including antibiotics and topical treatments. The prescription of this drug has been controversial ever since its initial marketing in 1982. It is the only non-psychotropic drug in the Food and Drug Administration top 10 drugs found to be associated with depression. Recently, Bremner et al published an extensive review (until 2010) of the evidence for the association of retinoic acid (RA) with depression and suicide. Some patients who are admitted in psychiatric hospitals report a history of present or past treatment with isotretinoin. Then, the imputability of the molecule in the occurrence of disorders represents necessarily an important question for both professionals and their patients. This paper aims to specify the links between the drug and specific psychiatric disorders. A review of the literature related to isotretinoin, RA, vitamin A, depression, suicide, anxiety, bipolar disorder, psychosis, schizophrenia was performed. Many studies demonstrated an increased risk of depression, attempted suicide and suicide following isotretinoin treatment. However, isotretinoin may have an antidepressant impact, according to some dermatological papers. They consider treating acne with this efficient treatment could improve self-image and make the patient feel better. Several studies showed that patients with bipolar disorder had an increased risk for a clinical exacerbation of symptoms undergoing treatment with isotretinoin. A few studies also seem to suggest a possible link between isotretinoin and psychosis. Nonetheless, studies point out a link between retinoid dysregulation and schizophrenia through modulation of dopamine receptors. From this review, we propose guidelines for isotretinoin prescription to healthcare professionals. PMID:26110123

  5. Decreased vitamin B12 and folic Acid concentrations in acne patients after isotretinoin therapy: a controlled study.

    PubMed

    Gökalp, Hilal; Bulur, I; Gürer, Ma

    2014-11-01

    Oral isotretinoin treatment might influence the levels of vitamin B12 and folic acid. The aim of this study is to compare vitamin B12 and folic acid levels in patients with moderate and severe acne vulgaris with those of the healthy control group and to investigate the effect of isotretinoin treatment on these vitamins. Patients who completed 6 months of isotretinoin therapy for moderate and severe forms of acne vulgaris and a control group consisting of healthy individuals between February 2011 and March 2012 were included in the study. Before isotretinoin therapy and at 6.- months of the therapy, serum vitamin B12 and folic acid levels were measured. In the healthy control group, vitamin B12 and folic acid levels were assessed only once. In total, 120 patients with moderate and severe acne vulgaris who completed 6 months isotretinoin therapy and 100 healthy individuals who constituted the control group were included in the study. Pre-treatment vitamin B12 values of the patient group were found to be statistically significantly higher (P = 0.002), but any statistically significant difference was not detected in folic acid measurements (P = 0.566). A statistically significant decrease was detected in post-treatment vitamin B12 and folic acid levels (P < 0.05). Vitamin B12/folic acid treatment should be given under medical surveillance before and during isotretinoin therapy. Supplementation of these vitamins should be recommended in cases of their deficiency, so as to decrease the risks of neuropsychiatric and occlusive vascular diseases.

  6. Novel isotretinoin microemulsion-based gel for targeted topical therapy of acne: formulation consideration, skin retention and skin irritation studies

    NASA Astrophysics Data System (ADS)

    Patel, Mrunali R.; Patel, Rashmin B.; Parikh, Jolly R.; Patel, Bharat G.

    2016-04-01

    Isotretinoin was formulated in novel microemulsion-based gel formulation with the aim of improving its solubility, skin tolerability, therapeutic efficacy, skin-targeting efficiency and patient compliance. Microemulsion was formulated by the spontaneous microemulsification method using 8 % isopropyl myristate, 24 % Labrasol, 8 % plurol oleique and 60 % water as an external phase. All plain and isotretinoin-loaded microemulsions were clear and showed physicochemical parameters for the desired topical delivery and stability. The permeation profiles of isotretinoin through rat skin from selected microemulsion formulation followed zero-order kinetics. Microemulsion-based gel was prepared by incorporating Carbopol®971 in optimized microemulsion formulation having suitable skin permeation rate and skin uptake. Microemulsion-based gel showed desired physicochemical parameters and demonstrated advantage over marketed formulation in improving the skin tolerability of isotretinoin, indicating its potential in improving topical delivery of isotretinoin. The developed microemulsion-based gel may be a potential drug delivery vehicle for targeted topical delivery of isotretinoin in the treatment of acne.

  7. Colloidal carriers of isotretinoin for topical acne treatment: skin uptake, ATR-FTIR and in vitro cytotoxicity studies.

    PubMed

    Gürbüz, Aslı; Özhan, Gül; Güngör, Sevgi; Erdal, M Sedef

    2015-09-01

    Acne vulgaris is the chronical, multifactorial and complex disease of the pilosebaceous unit in the skin. The main goal of the topical therapy in acne is to target the drug to epidermal and deep dermal regions by minimizing systemic absorption . Isotretinoin, a retinoic acid derivative, is the most effective drug in acne pathogenesis. Because systemic treatment may cause many side effects, topical isotretinoin treatment is an option in the management of acne. However, due to its high lipophilic character, isotretinoin tends to accumulate in the upper stratum corneum, thus its penetration into the lower layers is limited, which restricts the efficiency of topical treatment. Microemulsions are fluid, isotropic, colloidal drug carriers that have been widely studied as drug delivery systems. The percutaneous transport of active agents can be enhanced by microemulsions when compared with their conventional formulations. The purpose of this study was to evaluate microemulsions as alternative topical carriers for isotretinoin with an objective to improve its skin uptake. After in vitro permeation studies, the dermal penetration of isotretinoin from microemulsions was investigated by tape stripping procedure. Confocal laser scanning microscopy provided insight about the localization of the drug in the skin. The interaction between the microemulsion components and stratum corneum lipids is studied by ATR-FTIR spectroscopy. The relative safety of the microemulsions was assessed in mouse embryonic fibroblasts using MTT viability test. The results indicate that microemulsion-based novel colloidal carriers have a potential for enhanced skin delivery and localization of isotretinoin.

  8. The effect of different doses of isotretinoin on pituitary hormones.

    PubMed

    Karadag, Ayse Serap; Takci, Zennure; Ertugrul, Derun Taner; Bilgili, Serap Gunes; Balahoroglu, Ragip; Takir, Mumtaz

    2015-01-01

    There are a limited number of studies investigating the side effects and effectiveness of various doses of isotretinoin (ISO). We have previously shown that high-dose ISO affects pituitary hormones. To our knowledge, there is no study in the literature looking into the effects of various doses of ISO on pituitary hormones. We searched pituitary hormones in three groups of different doses in acne patients. We included 105 acne vulgaris patients from two different centers. We divided the patients into three groups; the first group received 0.5-1 mg/kg/day, the second 0.2-0.5 mg/kg/day and the third intermittent 0.5-1 mg/kg/day (only 1 week in 1 month) ISO treatment. Blood samples were collected for biochemistry and hormone analysis, before the treatment and after 3 months. After 3 months of treatment with ISO, luteinizing hormone (LH) (p < 0.001), prolactin (p < 0.001), total testosterone (p < 0.001), adrenocorticotropic hormone (ACTH) (p < 0.001), cortisol (p < 0.001), insulin-like growth factor-binding protein 3 (p < 0.001), insulin-like growth factor 1 (IGF-1) (p = 0.002), growth hormone (GH) (p = 0.002) and free T3 (fT3) (p < 0.001) levels had decreased significantly. Furthermore, we split data into three different groups. Among the patients receiving intermittent-dose ISO, LH, ACTH, IGF-1, GH and fT3 measurements lost significance. Most of the significant measurements observed in the whole group were also significant among the patients receiving high-dose ISO. Additionally, dehydroepiandrosterone sulfate (p = 0.003) levels increased, and free T4 levels decreased significantly. ISO affects pituitary hormones at all of these three doses. The differences in pituitary hormones are more pronounced in high-dose treatment. The weakest effect was observed in the intermittent-dose group. Choosing lower doses of ISO may decrease side effects, however the effectiveness of the treatment may also be diminished. ISO, by affecting the PPARγ/RXR system, may affecting hormone

  9. Isotretinoin conundrum: a randomized, openlabel, crossover study in Mexico to evaluate the bioavailability and bioequivalence of three pharmaceutical preparations of isotretinoin in healthy participants.

    PubMed

    Piñeyro-Garza, Everardo; Gómez-Silva, Magdalena; Gamino Peña, María Elena; Palmer, Jonathan; Berber, Arturo

    2015-10-01

    The oral retinoid agent isotretinoin (13-cis-retinoic acid) is approved for the treatment of severe recalcitrant cystic acne. For registrational renewal of Oratane® in Mexico (isotretinoin; Laboratorios Dermatologicos Darier S.A. de C.V., Mexico), it was necessary to establish bioequivalence to the reference product Roaccutan® (Isotretinoin; Roche, Mannheim, Germany). Three prior studies failed to establish the bioequivalence of Oratane to Mexican-sourced Roaccutan. However, 13 studies demonstrated the bioequivalence of Oratane to Roaccutane® from multiple sources. This study compared the bioavailability of Oratane with that of Mexicansourced Roaccutan and Australian-sourced Roaccutane. Study participants received each of the three agents in a randomized, open-label, 6-sequence, 3-way crossover study with a 2-week washout period between treatments. Pharmacokinetic analysis revealed that peak plasma concentration (Cmax) and area under the plasma concentration-time curve from time 0 (dosing) to infinite time (AUC0-∞) were lower for Roaccutan than for Roaccutane and Oratane (Cmax: 1,023.35, 1,223.08, and 1,224.25 ng/mL, respectively; AUC0-∞: 13,653.65, 15,681.35 and 15,733.55 ng/mL x h, respectively). The 90% CIs (test/reference) for the ratios of the geometric means indicated that Oratane was bioequivalent to Roaccutane but not to Roaccutan. In addition, Roaccutane (R2) was not bioequivalent to Roaccutan (R1; R1/R2 90% CIs: Cmax, 76.12 - 91.04; AUC0-t, 82.19 - 91.13; AUC0-∞, 82.94 - 91.57). Oratane and Australian-sourced Roaccutane could be considered bioequivalent, but neither formulation was found to be bioequivalent to Mexican-sourced Roaccutan.

  10. The efficacy of 5% dapsone gel plus oral isotretinoin versus oral isotretinoin alone in acne vulgaris: A randomized double-blind study

    PubMed Central

    Faghihi, Gita; Rakhshanpour, Mehrdad; Abtahi-Naeini, Bahareh; Nilforoushzadeh, Mohammad Ali

    2014-01-01

    Background: Acne vulgaris, a common human skin condition, is an inflammatory disease characterized by comedones, papules, nodules and possibly scarring. This study aimed to evaluate the efficacy of a combination of 5% dapsone gel plus oral isotretinoin in the treatment of acne vulgaris. Materials and Methods: A randomized, placebo-controlled, study was carried out on patients with moderate to severe acne. The patients were randomly divided in two groups: (dapsone gel and vehicle gel). All Patients were administered oral isotretinoin 20 mg daily and topical gel twice a day for 8 weeks. The Global Acne Assessment Score (GAAS), the number lesions and side-effects were documented at base line and weeks 4, 8 and 12. Results: A total of 58 patients (age range: 18-25 years) were included in our study. The number of lesions was significantly lower in the dapsone-treated group at all follow-up visits (P < 0.001). The mean GAAS score in the dapsone-treated group and in the Placebo-treated group decreased, but there was no statistical difference in two groups (P < 0.001). The side-effects on the dapsone-treated group were a mild burning sensation in 7 patients (24.13%), mild erythema of the skin and mild dryness in 4 (13.79%) and 3 (10.34%) cases respectively (P < 0.001). In our study, adverse effects were common but they were minor and tolerable. No clinically significant changes in laboratory parameters were observed (P < 0.001). Conclusions: Dapsone gel was an effective medication for patients who received isotretinoin for acne vulgaris treatment resulting in a significant reduction of the number of lesions. PMID:25250291

  11. What Is the Best Approach to Reducing Birth Defects Associated with Isotretinoin?

    PubMed Central

    Abroms, Lorien; Maibach, Edward; Lyon-Daniel, Katherine; Feldman, Steven R

    2006-01-01

    Background to the debate: Isotretinoin is an effective treatment for severe acne, a condition which can be physically, emotionally, and socially disabling. Because the drug is teratogenic, causing severe birth defects, women taking the drug are directed to avoid pregnancy. In the United States, a series of risk reduction programs have been implemented that aim to prevent pregnant women from taking the drug and to prevent women taking it from getting pregnant. The most recent, and most stringent, is an Internet-based, performance-linked system called iPLEDGE, which tries to ensure that the drug is dispensed only when there is documentary proof that the patient is not pregnant and is using two forms of birth control. Is iPLEDGE the best way to reduce isotretinoin birth defects, or is it an unproven and overly burdensome system? PMID:17121451

  12. A Randomized-Controlled Trial of Oral Low-Dose Isotretinoin for Difficult-To-Treat Papulopustular Rosacea.

    PubMed

    Sbidian, Emilie; Vicaut, Éric; Chidiack, Henri; Anselin, Elie; Cribier, Bernard; Dréno, Brigitte; Chosidow, Olivier

    2016-06-01

    Rosacea is a chronic inflammatory facial skin disease with psychosocial impact. Oral cyclines are recommended for moderate-to-severe papulopustular rosacea. Oral isotretinoin was found valuable for difficult-to-treat cases in several reports. This multicenter, double-blind, randomized-placebo-controlled trial compared oral isotretinoin (0.25 mg/kg/day) with placebo (2:1 ratio) for difficult-to-treat papulopustular rosacea. Included patients had at least eight papulopustular lesions. The primary endpoint after the 4-month treatment period was the response rate: at least 90% reduction of the number of papules/pustules compared with baseline. Secondary outcomes included measures on quality of life (Skindex score). Between February 2007 and August 2009, 156 patients were randomized to receive either isotretinoin (n = 108) or placebo (n = 48). In the intention-to-treat population, 57.4% of isotretinoin recipients reached the primary endpoint, compared with 10.4% of those taking the placebo (absolute difference, 47 percentage points; 95% confidence interval, 34.3-59.7; P < 0.0001). To consider therapy successful, 2.1 (95% confidence interval 1.7-2.9) patients had to be treated. Skindex scores had improved significantly more for isotretinoin- than placebo-treated patients. Rosacea relapsed in 27 (58.3%) of 51 patients who accepted 4 months of continued follow-up, with a median of 15 weeks to recurrence. The percentages of patients in each arm who stopped their treatment because of adverse event(s) did not differ. Low-dose isotretinoin was an effective therapeutic option for difficult-to-treat papulopustular rosacea. Further studies should investigate the value of a minimal effective isotretinoin dose to maintain these remissions. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  13. Oral isotretinoin in photoaging: objective histological evidence of efficacy and durability*

    PubMed Central

    Bravo, Bruna Souza Felix; Azulay, David Rubem; Luiz, Ronir Raggio; Mandarim-De-Lacerda, Carlos Alberto; Cuzzi, Tullia; Azulay, Mônica Manela

    2015-01-01

    BACKGROUND The off-label use of oral isotretinoin in photoaging is a therapeutic tool that has been used by dermatologists. There are few studies to corroborate its effectiveness and durability. OBJECTIVES To assess, both clinically and histologically, the changes caused by the use of oral isotretinoin in skin photoaging as well as the duration of the effects. METHODS 20 female patients, aged 45-50 years, with phototypes II-VI, none of whom had experienced menopause, were treated with 20mg oral isotretinoin, 3 days a week, for 12 weeks. They underwent clinical analysis and skin biopsies in the pre-auricular region, while histologic cuts enabled assessment of the solar elastosis level and morphologic analysis. RESULTS Clinically, patients, as well as the researching and the assessor physicians, noticed improvement in skin quality. One patient presented severe solar elastosis, 11 manifested the moderate form, while 8 presented the discreet type. According to histological analysis, 65% of the patients revealed alteration in the distribution and thickness of the elastic fibers, which can be interpreted as a histological improvement, while 60% showed an increase in collagen density. We observed an increase in collagen density, from 51.2% to 57.4%, (p=0.004). At the end of the 12-week follow-up period, this density decreased to 54.7% (p=0.050). There was an increase in the density of elastic fibers, from 26.5% to 31.3%, (p=0.02), which had dropped to 27.5% at the end of the 12-week follow-up period. CONCLUSIONS The study confirmed the role of oral isotretinoin in remodeling the extracellular matrix against photoaging, as well as its durability after 12 weeks, especially when we consider collagen fibers. PMID:26375216

  14. Effects of isotretinoin treatment on cartilage and tendon thicknesses: an ultrasonographic study.

    PubMed

    Yıldızgören, Mustafa Turgut; Karataş Toğral, Arzu; Baki, Ali Erdem; Ekiz, Timur

    2015-07-01

    Effects of retinoic acid on collagen synthesis and cartilage have previously been shown. However, its effects on cartilage and tendons in humans have not been studied yet. Therefore, in order to provide a morphologic insight, the aim of this study was to measure femoral cartilage, Achilles and supraspinatus tendon thicknesses in patients under systemic isotretinoin treatment by using ultrasound. Fifteen patients (nine F, six M) who used isotretinoin for their acnes were included. All patients were treated with isotretinoin 0.5 mg/kg/day for the first month, and the dosage was escalated up to 1 mg/kg/day thereafter. Distal femoral cartilage, supraspinatus, and Achilles tendons thicknesses have been evaluated both before the treatment and at the end of the third month. Femoral cartilage thicknesses were assessed from three midpoints bilaterally; medial condyle, lateral condyle, and intercondylar area. Short/long-axis diameters and cross-sectional area of the Achilles tendons and axial tendon thicknesses of supraspinatus tendon were evaluated from the nondominant side. The mean age of the patients was 20.1 ± 4.9 years, and body mass index was 21.7 ± 2.5 kg/m(2). Although posttreatment cartilage measurements of 30 knees were lower for the three midpoints, it reached significance only for lateral condyle (p = 0.05). In addition, posttreatment tendon measurements were not statistically significant compared with pretreatment values (all p > 0.05). Systemic isotretinoin treatment seems to make cartilage thinner. Further studies considering histological and molecular evaluations with more sample sizes are awaited.

  15. Isotretinoin: dose, duration and relapse. What does 30 years of usage tell us?

    PubMed

    Rademaker, Marius

    2013-08-01

    With 30 years of clinical use, it is appropriate to review the use of isotretinoin. We now understand that retinoids influence cellular growth, differentiation, morphogenesis and apoptosis, inhibit tumour promotion and malignant cell growth, exert immuno-modulatory actions and alter cellular cohesiveness. This has expanded the indications of isotretinoin from just acne and rosacea to a wide range of inflammatory and malignant skin disorders. While the standard dose of 0.5 to 1 mg/kg per day for 4 months to a cumulative dose of 120-140 mg/kg per day has served us well in the management of acne vulgaris, there is emerging evidence that much lower dosages (as low as 5 mg/day) are just as effective but have significantly fewer adverse effects. Relapse of acne vulgaris continues to be a problem but we are beginning to recognise that this is related less to the cumulative dose and more to the length of sebaceous gland suppression. Other factors important for relapse include a macrocomedonal pattern of acne, smoking and age, both younger (under 14 years) and older (over 25 years). After 30 years of use, we now understand why isotretinoin is such an effective drug. Not only does it clear acne in almost all patients, long-term remission can be achieved in 70-80% of patients with a single course. Important changes in the use of isotretinoin include using a lower daily dose for a longer period of time. New indications continue to emerge, particularly as a potential treatment for both intrinsic and extrinsic (photo) aging. Teratogenicity however, remains a very significant concern.

  16. Reduced salivary flow induced by systemic isotretinoin may lead to dental decay. A prospective clinical study.

    PubMed

    Lupi-Pégurier, L; Muller-Bolla, M; Fontas, E; Ortonne, J P

    2007-01-01

    The adverse effects of isotretinoin have been well documented, but dental side effects over the course of treatment have never been studied. To prospectively document the oral side effects experienced by a group of patients taking isotretinoin and to compare the changes in oral health and salivary parameters with a control group. A cohort study was conducted within the dermatology department at the University Hospital in collaboration with two private dermatology practices in Nice, France. Patients were treated at a dose of 0.5 mg/kg/day. The control group was made up of students from the University of Nice-Sophia-Antipolis. The salivary flow, the buffer capacity of saliva, the number of pathogen bacteria and the DMFT index (number of decayed, missing and filled teeth) were assessed at each visit. Eighteen patients and 99 controls were available for evaluation. None of the oral parameters varied with time in the control group, whereas the DMFT significantly increased in the treated group (3.07 +/- 3.85 vs. 3.41 +/- 4.36; p<0.036). The salivary flow gradually decreased with time (p<0.004), but the patients recovered their baseline salivary flow 2 months after the end of the treatment. This study clearly showed that patients treated with isotretinoin experienced oral side effects. Copyright (c) 2007 S. Karger AG, Basel.

  17. Isotretinoin systemic therapy and the shadow cast upon dermatology's downtrodden hero.

    PubMed

    Lowenstein, Elie B; Lowenstein, Eve J

    2011-01-01

    Isotretinoin has revolutionized the field of dermatology, offering a cure for severe acne vulgaris and a therapeutic option for a variety of other chronic diseases and cancers. This drug has done more for many diseases in medicine than many drug classes have done for a single disorder, and yet, its use and availability have been threatened in the United States. Federal restrictions in the form of the IPLEDGE teratogenicity prevention plan have made the use of this drug more complex. Millions of dollars in litigation and claims of injury have fueled hysteria among laymen about the use of this drug. Overwhelmed with worries of its potential adverse effects, the public forgets that withholding isotretinoin therapy is not without its own risks. Isoteretinoin therapy can prevent lifelong and permanent physical and psychological scarring that comes as a matter of course with severe acne. Over 20 million people worldwide have taken the drug, with several studies demonstrating its safety and few long term adverse effects. This wonder drug's continued availability depends upon its responsible and informed use. This paper will review and put in perspective the issues important to consider in the proper use of isotretinoin.

  18. Effects of oral antibiotics and isotretinoin on the murine gut microbiota.

    PubMed

    Becker, Eugenia; Schmidt, Thomas S B; Bengs, Susan; Poveda, Lucy; Opitz, Lennart; Atrott, Kirstin; Stanzel, Claudia; Biedermann, Luc; Rehman, Ateequr; Jonas, Daniel; von Mering, Christian; Rogler, Gerhard; Frey-Wagner, Isabelle

    2017-09-01

    Inflammatory bowel disease (IBD) may develop due to an immunogenic response to commensal gut microbiota triggered by environmental factors in the genetically susceptible host. Isotretinoin, applied in the treatment of severe acne, has been variably associated with IBD, but prior treatment with antibiotics, also associated with IBD development, confounds confirmation of this association. This study investigated the effects of doxycycline, metronidazole (frequently used in the treatment of acne and IBD, respectively) and isotretinoin on murine gut (faecal) microbiota after 2 weeks of treatment and after a 4-week recovery period. Faecal microbiota composition was assessed by 16S rRNA gene sequencing on the GS-FLX 454 platform with primers directed against the variable regions V1-V2. Doxycycline had a modest effect on bacterial richness and evenness, but had pronounced persistent and significant effects on the abundance of certain operational taxonomic units compared with the control group. In contrast, metronidazole induced a pronounced reduction in diversity after treatment, but these effects did not persist after the recovery period. This study demonstrates differential effects of antibiotics on the gut microbiota with doxycycline, unlike metronidazole, mediating long-term changes in the murine gut microbiota. Isotretinoin had no significant effect on the faecal microbiota. Copyright © 2017 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.

  19. A pregnancy-prevention program in women of childbearing age receiving isotretinoin.

    PubMed

    Mitchell, A A; Van Bennekom, C M; Louik, C

    1995-07-13

    Isotretinoin is effective in treating severe acne, but it is also teratogenic. To minimize pregnancies among exposed women, the manufacturer, together with the US Food and Drug Administration, implemented a multicomponent Pregnancy Prevention Program in 1988. The results of an ongoing survey designed to assess compliance with this program are reported. Treated women enrolled in the survey through their physician, by filling out a form in the medication package, or by calling a toll-free telephone number. They were randomly assigned to be followed by telephone or by mail. Telephone interviews were conducted at the start of therapy, in the middle of it, and 6 months after it ended; mailed questionnaires were completed 6 months after therapy ended (median duration of therapy, 20 weeks). Between January 1, 1989, and December 31, 1993, 177,216 eligible women enrolled in the survey. First telephone interviews were completed with 24,503 women within 1 month of enrollment. The median age of these women was 26 years, the median number of years of education was 14, and the median duration of acne was 8 years. 99% had been told to avoid pregnancy; 85% were told of the importance of using effective contraception for 1 month before starting isotretinoin. At that time, approximately 54% were not sexually active (of whom 37% used contraception); 42% were sexually active (of whom 99% used contraception); and 4% were infertile. As of June 30, 1994, 124,216 women had completed telephone or mail follow-up. There were 402 pregnancies during therapy (0.3% or 3.4 per 1000 20-week courses of isotretinoin); 46 were pregnant when therapy began, and 356 became pregnant during therapy. 290 (72%) of the 402 pregnant women had elective abortions, 63 (16%) had spontaneous abortions, 13 (3%) had ectopic pregnancies, and 32 (8%) had live births. Of the 32 liveborn infants, the survey teratologist examined 13, of whom 5 were judged to have defects compatible with the isotretinoin embryopathy. The

  20. Matrix metalloproteinases of epithelial origin in facial sebum of patients with acne and their regulation by isotretinoin.

    PubMed

    Papakonstantinou, Eleni; Aletras, Alexios J; Glass, Evelyn; Tsogas, Panagiotis; Dionyssopoulos, Alexander; Adjaye, James; Fimmel, Sabine; Gouvousis, Panagiotis; Herwig, Ralf; Lehrach, Hans; Zouboulis, Christos C; Karakiulakis, George

    2005-10-01

    Acne vulgaris is a skin disorder of the sebaceous follicles, involving hyperkeratinization and perifollicular inflammation. Matrix metalloproteinases (MMP) have a predominant role in inflammatory matrix remodeling and hyperproliferative skin disorders. We investigated the expression of MMP and tissue inhibitors of MMP (TIMP) in facial sebum specimens from acne patients, before and after treatment with isotretinoin. Gelatin zymography and Western-blot analysis revealed that sebum contains proMMP-9, which was decreased following per os or topical treatment with isotretinoin and in parallel to the clinical improvement of acne. Sebum also contains MMP-1, MMP-13, TIMP-1, and TIMP-2, as assessed by ELISA and western blot, but only MMP-13 was decreased following treatment with isotretinoin. The origin of MMP and TIMP in sebum is attributed to keratinocytes and sebocytes, since we found that HaCaT keratinocytes in culture secrete proMMP-2, proMMP-9, MMP-1, MMP-13, TIMP-1, and TIMP-2. SZ95 sebocytes in culture secreted proMMP-2 and proMMP-9, which was also confirmed by microarray analysis. Isotretinoin inhibited the arachidonic acid-induced secretion and mRNA expression of proMMP-2 and -9 in both cell types and of MMP-13 in HaCaT keratinocytes. These data indicate that MMP and TIMP of epithelial origin may be involved in acne pathogenesis, and that isotretinoin-induced reduction in MMP-9 and -13 may contribute to the therapeutic effects of the agent in acne.

  1. A double-blind, randomized, placebo-controlled trial of oral isotretinoin in the treatment of recalcitrant facial flat warts.

    PubMed

    Olguin-García, María Guadalupe; Jurado-Santa Cruz, Fermín; Peralta-Pedrero, María Luisa; Morales-Sánchez, Martha Alejandra

    2015-02-01

    Abstract Background: Recalcitrant facial flat warts are caused by human papillomavirus and may persist for years despite treatment. Isotretinoin has demonstrated benefits in the treatment of recalcitrant, genital and common warts, but placebo-controlled trials have not been performed. To determine whether isotretinoin is safe and effective for recalcitrant facial flat warts. Isotretinoin 30 mg/day or placebo was administered to 16 and 15 patients, respectively, in double-blind, randomized fashion for 12 weeks. Cutaneous lesions were assessed and adverse events including serologic and ophthalmologic changes were recorded. It is considered that warts were recalcitrant if the patient was treated for at least 3 years with at least three of the following options: retinoids, 5-fluorouracil, imiquimod and cryotherapy using liquid nitrogen. Each patient in the istotretinoin group showed complete clearance of all flat warts, while none of the patients in the placebo group showed any improvement (p=0.0001). The most frequent adverse event was cheilitis. There were no statistically significant changes in the laboratory findings. The study design does not permit complete blinding of the dermatologist who can easily recognize the adverse effects of isotretinoin. The clinical findings, however, were so dramatic that this would not have impacted the findings. Another limitation of the study is a lack of follow-up to assess for recurrence after the drug was discontinued. Isotretinoin is an effective treatment for recalcitrant flat facial warts with a well-known, manageable safety profile.

  2. Effect of isotretinoin on prothrombin time (PT), international normalized ratio (INR), and activated partial thromboplastin time (aPTT).

    PubMed

    Kaptanoglu, Asli Feride; Uncu, Murat; Ozyurt, Selcuk; Hincal, Evren

    2013-08-01

    Patients with severe acne may need elective/urgent surgical interventions during treatment with isotretinoin and it is critical for the surgeon to consider the possible effects of this medication on coagulation systems. The aim of this study is to determine the changes in prothrombin time (PT), international normalized ratio (INR), and activated partial thromboplastin time (aPTT) during isotretinoin treatment. PT, aPTT, and INR values of 51 severe acne patients were evaluated during routine pre-treatment biochemical analysis. Only patients with normal values were included in the study. The results of before and after 1 month treatment were compared statistically. There were no statistically significant change in mean alanine aminotranferease (ALT), aspartate aminotransferase (AST), PT, and INR values after treatment. A significant increase in aPTT was detected. The INR values, which are more trusted and safe, showed no difference. Isotretinoin seems to have no effect on these coagulation parameters.

  3. Decreased Vitamin B12 and Folic Acid Concentrations in Acne Patients After Isotretinoin Therapy: A Controlled Study

    PubMed Central

    Gökalp, Hilal; Bulur, I; Gürer, MA

    2014-01-01

    Background: Oral isotretinoin treatment might influence the levels of vitamin B12 and folic acid. Aims and Objectives: The aim of this study is to compare vitamin B12 and folic acid levels in patients with moderate and severe acne vulgaris with those of the healthy control group and to investigate the effect of isotretinoin treatment on these vitamins. Materials and Methods: Patients who completed 6 months of isotretinoin therapy for moderate and severe forms of acne vulgaris and a control group consisting of healthy individuals between February 2011 and March 2012 were included in the study. Before isotretinoin therapy and at 6.- months of the therapy, serum vitamin B12 and folic acid levels were measured. In the healthy control group, vitamin B12 and folic acid levels were assessed only once. Results: In total, 120 patients with moderate and severe acne vulgaris who completed 6 months isotretinoin therapy and 100 healthy individuals who constituted the control group were included in the study. Pre-treatment vitamin B12 values of the patient group were found to be statistically significantly higher (P = 0.002), but any statistically significant difference was not detected in folic acid measurements (P = 0.566). A statistically significant decrease was detected in post-treatment vitamin B12 and folic acid levels (P < 0.05). Conclusion: Vitamin B12/folic acid treatment should be given under medical surveillance before and during isotretinoin therapy. Supplementation of these vitamins should be recommended in cases of their deficiency, so as to decrease the risks of neuropsychiatric and occlusive vascular diseases. PMID:25484410

  4. Surgical Outcome in Patients Taking Concomitant or Recent Intake of Oral Isotretinoin: A Multicentric Study-ISO-AIMS Study

    PubMed Central

    Mahadevappa, Omprakash Heggadahalli; Mysore, Venkataram; Viswanath, Vishalakshi; Thurakkal, Salim; Majid, Imran; Talwar, Suresh; Aurangabadkar, Sanjeev J; Chatterjee, Manas; Bhat, M Ramesh; Barua, Shyamanta; Ganjoo, Anil

    2016-01-01

    Background: The current standard recommendation is to avoid surgical interventions in patients taking oral isotretinoin. However, this recommendation has been questioned in several recent publications. Aim: To document the safety of cosmetic and surgical interventions, among patients receiving or recently received oral isotretinoin. Materials and Methods: Association of Cutaneous Surgeons, India, in May 2012, initiated this study, at 11 centers in different parts of India. The data of 183 cases were collected monthly, from June 2012 to May 2013. Of these 61 patients had stopped oral isotretinoin before surgery and 122 were concomitantly taking oral isotretinoin during the study period. In these 183 patients, a total of 504 interventions were performed. These included[1] 246 sessions of chemical peels such as glycolic acid, salicylic acid, trichloroacetic acid, and combination peels;[2] 158 sessions of lasers such as ablative fractional laser resurfacing with erbium-doped yttrium aluminum garnet and CO2, conventional full face CO2 laser resurfacing, laser-assisted hair reduction with long-pulsed neodymium-doped yttrium aluminum garnet, diode laser, and LASIK surgery;[3] 27 sessions of cold steel surgeries such as microneedling, skin biopsy, subcision, punch elevation of scars, excision of skin lesion, and wisdom tooth extraction;[4] 1 session of electrosurgery. Results: No significant side effects were noted in most patients. 2 cases of keloid were documented which amounted to 0.4% of side effects in 504 interventions, with a significant P value of 0.000. Reversible transient side effects were erythema in 10 interventions and hyperpigmentation in 15. Conclusion: The study showed that performing dermatosurgical and laser procedures in patients receiving or recently received isotretinoin is safe, and the current guidelines of avoiding dermatosurgical and laser interventions in such patients taking isotretinoin need to be revised. PMID:27398012

  5. The safety of isotretinoin in patients with lupus nephritis: a comprehensive review.

    PubMed

    Miziołek, Bartosz; Bergler-Czop, Beata; Stańkowska, Anna; Brzezińska-Wcisło, Ligia

    2017-03-01

    Oral isotretinoin (13-cis-retinoinc acid) is a derivative of vitamin A and belongs to the first generation of retinoids, which act as synthetic isomers of retinoic acid (RA). It is a very effective agent in a treatment of acne vulgaris; however, multiple side effects related to therapy with retinoids preclude the use of isotretinoin in less severe acne vulgaris. A significant limitation for the administration of isotretinoin appears in case of concomitant kidney disease with a special attention regarding the safety of the agent in patients with lupus nephritis (LN). The aim of this review is an assessment of the safety of isotretinoin for the treatment of acne vulgaris in patients with LN. We searched both MEDLINE and SCOPUS databases, as well as several dermatological textbooks, to present all limitations and benefits of therapy with isotretinoin or its isomer (ATRA) for patients with kidney diseases. Several mouse models of SLE revealed a significant modulatory influence of retinoids on autoimmune injury of the glomerular unit. Retinoids were demonstrated to affect mononuclear cell infiltrations of renal tissue allowing for a reduction in the overall glomerular damage. Presumptively, they can affect a synthesis of autoantibodies significantly limiting their deposition in the glomerular unit. Moreover, retinoids were also shown to affect the synthesis of different cytokines specific both for lymphocytes Th1 (IL-2, IL-12, INFγ) ant Th2 (IL-4, IL-10). The influence of retinoids on the course of LN seems to be more multidimensional than only restricted to immune aspects and these synthetic RA isomers manifest also antiproteinuric activity in comparable extent to steroidal agents. The agents were demonstrated to counteract a loss of podocytes after the injury of the glomerular unit. They can promote a differentiation of renal progenitor cells (RPCs) within the Bowman capsule into mature podocytes leading to regeneration of podocyte number. Additionally, retinoids can

  6. Not every patient needs a triglyceride check, but all can get pancreatitis: a systematic review and clinical characterization of isotretinoin-associated pancreatitis.

    PubMed

    Opel, D; Kramer, O N; Chevalier, M; Bigby, M; Albrecht, J

    2016-11-28

    Monitoring of triglycerides for patients on isotretinoin is practised primarily to avoid hypertriglyceridaemia-associated pancreatitis. The aim of this study was to describe clinically the published cases of hypertriglyceride-associated pancreatitis. A comprehensive search strategy using MEDLINE, Embase and grey literature was conducted (1960 to January 2016) to identify all case reports of isotretinoin-associated pancreatitis and all relevant studies of isotretinoin and triglycerides for any indication (≥ 20 patients). Terms related to isotretinoin, triglycerides and pancreatitis were searched with all available synonyms. Any studies that used isotretinoin and mentioned triglycerides or pancreatitis were searched in full text, where available, for cases of pancreatitis. Studies from all countries and published in any language were included, but Korean and Turkish studies could not be analysed. Two authors independently reviewed the publications to determine eligibility, and for data extraction. In total, 125 papers fulfilled the inclusion criteria and were searched for cases of pancreatitis. Eleven papers with 25 cases of pancreatitis associated with isotretinoin were identified; four of these cases were likely due to hypertriglyceridaemia. Three patients had elevated baseline triglycerides, but no monitoring. Pancreatitis occurred 6 and 7 weeks, and 6 months after initiation of therapy. For the fourth patient who was treated for glioblastoma and died, no detailed clinical information was available. Idiosyncratic pancreatitis associated with isotretinoin is the most frequent pancreatitis on isotretinoin, and patients should be warned about it. Hypertriglyceride-associated pancreatitis is an exceedingly rare adverse event of isotretinoin therapy. Our data cannot give a frequency or risk for either adverse event. Based on the clinical information of the patients available, we conclude that for patients without elevated baseline triglycerides, or risk thereof

  7. Structural and Functional Assessment in Patients Treated with Systemic Isotretinoin Using Optical Coherence Tomography and Frequency-Doubling Technology Perimetry

    PubMed Central

    Bakbak, Berker; Gedik, Sansal; Koktekir, Bengu Ekinci; Guzel, Huseyin; Altınyazar, Hilmi Cevdet

    2013-01-01

    Abstract A causal association between central nervous system neuropathy and oral isotretinoin has been reported. In this study we aimed to assess retinal nerve fibre layer (RNFL) thickness and visual field changes in patients treated with systemic isotretinoin. Thirty-nine patients treated with 1 mg/kg daily oral isotretinoin were enrolled in this prospective clinical trial. All patients underwent complete ophthalmologic assessment before treatment, on day 60, and 3 months after completion of treatment. RNFL thickness measurements were performed with Stratus optical coherence tomography. Functional testing included frequency-doubling technology perimetry and Humphrey field analyser. Main outcome measures were average RNFL thicknesses and visual field indices (mean deviation, pattern standard deviation). Measurements of RNFL thickness showed no statistically significant change between the three measurements (p = 0.180). No statistically significant differences were observed in the frequency-doubling technology indices (mean deviation and pattern standard deviation, p = 0.066 and p = 0.103, respectively) and in the Humphrey field analyser indices (mean deviation and pattern standard deviation, p = 0.091 and p = 0.087, respectively) at day 60 of treatment or 3 months after the cessation of treatment. In this study of 39 patients, systemic use of isotretinoin (1 mg/kg daily) does not cause a statistically significant change in peripapillary RNFL thickness or visual field findings within the usage period, and within 3 months after cessation. PMID:28163763

  8. Oral isotretinoin in the treatment of recalcitrant condylomata acuminata of the cervix: a randomised placebo controlled trial

    PubMed Central

    Georgala, S; Katoulis, A; Georgala, C; Bozi, E; Mortakis, A

    2004-01-01

    Objectives: To investigate the efficacy and safety of low dose oral isotretinoin in recalcitrant condylomata acuminata (RCA) of the cervix. Methods: Double blind placebo controlled clinical trial. 60 women, aged 21–43 years, with RCA of the cervix, refractory to at least one conventional therapy, were randomly assigned to receive either isotretinoin, 0.5 mg/kg daily for 12 weeks (group 1), or placebo (group 2). Results: Of the 28 evaluable group 1 patients, nine (32.1%) responded to the treatment completely, 11 (39.2%) responded partially, and eight (28.5%) did not respond. Of the 25 group 2 patients, no one responded to the treatment completely, two (8%) responded partially, and 23 (92%) did not respond. The therapeutic difference between patients receiving active and placebo therapy was statistically significant (χ2 = 19.35, p<0.001). Only one (11.1%) of the complete responders experienced recurrence during the 12 month follow up. Side effects were generally mild and resolved upon completion of therapy. Conclusions: Compared to placebo, low dose oral isotretinoin showed considerable efficacy with insignificant and reversible side effects and a low recurrence rate. Isotretinoin may represent an efficacious and safe alternative systemic form of therapy for RCA of the cervix. PMID:15170007

  9. Evaluation of the effect of isotretinoin on salivary gland function by Tc-99m pertechnetate imaging in acne vulgaris patients.

    PubMed

    Örsal, Ebru; Seven, Bedri; Erdem, Mustafa Teoman; Varoğlu, Erhan; Farimaz, Hatice; Ayan, Arif Kürşad

    2015-01-01

    Isotretinoin is an effective drug utilized in the management of acne vulgaris and is known to cause dry mouth. In this study, we aimed to evaluate this effect of isotretinoin on the salivary gland function in patients with acne vulgaris using technetium-99m (Tc-99m) pertechnetate imaging of the salivary glands. The study population consisted of 28 patients with acne vulgaris (6 males and 22 females, mean age 20.2 ± 2.3 years), who were treated with isotretinoin for 6 months. We performed radionuclide imaging of the salivary glands pretreatment and at months 3 and 6 of treatment. After 185 MBq (5 mCi) of Tc-99m pertechnetate was intravenously administered, imaging of the salivary glands was performed over a 25-min period. We measured the following glandular function parameters for the parotid and submandibular salivary glands via time-activity curves: uptake ratio, maximum accumulation, and ejection fraction. Statistically significant differences were observed in the values obtained at months 3 and 6 of treatment, compared with the pretreatment values. This study demonstrated that radionuclide imaging of the salivary glands can clearly show the glandular functions that are affected by drugs such as isotretinoin.

  10. Comparison of the efficacies of intermittent and continuous low-dose isotretinoin regimens in the treatment of moderate acne vulgaris.

    PubMed

    Boyraz, Nermin; Mustak, Pelin Kocyiğit

    2013-10-01

    Acne vulgaris is a chronic inflammatory disease that usually requires systemic treatment for severe forms. Isotretinoin is the most effective drug in the treatment of acne vulgaris. In this study, we aimed to compare the efficacies of intermittent and continuous low-dose isotretinoin regimens in the treatment of moderate acne vulgaris. Sixty patients with moderate acne were included. They were divided into two groups to receive either intermittent or continuous low-dose isotretinoin. All patients were followed up monthly during the treatment period and for at least six months after completion of therapy. There were no statistically significant differences between the two groups regarding improvement rates at the end of treatments. However, reduction rates in mean acne scores at post-treatment controls were in favor of the continuous low-dose group. During the post-treatment follow-up period, three patients in the intermittent group relapsed, while no relapses were observed in the low-dose group. No significant side effects were observed in any groups. Both intermittent and continuous low-dose isotretinoin regimens are very well tolerated and effective as classical regimens in the treatment of moderate acne vulgaris. However, a continuous low-dose regimen seems to be slightly superior in terms of patients' compliance to the treatment and lower risk of relapse. © 2013 The International Society of Dermatology.

  11. Treatment of Plane Warts with a Low-Dose Oral Isotretinoin

    PubMed Central

    Al-Hamamy, Hayder R.; Salman, Husam Ali; Abdulsattar, Nawar A.

    2012-01-01

    Objective. To assess the efficacy of a low-dose oral isotretinoin in the treatment of plane warts. Patients and Methods. Thirty-one patients with recalcitrant facial plane warts were enrolled. A cumulative dose of 30 mg/kg for two months of treatment was calculated; this was equal to a mean of 0.5 mg/kg/day. Each patient was seen every two weeks during the treatment period. Response to treatment was either complete or no response. Patients with complete response were followed up monthly for four months to record the relapse rate. Results. Twenty-six patients completed the study; their ages range from 5 to 35 with a mean ± SD 15.28 ± 8.51 years. Fifteen (57.69%) patients were females and eleven (42.30%) were males. Nineteen (73.07%) patients showed complete response and seven (26.92%) patients showed no response at the end of two months of therapy. The difference was statistically significant; P value <0.0001. Fifteen (78.94%) out of nineteen patients, who had complete response, were still free from warts at the end of four-month followup. Conclusion. Oral isotretinoin is effective in the treatment of recalcitrant facial plane warts. PMID:23304543

  12. A randomized comparative trial of two low-dose oral isotretinoin regimens in moderate to severe acne vulgaris

    PubMed Central

    Dhaked, Daulat Ram; Meena, Ram Singh; Maheshwari, Anshul; Agarwal, Uma Shankar; Purohit, Saroj

    2016-01-01

    Background: Oral isotretinoin is highly effective in all forms and grades of acne, even in lower dosages (<0.5 mg/kg/day). There is a paucity of comparative data on the various low-dose regimens of oral isotretinoin in the Indian literature. Objectives: To assess and compare the efficacy and tolerability of two low-dose oral isotretinoin treatment regimens (20 mg daily and 20 mg alternate days) in moderate to severe acne vulgaris. Materials and Methods: A total of 240 patients with moderate to severe acne vulgaris were selected and randomized into two groups and treated with a fixed dose of 20 mg of isotretinoin (Group A - daily and Group B - alternate days) for 24 weeks and followed up for 12 weeks post therapy. Results: A total of 234 patients completed the study. At the end of therapy, decrease in the total acne loads up to 98.99% (Group A) and 97.69% (Group B) was achieved from the baseline (P < 0.01), excellent response was observed in 98.3% (Group A) and 93.96% (Group B) patients (P = 0.166). In the severe acne, Group A performed significantly better than Group B until the end of 36 weeks. While in the moderate acne, significant difference in the response between both groups was observed only up to 12 weeks. No serious side effect was observed. Conclusion: Both isotretinoin regimens were well tolerated and found to be an effective treatment for moderate to severe acne vulgaris. However, in moderate acne 20 mg alternate day regimen may be preferred. A 20 mg daily regimen is a better choice for severe acne in terms of response. Limitation: Small sample size and short follow-up period. PMID:27730033

  13. Safety of non-ablative fractional laser for acne scars within 1 month after treatment with oral isotretinoin: A randomized split-face controlled trial.

    PubMed

    Saluja, Sandeep S; Walker, Matthew L; Summers, Erika M; Tristani-Firouzi, Payam; Smart, David R

    2017-08-29

    Based on reports of poor wound healing and scarring, it is currently recommended that patients wait 6 months after completion of oral isotretinoin therapy before the safe initiation of laser treatment. Our aim was to evaluate the safety of non-ablative fractional laser (NAFL) treatment for acne scars within 1 month after isotretinoin therapy. This was a randomized split-face controlled trial involving 10 patients with acne scars who had completed isotretinoin treatment. All patients received three treatments each spaced 4 weeks apart with an erbium-doped 1550 nm NAFL on one side of the face within 1 month after isotretinoin therapy. The untreated side acted as a control. Wound healing and adverse effects as well as acne scar improvement were evaluated by two blinded dermatologists. All patients demonstrated normal wound healing post NAFL treatments, and neither hypertrophic scars nor keloids were observed. Acne scar improvement was satisfactory. NAFL treatment for acne scarring appears to be well tolerated within 1 month of completing isotretinoin treatment. Dermatologists should reevaluate the current recommendation to wait 6 months after isotretinoin treatment for acne scar revision with lasers. Other larger studies are necessary to further challenge this dogma. Lasers Surg. Med. XX:XX-XX, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  14. Matrix based system of isotretinoin as nail lacquer to enhance transungal delivery across human nail plate.

    PubMed

    Joshi, Monika; Sharma, Vijay; Pathak, Kamla

    2015-01-15

    The project was aimed at development of isotretinoin nail lacquer and assessment of its penetration efficiency across human nail plate. Preliminary studies (hydration enhancement factor and SEM) aided the selection of thioglycolic acid as permeation and eugenol was selected as local anesthetic in the formulation. The nail lacquer was optimized by 3(2) factorial design and a total of nine formulations were prepared and screened. In vitro adhesion and ex vivo permeation (cumulative drug permeation per unit area (CDP/A) = 6.61 ± 0.57 mg/cm(2)) across bovine hoof guided the selection of F3 as optimized formulation that was improvised. Viscosity adjustments to improve handling characteristics were affected by incorporation of ethyl cellulose (6%; F3M1) that scaled the viscosity to 312.681 cp and insignificantly (p > 0.05) affected CDP/A (6.32 ± 0.45 mg/cm(2)). In comparison to marketed preparation (Retino-A cream) F3M1 afforded two fold increase in CDP/A. The permeation characteristics were defined by Higuchi model (r(2) = 0.964) and flux value of 176 μg/cm(2)/h. Confocal laser scanning microscopy, after 72 h of nail lacquer application, revealed extensive distribution of the fluorescent tracer across the human nail plate in comparison to control that was confined to the top layer. Conclusively, an efficacious and stable nail lacquer of isotretinoin was developed for potential clinical topical use to target the drug to nail bed in treatment of nail psoriasis. Copyright © 2014 Elsevier B.V. All rights reserved.

  15. Fixed-Dose Combination Gel of Adapalene and Benzoyl Peroxide plus Doxycycline 100 mg versus Oral Isotretinoin for the Treatment of Severe Acne: Efficacy and Cost Analysis.

    PubMed

    Penna, Pete; Meckfessel, Matthew H; Preston, Norman

    2014-01-01

    Acne vulgaris is a chronic skin disease with a high prevalence. Left untreated or inadequately treated, acne vulgaris can lead to psychological and physical scarring, as well as to unnecessary medical expenses. Oral isotretinoin is an effective treatment for severe resistant nodular and conglobate acne vulgaris. A regimen consisting of a fixed-dose combination of adapalene and benzoyl peroxide gel, 0.1%/2.5% (A-BPO) with oral doxycycline 100 mg (A-BPO/D) has been demonstrated to be efficacious and well tolerated in patients with severe acne and may be an alternative to oral isotretinoin for some patients with severe acne. The objective of this analysis was to compare the relative efficacy and associated costs of A-BPO/D versus oral isotretinoin. In this analysis, comparisons of relative efficacy were made using previously published studies involving similar patient populations with severe acne that warrant the use of oral isotretinoin. The pricing for oral doxycycline and oral isotretinoin was estimated based on the maximum allowable cost from 9 states, and the pricing for A-BPO was calculated as the range between the average wholesale price and the wholesale acquisition cost. For this analysis, 2 treatment models were generated to compare costs: (1) a basic treatment model that examined the costs of an initial regimen of either A-BPO/D or oral isotretinoin without considering probable outcomes, and (2) a long-term model that factored in likely treatment outcomes and subsequent treatments into associated costs. The basic treatment model assumed that patients would be prescribed a single regimen of A-BPO/D for 12 weeks or oral isotretinoin for 20 weeks. The long-term model considered the probability of each treatment successfully managing patients' acne, as well as likely additional regimens of A-BPO monotherapy or an additional regimen of oral isotretinoin. As a result of different treatment durations, the costs for each treatment were normalized to weekly cost of

  16. Multi-drugs resistant acne rosacea in a child affected by Ataxia-Telangiectasia: successful treatment with Isotretinoin.

    PubMed

    Cantarutti, Nicoletta; Claps, Alessia; Angelino, Giulia; Chessa, Luciana; Callea, Francesco; El Hachem, May; Diociaiuti, Andrea; Finocchi, Andrea

    2015-03-28

    Ataxia-Telangiectasia is a rare multisystem autosomal recessive disorder [OMIM 208900], caused by mutations in Ataxia-Telangiectasia Mutated gene. It is characterized by neurological, immunological and cutaneous involvement. Granulomas have been previously reported in Ataxia-Telangiectasia patients, even if acne rosacea has not been described.We report a case of a young Ataxia-Telangiectasia patient with a severe immunological and neurological involvement, who developed granulomatous skin lesions diagnosed by skin biopsy as acne rosacea. Considering the severe clinical picture and the lack of improvement to multiple topic and systemic therapies, treatment with Isotretinoin was started and the skin lesions disappeared after five months. However the therapy was stopped due to drug-hepatotoxicity.Systemic treatment with Isotretinoin should be carefully considered in patient with Ataxia-Telangiectasia for the treatment of multi-drug resistant acne rosacea, however its toxicity may limit long-term use and the risk/benefit ratio of the treatment should be evaluated.

  17. Rosacea Fulminans Precipitated by Acute Stress: A Case Report Describing an Integrative Approach for a Patient Reluctant to Use Isotretinoin

    PubMed Central

    Veerkamp, Patrick; Mousdicas, Nico; Bednarek, Robert

    2016-01-01

    Context Rosacea fulminans is a rare skin disorder with a multifactorial etiology. Stress is one of the common precipitating factors of this condition but is not often targeted in treatment. Isotretinoin is considered part of the first-line therapy for this condition but, in cases where its use is restricted, other therapeutic interventions as part of an integrative approach may be effective. Patient Concerns A 38-y-old female presented with rosacea fulminans brought on by an acutely stressful event. After multiple failed therapies, she experienced resolution of her symptoms with a combination of systemic corticosteroids, antibiotics, diet modification, and stress reduction, with the treatment of stress playing a significant role. Conclusions Stress management and diet modification are key adjunctive therapies in the treatment of rosacea fulminans and need to be addressed more often in treatment. In cases where patients are reluctant or unable to take isotretinoin, an integrative approach may be effective in achieving symptomatic improvement. PMID:28223895

  18. Melanoma-associated retinopathy versus abnormal retinal function due to interferon-alpha/Isotretinoin therapy in cutaneous malignant melanoma.

    PubMed

    Feigl, B; Faschinger, C; Soyer, P

    2000-01-01

    To analyze whether an abnormal retinal function in patients with a cutaneous malignant melanoma was due to paraneoplastic retinopathy or due to isotretinoin or interferon-alpha. We studied 15 patients with malignant melanoma in stage IIa and IIb who are all participants in a randomized, multicentered, double-blind placebo-controlled clinical trial comparing interferon-alpha/isotretinoin versus interferon-alpha/placebo performed by the Department of Dermatology, University of Graz. Our assessment included a full ophthalmic history and examination, electrophysiological testing (ERG, EOG), dark adaption, color vision and visual field testing. The most prevalent ocular symptom patients complained about was ocular dryness (8 patients). Electrophysiological as well as psychophysical testings showed no abnormalities in 12 patients. In 1 patient the therapy was stopped because of electrophysiological and psychophysiological pathology. This patient suffered from severe reduction of night vision and visual disturbances. Another patient had had night blindness since childhood which remained stable. We postulate that in 1 of 15 patients, visual complaints are caused with a high probability by melanoma-associated retinopathy although, in the literature, isotretinoin is described to show similar effects on retinal function. Copyright 2000 S. Karger AG, Basel.

  19. Assessment of the efficacy and safety of a combination of 2 topical retinoids (RetinSphere) in maintaining post-treatment response of acne to oral isotretinoin.

    PubMed

    Truchuelo, M T; Jiménez, N; Mavura, D; Jaén, P

    2015-03-01

    The high rate of relapse of acne lesions following oral isotretinoin treatment is a common problem which remains unsolved. To avoid or minimize relapses, topical retinoids have been used for many years as maintenance treatment. However, adverse effects frequently occur. To determine the efficacy and safety of a new retinoid combination (Retinsphere technology) in maintaining post-treatment response to oral isotretinoin. Prospective, randomized, double-blind and vehicle-controlled study of 30 patients with acne previously treated with isotretinoin. Treatment with the retinoid combination was applied to one side of the face and vehicle was applied to the other, once daily, for 3 months. Standardized photographs were taken using RBX technology at baseline, 1.5 months and 3 months. The primary efficacy endpoint was the appearance of relapse on the treated side compared to the vehicle-treated side. Other endpoints included lesion count, investigator-reported improvement, patient-reported improvement, impact on quality-of-life, and side effects. Although the majority of patients did not reach the total target dose of oral isotretinoin, the relapse rate was significantly lower on the retinoid-treated side compared to the vehicle-treated side. Likewise, improved lesion count and excellent tolerance were observed. This new retinoid combination (Retinsphere technology) were effective and safe as maintenance therapy after post-treatment response to oral isotretinoin in patients with acne. Copyright © 2014 Elsevier España, S.L.U. and AEDV. All rights reserved.

  20. Presenile diffuse familial sebaceous hyperplasia successfully treated with low-dose isotretinoin: A report of two cases and review of the published work.

    PubMed

    Liu, You-Chen Serena; Cheng, Yu-Pin; Liu, Chuan-I; Yang, Chin-Yi; Yang, Chia-Yi

    2016-10-01

    Presenile diffuse familial sebaceous hyperplasia (PDFSH) presents as extensive yellowish papules with central umbilication on the face without involvement of periorificial regions and occurs in adolescents or young adults with a positive family history. Thirteen cases of PDFSH have been reported in the English-language published work, 10 of which responded to oral isotretinoin from 0.5 to 1 mg/kg per day but recurrences were often observed. Herein, we report two cases of PDFSH, which were successfully managed without recurrence with prolonged low-dose isotretinoin (0.2 mg/kg per day, a cumulative dose of 41 and 64 mg/kg, respectively). Treatment protocols among different published works were reviewed to verify the efficacy of isotretinoin. © 2016 Japanese Dermatological Association.

  1. [Keratosis follicularis spinulosa decalvans. Therapy with isotretinoin and etretinate in the inflammatory stage].

    PubMed

    Richard, G; Harth, W

    1993-08-01

    Keratosis follicularis spinulosa decalvans (KFSD) is a rare X-linked disorder of keratinization of the hair follicle associated with corneal dystrophy. The clinical picture is characterized by solid follicular hyperkeratosis, especially on the exposed skin, sparse eyebrows/eyelashes, follicular scaling and scarring alopecia of the scalp, dry skin and ocular symptoms with keratitis and photophobia. We describe the three stages of the disease: onset, inflammation and partial remission and the treatment appropriate in each. Two patients in the inflammatory stage of KFSD, with recurrent deep, fibrosing folliculitis and perifolliculitis followed by spreading and scarring alopecia on the scalp, responded to oral therapy with retinoids. In both cases there was a distinct and lasting remission of the inflammation and stabilization of the spreading alopecia after treatment with etretinate (Tigason), up to 0.8 mg/kg body weight, or isotretinoin (Roaccutan), 0.5 mg/kg body weight, for 12 weeks. The follicular spinulous hyperkeratosis became softer, but persisted. Thus, oral therapy with retinoids appears helpful in the inflammatory stage of KFSD, even though there is little improvement in the follicular hyperkeratosis.

  2. Nanocolloidal carriers of isotretinoin: antimicrobial activity against Propionibacterium acnes and dermatokinetic modeling.

    PubMed

    Raza, Kaisar; Singh, Bhupinder; Singla, Saloni; Wadhwa, Sheetu; Garg, Babita; Chhibber, Sanjay; Katare, Om Prakash

    2013-05-06

    Acne, a common skin disease in teenagers, is caused by Propionibacterium acnes (P. acnes). Isotretinoin (ITR) is though reported to have immense antiacne potential, yet there are hardly any reports vouching its antimicrobial activity. The present study, therefore, was undertaken to study the antimicrobial activity of ITR and evaluate the effect of its encasement in nanocarriers on its minimum inhibitory concentration (MIC). The nanocarriers were also evaluated for the skin transport characteristics. MICs of pure drug and entrapped drug in nanolipid carriers (ITR-NLCs) and in solid lipid nanoparticles (ITR-SLNs) were determined by broth dilution method against clindamycin phosphate as the reference antibiotic. It was observed that ITR possessed marked antimicrobial activity against anaerobic pathogen, P. acnes. Nanocarriers loaded with ITR, that is, SLNs and NLCs, enhanced the antimicrobial activity even at lower concentrations vis-à-vis the drug alone and improved drug transport potential vis-à-vis the commercial gel. The unique findings could be the result of effective adhesion of ITR-loaded nanocarriers to the bacterial membranes and release of drug directly to the target. Besides establishing ITR as an antimicrobial agent against acne-causing bacteria, the current work ratifies immense potential of nanocolloidal carriers like SLNs and NLCs to treat acne in a more efficient manner.

  3. Selenium ameliorates isotretinoin-induced liver injury and dyslipidemia via antioxidant effect in rats.

    PubMed

    Saied, Nashwa Mostafa; Hamza, Alaaeldin Ahmed

    2014-09-01

    Isotretinoin (Iso) is a widely used retinoid for the treatment of dermatologic conditions. Although it has broad side effects, there is no well-designed study about preventive effects against its hepatic toxicity. This study was undertaken to evaluate the protective effect of selenium (Se) against Iso-induced hepatotoxicity in Wistar rats. Animals were divided into four groups. The first group served as control. The second, third and fourth groups received Se, Iso and Se & Iso, respectively, for 28 days. Se was administered daily orally at a dose of 50 µg / 100 g body weight. Iso was given daily orally at a dose of 0.75 mg/ 100 g /day in olive oil. Iso caused significant increases in serum levels of alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, cholesterol, triglycerides, and high-density lipids content. Animals also showed significant rise in thiobarbituric acid reacting substance and nitric oxide content with concomitant decrease in reduced glutathione content and the antioxidant enzyme activities of superoxide dismutase and catalase in liver tissue after Iso exposure. Se administration produced a significant protection against the hepatotoxic effects of Iso and markedly alleviated alterations in these parameters. The results obtained herein clearly indicate that Iso causes induction of oxidative stress and the co-administration of Iso and Se provides protection against Iso-induced liver injury.

  4. Overview of existing research and information linking isotretinoin (accutane), depression, psychosis, and suicide.

    PubMed

    O'Donnell, James

    2003-01-01

    Isotretinoin (Accutane; Hoffmann-La Roche, Nutley, NJ) is a drug closely related to the chemical structure of vitamin A. The pharmacology and toxicology of these two retinoids are similar enough to warrant comparison. Accutane is a powerful drug that its manufacturer, Roche, indicates is limited for severe recalcitrant nodular acne. This potency is also reflected in Accutane's well-known ability to produce severe birth defects if taken during pregnancy. Less well known is the risk of this lipid-soluble chemical to affect the central nervous system. Reports of intracranial hypertension, depression, and suicidal ideation with Accutane use have prompted an examination of its serious and life-threatening potential. Although Roche has added a warning to its product label for signs of depression, and suicidal ideation, this product is overprescribed for all forms of acne, including mild and moderate cases that have not been treated with alternative medications with less risk of depression and suicide. There is no contesting that this drug is effective at clearing up the most severe forms of acne, but the public must be informed of the proper limited indication for its use, because depression and suicide can follow in patients with no prior history of psychiatric symptoms or suicide attempts.

  5. Isotretinoin was not associated with depression or anxiety: A twelve-week study

    PubMed Central

    Suarez, Bella; Serrano, Ana; Cova, Yves; Baptista, Trino

    2016-01-01

    AIM: To investigate the frequency and severity of depression and/or anxiety in isotretinoin (ITT)-treated subjects and in a non-ITT control group. METHODS: Sixty consecutively-admitted non-psychiatric outpatients with acne were assigned to either ITT at a fixed dose of 30 mg/d (n = 36) or “other treatment” group (OT; n = 24). The Zung depression or anxiety scales (with cut-off points), two locally developed scales for depression (GeDepr) and anxiety (Ansilet) (without cut-off points) and clinical global impression scales of acne severity were administered at baseline and at weeks 6 and 12 of treatment. Data was analyzed with the chi-squared test and covariance analysis. RESULTS: Gender distribution, age, marital status and education level did not differ between both treatment groups. The frequency of depression, as defined by the Zung scale cut-off points was similar in the ITT and in the non-ITT groups: Weeks 6 and 12: 8.3% in both groups, P = 0.9. The frequency of anxiety was similar in the groups as well: Week 6: ITT = 8.3%; OT = 0.0%, P > 0.05; week 12: ITT = 11.1%, OT = 4.2%, P > 0.05. The scores in both scales’ sets did not differ between the treatment groups at any evaluation time point (P > 0.05). Five ITT-treated subjects (13.8%) and two from the OT-treated group (8.3%) developed clinically significant anxiety and/or depression during treatment (P > 0.05). CONCLUSION: Our study confirms the safety of ITT regarding psychological side effects in regular dermatological patients. Susceptible subjects may exist but their identification requires additional strategies. PMID:27014604

  6. ASDS Guidelines Task Force: Consensus Recommendations Regarding the Safety of Lasers, Dermabrasion, Chemical Peels, Energy Devices, and Skin Surgery During and After Isotretinoin Use.

    PubMed

    Waldman, Abigail; Bolotin, Diana; Arndt, Kenneth A; Dover, Jeffrey S; Geronemus, Roy G; Chapas, Anne; Iyengar, Sanjana; Kilmer, Suzanne L; Krakowski, Andrew C; Lawrence, Naomi; Prather, Heidi B; Rohrer, Thomas E; Schlosser, Bethanee J; Kim, John Y S; Shumaker, Peter R; Spring, Leah K; Alam, Murad

    2017-10-01

    Currently, the isotretinoin (13-cis-retinoic acid) package insert contains language advising the discontinuation of isotretinoin for 6 months before performing cosmetic procedures, including waxing, dermabrasion, chemical peels, laser procedures, or incisional and excisional cold-steel surgery. It is common practice to follow this standard because of concerns regarding reports of sporadic adverse events and increased risk of scarring. To develop expert consensus regarding the safety of skin procedures, including resurfacing, energy device treatments, and incisional and excisional procedures, in the setting of concurrent or recent isotretinoin use. The American Society for Dermatologic Surgery authorized a task force of content experts to review the evidence and provide guidance. First, data were extracted from the literature. This was followed by a clinical question review, a consensus Delphi process, and validation of the results by peer review. The task force concluded that there is insufficient evidence to justify delaying treatment with superficial chemical peels and nonablative lasers, including hair removal lasers and lights, vascular lasers, and nonablative fractional devices for patients currently or recently exposed to isotretinoin. Superficial and focal dermabrasion may also be safe when performed by a well-trained clinician.

  7. Decrease of insulin growth factor-1 as a novel mechanism for anti-androgen effect of isotretinoin and its reported association with depression in some cases.

    PubMed

    Feily, Amir; Namazi, Mohammad R

    2011-07-01

    Isotretinoin and its desirable effects have received tremendous attention in recent years by scientists. This article reviews the evidence that decrease of insulin growth factor-1 is implicated as a novel mechanism of anti androgenic effect and its reported association with depression in some cases.

  8. Decreased plasma folate concentration in young and elderly healthy subjects after a short-term supplementation with isotretinoin.

    PubMed

    Chanson, A; Cardinault, N; Rock, E; Martin, J F; Souteyrand, P; D'Incan, M; Brachet, P

    2008-01-01

    In the last two decades, there has been an increasing use of isotretinoin (13-cis-retinoic acid or 13-CRA) for treatment of severe, and recently mild and moderate, acne in Westernized populations. Recent human and animal studies emphasized alterations caused by 13-CRA administration on folate-dependent, one-carbon metabolism. Folate deficiency and subsequent hyperhomocysteinemia increase the risk of degenerative diseases. We determine whether a short-term supplementation with 13-CRA alters folate status and homocysteinemia in young and elderly healthy human subjects. Twenty young and 20 elderly (age mean, 26.1 and 65.4 years, respectively) healthy male volunteers were supplemented with approximately 0.5 mg/kg/day of 13-CRA for 28 days. Fasting plasma concentrations of 13-CRA, 5-methyltetrahydrofolate (5-mTHF) as the main circulating form of folate, and homocysteine (Hcy), as well as haematologic parameters and biochemical markers of liver and renal function, were measured at baseline and at the end of supplementation. Statistical analyses were carried out using two-way anova and standard tests. In both groups, isotretinoin supplementation caused a dramatic increase in the circulating concentration of 13-CRA and its derivatives. It also led to significant increases in serum triglyceride (P < 0.0001) and creatinine (P = 0.002) concentrations and gamma-glutamyltranspeptidase activity (P = 0.0001) and decrease in serum level of urea (P = 0.027). However, the latter four parameters remained within normal ranges. These changes were accompanied by a 17.7% and 13.5% decrease in the plasma level of 5-mTHF (P = 0.001) in the young and elderly volunteers, respectively. Supplementation with 13-CRA did not cause significant variations in their plasma Hcy concentration. However, the latter parameter seemed to respond differently in each group of age (P = 0.046). Our data indicate that a 28-day supplementation with isotretinoin alters the plasma folate in young and old healthy

  9. The role of transcription factor FoxO1 in the pathogenesis of acne vulgaris and the mode of isotretinoin action.

    PubMed

    Melnik, B C

    2010-10-01

    It is the purpose of this review to demonstrate that oral isotretinoin treatment restores all major pathogenetic factors of acne vulgaris by upregulation of the nuclear transcription factor FoxO1, which will be shown to be the major target of retinoid action. Nuclear FoxO1 deficiency is the result of increased growth factor signaling with activated phosphoinositol-3-kinase (PI3K) and Akt kinase during growth hormone signaling of puberty and increased insulin/IGF-1 signaling due to consumption of insulinotropic milk/dairy products as well as hyperglycemic carbohydrates of Western diet. Nuclear FoxO1 deficiency increases androgen receptor transactivation and modifies the activity of important nuclear receptors and key genes involved in pilosebaceous keratinocyte proliferation, sebaceous lipogenesis and expression of perifollicular inflammatory cytokines. Isotretinoin-induced upregulation of nuclear FoxO1 is proposed to be responsible for the mode of action of isotretinoin on all major pathogenetic factors in acne. Acne pathogenesis can be explained at the genomic level of transcriptional regulation. All major events in acne pathogenesis as well as all major effects of isotretinoin treatment appear to be related to modifications of the PI3K/Akt/FoxO1 signaling pathway, the well-known oncogenic pathway. These insights extend our understanding of FoxO1-mediated retinoid action in acne and other hyperproliferative skin diseases, cancer chemoprevention and cutaneous immune regulation. Understanding FoxO´s pivotal regulatory role in acne allows the development of novel treatment strategies and dietary interventions in acne which focus on the restoration of growth factor- and diet-induced imbalances of nuclear FoxO protein levels.

  10. Effect of different doses of isotretinoin treatment on the levels of serum homocysteine, vitamin B 12 and folic acid in patients with acne vulgaris: A prospective controlled study.

    PubMed

    Kamal, Muhammad; Polat, Muhterem

    2015-09-01

    To investigate the effects of different doses of isotretinoin on serum homocysteine, vitamin B12 and folic acid in patients with acne vulgaris. The case-control study was conducted at Gazi University School of Medicine, Ankara, Turkey, from November 2012 to March 2013, and comprised male or non-pregnant female patients more than 18 years of age. The cases had moderate to severe nodulocystic acne, while an equal and matching control group had healthy individuals. Isotretinoin was started in a dosage of 0.5 mg/kg/day, and 1.0 mg/kg/day in patients with medium and severe acne vulgaris respectively. Homocysteine, vitamin B12, folic acid, liver function tests, serum cholesterol and triglyceride levels were tested at the baseline and on day 45. SPSS 11 was used for statistical analysis. The two groups had 62 subjects each. The cases had 47(76%) women and 15(25%) men with a group mean age of 21.0±2.7 years. The controls had 45(72.6%) women and 17(27.4%) men with a group mean age of 21.6±3.0 years. Homocysteine levels were significantly increased in both groups taking 0.5 mg/kg/day and 1.0 mg/kg/day isotretinoin (p<0.05). There were no statistically significant differences in the levels of vitamin B12, folate and liver function tests (p>0.05 each). Total cholesterol level increased significantly in the group using 1.0 mg/kg/day (p<0.05). In the triglyceride levels, significant increases were seen in both groups (p<0.05). Evaluation of homocysteine, vitamin B12 and folic acid beside the routine tests were beneficial for the patients before they started isotretinoin treatment.

  11. Complete remission of recalcitrant genital warts with a combination approach of surgical debulking and oral isotretinoin in a patient with systemic lupus erythematosus.

    PubMed

    Yew, Yik Weng; Pan, Jiun Yit

    2014-01-01

    Genital warts in immunocompromised patients can be extensive and recalcitrant to treatment. We report a case of recalcitrant genital warts in a female patient with systemic lupus erythematosus (SLE), who achieved complete remission with a combination approach of surgical debulking and oral isotretinoin at an initial dose of 20 mg/day with a gradual taper of dose over 8 months. She had previously been treated with a combination of topical imiquimod cream and regular fortnightly liquid nitrogen. Although there was partial response, there was no complete clearance. Her condition worsened after topical imiquimod cream was stopped because of her pregnancy. She underwent a combination approach of surgical debulking and oral isotretinoin after her delivery and achieved full clearance for more than 2 years duration. Oral isotretinoin, especially in the treatment of recalcitrant genital warts, is a valuable and feasible option when other more conventional treatment methods have failed or are not possible. It can be used alone or in combination with other local or physical treatment methods.

  12. Analysis of clinical efficacy, side effects, and laboratory changes among patients with acne vulgaris receiving single versus twice daily dose of oral isotretinoin.

    PubMed

    Ahmad, Hesham M

    2015-01-01

    Acne vulgaris is a debilitating disorder and requires proper treatment. This work evaluates the clinical efficacy, side effects, and laboratory changes of serum lipids and liver function during oral isotretinoin therapy for acne vulgaris, comparing single versus twice daily dose. Fifty-eight patients with acne vulgaris were included and randomized into group I (26 patients), who received once daily dose, and group II (32 patients), who received twice daily dose of oral isotretinoin. Global acne scoring system was used to evaluate acne severity and post-treatment improvement. Both regimens resulted in highly significant clinical improvement of acne with no significant difference. However, side effects were significantly more common among patients of group I. Both regimens caused mild rise of serum cholesterol, alanine transaminase (ALT), and aspartate aminotransferase (AST) with more prominent rise of triglycerides especially with twice daily dose. Oral isotretinoin is a very effective treatment for acne vulgaris with no statistically significant difference in clinical efficacy between once and twice daily doses. However, dividing dose to twice per day might cause fewer incidence of side effects without reducing clinical efficacy. The drug causes mild clinically insignificant rise of serum cholesterol, triglycerides, AST, and ALT.

  13. Doxycycline, metronidazole and isotretinoin: Do they modify microRNA/mRNA expression profiles and function in murine T-cells?

    PubMed Central

    Becker, Eugenia; Bengs, Susan; Aluri, Sirisha; Opitz, Lennart; Atrott, Kirstin; Stanzel, Claudia; Castro, Pedro A. Ruiz; Rogler, Gerhard; Frey-Wagner, Isabelle

    2016-01-01

    Inflammatory bowel disease (IBD) may develop due to an inflammatory response to commensal gut microbiota triggered by environmental factors in a genetically susceptible host. Isotretinoin (acne therapy) has been inconsistently associated with IBD onset and flares but prior treatment with antibiotics, also associated with IBD development, complicates the confirmation of this association. Here we studied in mice whether doxycycline, metronidazole or isotretinoin induce epigenetic modifications, and consequently change T-cell mRNA expression and/or function directly after treatment and after a 4 week recovery period. Isotretinoin induced IL-10 signaling in Tregs and naive T-cells directly after treatment and reduced effector T-cell proliferation alone and in co-culture with Tregs. Metronidazole activated processes associated with anti-inflammatory pathways in both T-cell subsets directly after the treatment period whereas doxycycline induced an immediate pro-inflammatory expression profile that resolved after the recovery period. Long-term changes indicated an inhibition of proliferation by doxycycline and induction of beneficial immune and metabolic pathways by metronidazole. Persistent alterations in microRNA and mRNA expression profiles after the recovery period indicate that all three medications may induce long-term epigenetic modifications in both T-cell subsets. Yet, our data do not support the induction of a long-term pro-inflammatory phenotype in murine Tregs and naive T-cells. PMID:27853192

  14. Inhaled isotretinoin (13-cis retinoic acid) is an effective lung cancer chemopreventive agent in A/J mice at low doses: a pilot study.

    PubMed

    Dahl, A R; Grossi, I M; Houchens, D P; Scovell, L J; Placke, M E; Imondi, A R; Stoner, G D; De Luca, L M; Wang, D; Mulshine, J L

    2000-08-01

    In previously treated head-and-neck cancer patients, p.o. administered isotretinoin (13-cis retinoic acid) reduced the occurrence of second aerodigestive tumors, including lung tumors, but side effects made chronic therapy problematic. We reasoned that inhaled isotretinoin might provide sufficient drug to the target cells for efficacy while avoiding systemic toxicity, and we proceeded with the pilot study reported here. Male A/J mice were given single i.p. doses of urethane, a common experimental lung carcinogen, or benzo[a]pyrene (BaP) or 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK), putative major carcinogens in tobacco smoke. The following day, exposures to isotretinoin aerosols for 45 min daily at 1.3, 20.7, or 481 microg/l were initiated. After 2 weeks, the high dose caused severe toxicity on the snout skin, necessitating a reduction of dose frequency to twice a week. As a precaution, the mid dose was reduced to three exposures per week. The weekly total deposited doses after the dose frequency reductions were calculated to be 0.24, 1.6, and 24.9 mg/kg for the low, mid, and high doses, of which 16% was estimated to be deposited in the lungs. The weekly deposited pulmonary drug doses were calculated to be 0.01, 0.07, and 1.1% of a previously reported ineffective oral dose in urethane-treated A/J mice. After 10-16 weeks, mice were sacrificed to count areas of pulmonary hyperplasia and adenomas. For all carcinogens, the mice exposed to the high isotretinoin dose showed reductions of tumor multiplicity ranging from 56 to 80% (P < 0.005). The mid dose was associated with reductions of tumor multiplicity by 67 and 88% (P < 0.005) in BaP- and NNK-treated mice, respectively, and was tolerated until approximately 12 weeks, when both these and the high-dose mice began losing weight. The low-dose mice had nonsignificant reductions of 30% (P < 0.13) and 16% (P < 0.30) for BaP- and NNK-treated mice, respectively without any evidence of side effects. For BaP- and

  15. Comparison of alternative survey methods for sensitive self-reported behaviours in a follow-up study of isotretinoin.

    PubMed

    Rao, R S; Glynn, R J; Werler, M M; Van Bennekom, C M; Mitchell, A A

    2000-01-01

    Responses to questions on sensitive behaviours can be affected by when and how questions are asked. Using data from an ongoing survey of women taking isotretinoin (a teratogenic drug used to treat acne), we compared answers to questions on contraceptive use during therapy among 126966 women who had begun treatment in 1990-93. 20503 were randomly assigned to a group which was surveyed by telephone at the start of treatment, during treatment and 6 months after treatment ended (DAT group). 106463 received a mail survey 6 months after treatment ended (AT group). Women who could not be contacted during treatment, along with the non-respondents in the AT group, received follow-up surveys by US mail, air courier and, if necessary, were called by telephone. The response rate was higher in the DAT group (96.4%) than in the AT group (84.8%). Among respondents, the odds of reported contraceptive use in the AT group compared with the DAT group (asked at 6 months after treatment) was 1.41 [95% confidence interval (CI): 1.36-1.46]. However, rates of oral contraceptive (OC) use were virtually identical in the two groups. In both groups, women surveyed by telephone reported lower rates of contraceptive use than women surveyed by mail. In the AT group, a late response was associated with a significantly lower rate of contraceptive use. Both mode of data collection (phone versus mail) and time to response affected reported rates of contraceptive use. Reasonable assumptions about the effect of non-response could not account for the difference between the AT and DAT groups. We found that contacting women during their treatment did not increase their reported use of contraceptives.

  16. Oral toxicity of isotretinoin, misoprostol, methotrexate, mifepristone and levonorgestrel as pregnancy category X medications in female mice.

    PubMed

    Kim, Seong-Kwan; Shin, Soo-Jeong; Yoo, Yohan; Kim, Na-Hyun; Kim, Dong-Soon; Zhang, Dan; Park, Jin-A; Yi, Hee; Kim, Jin-Suk; Shin, Ho-Chul

    2015-03-01

    An oral toxicity study of several pregnancy category X drugs was performed in female ICR mice. The drugs were administered orally once daily for 3 days at doses of 1, 10 and 100 μg/kg for isotretinoin; 6.7, 67 and 670 μg/kg for misoprostol; 83, 830 and 8,300 μg/kg for methotrexate; 3.3, 33 and 330 μg/kg for mifepristone; and 25, 250 and 2,500 μg/kg for levonorgestrel. During the test period, clinical signs, mortality, body weight, hematology, serum biochemistry and necropsy findings were examined. Following administration of methotrexate at 8,300 μg/kg, a number of animals exhibited decreased spontaneous activity, and one animal died. In the hematological analysis, compared with those treated with the control, the animals treated with the drugs exhibited similar significant decreases in the number of granulocytes and granulocyte differentiation, and increases in lymphocyte differentiation. In the serum biochemical analysis, animals receiving high doses of the five drugs demonstrated significant changes in uric acid, glucose, alkaline phosphatase, total bilirubin, lipase, total cholesterol and calcium. At necropsy, intestinal redness was frequently observed in animals that received the high dose of methotrexate. Uterus enlargement and ovary dropsy were also detected in the groups receiving mifepristone and levonorgestrel. Despite the short-term exposure, these drugs exhibited significant side effects, including white blood cell toxicity, in the mouse model. Category X drugs can be traded illegally via the internet for the purpose of early pregnancy termination. Thus, illegal abuse of the drugs should be further discouraged to protect mothers.

  17. Double-blinded, vehicle-controlled proof of concept study to investigate the recurrence of inflammatory and noninflammatory acne lesions using tretinoin gel (microsphere) 0.04% in male patients after oral isotretinoin use.

    PubMed

    Vender, Reid; Vender, Ronald

    2012-01-01

    Background. Although isotretinoin orally is commonly used for moderate to severe or scarring acne, it is not a cure. Unfortunately recurrence is unpredictable and varies within the acne population. Objectives. Using a proof of concept study, determine the recurrence of acne after isotretinoin use in male patients. Methods. Twenty males aged 18-45 years old were enrolled. Subjects successfully completed a treatment of acne vulgaris with oral isotretinoin (120-150 mg/kg/course). Subjects were randomized 1 to 1. The study duration was 24 weeks. The primary endpoint measured was the absolute change in lesion counts from baseline to weeks 16 and 24. Local tolerability assessments were measured. Results. There were favorable changes in all outcomes measured. Overall, there was a 38.7% lower lesion count with tretinoin 0.04% microsphere gel use versus vehicle. The active product was well tolerated with great patient satisfaction. There were no significant safety issues. The limitations included the low number of patients enrolled, average age, and percentage of patients lost to follow-up. Conclusion. In summary, the results favored tretinoin 0.04% microsphere gel in the prevention of recurrent acne after isotretinoin use in male patients over 18 years old over a six-month period.

  18. Double-Blinded, Vehicle-Controlled Proof of Concept Study to Investigate the Recurrence of Inflammatory and Noninflammatory Acne Lesions Using Tretinoin Gel (Microsphere) 0.04% in Male Patients after Oral Isotretinoin Use

    PubMed Central

    Vender, Reid; Vender, Ronald

    2012-01-01

    Background. Although isotretinoin orally is commonly used for moderate to severe or scarring acne, it is not a cure. Unfortunately recurrence is unpredictable and varies within the acne population. Objectives. Using a proof of concept study, determine the recurrence of acne after isotretinoin use in male patients. Methods. Twenty males aged 18–45 years old were enrolled. Subjects successfully completed a treatment of acne vulgaris with oral isotretinoin (120–150 mg/kg/course). Subjects were randomized 1 to 1. The study duration was 24 weeks. The primary endpoint measured was the absolute change in lesion counts from baseline to weeks 16 and 24. Local tolerability assessments were measured. Results. There were favorable changes in all outcomes measured. Overall, there was a 38.7% lower lesion count with tretinoin 0.04% microsphere gel use versus vehicle. The active product was well tolerated with great patient satisfaction. There were no significant safety issues. The limitations included the low number of patients enrolled, average age, and percentage of patients lost to follow-up. Conclusion. In summary, the results favored tretinoin 0.04% microsphere gel in the prevention of recurrent acne after isotretinoin use in male patients over 18 years old over a six-month period. PMID:22577372

  19. Folliculitis et perifolliculitis capitis abscedens et suffodiens controlled with a combination therapy: systemic antibiosis (metronidazole plus clindamycin), dermatosurgical approach, and high-dose isotretinoin.

    PubMed

    Tchernev, Georgi

    2011-05-01

    Folliculitis et perifolliculitis capitis abscedens et suffodiens is a rare disease of unknown etiology. It is a suppurative process that involves the scalp, eventually resulting in extensive scarring and irreversible alopecia. The condition is also known as 'acne necrotica miliaris' or 'Proprionibacterium' folliculitis. Most often the disease affects men of African-American or African-Caribbean descent between 20 and 40 years of age. The clinical picture is determined by fluctuating painful fistule-forming conglomerates of abscesses in the region of the occipital scalp. The cause of scalp folliculitis is not well understood. It is generally considered to be an inflammatory reaction to components of the hair follicle, particularly the micro-organisms. These include: bacteria (especially Propionibacterium acnes, but in severe cases, also Staphylococcus aureus), Yeasts (Malassezia species) and mites (Demodex folliculorum). The initial histopathologic finding is an exclusively neutrophilic infiltration followed by a granulomatous infiltrate. The treatment of the disease is usually difficult and often disappointing. Successful treatment with isotretinoin 1 mg/kg body mass could be achieved only after regular systematic administration in the course of 3-4 months. Here we describe a patient with eruptive purulent form of the disease, which has been controlled with combination therapy: systemic antibiosis with metronidazole and clindamycin, dermatosurgical removal of single nodular formations, and isotretinoin 1 mg/kg body mass for 3-5 months.

  20. Maintenance therapy for acne vulgaris: efficacy of a 12-month treatment with adapalene-benzoyl peroxide after oral isotretinoin and a review of the literature.

    PubMed

    Bettoli, Vincenzo; Borghi, Alessandro; Zauli, Stefania; Toni, Giulia; Ricci, Michela; Giari, Silvia; Virgili, Annarosa

    2013-01-01

    The correct therapeutic management of acne should include a maintenance therapy with topical retinoids to prevent recurrences after discontinuing a successful treatment. To investigate the efficacy of a 12-month maintenance treatment with adapalene 0.1% and benzoyl peroxide (BPO) 2.5% fixed combination gel to control acne relapse after treatment with oral isotretinoin (OI). The study consisted of 2 phases, namely an active treatment phase (AP) and a maintenance phase (MP). In the AP, 70 consecutive patients with moderate to severe acne were treated with OI until acne remission. Then, patients entered the MP and were treated with adapalene-BPO fixed combination once daily for 12 months. The primary efficacy parameter was the relapse rate during MP. Sixty-eight patients completed the study. Relapse occurred in 2 patients (2.94%). Comparing our findings with published data, the association of a topical retinoid and BPO seems to provide favorable evidence for this combination as maintenance therapy.

  1. A treatment for severe nodular acne: a randomized investigator-blinded, controlled, noninferiority trial comparing fixed-dose adapalene/benzoyl peroxide plus doxycycline vs. oral isotretinoin.

    PubMed

    Tan, J; Humphrey, S; Vender, R; Barankin, B; Gooderham, M; Kerrouche, N; Audibert, F; Lynde, C

    2014-12-01

    Oral isotretinoin (ISO) is the gold standard for severe nodular acne. However, as some patients are unwilling or unable to take, or are intolerant to, ISO, other options are needed. To compare efficacy and safety of oral ISO vs. doxycycline 200 mg plus adapalene 0·1%/benzoyl peroxide 2·5% gel (D+A/BPO) in severe nodular acne over 20 weeks. This was a multicentre, randomized, controlled, noninferiority investigator-blinded study involving 266 subjects. D+A/BPO showed a significantly earlier onset of action in reducing nodules, papules/pustules and total lesions at week 2. ISO was superior in reducing nodules (95·6% vs. 88·7%), papules/pustules (95·2% vs. 79·6%) and total lesions (92·9% vs. 78·2%; all P < 0·01) at week 20. Half as many subjects for D+A/BPO compared with ISO had treatment-related, medically relevant adverse events (33 events in 18·0% of subjects vs. 73 in 33·8% of subjects, respectively). D+A/BPO was noninferior to ISO in the intent-to-treat population [95% confidence interval (CI) -2·7 to 20·8 (P = 0·13); 63·9% vs. 54·9% of subjects, respectively] and per-protocol population [95% CI 3·9-28·6 (P = 0·01); 74·3% vs. 58% of subjects, respectively), based on the composite efficacy/safety end point. D+A/BPO showed a favourable composite efficacy/safety profile compared with ISO. This combination is an alternative to ISO in patients intolerant to, or unable or unwilling to take, oral ISO, and is an option for treatment of severe nodular acne. © 2014 British Association of Dermatologists.

  2. Isotretinoin and Other Retinoids During Pregnancy

    MedlinePlus

    ... Global Map Premature birth report card Careers Archives Pregnancy Before or between pregnancies Nutrition, weight & fitness Prenatal ... virus and pregnancy Folic acid Medicine safety and pregnancy Birth defects prevention Learn how to help reduce ...

  3. Isotretinoin and Other Retinoids During Pregnancy

    MedlinePlus

    ... Global Map Premature birth report card Careers Archives Pregnancy Before or between pregnancies Nutrition, weight & fitness Prenatal ... virus and pregnancy Folic acid Medicine safety and pregnancy Birth defects prevention Learn how to help reduce ...

  4. Diffuse idiopathic skeletal hyperostosis and isotretinoin in cystic acne.

    PubMed

    Zhao, Sizheng; Goodson, Nicola J

    2015-06-23

    We present the case of a 35-year-old man with thoracic back pain and stiffness, whose only medical history was cystic acne treated with repeated courses of retinoids. His thoracic spine was severely limited in range of movement and was found, on X-ray, to have unilateral hyperostosis typical of diffuse idiopathic skeletal hyperostosis (DISH)--an often asymptomatic condition rarely found in those under 50. Back stiffness in young patients with prolonged retinoid exposure should be investigated.

  5. Isotretinoin (Ro-Accutane) teratogenesis. A case report.

    PubMed

    Giannoulis, C H; Papathanasiou, K; Tantanasis, T H; Vaitsi, V; Tzafettas, I

    2005-01-01

    A case of teratogenesis in a 16-year-old pregnant patient is described. She had been using 60 mg Ro-Accutane daily till the 16th week of gestation. Sonography showed no cephalic skull up to the frontal bone of the fetus. A central lagostroma was also detected.

  6. MS-275 and Isotretinoin in Treating Patients With Metastatic or Advanced Solid Tumors or Lymphomas

    ClinicalTrials.gov

    2013-01-23

    Adult Grade III Lymphomatoid Granulomatosis; Anaplastic Large Cell Lymphoma; Angioimmunoblastic T-cell Lymphoma; Extranodal Marginal Zone B-cell Lymphoma of Mucosa-associated Lymphoid Tissue; Intraocular Lymphoma; Nodal Marginal Zone B-cell Lymphoma; Primary Central Nervous System Non-Hodgkin Lymphoma; Recurrent Adult Burkitt Lymphoma; Recurrent Adult Diffuse Large Cell Lymphoma; Recurrent Adult Diffuse Mixed Cell Lymphoma; Recurrent Adult Diffuse Small Cleaved Cell Lymphoma; Recurrent Adult Grade III Lymphomatoid Granulomatosis; Recurrent Adult Hodgkin Lymphoma; Recurrent Adult Immunoblastic Large Cell Lymphoma; Recurrent Adult Lymphoblastic Lymphoma; Recurrent Adult T-cell Leukemia/Lymphoma; Recurrent Cutaneous T-cell Non-Hodgkin Lymphoma; Recurrent Grade 1 Follicular Lymphoma; Recurrent Grade 2 Follicular Lymphoma; Recurrent Grade 3 Follicular Lymphoma; Recurrent Mantle Cell Lymphoma; Recurrent Marginal Zone Lymphoma; Recurrent Mycosis Fungoides/Sezary Syndrome; Recurrent Small Lymphocytic Lymphoma; Small Intestine Lymphoma; Splenic Marginal Zone Lymphoma; Stage IV Adult Burkitt Lymphoma; Stage IV Adult Diffuse Large Cell Lymphoma; Stage IV Adult Diffuse Mixed Cell Lymphoma; Stage IV Adult Diffuse Small Cleaved Cell Lymphoma; Stage IV Adult Hodgkin Lymphoma; Stage IV Adult Immunoblastic Large Cell Lymphoma; Stage IV Adult Lymphoblastic Lymphoma; Stage IV Adult T-cell Leukemia/Lymphoma; Stage IV Cutaneous T-cell Non-Hodgkin Lymphoma; Stage IV Grade 1 Follicular Lymphoma; Stage IV Grade 2 Follicular Lymphoma; Stage IV Grade 3 Follicular Lymphoma; Stage IV Mantle Cell Lymphoma; Stage IV Marginal Zone Lymphoma; Stage IV Mycosis Fungoides/Sezary Syndrome; Stage IV Small Lymphocytic Lymphoma; Unspecified Adult Solid Tumor, Protocol Specific; Waldenström Macroglobulinemia

  7. Recognizing off-target drug effects in the gut and brain: revisiting isotretinoin and depression.

    PubMed

    Kollipara, R; Reisz, C

    2016-04-01

    Clinicians often face complex decisions regarding off-target drug effects, both in diagnosis and treatment. A key component in the formulation of the correct diagnosis is the temporal relationship between drug introduction and adverse effect. The sentinel injury may target the gut and brain. The description of the complaint may vary among providers. Modeling Information visualization for clinicians in real time will require the integration of time-stamped data with organ-specific complaints.

  8. Successful treatment of recurrent vulvar intraepithelial neoplasia resistant to interferon and isotretinoin with cidofovir.

    PubMed

    Koonsaeng, S; Verschraegen, C; Freedman, R; Bossens, M; Kudelka, A; Kavanagh, J; Sittisomwong, T; DeClercq, E; Snoeck, R

    2001-06-01

    Vulvar intraepithelial neoplasias are difficult to eradicate completely without extensive surgical intervention. Cidofovir, a deoxycytidine monophosphate analog, may have a therapeutic role in this disease. A 43-year-old woman with a 20-year history of genital warts presented with extensive vulvar intraepithelial neoplasia III, and refused surgical resection. Topical cidofovir 1% in Beeler base completely eradicated the lesion. Successive treatment applications, however, were necessary. Cidofovir is a promising topical antiviral compound for HPV induced vulvar intraepithelial neoplasia. Copyright 2001 Wiley-Liss, Inc.

  9. [Isotretinoin and depressive symptoms in patiens with severe and recurrent acne].

    PubMed

    Rubio-García, Leticia; Pulido-Díaz, Nancy; Jímenez-López, José Luis

    2015-01-01

    Introducción: a partir del uso de isotretinoína para el manejo del acné, se han publicado resultados controversiales en torno a una probable asociación entre esta y depresión. El objetivo de este estudio fue conocer si el uso de isotretinoína en pacientes con acné severo y recurrente (ASR) se asocia a depresión.Métodos: se incluyeron 22 pacientes con diagnóstico de ASR pertenecientes a la clínica de acné del Centro Médico Nacional La Raza. Se les aplicó el inventario de depresión de Beck (IDB-II) antes, durante (2 meses) y después del tratamiento con isotretinoína (4 meses), calculada a 0.5 mg/kg.Resultados: en las primeras mediciones se reportaron puntuaciones bajas de síntomas depresivos que disminuyeron aún más al final del tratamiento (mediana = 6.5 antes del tratamiento, 3 a los dos meses y 0 al final, con una p < 0.001).Conclusiones: el tratamiento con isotretinoína en esta muestra de pacientes con acné severo y recurrente no produjo aumento de síntomas depresivos, por el contrario los redujo de manera indirecta al mejorar su imagen corporal.

  10. Erlotinib Hydrochloride and Isotretinoin in Treating Patients With Recurrent Malignant Glioma

    ClinicalTrials.gov

    2017-02-20

    Adult Anaplastic Astrocytoma; Adult Anaplastic Oligodendroglioma; Adult Diffuse Astrocytoma; Adult Giant Cell Glioblastoma; Adult Glioblastoma; Adult Gliosarcoma; Adult Mixed Glioma; Adult Oligodendroglioma; Recurrent Adult Brain Tumor

  11. Vorinostat Combined With Isotretinoin and Chemotherapy in Treating Younger Patients With Embryonal Tumors of the Central Nervous System

    ClinicalTrials.gov

    2017-09-12

    Medulloblastoma; Pineoblastoma; Supratentorial Embryonal Tumor, Not Otherwise Specified; Untreated Childhood Medulloblastoma; Untreated Childhood Pineoblastoma; Untreated Childhood Supratentorial Primitive Neuroectodermal Tumor

  12. Vorinostat With or Without Isotretinoin in Treating Young Patients With Recurrent or Refractory Solid Tumors, Lymphoma, or Leukemia

    ClinicalTrials.gov

    2014-06-16

    Childhood Acute Promyelocytic Leukemia (M3); Childhood Atypical Teratoid/Rhabdoid Tumor; Childhood Burkitt Lymphoma; Childhood Chronic Myelogenous Leukemia; Childhood Diffuse Large Cell Lymphoma; Childhood Immunoblastic Large Cell Lymphoma; Juvenile Myelomonocytic Leukemia; Recurrent Childhood Acute Lymphoblastic Leukemia; Recurrent Childhood Acute Myeloid Leukemia; Recurrent Childhood Grade III Lymphomatoid Granulomatosis; Recurrent Childhood Large Cell Lymphoma; Recurrent Childhood Lymphoblastic Lymphoma; Recurrent Childhood Medulloblastoma; Recurrent Childhood Small Noncleaved Cell Lymphoma; Recurrent Childhood Supratentorial Primitive Neuroectodermal Tumor; Recurrent Neuroblastoma; Recurrent/Refractory Childhood Hodgkin Lymphoma; Relapsing Chronic Myelogenous Leukemia; Unspecified Childhood Solid Tumor, Protocol Specific

  13. Gynecomastia: a rare complication of isoretinoin?

    PubMed

    Ustun, Ihsan; Rifaioglu, Emine Nur; Sen, Bilge Bulbul; Inam, Mehmet Ugur; Gokce, Cumali

    2013-03-01

    Isotretinoin is a retinoic acid derivative mostly used in the treatment of cystic acne vulgaris. The adverse effects of isotretinoin are well defined being the major limitation factor for its usage. The decrement of testosterone during isoretinoin treatment is defined in literature. We present a case with 20 years old man who developed gynecomastia after treatment with isotretinoin. To the best of our knowledge, this is the third report of the development of gynecomastia after isotretinoin treatment.

  14. 75 FR 71135 - Hoffmann-La Roche Inc.; Withdrawal of Approval of a New Drug Application

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-22

    ... Administration (FDA) is withdrawing approval of a new drug application (NDA) for ACCUTANE (isotretinoin) Capsules... INFORMATION: Hoffmann-La Roche Inc. has requested that FDA withdraw approval of NDA 18-662, ACCUTANE... Commissioner of Food and Drugs, approval of NDA 18-662, ACCUTANE (isotretinoin) Capsules, and all...

  15. Changing the calculus of pediatric product development: narrowing the too-big gap between need and solution in a small market.

    PubMed

    Campbell, Sarah

    2015-01-01

    First, Deliece Hofen drops the pill into hot water to soften the outside coating. Then, she slices through the center of the pill with an X-ACTO knife and squeezes the isotretinoin inside into a syringe. With the drug in liquid form, she can now administer it to her ten-year-old son Brandon. ?The problem is...some of [the isotretinoin] is still left inside of the capsule and I?m not getting an exact dosage,? admits Hofen.

  16. Retinoic Acid and Affective Disorders: The Evidence for an Association

    PubMed Central

    Bremner, J Douglas; Shearer, Kirsty; McCaffery, Peter

    2011-01-01

    Objective Isotretinoin (13-cis-retinoic acid, or 13-cis-RA) (Accutane), approved by the FDA for the treatment of acne, carries a black box warning related to the risk of depression, suicide, and psychosis. Retinoic acid (RA), the active form of vitamin A, regulates gene expression in the brain, and isotretinoin is its 13-cis isomer. Retinoids represent a group of compounds derived from vitamin A that perform a large variety of functions in many systems, in particular the CNS, and abnormal retinoid levels can have neurological effects. Although infrequent, proper recognition and treatment of psychiatric side effects in acne patients is critical given the risk of death and disability. This paper reviews the evidence for a relationship between isotretinoin, depression and suicidality. Data Sources Evidence examined includes: 1) case reports; 2) temporal association between onset of depression and exposure to the drug; 3) challenge-rechallenge cases; 4) class effect (other compounds in the same class, like vitamin A, having similar neuropsychiatric effects); 5) dose response; and 6) biologically plausible mechanisms. Study Selection All papers in the literature related to isotretinoin, depression and suicide were reviewed, as well as papers related to class effect, dose response, and biological plausibility. Data Extraction Information from individual articles in the literature was extracted. Data Synthesis The literature reviewed is consistent with an association between isotretinoin administration, depression and suicide in some individuals. Conclusions The relationship between isotretinoin and depression may have implications for a greater understanding of the neurobiology of affective disorders. PMID:21903028

  17. Update and future of systemic acne treatment.

    PubMed

    Zouboulis, Christos C; Piquero-Martin, Jaime

    2003-01-01

    Systemic treatment is required in patients with moderate-to-severe acne, especially when acne scars start to occur. Antibiotics with anti-inflammatory properties, such as tetracyclines (oxytetracycline, tetracycline chloride, doxycycline, minocycline and limecycline) and macrolide antibiotics (erythromycin and azithromycin) are the agents of choice for papulopustular acne, even though the emerging resistant bacterial strains are minimizing their effect, especially regarding erythromycin. Systemic antibiotics should be administered during a period of 8-12 weeks. In severe papulopustular and in nodulocystic/conglobate acne, oral isotretinoin is the treatment of choice. Hormonal treatment represents an alternative regimen in female acne, whereas it is mandatory in resistant, severe pubertal or post-adolescent forms of the disease. Compounds with anti-androgenic properties include estrogens combined with progestins, such as ethinyl estradiol with cyproterone acetate, chlormadinone acetate, desogestrel, drospirenone, levonogestrel, norethindrone acetate, norgestimate, and other anti-androgens directly blocking the androgen receptor (flutamide) or inhibiting androgen activity at various levels, corticosteroids, spironolactone, cimetidine, and ketoconazole. After 3 months of treatment control of seborrhea and acne can be obtained. Low-dose corticosteroids (prednisone, prednisolone, or dexamethasone) are indicated in patients with adrenal hyperandrogenism or acne fulminans. New developments and future trends represent low-dose long-term isotretinoin regimens, new isotretinoin formulations (micronized isotretinoin), isotretinoin metabolites, combination treatments to reduce toxicity, insulin-sensitizing agents, 5alpha-reductase type 1 inhibitors, antisense oligonucleotide molecules, and, especially, new anti-inflammatory agents, such as lipoxygenase inhibitors.

  18. What's new in acne and rosacea?

    PubMed

    Keri, Jonette

    2016-06-01

    Acne and rosacea are common conditions seen every day by dermatologists. This review will discuss the most recent therapeutic options for patients with these conditions. Specifically, for acne, there will be a discussion of the use of isotretinoin at higher cumulative doses as well as a new formulation of isotretinoin, isotretinoin-lidose. Adult women with acne represent a growing population of patients who present for treatment of acne; the use of hormonal therapies as well as topical dapsone gel will be reviewed for these patients. For rosacea patients, the new topical agents - brimonidine gel and ivermectin cream - will be reviewed, with a discussion on possible rebound phenomenon from brimonidine. Finally, future treatments in the pipeline will be discussed.

  19. Sudden Appearance of Indurated Erythematous Plaques on a Man's Face

    PubMed Central

    Carter, A.; Shulman, K.

    2016-01-01

    Rosacea fulminans (RF), previously known as pyoderma faciale, is a rare presentation of rosacea mostly seen in young women. RF is seen very rarely in men. We present below a case of a fifty-year-old male who presented with RF and was successfully treated with a combination of corticosteroids and isotretinoin. PMID:27703816

  20. Peroxisome proliferator-activated receptors increase human sebum production.

    PubMed

    Trivedi, Nishit R; Cong, Zhaoyuan; Nelson, Amanda M; Albert, Adam J; Rosamilia, Lorraine L; Sivarajah, Surendra; Gilliland, Kathryn L; Liu, Wenlei; Mauger, David T; Gabbay, Robert A; Thiboutot, Diane M

    2006-09-01

    Sebum production is key in the pathophysiology of acne, an extremely common condition, which when severe, may require treatment with isotretinoin, a known teratogen. Apart from isotretinoin and hormonal therapy, no agents are available to reduce sebum. Increasing our understanding of the regulation of sebum production is a milestone in identifying alternative therapeutic targets. Studies in sebocytes and human sebaceous glands indicate that agonists of peroxisome proliferator-activated receptors (PPARs) alter sebaceous lipid production. The goal of this study is to verify the expression and activity of PPARs in human skin and SEB-1 sebocytes and to assess the effects of PPAR ligands on sebum production in patients. To investigate the contribution of each receptor subtype to sebum production, lipogenesis assays were performed in SEB-1 sebocytes that were treated with PPAR ligands and isotretinoin. Isotretinoin significantly decreased lipogenesis, while the PPARalpha agonist-GW7647, PPARdelta agonist-GW0742, PPARalpha/delta agonist-GW2433, PPARgamma agonist rosiglitazone, and the pan-agonist-GW4148, increased lipogenesis. Patients treated with thiazolidinediones or fibrates had significant increases in sebum production (37 and 77%, respectively) when compared to age-, disease-, and sex-matched controls. These data indicate that PPARs play a role in regulating sebum production and that selective modulation of their activity may represent a novel therapeutic strategy for the treatment of acne.

  1. Chloracne from pentachlorophenol-preserved wood.

    PubMed

    Cole, G W; Stone, O; Gates, D; Culver, D

    1986-09-01

    A patient is presented who developed chloracne after exposure to lumber which was pressure-treated with pentachlorophenol (PCP). It was presumed that his disease arose via percutaneous absorption of polychlorinated aromatic compounds (dioxins and furans) which are known to contaminate technical grade PCP. The patient's condition improved after treatment with oral isotretinoin.

  2. Update on acne therapy.

    PubMed

    O'Donoghue, M N

    1999-06-01

    Current therapy of acne vulgaris is very effective. It consists of a combination of topical comedolytic agents, antibacterial agents, and combinations of both. The use of systemic therapy with antibiotics, isotretinoin, and hormones is necessary for cystic acne. The management of patients with the various combinations of topical and systemic medications is discussed.

  3. Historical aspects of the oral use of retinoids in acne.

    PubMed

    Hartmann, D; Bollag, W

    1993-11-01

    A number of investigations of the effects of vitamin A deficiency in animals and man and its treatment with natural products containing vitamin A were carried out in the twenties and thirties. In 1942, a clinical study in patients with acne treated with vitamin A yielded encouraging results. Further trials in the forties and fifties, trying to confirm the beneficial effect of oral vitamin A in acne, met with equivocal success. In the sixties, all-trans retinoic acid (tretinoin) became clinically available, and its topical efficacy in acne could be demonstrated. In 1971, oral tretinoin also was shown to be active in patients with acne. Coincidentally, the efficacy of oral 13-cis retinoic acid (isotretinoin) became evident in a series of unpublished studies in Europe. Then, in 1978, a trial carried out at the NIH, Bethesda, Maryland, yielded convincing evidence that isotretinoin is a potent new drug for the treatment of severe cystic acne. In 1982, isotretinoin was registered in the United States and one year later in Europe for the treatment of severe, recalcitrant, cystic acne. Since then, many thousands of patients suffering psychologically and physically from the severity of their disease have been treated successfully with this drug. However, the main concern of physicians prescribing isotretinoin has to focus on its potentially severe side effects, particularly its teratogenicity.

  4. The new therapy schema of the various kinds of acne based on the mucosa-skin side effects of the retinoids.

    PubMed

    Bergler-Czop, Beata; Brzezińska-Wcisło, Ligia

    2012-09-01

    The most common adverse effects of oral isotretinoin (>1/10) are: cheilitis, skin dryness, erythema, itching, scaling, bruising, skin atopy, conjunctivitis, dry eyes and eyelid inflammation. The aim of this work was to define an optimal dose regime of the oral isotretinoin allowing for effective reduction of sebum production and minimalization of adverse effects such as decreased skin moisturization, increase in TEWL and intensified erythema. The skin parameters were assessed using the MPA 5 diagnostic apparatus. Moisturization together with an increase in TEWL and erythema during treatment with isotretinoin seem to be crucial factors responsible for patient discomfort. The decrease in the pigment content in the skin during retinoid treatment is a favourable symptom, due to the frequent tendency of skin pigmentation disturbances in the sites after acne changes. On the basis of performed analyses it was concluded that the new therapy schema is the most advantageous form of isotretinoin dosing and it involves the use of a constant drug dose - 0.4-1.0 mg/kg body mass/day without modification during treatment.

  5. Acne Fulminans: Case Series and Review of the Literature.

    PubMed

    Alakeel, Abdullah; Ferneiny, Marie; Auffret, Nicole; Bodemer, Christine

    2016-11-01

    Acne fulminans (AF) is a rare manifestation and the most severe form of the entire clinical spectrum of acne. The disease is destructive and is characterized by the sudden onset of painful and ulcerative pustules and systemic symptoms including high fever, hepatomegaly, polyarthralgia, leukocytosis, plaquetose, and increased inflammatory markers and transaminases. Osteolytic lesions in multiple skeletal sites could also be associated. The use of isotretinoin is considered a related trigger, as well as the use and cessation of testosterone, although a bacterial infection, a drug-induced disease, or an intake of anabolic androgenic steroids has been suggested. The treatment of AF is challenging and controversial. The recommended treatment is aggressive and consists of a combination of oral steroids and low doses of isotretinoin, with no consensus at this time. The patient may require several weeks of hospitalization to control the eruption. The cutaneous lesions usually leave scars and milia. We report on two boys and two girls presenting with AF, triggered by isotretinoin in three patients and by an antibiotic in one patient. All the patients treated with corticosteroids and isotretinoin with success.

  6. [Acne conglobata: personality and psychological sequelae in 13-cis-retinoic acid therapy. Initial results].

    PubMed

    Studt, H H; Riehl, A; Gollnick, H

    1986-05-15

    16 patients suffering from acne conglobata were prospectively examined by means of analytical interviews and 5 psychometric procedures before and 6 months after oral treatment with 13-cis retinoic acid (isotretinoin). In comparison with a control group of psychosomatic patients, acne conglobata patients are more frequently affected by childhood influences leading to a neurotic personality structure already before the outbreak of acne; the patients more often complain of disturbed social contact, depressive moods, or general disorders. After successful treatment with isotretinoin, we observed augmented self-confidence and positive aggressiveness, on one hand, and increase of anxiety depressive moods, and general complaints, on the other. These effects are not drug related in a pharmacological way. These observations suggest the influence of psychic factors in the pathogenesis of acne conglobata. Regarding the medical management of these patients, it should be considered that psychic and psychosomatic disorders might be intensified after successful drug therapy.

  7. Emerging drugs for acne.

    PubMed

    James, Kirk A; Burkhart, Craig N; Morrell, Dean S

    2009-12-01

    Acne vulgaris is a common skin disorder that affects most individuals at some point in their lives. It may result in significant morbidity, including cutaneous scarring and psychological impairment. Current treatments include topical retinoids, benzoyl peroxide, topical and systemic antibiotics, and systemic isotretinoin. There are growing concerns of rising antibiotic resistance, significant side effects of isotretinoin therapy, and lack of safe and effective treatment for pregnant females. Recent advances in the pathogenesis of acne have led to a greater understanding of the underlying inflammatory mechanisms and the role the Propionibacterium acnes and biofilms. This has led to the development of new therapeutic targets. This article reviews emerging treatments of acne, including topical picolinic acid, topical antibiotic dapsone, systemic zinc salts, oral antibiotic lymecycline, new formulations of and synergistic combinations of benzoyl peroxide, photodynamic therapy with topical photosensitizers and potential acne vaccines.

  8. Hormonal therapy for acne: why not as first line therapy? facts and controversies.

    PubMed

    Katsambas, Andreas D; Dessinioti, Clio

    2010-01-01

    Standard systemic therapeutic agents used in acne include oral antimicrobials, isotretinoin, and hormonal agents. Appropriate patient selection is the key to decide when to use hormonal agents as first-line therapy as well as to achieve optimal results. Indications of hormonal therapy in acne in girls and women include proven ovarian or adrenal hyperandrogenism, recalcitrant acne, acne not responding to repeated courses of oral isotretinoin, acne tarda, polycystic ovary syndrome, or the presence of clinical signs of hyperandrogenism such as androgenic alopecia or the presence of the seborrhea, acne, hirsutism, alopecia syndrome. We describe the hormonal agents currently available for acne treatment, discuss their indications and contraindications, and address the question of whether they may be used as a first-line therapy in acne.

  9. Clinical and Molecular Consequences of NF1 Microdeletion

    DTIC Science & Technology

    2009-08-01

    intercellular cohesion with- in the stratum corneum (Menon et al. 1992; Elias et al. 2000). Lipid delivery to lamellar bodies has also been shown to be...sloughed off. This parakeratosis along with hyperkeratosis and hyper- granulosis (retention of keratohyalin granules in the stratum granulosum) is a...50 British white 36 2,300 Acitretin (1) 3 SIE, now aged 4 yearsb Neonatal mild hypothermia 955-01 African -American 36 2,355 Isotretinoin (1) 7 Died at

  10. Status Report from the Scientific Panel on Antibiotic Use in Dermatology of the American Acne and Rosacea Society

    PubMed Central

    Gallo, Richard L.; Thiboutot, Diane; Webster, Guy F.; Rosen, Ted; Leyden, James J.; Walker, Clay; Zhanel, George; Eichenfield, Lawrence

    2016-01-01

    In this second part of a three-part series addressing several issues related to antibiotic use in dermatology, potential effects of antibiotic use on the human microbiota and microbiome are reviewed. Data from available literature on the microbiologic effects of specific therapeutic agents commonly used in dermatology, including oral isotretinoin, tetracycline agents, and sub-antimicrobial (sub-antibiotic) dose doxycycline, are also discussed.

  11. Status report from the American Acne & Rosacea Society on medical management of acne in adult women, part 3: oral therapies.

    PubMed

    Del Rosso, James Q; Harper, Julie C; Graber, Emmy M; Thiboutot, Diane; Silverberg, Nanette B; Eichenfield, Lawrence F

    2015-12-01

    Parts 1 and 2 of this 3-part series provided an overview of the epidemiology, visible patterns, and important considerations for clinical and laboratory evaluation of acne vulgaris (AV) in adult women and reviewed the role of proper skin care and topical therapies in this patient population. In Part 3, oral therapies including combination oral contraceptives, spironolactone, antibiotics, and isotretinoin are discussed along with important considerations that clinicians should keep in mind when selecting oral agents for management of AV in adult women.

  12. Acne: Kids are not just little people.

    PubMed

    Que, Syril Keena T; Whitaker-Worth, Diane L; Chang, Mary Wu

    Acne vulgaris is a common inflammatory disease of the pilosebaceous follicles that affects patients of all ages, from neonates to adults. We have compared and contrasted the clinical presentation of acne in neonates, infants, children, teenagers, and young adults and review the scenarios in which further systemic endocrine or hormonal tests are indicated. We also discuss age-dependent treatment considerations, including appropriate oral antimicrobial regimens and the proper dosing of isotretinoin in young children versus teenagers and adults.

  13. Zileuton, an oral 5-lipoxygenase inhibitor, directly reduces sebum production.

    PubMed

    Zouboulis, Ch C; Saborowski, A; Boschnakow, A

    2005-01-01

    Zileuton, a 5-lipoxygenase inhibitor, reduces the number of inflammatory lesions in moderate acne and inhibits the synthesis of sebaceous lipids. To detect whether zileuton directly reduces sebum synthesis. A 40-year-old female with mild disseminated sebaceous gland hyperplasia and seborrhea was treated with zileuton 4 x 600 mg/day over 2 weeks, was followed-up for 6 weeks after discontinuation of zileuton and was re-treated with low-dose isotretinoin 10 mg/2nd day over 5 weeks. Casual skin surface lipids and sebum synthesis were determined. Under treatment with zileuton increased casual skin surface lipids were normalized and synthesis of facial sebum was decreased. Six weeks after discontinuation of treatment casual skin surface lipids were increased again and synthesis of sebum returned to baseline. Subsequent low-dose isotretinoin treatment led to similar changes of casual skin surface lipids and sebum synthesis with zileuton already after 2 weeks. Zileuton directly inhibits sebum synthesis in a transient manner with a potency similar to low-dose isotretinoin at least in our patient.

  14. Acne vulgaris.

    PubMed

    Wilson, B B

    1989-09-01

    Acne vulgaris is a disease of the pilosebaceous unit that affects nearly all persons to some degree during the teenage years. It is a disease that should be treated because of the anxiety and disfigurement it causes in the affected patient. Acne therapy is directed against the three probable pathogenic processes in acne: (1) abnormal keratinization of the sebaceous follicle, (2) excessive production of sebum, and (3) proliferation of bacteria in the follicle. Superficial acne consisting of comedones and small papulopustules will frequently respond to topical therapy such as retinoic acid, benzoyl peroxide, and topical antibiotics. Deeper lesions require systemic antibiotics of which tetracycline is the drug of choice. Severe, recalcitrant cystic acne usually responds well to the oral retinoid, isotretinoin. The severe teratogenic effects of isotretinoin on a developing fetus make this a risky drug to prescribe for women with childbearing potential. In such cases the greatest precautions should be taken to avoid pregnancy during a course of isotretinoin. Such precautions include pregnancy testing, contraceptive counseling, and the use of at least two effective forms of birth control in sexually active women.

  15. Hepatitis B, interferon, and acne fulminans in a young girl

    PubMed Central

    Arora, Sandeep; Malik, Ajay; Kumar, Dharmendra; Sodhi, Neha

    2016-01-01

    Acne fulminans (AF) is a very rare severe form of acne seen in young males, characterized by a sudden and explosive onset of hemorrhagic pustules and ulceration on the trunk, systemic features in the form of fever, polyarthropathy, malaise, erythema nodosum and painful osteolytic bone involvement with leukocytosis, and an elevated erythrocyte sedimentation rate. Conventional treatment of AF includes corticosteroids or immunosuppressive agents for the initial phase followed by isotretinoin. Active hepatitis B infection with a high viral load precludes the administration of any immunosuppressive drugs. We present the case of an 18-year-old girl with a history of occasional acne who presented with AF of sudden onset following administration of interferon-alpha-2a for her recently detected hepatitis B infection. Management of hepatitis B was withheld in view of her general condition. The patient was managed with low dose isotretinoin with subsidence of lesions. AF in a young female precipitated by interferon and its management with isotretinoin in the presence of active hepatitis B infection make the case unique. PMID:27057488

  16. Depression and acitretin: a true association or a class labeling?

    PubMed

    Hayes, Jennifer; Koo, John

    2011-04-01

    The potential relationship between systemic retinoids used in dermatology and affective disorders is controversial. Acitretin, which is widely used in the treatment of psoriasis is part of this controversy secondary to its chemical relation to isotretinoin, a drug which has been associated with a large number of anecdotal case reports of depression and suicidal ideation. Moreover, an FDA package insert precaution regarding acitretin's association with depression and suicide has elevated the level of concern for patient safety. The objective of this article is to review the evidence in the literature regarding acitretin's association with affective disorders. After 12 years of worldwide use only two cases involving acitretin have been reported in the literature. In addition, despite many anecdotal cases involving isotretinoin, there have been no clinical studies that have proven a causal relationship between isotretinoin and depression or suicidal ideation. For acitretin there have been no systematic clinical studies that examine such a relationship. Moreover, it is notable that the FDA precaution regarding depression and suicide on the package insert of acitretin predates the publication of the aforementioned two cases. This suggests that a relationship between acitretin and affective disorders is a class labeling rather than a scientifically proven association.

  17. p53: key conductor of all anti-acne therapies.

    PubMed

    Melnik, Bodo C

    2017-09-19

    This review based on translational research predicts that the transcription factor p53 is the key effector of all anti-acne therapies. All-trans retinoic acid (ATRA) and isotretinoin (13-cis retinoic acid) enhance p53 expression. Tetracyclines and macrolides via inhibiting p450 enzymes attenuate ATRA degradation, thereby increase p53. Benzoyl peroxide and hydrogen peroxide elicit oxidative stress, which upregulates p53. Azelaic acid leads to mitochondrial damage associated with increased release of reactive oxygen species inducing p53. p53 inhibits the expression of androgen receptor and IGF-1 receptor, and induces the expression of IGF binding protein 3. p53 induces FoxO1, FoxO3, p21 and sestrin 1, sestrin 2, and tumour necrosis factor-related apoptosis-inducing ligand (TRAIL), the key inducer of isotretinoin-mediated sebocyte apoptosis explaining isotretinoin's sebum-suppressive effect. Anti-androgens attenuate the expression of miRNA-125b, a key negative regulator of p53. It can thus be concluded that all anti-acne therapies have a common mode of action, i.e., upregulation of the guardian of the genome p53. Immortalized p53-inactivated sebocyte cultures are unfortunate models for studying acne pathogenesis and treatment.

  18. Cheilitis in acne vulgaris patients with no previous use of systemic retinoid products.

    PubMed

    Balighi, Kamran; Daneshpazhooh, Maryam; Lajevardi, Vahideh; Talebi, Shahin; Azizpour, Arghavan

    2017-08-01

    Isotretinoin is commonly used in the treatment of acne vulgaris. While one of the more common side-effects is cheilitis, we have observed an increased incidence of cheilitis prior to the commencement of systemic isotretinoin. The aim of this study was to assess the prevalence of cheilitis among acne vulgaris patients. A non-interventional cross-sectional study of patients with acne vulgaris. Patients with previous use of systemic retinoids were excluded. The patients were examined for signs and symptoms of cheilitis. Of a total of 400 patients, 134 (34%) had evidence of cheilitis at initial presentation. Two-thirds (63%) were female (P < 0.001). The distribution of the cheilitis was as follows; 55% on the lower lip, 30% on both lips, and 16% on the upper lip. Over a quarter (27%) of patients with cheilitis had acne excorie, compared with only 8% of patients with no signs of cheilitis. Our findings suggest that cheilitis is quite common among acne vulgaris patients even before treatment with isotretinoin. © 2016 The Australasian College of Dermatologists.

  19. Neuroblastoma Patients' KIR and KIR-ligand Genotypes Influence Clinical Outcome for Dinutuximab-based Immunotherapy: A Report from the Children's Oncology Group.

    PubMed

    Erbe, Amy K; Wang, Wei; Carmichael, Lakeesha; Kim, KyungMann; Mendonca, Eneida A; Song, Yiqiang; Hess, Dustin; Reville, Patrick K; London, Wendy B; Naranjo, Arlene; Hank, Jacquelyn A; Diccianni, Mitchell B; Reisfeld, Ralph A; Gillies, Stephen D; Matthay, Katherine K; Cohn, Susan L; Hogarty, Michael D; Maris, John M; Park, Julie R; Ozkaynak, Mehmet Fevzi; Gilman, Andrew; Yu, Alice L; Sondel, Paul M

    2017-10-02

    In 2010, a Children's Oncology Group (COG) phase III randomized trial for high-risk neuroblastoma patients (ANBL0032) demonstrated improved event-free survival (EFS) and overall survival (OS) following treatment with an immunotherapy regimen of dinutuximab, GM-CSF, IL-2, and isotretinoin compared to treatment with isotretinoin alone. Dinutuximab, a chimeric anti-GD2 monoclonal antibody, acts in part via NK cells. Killer Immunoglobulin-like Receptors (KIRs) on NK cells and their interactions with KIR-ligands can influence NK cell function. We investigated whether KIR/KIR-ligand genotypes were associated with EFS or OS in this trial. We genotyped patients from COG study, ANBL0032, and evaluated the effect of KIR/KIR-ligand genotypes on clinical outcomes. Cox regression models and log-rank tests were used to evaluate associations of EFS and OS with KIR/KIR-ligand genotypes. In this trial, patients with the "all KIR-ligands present" genotype, as well as patients with inhibitory KIR2DL2 with its ligand (HLA-C1) together with inhibitory KIR3DL1 with its ligand (HLA-Bw4) were associated with improved outcome if they received immunotherapy. In contrast, for patients with the complementary KIR/KIR-ligand genotypes, clinical outcome was not significantly different for patients that received immunotherapy vs. those receiving isotretinoin alone. These data show that administration of immunotherapy is associated with improved outcome for neuroblastoma patients with certain KIR/KIR-ligand genotypes, while this was not seen for patients with other KIR/KIR-ligand genotypes. Further investigation of KIR/KIR-ligand genotypes may clarify their role in cancer-immunotherapy, and may enable KIR/KIR-ligand genotyping to be utilized prospectively for identifying patients likely to benefit from certain cancer immunotherapy regimens. Copyright ©2017, American Association for Cancer Research.

  20. Evaluation of nasal and oropharyngeal flora in patients with acne vulgaris according to treatment options.

    PubMed

    Ozuguz, Pınar; Callioglu, Elif E; Tulaci, Kamil G; Kacar, Seval D; Balta, Ilknur; Asik, Gulsah; Karatas, Serap; Karaca, Semsettin

    2014-11-01

    The aim of this study was to evaluate changes in nasal and oropharyngeal flora in patients with acne during treatments with tetracycline and isotretinoin. Swab specimens were taken from the right and left nasal cavities and oropharynx of 55 patients with acne and 20 healthy volunteers who were admitted to the dermatology department (Etlik Educational and Research Hospital, Ankara, Turkey) before the administration of treatment and in the third month of treatment. Study participants were divided into four groups as follows: patients with acne on topical treatment only, systemic isotretinoin, and systemic tetracycline, and the control group. Of 55 patients with acne, 18 were male and 37 were female. The mean age of the patients and the control group was 22.21 ± 4.22 and 21.95 ± 7.64, respectively. Staphylococcus aureus was isolated from the nasal flora of five patients, normal flora was suppressed in the oropharyngeal cultures of seven patients, and normal flora grew in the cultures of the other 20 patients who were on tetracycline treatment. On the other hand, normal flora grew in the nasal and oropharyngeal cultures of all the patients who were on isotretinoin treatment. Treatment options and follow-up procedures for acne vulgaris may lead to the development of bacterial resistance and damage to flora. In particular, systemic tetracycline treatment leads to changes in flora of the nose and throat in patients with acne with an increased carriage of S. aureus. Therefore, careful attention should be paid to the duration of tetracycline treatment in order to not increase the risk of disturbance of microbial flora. © 2014 The International Society of Dermatology.

  1. Revealed: The spy who regulates neuroblastoma stem cells.

    PubMed

    Vora, Parvez; Venugopal, Chitra; Singh, Sheila K

    2014-11-30

    Neuroblastoma (NB), an embryonal tumour of the sympathetic nervous system, is thought to originate from undifferentiated neural crest cells and is known to exhibit extremely heterogeneous biological and clinical behaviors. Occurring in very young children, the median age at diagnosis is 17 months and it accounts for 10% of all pediatric cancer mortalities. The standard treatment regimen for patients with high-risk NB includes induction and surgery followed by isotretinoin or Accutane (13-cis retinoic acid) treatment, which is shown to induce terminal differentiation of NB cells. However, molecular regulators that maintain an undifferentiated phenotype in NB cells are still poorly understood.

  2. Morbihan syndrome

    PubMed Central

    Veraldi, Stefano; Persico, Maria Chiara; Francia, Claudia

    2013-01-01

    We report a case of severe Morbihan syndrome (chronic erythematous edema of the upper portion of the face) in a 60-year-old man. The syndrome was characterized clinically by erythematous edema involving the forehead, glabella, and both eyelids, because of which the patient was not able to open completely his eyes. Furthermore, erythema and telangiectasiae were visible on the nose and cheeks. Laboratory and instrumental examinations were within normal ranges or negative. Histopathological examination showed dermal edema, perivascular and periadnexal lympho-histiocytic infiltrate, and sebaceous gland hyperplasia. Oral isotretinoin was ineffective despite the relatively long duration of the therapy (26 weeks). PMID:23741671

  3. Folliculitis spinulosa decalvans: an uncommon entity within the keratosis pilaris atrophicans spectrum.

    PubMed

    Di Lernia, Vito; Ricci, Cinzia

    2006-01-01

    Folliculitis spinulosa decalvans is an uncommon condition characterized by follicular hyperkeratosis, followed by scarring alopecia. We report a 12-year-old boy affected by keratotic papules of the scalp and keratosis pilaris of the limbs who developed erythema, pustules, and scale crusts on the scalp associated with scarring alopecia. Histologic examination showed follicular and interfollicular hyperkeratosis, follicular plugging, mild inflammation, and focal scarring. A transient remission of the inflammatory changes on the scalp was obtained after treatment with isotretinoin. The follicular spinulous hyperkeratosis persisted. A severe relapse of the scalp inflammation was observed during a 2-year follow-up.

  4. Folliculitis spinulosa decalvans: successful therapy with dapsone.

    PubMed

    Kunte, C; Loeser, C; Wolff, H

    1998-11-01

    A 27-year-old male patient presented with scaly erythema and crusts on the scalp. Since birth, he suffered from dry skin and inflammation of the eyelids. Scarring alopecia was noticed in some regions of his scalp. Folliculitis spinulosa decalvans was diagnosed. Therapy with isotretinoin and topical corticosteroids was without effect. In contrast, 100 mg of Dapsone per day led to resolution of the inflammatory signs. This enabled him to cover the disfiguring scarring alopecia with a permanent hairpiece. His condition has been stable after 18 months without the enlargement of the scarred alopecic areas.

  5. General Medical Drugs Associated with Depression

    PubMed Central

    2008-01-01

    Drug-induced depression has been the focus of intense scrutiny by the US Food and Drug Administration and has serious clinical and medicolegal implications. “Gold standard” studies of drug-induced depression—involving randomized, placebo-controlled design and direct assessment of depressive symptoms—are lacking. Based on the available literature, our review suggests that only a few types of drugs are strongly linked with induction of depression. However, the potential for idiosyncratic reactions—not necessarily detected in large-scale studies—suggests that particular caution and careful monitoring are warranted with several types of drugs, including isotretinoin, rimonabant, and alpha interferons. PMID:19724774

  6. Systemic retinoid therapy for psoriasis.

    PubMed

    Lowe, N J; Lazarus, V; Matt, L

    1988-07-01

    Retinoids are potent therapuetic agents that have been found to be effective in a variety of skin diseases. They are of benefit in various forms of severe psoriasis. With severe plaque psoriasis, they are used most effectively in combination with other forms of therapy, such as phototherapy. With generalized pustular psoriasis, they are effective monotherapy and are frequently helpful for the control of exfoliative psoriasis. A variety of new retinoid analogs have been studied in clinical investigations. This article discusses important aspects of the use of etretinate, isotretinoin, acitretin, and arotinoid ethyl ester in the treatment of severe forms of psoriasis.

  7. Psychiatric side effects of medications prescribed in internal medicine

    PubMed Central

    Casagrande Tango, Rodrigo

    2003-01-01

    Several pharmacological treatments used in internal medicine can induce psychiatric side effects (PSEs) that mimic diagnoses seen in psychiatry. PSEs may occur upon withdrawal or intoxication, and also at usual therapeutic doses. Drugs that may lead to depressive, anxious, or psychotic syndromes include corticosteroids, isotretinoin, levo-dopar mefloquine, interferon-a, and anabolic steroids, as well as some over-the-counter medications. PSEs are often difficult to diagnose and can be very harmful to patients. PSEs are discussed in this review, as well as diagnostic clues to facilitate their identification. PMID:22034468

  8. [Treatment of acne].

    PubMed

    Delanoë, P; de Prost, Y

    1997-11-01

    The treatment of acne is based upon simple pathogenic arguments, but needs to be adapted to the type of acne. Patients must always be informed that it is long and difficult and that no significant response will be expected before 2 to 3 months of regular treatment. The authors present the different therapeutic agents and strategies. Isotretinoin should be used only in severe acne after failure of at least 3 months of a well conducted classical treatment and in nodulo-cystic acne; because of its major side effect of teratogenicity its use in adolescent girl's requires pregnancy testings before and during treatment and an effective contraception.

  9. Acne Vulgaris in the Athlete.

    PubMed

    Conklin, R J; Taunton, J E

    1988-10-01

    In brief: The treatment of acne is basically the same for athletes and nonathletes. However, certain aspects of sports can affect acne adversely, and in some cases treating athletes may require a cautious approach. The best treatments are topical tretinoin for comedonal acne, benzoyl peroxide or topical antibiotics and tretinoin for comedonal and mild pustular acne, and a combination of oral antibiotics and long-term benzoyl peroxide or topical antibiotics (with the eventual aim of stopping the oral antibiotics in three to five months) for moderate to severe pustular acne. For severe cystic/nodular acne, highdose oral antibiotics and intralesional steroid injections or oral isotretinoin should be considered.

  10. Dissecting cellulitis (Perifolliculitis Capitis Abscedens et Suffodiens): a comprehensive review focusing on new treatments and findings of the last decade with commentary comparing the therapies and causes of dissecting cellulitis to hidradenitis suppurativa.

    PubMed

    Scheinfeld, Noah

    2014-05-16

    Dissecting cellulitis (DC) also referred to as to as perifolliculitis capitis abscedens et suffodiens (Hoffman) manifests with perifollicular pustules, nodules, abscesses and sinuses that evolve into scarring alopecia. In the U.S., it predominantly occurs in African American men between 20-40 years of age. DC also occurs in other races and women more rarely. DC has been reported worldwide. Older therapies reported effective include: low dose oral zinc, isotretinoin, minocycline, sulfa drugs, tetracycline, prednisone, intralesional triamcinolone, incision and drainage, dapsone, antiandrogens (in women), topical clindamycin, topical isotretinoin, X-ray epilation and ablation, ablative C02 lasers, hair removal lasers (800nm and 694nm), and surgical excision. Newer treatments reported include tumor necrosis factor blockers (TNFB), quinolones, macrolide antibiotics, rifampin, alitretinoin, metronidazole, and high dose zinc sulphate (135-220 mg TID). Isotretinoin seems to provide the best chance at remission, but the number of reports is small, dosing schedules variable, and the long term follow up beyond a year is negligible; treatment failures have been reported. TNFB can succeed when isotretinoin fails, either as monotherapy, or as a bridge to aggressive surgical treatment, but long term data is lacking. Non-medical therapies noted in the last decade include: the 1064 nm laser, ALA-PDT, and modern external beam radiation therapy. Studies that span more than 1 year are lacking. Newer pathologic hair findings include: pigmented casts, black dots, and "3D" yellow dots. Newer associations include: keratitis-ichthyosis-deafness syndrome, Crohn disease and pyoderma gangrenosum. Older associations include arthritis and keratitis. DC is likely a reaction pattern, as is shown by its varied therapeutic successes and failures. The etiology of DC remains enigmatic and DC is distinct from hidradenitis suppurativa, which is shown by their varied responses to therapies and their

  11. In vitro interaction study of retinoic acid isomers with telmisartan and amlodipine by equilibrium dialysis method using UV spectroscopy

    NASA Astrophysics Data System (ADS)

    Varghese, Susheel John; Johny, Sojimol K.; Paul, David; Ravi, Thengungal Kochupappy

    2011-07-01

    The in vitro protein binding of retinoic acid isomers (isotretinoin and tretinoin) and the antihypertensive drugs (amlodipine and telmisartan) was studied by equilibrium dialysis method. In this study, free fraction of drugs and the % of binding of drugs in the mixture to bovine serum albumin (BSA) were calculated. The influence of retinoic acid isomers on the % of protein binding of telmisartan and amlodipine at physiological pH (7.4) and temperature (37 ± 0.5 °C) was also evaluated. The in vitro displacement interaction study of drugs telmisartan and amlodipine on retinoic acid isomers and also interaction of retinoic acid isomers on telmisartan and amlodipine were carried out.

  12. Morbihan Disease: Successful treatment with Slow-Releasing Doxycycline monohydrate.

    PubMed

    Chaidemenos, George; Apalla, Zoe; Sidiropoulos, Theodoros

    2017-08-17

    Morbihan Disease (MD), designated so after the place of origin of the first ever reported patient by R. Degos in 1957, is a rare disorder of unknown etiology, characterized by a persistent, erythematous, non-pitting, solid edema of the middle and upper third of the face with a non-specific histology(1) . The hallmark of MD is its refractoriness to treatment, oral isotretinoin and tetracyclines being the most successful therapeutic approaches. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  13. Acne with chronic recurrent multifocal osteomyelitis involving the mandible as part of the SAPHO syndrome: case report.

    PubMed

    Roldán, J C; Terheyden, H; Dunsche, A; Kampen, W U; Schroeder, J O

    2001-04-01

    For 12 years, a 26-year-old man had acne conglobata and a non-suppurative diffuse sclerosing osteomyelitis of the mandible as part of a chronic recurrent multifocal osteomyelitis of the sternum, the pelvic bones, and the femoral head, and aseptic arthritis of the knee, the fibulotalar, and the sternoclavicular joints. This fulfills the formal criteria of the SAPHO syndrome. Repeated surgical and antibiotic treatment combined with hyperbaric oxygen caused partial improvement. Complete relief and partial disappearance of the scintigraphic lesions was achieved with long-term corticosteroids, non-steroidal anti-inflammatory drugs, minocycline, and isotretinoin.

  14. [Dermatologic aspects of SAPHO-syndrome].

    PubMed

    Károlyi, Z; Harhai, I; Erós, N

    2001-08-19

    SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis, osteitis) as a new disease entity was first described in 1987. The syndrome is characterized by the presence of pustular dermatoses together with aseptic osteoarticular lesions. The bone involvement includes hyperostosis, aseptic osteomyelitis or arthritis of the anterior chest wall, sacroiliac joints or long bones. Skin diseases include acne conglobata or acne fulminans, palmoplantar pustulosis and hidradenitis suppurativa. Authors describe the dermatological relationship of SAPHO syndrome reporting their 7 cases (3 acne fulminans, 4 palmoplantar pustulosis). Authors draw attention to the isotretinoin therapy as a possible provoking factor of the articular symptoms, and they emphasize the diagnostic role of bone scintigraphy.

  15. Facial porokeratosis: A series of six patients.

    PubMed

    Gutierrez, Ericson L; Galarza, Carlos; Ramos, Willy; Tello, Mercedes; De Paz, Patricia Chávez; Bobbio, Lucia; Barquinero, Alicia; Ronceros, Gerardo; Ortega-Loayza, Alex G

    2010-08-01

    Porokeratosis is a disorder of epidermal keratinization characterized by annular plaques with an atrophic centre and hyperkeratotic edges, and includes a heterogeneous group of disorders that are mostly inherited in an autosomal dominant fashion. Facial porokeratosis is rare and is not well documented. We present six cases of facial porokeratosis seen over a period of 15 years in a hospital in Lima, Peru. In most of the cases, porokeratosis was found in younger women without any significant past medical history. Oral isotretinoin showed moderate improvement in two of our patients.

  16. Emerging drugs for the treatment of acne.

    PubMed

    Aslam, Imran; Fleischer, Alan; Feldman, Steve

    2015-03-01

    Acne is the most common skin condition in the US. The mainstay of acne therapy includes: topical retinoids, topical antibiotics, benzoyl peroxide (BP), and oral isotretinoin for severe cases. Although these treatment options are highly effective they do have certain drawbacks. Current acne treatment regimens often require patients to use multiple medications, some of which may have irritating side effects. Furthermore, Propionibacterium acnes resistance to antibiotics has become an increasing problem due to the rise in antibiotic use. New therapies that have either been released onto the market or that are being developed include: adapalene-BP combination agent, dapsone 5% gel, minocycline foam, topical nitric oxide-releasing agent, cortexolone 17 α-propionate, and CIP isotretinoin. Some of these new therapies address the challenges faced with existing treatment options. For instance, the relatively new combination therapy, adapalene-BP, limits antibiotic resistance and also helps simplify treatment regimens. The newly developed topical nitric oxide-releasing agent also holds potential in limiting antibiotic resistance. Many of the new therapies discussed in this paper are still in early stages of testing so it is difficult to predict their outlook; however, based on preliminary findings, these therapies seem to be promising.

  17. A Study on the Prescribing Pattern of Drugs for Acne in a Tertiary Care Teaching Hospital in Odisha

    PubMed Central

    Patro, Nibedita; Panda, Maitreyee; Dash, Mrutyunjay

    2015-01-01

    Background: Acne vulgaris is a common disease of the skin affecting the socially vulnerable young age group. There are multitudes of treatment options available but till now no studies have been reported to demonstrate the current prescribing pattern of drugs in acne vulgaris. Aim: To study the prescribing pattern of drugs in acne in a tertiary care teaching hospital in Odisha, India. Materials and Methods: The study was an observational study conducted for a period of one year on patients more than 10 yeras age and having acne attending the Skin & VD OPD. Drug induced acne and acneiform eruptions were excluded. Results: A total of 1210 prescriptions of acne were analysed. The male to female ratio was 1:1.29. Most patients presented with grade 2 (60%) acne followed by grade 3 (20.99%). Out of prescribed drugs, 47.44% were oral and 52.56% were topical formulations. Oral isotretinoin (68.10%) was the most frequently prescribed drug among oral formulations. Doxycycline (54.18%) was the most preferable oral antibiotic. The average number of drugs per prescription was 3.003. Polypharmacy was preferred over monotherapy. Conclusion: In the management of acne, judicious and early intervention with oral isotretinoin improves the overall treatment outcome, the fact which has increased its use in acne patients. PMID:25954687

  18. Systemic therapy with immunosuppressive agents and retinoids in hidradenitis suppurativa: a systematic review.

    PubMed

    Blok, J L; van Hattem, S; Jonkman, M F; Horváth, B

    2013-02-01

    Hidradenitis suppurativa (HS) is a difficult disease to treat. Although the pathogenesis of this inflammatory skin disease is largely unknown, the important role of the immune system has been demonstrated in both experimental and clinical studies. Clinicians are therefore increasingly prescribing systemic treatments with immunosuppressive agents, but the more traditionally used systemic retinoids, especially isotretinoin, also remain relatively common therapies. In order to provide an overview of all currently available systemic immunosuppressive agents and retinoids for the treatment of HS, a systematic search was performed using the Medline and Embase databases. All published papers concerning systemic retinoids or immunosuppressive treatments for HS in adults were included. The primary endpoints were the percentages of significant responders, moderate responders and nonresponders. Other endpoints were the relapse rate and adverse events. In total 87 papers were included, comprising 518 patients with HS who were treated with systemic retinoids, biological agents or another immunosuppressive agents, including colchicine, ciclosporin, dapsone or methotrexate. The highest response rates were observed with infliximab, adalimumab and acitretin. Overall, the quality of evidence was low and differed between the agents, making direct comparisons difficult. However, based on the amount of evidence, infliximab and adalimumab were the most effective agents. Acitretin was also effective in HS, although the quality of the evidence was low. The therapeutic effect of isotretinoin is questionable. Randomized controlled trials are needed to confirm the effectiveness of acitretin, and to identify the most effective immunosuppressive agents in HS. © 2012 The Authors. BJD © 2012 British Association of Dermatologists.

  19. Terminations of pregnancy for exposure to oral retinoids in South Australia, 1985-1993.

    PubMed

    Chan, A; Keane, R J; Hanna, M; Abbott, M

    1995-11-01

    The oral retinoids, isotretinoin and etretinate, are highly teratogenic drugs which have been available in Australia since 1985 because of their unique effectiveness in severe cystic acne, psoriasis and other keratinization disorders. Only dermatologists can prescribe them, but in spite of strict guidelines by the manufacturers and the College of Dermatologists, exposed pregnancies have occurred. We attempted to determine the circumstances of exposure to these drugs for the 18 pregnancies terminated in South Australia in 1985-1993, using questionnaires to medical practitioners who notified the terminations under legislation. The main reason for their occurrence was the lack of compliance with the use of effective contraception by the women. In South Australia, some prescriptions of oral retinoids by unauthorized doctors have been dispensed during this period. Using statistics on prescriptions dispensed, an estimate was made of 1 termination of pregnancy for 319 courses of treatment for women with isotretinoin. Extension of guidelines for prescription and more detailed counselling in relation to the use of contraception are recommended. It is also suggested that doctors intending to recommend terminations obtain consent to discuss exposure with the dermatologists concerned, who may not be aware of the exposed pregnancy.

  20. Acne vulgaris

    PubMed Central

    2011-01-01

    Introduction Acne vulgaris affects over 80% of teenagers, and persists beyond the age of 25 years in 3% of men and 12% of women. Typical lesions of acne include comedones, inflammatory papules, and pustules. Nodules and cysts occur in more severe acne and can cause scarring and psychological distress. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical question: What are the effects of topical and oral treatments in people with acne vulgaris? We searched: Medline, Embase, The Cochrane Library, and other important databases up to February 2010 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 69 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: topical treatments (adapalene, azelaic acid, benzoyl peroxide, clindamycin, erythromycin [alone or plus zinc]; isotretinoin, tetracycline, tretinoin); and oral treatments (doxycycline, isotretinoin, lymecycline, minocycline, oxytetracycline, tetracycline). PMID:21477388

  1. Acne vulgaris.

    PubMed

    Purdy, Sarah; de Berker, David

    2011-01-05

    Acne vulgaris affects over 80% of teenagers, and persists beyond the age of 25 years in 3% of men and 12% of women. Typical lesions of acne include comedones, inflammatory papules, and pustules. Nodules and cysts occur in more severe acne and can cause scarring and psychological distress. We conducted a systematic review and aimed to answer the following clinical question: What are the effects of topical and oral treatments in people with acne vulgaris? We searched: Medline, Embase, The Cochrane Library, and other important databases up to February 2010 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). We found 69 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. In this systematic review we present information relating to the effectiveness and safety of the following interventions: topical treatments (adapalene, azelaic acid, benzoyl peroxide, clindamycin, erythromycin [alone or plus zinc]; isotretinoin, tetracycline, tretinoin); and oral treatments (doxycycline, isotretinoin, lymecycline, minocycline, oxytetracycline, tetracycline).

  2. Acne vulgaris

    PubMed Central

    2008-01-01

    Introduction Acne vulgaris affects over 80% of teenagers, and persists beyond the age of 25 years in 3% of men and 12% of women. Typical lesions of acne include comedones, inflammatory papules, and pustules. Nodules and cysts occur in more severe acne and can cause scarring and psychological distress. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical question: What are the effects of topical and oral treatments in people with acne vulgaris? We searched: Medline, Embase, The Cochrane Library and other important databases up to June 2007 (BMJ Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 67 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: topical treatments (adapalene, azelaic acid, benzoyl peroxide, clindamycin, erythromycin (alone or plus zinc), isotretinoin, tetracycline, tretinoin), and oral treatments (doxycycline, isotretinoin, lymecycline, minocycline, oxytetracycline, tetracycline). PMID:19450306

  3. Developmental Neurotoxic Effects of Percutaneous Drug Delivery: Behavior and Neurochemical Studies in C57BL/6 Mice

    PubMed Central

    Lv, Wenting; Huang, Qiaoling; Fu, Mengsi; Cai, Minxuan; He, Qiangqiang

    2016-01-01

    Dermatosis often as a chronic disease requires effective long-term treatment; a comprehensive evaluation of mental health of dermatology drug does not receive enough attention. An interaction between dermatology and psychiatry has been increasingly described. Substantial evidence has accumulated that psychological stress can be associated with pigmentation, endocrine and immune systems in skin to create the optimal responses against pathogens and other physicochemical stressors to maintain or restore internal homeostasis. Additionally, given the common ectodermal origin shared by the brain and skin, we are interested in assessing how disruption of skin systems (pigmentary, endocrine and immune systems) may play a key role in brain functions. Thus, we selected three drugs (hydroquinone, isotretinoin, tacrolimus) with percutaneous excessive delivery to respectively intervene in these systems and then evaluate the potential neurotoxic effects. Firstly, C57BL/6 mice were administrated a dermal dose of hydroquinone cream, isotretinoin gel or tacrolimus ointment (2%, 0.05%, 0.1%, respectively, 5 times of the clinical dose). Behavioral testing was performed and levels of proteins were measured in the hippocampus. It was found that mice treated with isotretinoin or tacrolimus, presented a lower activity in open-field test and obvious depressive-like behavior in tail suspension test. Besides, they damaged cytoarchitecture, reduced the level of 5-HT-5-HT1A/1B system and increased the expression of apoptosis-related proteins in the hippocampus. To enable sensitive monitoring the dose-response characteristics of the consecutive neurobehavioral disorders, mice received gradient concentrations of hydroquinone (2%, 4%, 6%). Subsequently, hydroquinone induced behavioral disorders and hippocampal dysfunction in a dose-dependent response. When doses were high as 6% which was 3 times higher than 2% dose, then 100% of mice exhibited depressive-like behavior. Certainly, 6% hydroquinone

  4. Combination Therapy for Acne Scarring: Personal Experience and Clinical Suggestions.

    PubMed

    Kroepfl, Lucija; Emer, Jason J

    2016-11-01

    Acne is one of the most prevalent skin conditions seen by dermatologists. The cosmetic sequelae of severe acne, including scarring and pigmentation, have a profound psychological impact on those in icted. Topical (eg, retinoids, antibiotics, dapsone, hydroxyacids) and oral treatments (eg, antibiotics and/or spironolactone) are often bene cial to control acne or in the instance of oral isotretinoin use, rid the acne permanently; however, these treatments have very little affect on the ultimate cosmetic outcome of the acne scarring and skin texture that results. Given the variety of scar types that can form and the variability of responses seen in various skin types and textures, treatment options are vast without appropriate guidelines for pathways that dictate best timing, combinations, and options in given clinical scenarios. Current treatment options include solo or combina- tions of energy-based (eg, laser, radiofrequency), chemical-based (eg, peels, TCA cross), surgical-based options (eg, subcision, punch excision), microneedling, and llers and/or fat injections. Most recently, fractional radiofrequency-based treatments have been used to improve acne scarring with less reported downtime as compared to lasers or chemical peels and the ability to treat darker or sensitive skin types with less risk of scarring or hyperpigmentation. In severe cystic ares, scarring treatments are often postposed till the acne is under control and in many instances this can limit the dermatologists ability to affect future cosmetic treatments. Based on personal experience of various clinical scenarios in a busy laser practice that treats a signi cant number of patients with acne scarring, fractional radiofrequency is an excellent choice for treating all forms of acne scars with minimal risk to patients, even those on concurrent treatments such as isotretinoin. Additionally, fractional radiofrequency can be used in combination with all other treatment options to speed the time to

  5. Rosacea and rhinophyma.

    PubMed

    Tüzün, Yalçın; Wolf, Ronni; Kutlubay, Zekayi; Karakuş, Ozge; Engin, Burhan

    2014-01-01

    Rosacea is a common and chronic inflammatory cutaneous disease with unknown etiology. The pathophysiology of rosacea is still poorly understood. Epidemiological studies indicate a genetic component, but a rosacea gene has not been detected yet. Recent molecular studies propose that an altered innate immune response is involved in the pathogenesis of the rosacea disease. Signs of rosacea are indicated by the presence of characteristic facial or ocular inflammation involving both the vascular and tissue stroma. A wide range of drug options is available for the treatment of rosacea, including several topical ones (metronidazole, antibiotics, azelaic acid, benzoyl peroxide, sulfacetamide/sulfur, retinoids) and oral ones (mainly tetracyclines, metronidazole, macrolides, isotretinoin). This review highlights the recent clinical and pathophysiological developments concerning rosacea.

  6. Epigallocatechin-3-gallate improves acne in humans by modulating intracellular molecular targets and inhibiting P. acnes.

    PubMed

    Yoon, Ji Young; Kwon, Hyuck Hoon; Min, Seong Uk; Thiboutot, Diane M; Suh, Dae Hun

    2013-02-01

    Acne vulgaris is a highly prevalent skin disorder characterized by hyperseborrhea, inflammation, and Propionibacterium acnes overgrowth. Only isotretinoin and hormonal therapy reduce sebum production. To identify a new drug candidate that modulates sebum, we examined the effects of EGCG, the major polyphenol in green tea, on human SEB-1 sebocytes and in patients with acne. In SEB-1 sebocytes, we found that EGCG reduced sebum by modulating the AMPK-SREBP-1 signaling pathway. EGCG also reduces inflammation by suppressing the NF-κB and AP-1 pathways. EGCG also induces cytotoxicity of SEB-1 sebocytes via apoptosis and decreases the viability of P. acnes, thus targeting almost all the pathogenic features of acne. Finally, and most importantly, EGCG significantly improved acne in an 8-week randomized, split-face, clinical trial, and was well tolerated. Our data provide a therapeutic rationale for the use of EGCG in acne.

  7. Pityriasis Rubra Pilaris in a 3-Year-Old Male.

    PubMed

    Stacey, Stephen K; Novek, Steven J; Maddox, Craig L

    2016-03-01

    A 3-year-old male presented with progressive pruritic red-orange plaques across most of his body with erythema, desquamation, and fissuring of the hands and feet. He was diagnosed with classic juvenile (type III) pityriasis rubra pilaris (PRP) and treated with oral isotretinoin for 6 months. His skin findings resolved quickly during the treatment period, with residual postinflammatory hypopigmentation resolving within a year. PRP is rare in pediatric patients and standard recommended treatment algorithms for this population are not currently available. Diagnostic and treatment guidelines for PRP are based almost exclusively on case reports or case series, most of which focus on adult patients. The presentation, evaluation, and management of PRP are discussed. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

  8. Oral Azithromycin for Treatment of Intractable Rosacea

    PubMed Central

    Kim, Jae-Hong; Oh, Yoon Seok

    2011-01-01

    Rosacea is a common chronic cutaneous disorder that primarily occurs on the convex surfaces of the central face and is often characterized by exacerbations and remissions. A case of a 52-yr-old woman visited our clinic in February 2008 complaining typical features of rosacea including multiple pinhead to rice-sized erythematous papules. We applied various conventional treatments including topical benzoyl peroxide and metronidazole as well as oral metronidazole, isotretinoin, and doxycycline. The lesions were not controlled but were rather aggravated by complications from these treatments. Therefore, we prescribed oral azithromycin, which has anti-inflammatory effects and reduces reactive oxygen species. Ten weeks after the administration of oral azithromycin, 500 mg per day for 2 weeks, the lesions had mostly disappeared and no specific side effects related to the azithromycin were noted. Oral azithromycin dosing 500 mg/day for 2 weeks is effective for treatment of intractable rosacea. PMID:21532865

  9. Structural changes of β-carotene and some retinoid pharmaceuticals induced by environmental factors

    NASA Astrophysics Data System (ADS)

    Roman, Maciej; Kaczor, Agnieszka; Dobrowolski, Jan Cz.; Baranska, Malgorzata

    2013-04-01

    Four pharmaceuticals (β-carotene (1), retinoic acid (2), isotretinoin (3), and etretinate (4)) were analyzed using Raman spectroscopy and quantum-chemical calculations followed by potential energy distribution (PED) analysis to gain deeper insight into the experimental vibrational spectra. Small shifts of characteristic bands of (4) upon change of solvent and pH were interpreted as a result of molecular aggregation. Temperature-dependent studies on the Raman spectrum of (1) were performed in the temperature region of -150 °C to +150 °C. The observed small shifts in the experimental spectra upon heating were explained by increase of the high-energy conformers (of the trans type) in the population of (1) related to weakening of the intermolecular interactions that enables rotation of the terminal rings with respect to the polyene chain. Deconvolution of the ν1 band showed changes in intensity and position of the deconvoluted bands with the increase of temperature.

  10. Keratosis follicularis spinulosa decalvans and acne keloidalis nuchae.

    PubMed

    Goh, Michelle S Y; Magee, Jill; Chong, Alvin H

    2005-11-01

    A 27-year-old man presented with a 10-year history of scarring alopecia on the vertex of the scalp associated with follicular crusting and pustule formation, and a papular eruption on the posterior neck. Additionally, there was keratosis pilaris on the cheeks, eyebrows and thighs. Histology from the vertex showed scarring with a mixed perifollicular inflammatory infiltrate and foci of acute suppurative folliculitis. With clinical correlation, the diagnosis of keratosis follicularis spinulosa decalvans and concurrent acne keloidalis nuchae was made. The association of keratosis follicularis spinulosa decalvans with acne keloidalis nuchae has not previously been described. The patient responded to treatment with oral isotretinoin 20 mg (0.25 mg/kg) daily for 12 months.

  11. Consensus recommendations from the American Acne & Rosacea Society on the management of rosacea, part 3: a status report on systemic therapies.

    PubMed

    Del Rosso, James Q; Thiboutot, Diane; Gallo, Richard; Webster, Guy; Tanghetti, Emil; Eichenfield, Lawrence F; Stein-Gold, Linda; Berson, Diane; Zaenglein, Andrea

    2014-01-01

    The third article in this 5-part series reviews systemic therapies used to treat cutaneous rosacea based on consensus recommendations from the American Acne & Rosacea Society (AARS) on the management of the common presentations of cutaneous rosacea. The consensus recommendations are based on current understanding of research that describes pathophysiologic mechanisms that appear to be operative in rosacea, correlation of these underlying pathophysiologic mechanisms with specific clinical manifestations of rosacea, and outcomes from clinical trials that evaluate therapies for rosacea both as monotherapy and in combination with other agents. Systemic agents used for treatment of rosacea have been administered as oral formulations (ie, tablets, capsules). The only oral agent for rosacea approved by the US Food and Drug Administration (FDA) is a modified-release doxycycline 40-mg capsule. Other non-FDA-approved oral agents also are discussed including other tetracyclines, macrolides, metronidazole, and isotretinoin.

  12. SYSTEMIC RETINOIDS IN THE MANAGEMENT OF OF ICHTHYOSES AND RELATED SKIN TYPES

    PubMed Central

    DiGiovanna, John J.; Mauro, Theodora; Milstone, Leonard M.; Schmuth, Matthias; Toro, Jorge

    2013-01-01

    The term retinoid includes both natural and synthetic derivatives of vitamin A. Retinoid containing treatments have been used since the early Egyptians ~1550BC. Treatment of ichthyosiform disorders with retinoids dates back at least to the 1930’s. Early use of high dose vitamin A demonstrated efficacy but, because vitamin A is stored in the liver, toxicity limited usefulness. Interest turned to synthetic retinoids in an effort to enhance efficacy and limit toxicity. Acetretin, isotretinoin and, in the past etretinate, have provided the most effective therapy for ichthyosiform conditions. They have been used for a variety of ages, including in newborns with severe ichthyosis and for decades in some patients. Careful surveillance and management of mucous membrane, laboratory, skeletal, and teratogenic side effects has made systemic retinoids the mainstay of therapy for ichthyosis and related skin types. PMID:23384018

  13. P160L mutation in the Ca(2+) ATPase 2A domain in a patient with severe Darier disease.

    PubMed

    Godic, Aleksandar; Glavac, Damjan; Korosec, Branka; Miljković, Jovan; Potocnik, Marko; Kansky, Aleksej

    2004-01-01

    Darier disease (DD) is caused by mutations of the ATP2A2 gene, which encodes the sarco/endoplasmic reticulum Ca(2+)-ATPase isoform 2 (SERCA2). The mutations affect protein expression, degradation and activity. We report a patient with severe sporadic DD, who did not respond adequately to repeated courses of orally administered acitretin and isotretinoin. He was found to harbor the missense P160L mutation of the ATP2A2 gene in a heterozygous state in the A domain of SERCA2 and polymorphism in intron 18 (2741 + 54 G --> A). The A domain plays a key role in translocation of Ca(2+) from cytoplasm to endoplasmic reticulum lumen, thus establishing a low intracellular Ca(2+) concentration.

  14. Aggressive giant condyloma acuminatum associated with oncogenic human papilloma virus: a case report

    PubMed Central

    Kibrité, Antoine; Zeitouni, Nathalie C.; Cloutier, Richard

    1997-01-01

    Malignant transformation has been described in 30% of cases of giant anorectal condyloma acuminatum. The authors report on a 33-year-old man who was heterosexual and HIV negative and who had a giant anal condyloma. Despite aggressive therapy with multiple fulgurations, interferon alpha and isotretinoin, an invasive squamous cell carcinoma of the rectum developed. An abdominoperineal resection was done followed by radiotherapy and chemotherapy, but this treatment regimen was unsuccessful in controlling the progression of his carcinoma. Human papillomavirus (HPV) serotyping in tumoral tissue was positive for HPV types 11 and 16. In patients with giant anorectal condylomas associated with oncogenic HPV, the course of the disease may be aggressive, so they may benefit from early surgical and medical intervention. PMID:9126130

  15. What's new in pediatric dermatology?: part II. Treatment.

    PubMed

    Pride, Howard B; Tollefson, Megha; Silverman, Robert

    2013-06-01

    The field of pediatric dermatology has been rich in new developments. Part II of this continuing medical education article will focus on new therapeutic modalities for several entities encountered in pediatric dermatology. The treatment of atopic dermatitis, exciting advances in the use of propranolol and other beta-blockers for the use of infantile hemangiomas, the use of rapamycin for vascular anomalies, the use of biologics in children, the central nervous system risks of general anesthesia in young children, side effects in the use of isotretinoin, the treatment of tinea capitis, treatment of herpes simplex infections, and the use of technologies such as texting and social media in medicine will be discussed. Copyright © 2013 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.

  16. Acne: clinical presentations.

    PubMed

    Shalita, Alan R

    2004-01-01

    Acne vulgaris, the most common disease of the skin, can be manifested in a wide variety of clinical presentations. As a result of this clinical variation, there are almost as many classifications of acne as there are clinicians with particular interest in the disease. Thus acne has been classified as types I-IV, inflammatory versus noninflammatory, comedonal, comedopapular, papular, papulopustular, pustular, and "cystic" or nodular (even nodular-cystic). For those who are enamored of classification, there are subdivisions of the various categories, including "sandpaper comedones" and microcysts. There is even disagreement as to what constitutes a papule versus a nodule. The classic textbook definition of a nodule refers to lesions 1 cm or larger, but the early investigators of oral isotretinoin defined nodules as 4 mm or larger, and this definition has creeped into many texts, recently clarified by Bologna.(1)

  17. Oral Accutane (13-cis-retinoic acid) has no effects on spatial learning and memory in male and female Sprague-Dawley rats.

    PubMed

    Ferguson, Sherry A; Berry, Kimberly J

    2007-01-01

    Descriptions of psychiatric effects with Accutane (13-cis-retinoic acid (13-cis-RA)) use prompted a series of studies in a rodent model to ascertain its cognitive effects. Previously, we reported no effects on measures of anhedonia and depression in rats treated with 7.5, 22.5, or 30 mg/kg 13-cis-RA [S.A. Ferguson, F.J. Cisneros, B. Gough, J.P. Hanig, K.J. Berry, Chronic oral treatment with 13-cis-retinoic acid (isotretinoin) or all-trans-retinoic acid does not alter depression-like behaviors in rats, Toxicol. Sci. 87 (2005) 451-459 [16]; S.A. Ferguson, F.J., Cisneros, J.P. Hanig, K.J. Berry, Chronic oral treatment with Accutane (13-cis-retinoic acid) does not increase measures of anhedonia or depression in male and female Sprague-Dawley rats, (in preparation) [19

  18. 1,450-nm diode laser in combination with the 1550-nm fractionated erbium-doped fiber laser for the treatment of steatocystoma multiplex: a case report.

    PubMed

    Moody, Megan N; Landau, Jennifer M; Goldberg, Leonard H; Friedman, Paul M

    2012-07-01

    Steatocystoma multiplex (SM) is a rare condition characterized by multiple, small, asymptomatic dermal cysts. Treatment options are limited, with varying degrees of success; these include oral isotretinoin, surgical excision or drainage, and liquid nitrogen cryotherapy. The most effective method is excision, but cosmetic considerations, time, overall cost, and pain must be considered, because patients tend to have multiple cysts. Lasers, especially nonablative devices, have not frequently been used to treat SM. Herein, we present the case of a patient with isolated steatocystoma multiplex on the abdomen and lower chest with substantial clearance after two laser treatment sessions using two complementary lasers: a 1,450-nm diode laser to target the abnormal sebaceous glands and a 1,550-nm fractionated erbium-doped fiber laser to target the dermal cysts. © 2012 by the American Society for Dermatologic Surgery, Inc. Published by Wiley Periodicals, Inc.

  19. Idiopathic pustular vulvitis.

    PubMed

    Dhanjal, M; Teixeira, F; Dadzie, O; Rose, G

    2009-12-01

    A 31-year-old woman presented in the 23rd week of her third pregnancy with extremely painful pustular vulvitis, unresponsive to antibiotics. Although the histological findings were was consistent with a diagnosis of hidradenitis suppurativa (HS), bridged comedones, the hallmark of this disease, were absent and there were no dermal sinuses. Incision and drainage of the pustules provided only temporary improvement, which was briefly maintained with oral clindamycin and topical steroids. After the birth, a course of isotretinoin produced almost total clearance, a response not typically found in HS. This patient's condition may represent a variant of HS, and if so, it would be the first case report of de novo HS in pregnancy, but its clinical features and evolution differed so much from those in HS that the possibility of a previously unrecognised condition cannot be excluded.

  20. [Drug treatment of alopecia].

    PubMed

    Wolff, H

    2015-10-01

    Alopecia is the term used to describe hairless areas of the scalp. They can follow a specific pattern, be diffuse or circumscript. Androgenetic alopecia (AGA) follows a pattern: in men thinning of temples and vertex up to total baldness; in women thinning of the midline or parietal area. Lack of iron or cytostatic drugs cause diffuse alopecia, while in autoimmune diseases such as alopecia areata or lichen planus bizarre shapes of hairless areas are observed. For therapy, the following medications are used: topical minoxidil solution for AGA of men and women; systemic finasteride 1 mg for men with AGA; topical diphencyprone immunotherapy for alopecia areata; systemic antimycotic agents for tinea capitis; antibiotics such as clindamycin and rifampicin for folliculitis decalvans; systemic corticosteroids and isotretinoin for folliculitis et perifolliculitis capitis abscedens et suffodiens; topical corticosteroids for lichen planus and Kossard's frontal fibrosing alopecia.

  1. Acne pathogenesis: history of concepts.

    PubMed

    Tilles, Gérard

    2014-01-01

    From the first reliable descriptions of acne in the early 19th century, dermatologists recognized it as a disease of the pilosebaceous follicle. Until the middle of the 20th century, they hypothesized that seborrhoea, follicular keratosis and microorganisms could be individually responsible for the acne lesions. Inflammation was only regarded as the final and inescapable step of the acne process. Although the importance of these factors has been reevaluated, recent works still regarded them as mandatory. In the 1970s, the onset of isotretinoin dramatically improved acne management. It also provided great opportunities for a better understanding of the pathogenic factors of acne. This study analyzes their genesis and development from the seminal contributions until recent advances.

  2. [Successful therapy of sacroiliitis in SAPHO syndrome by etanercept].

    PubMed

    Wolber, Carola; David-Jelinek, Karin; Udvardi, Astrid; Artacker, Gottfried; Volc-Platzer, Beatrix; Kurz, Herbert

    2011-04-01

    Painful, aseptic osteitis remains the major problem in the treatment of patients with SAPHO syndrome. We present a child suffering of both sacroiliitis and acne conglobata in the context of SAPHO syndrome. While acne lesions responded well to systemic isotretinoin, sacroiliitis associated pain could be controlled neither by NSAR nor by intralesional or systemic steroid injection. Worse pain limited substantially patient's mobility. This changed immediately after starting etanercept. Within a few days, pain resolved and the patient regained his mobility. This favourable response lasted for 8 months when we tried to stop etanercept under protection with the DMARD sulfazalazin. Unfortunately, within a few days, pain and immobility re-occurred requiring reinstitution of etanercept. This case demonstrates that, similar to other reports, TNF blockade is able to induce prompt and long-lasting response of SAPHO syndrome associated osteoarthritis to TNF blockade.

  3. SAPHO syndrome in an adolescent: a clinical case with unusual severe systemic impact.

    PubMed

    Freira, Sílvia; Fonseca, Helena; Ferreira, Pedro Dias; Vasconcelos, Pedro; Fonseca, João Eurico

    2014-08-01

    SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) syndrome includes both dermatological and rheumatologic symptoms. Being a rare condition, the diagnosis is frequently late. The authors report a case of a 13-year-old boy diagnosed with synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome with unusual severe systemic repercussions. The patient presented with acne conglobata, inability to walk due to pain and weakness and weight loss. Bone scintigraphy was suggestive of sacroiliitis, and lumbar spine x-ray showed signs of hyperostosis. His clinical state improved after treatment with nonsteroidal anti-inflammatory drugs, methotrexate, clindamycin, and isotretinoin. A review of the clinical aspects of this syndrome is presented, emphasizing how this underdiagnosed syndrome can lead to severe weight loss and significant functional and psychological impairment at an early age.

  4. Management of Periocular Granuloma Annulare Using Topical Dapsone

    PubMed Central

    Patel, Mayha; Shitabata, Paul; Horowitz, David

    2015-01-01

    Granuloma annulare is a disease characterized by granulomatous inflammation of the dermis. Localized granuloma annulare may resolve spontaneously, while generalized granuloma annulare may persist for decades. The authors present the case of a 41-year-old Hispanic man with a two-week history of periocular granuloma annulare. Due to previously reported success in the use of systemic dapsone for the treatment of granuloma annulare, and the periocular proximity of the patient’s lesion, topical dapsone was used for treatment. Various additional therapies for the management of granuloma annulare have been reported, such as topical and systemic steroids, isotretinoin, pentoxifylline, cyclosporine, Interferon gamma, potassium iodide, nicotinamide, niacinamide, salicylic acid, fumaric acid ester, etanercept, infliximab, and hydroxychloroquine. Additional clinical trials are necessary to further evaluate the effectiveness of topical dapsone in the management of granuloma annulare. PMID:26203321

  5. Epitheliotropic cutaneous lymphoma (mycosis fungoides) in a dog.

    PubMed

    Bhang, Dong Ha; Choi, Ul Soo; Kim, Min Kyu; Choi, Eun-Hwa; Kang, Min-Soo; Hwang, Cheol-Yong; Kim, Dae-Yong; Youn, Hwa Young; Lee, Chang Woo

    2006-03-01

    A seven-year-old castrated male Yorkshire terrier dog was presented for a recurrent skin disease. Erythematous skin during the first visit progressed from multiple plaques to patch lesions and exudative erosion in the oral mucosa membrane. Biopsy samples were taken from erythematous skin and were diagnosed with epitheliotropic T cell cutaneous lymphoma by histopathology and immunochemical stain. In serum chemistry, the dog had a hypercalcemia (15.7 mg/dl) and mild increased alkaline phosphatase (417 U/l). Immunohistochemistry was performed to detect parathyroid hormone-related peptide (PTH-rP) in epitheliotropic cutaneous lymphoma tissues but the neoplastic cells were not labeled with anti-PTH-rP antibodies. The patient was treated with prednisolone and isotretinoin. However, the dog died unexpectedly.

  6. Pityriasis rubra pilaris sensitive to narrow band-ultraviolet B light therapy.

    PubMed

    Vergilis-Kalner, Irene J; Mann, David J; Wasserman, Justin; Petronic-Rosic, Vesna; Tsoukas, Maria M

    2009-03-01

    Pityriasis rubra pilaris (PRP) is a rare skin condition which typically presents in adults as red-orange plaques with islands of sparing, perifollicular keratotic papules, waxy palmoplantar keratoderma, and erythema with fine, diffuse scale. Currently, there are no well-established treatment guidelines for this condition. This is party due to a lack of universally effective treatments for PRP, with some cases being resistant to multiple topical and systemic therapies. Systemic retinoids have been used with some success. Several phototherapy regimens have lead to variable results. The authors present a case of PRP, unresponsive to 6 month treatment of isotretinoin, that was subsequently treated with narrow-band ultraviolet B (NB-UVB) light therapy with complete resolution after four months of light treatment. The observed clinical benefit may encourage future phototesting and consideration of NB-UVB light therapy in recalcitrant PRP cases.

  7. [Effect of topical retinoid therapy on seborrhea using iontophoresis].

    PubMed

    Knor, Tanja

    2003-01-01

    Increased sebum production is one of causes of Acne. This is under androgen control. Acne subjects have significantly greater sebum production than subjects without Acne and this relates to Acne's severity. Reduction in sebum production is associated with improvement in Acne and it can realize with anti-androgen therapy and isotretinoin therapy. But these therapies can not keep away from systematically influence. Topical retinoids do not affect sebum production and approximately 80% of tretinoin applied remains on the skin surface. Iontophoresis offer methods for enhancing the percutaneous absorption of drugs and increase of drug concentration in skin. The aim of the study was to establish possibility of improvement retinoin efficacy by iontophoresis. Our results show that application of tretinoin by iontophoresis do not affect on sebum production.

  8. Rosacea fulminans or acute rosacea? Report of 5 cases and review of the literature.

    PubMed

    Mantovani, Lucia; Zauli, Stefania; Virgili, Annarosa; Bettoli, Vincenzo

    2016-10-01

    Rosacea fulminans, previously called pyoderma faciale, is an inflammatory disease considered a dramatic form of rosacea rather than of acne. Typical features are: exclusive facial involvement of young women, sudden onset of large nodules without other signs of acne, remission without scarring or with minimal scars, no recurrences or systemic symptoms. Oral isotretinoin associated with a short course of systemic and topical corticosteroids represent the recommended treatment. Personal observation of 5 cases has induced us to make a review of worldwide literature in order to better define this clinical entity. In our opinion, rosacea fulminans is a valid diagnosis, but clinical criteria should be rigorously respected to fully exclude rosacea conglobata and acne fulminans.

  9. Management strategies for acne vulgaris

    PubMed Central

    Whitney, Kristen M; Ditre, Chérie M

    2011-01-01

    Clinical question: What are the most effective treatment(s) for mild, moderate, severe, and hormonally driven acne? Results: Mild acne responds favorably to topical treatments such as benzoyl peroxide, salicylic acid, and a low-dose retinoid. Moderate acne responds well to combination therapy comprising-topical benzoyl peroxide, antibiotics, and/or retinoids, as well as oral antibiotics in refractory cases and oral contraceptive pills for female acne patients. Severe nodulocystic acne vulgaris responds best to oral isotretinoin therapy. In female patients with moderate to severe acne, facial hair, loss of scalp hair and irregular periods, polycystic ovarian syndrome should be considered and appropriate treatment with hormonal modulation given. Adjunctive procedures can also be considered for all acne patients. Implementation: Pitfalls to avoid when treating acne: treatment of acne in women of child-bearing age; familiarization of all acne treatments in order to individualize management for patients; indications for specialist referral. PMID:21691566

  10. Clinical Effects of Topical Tacrolimus on Fox-Fordyce Disease

    PubMed Central

    Kaya Erdoğan, Hilal; Bulur, Işıl; Kaya, Zeliha

    2015-01-01

    Fox-Fordyce Disease (FFD) is a rare, chronic, pruritic, inflammatory disorder of apocrine glands. It is characterized by dome-shaped, firm, discrete, skin-colored, and monomorphic perifollicular papules. The most common sites of involvement are axillae and anogenital and periareolar regions which are rich in apocrine sweat glands. Treatment is difficult. Topical, intralesional steroids, topical tretinoin, adapalene, clindamycin, benzoyl peroxide, oral contraceptives, isotretinoin, phototherapy, electrocauterisation, excision-liposuction and curettage, and fractional carbon dioxide laser are among the treatment options. In the literature, there are articles reporting beneficial effects of pimecrolimus in FFD. Nevertheless, there have not been any reports about the use of tacrolimus in FFD. We report two patients diagnosed with FFD by clinical and histopathologic examination and discussed therapeutic effects of topical tacrolimus on FFD in the light of literature. PMID:26171257

  11. Acne fulminans with synovitis-acne-pustulosis-hyperostosis-osteitis (SAPHO) syndrome treated with infliximab.

    PubMed

    Iqbal, Marvi; Kolodney, Michael S

    2005-05-01

    Acne fulminans is a syndrome of sudden onset hemorrhagic and ulcerative acne involving the back, chest, and face combined with systemic symptoms. It can be the dermatologic manifestation of the synovitis-acne-pustulosis-hyperostosis-osteitis (SAPHO) syndrome. Current therapy for acne fulminans consists of wound care, topical and systemic corticosteroids, isotretinoin, and nonsteroidal anti-inflammatory drugs (NSAIDs). Infliximab, a recently developed monoclonal antibody against tumor necrosis factor-alfa, has shown efficacy in the treatment of psoriatic arthritis and ankylosing spondylitis both of which share clinical similarities to the SAPHO syndrome. We report the case of a patient with the SAPHO syndrome and acne fulminans who was treated with infliximab. Ten months after initiating therapy with infliximab, the area of the patient's ulcerative lesions was reduced by 70%. Infliximab might be considered as a treatment option for patients with acne fulminans unresponsive to conventional therapies.

  12. [Acne vulgaris in connection with the use of progestagens in a hormonal IUD or a subcutaneous implant].

    PubMed

    Cohen, E B; Rossen, N N

    2003-10-25

    Three women developed severe acne vulgaris within several weeks to a few months after either insertion of a levonorgestrel IUD (two women, 27 and 33 years of age) or subcutaneous implantation of an etonogestrel implant (26-year-old woman). The first woman had had acne previously; her IUD was removed and she was transferred to oral contraception with cyproterone-ethinyloestradiol. The second woman was treated with a peeling cream. The third woman changed to an oral anticonceptive and was treated with isotretinoin. The acne disappeared in all three patients. Progestagens have androgenic activity, even in low doses, and it is well known that androgenic stimulation of the sebaceous glands can cause acne vulgaris. The possibility that acne vulgaris may be an adverse reaction is probably not always considered. When asking the patient about her use of drugs, one should therefore ask specifically about an IUD or a subcutaneous implant.

  13. Oral contraceptives in the treatment of acne.

    PubMed

    Tan, J K; Degreef, H

    2001-02-01

    Oral contraceptives (OCs) can reduce acne by lowering the production of adrenal and ovarian androgens, by inhibiting 5-alpha-reductase, which in turn, reduces the levels of dihydrotestosterone, and by stimulating sex hormone binding globulin (SHBG), thus reducing the levels of free testosterone. In newer OCs, such as Tricyclen and Diane-35, the progestin component is minimally androgenic and anti-androgenic respectively, thereby enhancing the favorable profile of these products in the treatment of hyperandrogenic disorders, including acne. The efficacy of these agents and their long-term safety profile supports their use in various grades of acne in females: * As adjunctive therapy to topical agents for women with mild non-scarring acne desiring oral contraception * As primary therapy for patients with moderate non-scarring acne in combination with topical therapy and systemic antibiotics * As one of two preferred methods of contraception in patients with scarring and severe inflammatory acne being treated with systemic isotretinoin.

  14. [Drug therapy of acne].

    PubMed

    Ochsendorf, F R; Degitz, K

    2008-07-01

    Acne is treated according to the clinical picture and the pathophysiologically relevant mechanisms, such as seborrhea, follicular hyperkeratosis, P. acnes colonisation,and inflammation. In mild forms of acne, topical therapy is most appropriate. Comedonal acne can be treated with topical retinoids; papulopustular acne with a combination of retinoids and topical antimicrobial substances (benzoyl peroxide, antibiotics, or azelaic acid). Moderate forms or those with extrafacial involvement can be treated with oral antibiotics combined with topical retinoids or benzoyl peroxide. Acne conglobata and other severe manifestations are treated with oral isotretinoin. Women are also treated with oral contraceptives containing anti-androgenic progestins. If inflammation is prominent, initial short term treatment with oral glucocorticoids is helpful. Second-line agents include oral zinc or dapsone. Following successful treatment, topical retinoids are suitable for maintenance therapy.

  15. Post-adolescent acne in women: more common and more clinical considerations.

    PubMed

    Kim, Grace K; Michaels, Brent B

    2012-06-01

    Current evidence suggests that post-adolescent acne in women is on the rise. Acne in this subgroup of patients commonly follows a specific pattern that can often be treatment resistant and/or prone to relapse, including after oral isotretinoin therapy. With a plethora of medications to choose from for acne treatment, many of which have been used in the past by patients without success, dermatology practitioners often find oral contraceptives and spironolactone to be of benefit in otherwise healthy adult females. Also, some of these patients may have concurrent hormonal anomalies such as polycystic ovarian syndrome or other underlying endocrine disorders, which should also be appropriately worked up by the clinician and managed accordingly. This article reviews some of the underlying pathophysiological factors, available treatment options, and screening guidelines to assist clinicians in the management of acne in adult females.

  16. Perception of teratogenic and foetotoxic risk by health professionals: a survey in Midi-Pyrenees area.

    PubMed

    Damase-Michel, Christine; Pichereau, Juliette; Pathak, Atul; Lacroix, Isabelle; Montastruc, Jean Louis

    2008-01-01

    Counselling or prescribing drugs during pregnancy requires health professionals to assess risk/benefit ratio for women and their baby. A misperception of the risk may lead to inappropriate decisions for pregnancy outcomes. The aim of the present study was to assess teratogenic and/or foetotoxic risk perception of common medications by general practitioners (GPs) and community pharmacists (CPs) from the Midi-Pyrenees area. 103 GPs and 104 CPs were interviewed. For 21 given drugs, a visual-analogue scale was used to evaluate the risk to give birth to a malformed infant if the mother had taken the drug during first trimester of pregnancy. For 9 drugs, health professionals had to say if they thought there was a potential foetotoxic and/or neonatal risk when drugs were administered during late pregnancy. 97% and 91% of GPs and CPs respectively thought that isotretinoin and thalidomide are teratogenic and more than 80% thought that amoxicillin and acetaminophen are safe in early pregnancy. However, 19% of the GPs and 33% of CPs answered there were no teratogenic risk for valproate. Around 11% of both GPs and CPs said that warfarin was safe during pregnancy. For 22% of GPs and for 13% and 27% of CPs respectively, ibuprofen and enalapril were safe on late pregnancy. For each drug, mean value of perceived teratogenic risk by health professionals was higher than values that can be found in scientific references. Concerning isotretinoin, thalidomide and metoclopramide, perceived teratogenic risk was higher for CPs. These data show that the potential teratogenic and foetotoxic risk of several commonly used drugs is unknown by health professionals. Conversely, GPs and CPs who think that a risk exists, overestimate it. This misperception can lead to inappropriate decisions for pregnancy outcomes.

  17. Minor malformations characteristic of the retinoic acid embryopathy and other birth outcomes in children of women exposed to topical tretinoin during early pregnancy.

    PubMed

    Loureiro, Kirsten D; Kao, Kelly K; Jones, Kenneth Lyons; Alvarado, Sonia; Chavez, Carmen; Dick, Lyn; Felix, Robert; Johnson, Diana; Chambers, Christina D

    2005-07-15

    Topical tretinoin (Retin-A) is used to treat acne and photodamaged skin. Its teratogenic potential is of concern due to its similarity to isotretinoin (Accutane), a recognized human teratogen. Through the California Teratogen Information Service and Clinical Research Program, between 1983 and 2003, 106 pregnant women with first-trimester exposure to topical tretinoin were prospectively ascertained and followed. Birth outcomes, including pregnancy loss, major structural defects, and pre- and postnatal growth were compared to 389 similarly and prospectively ascertained women with no topical tretinoin exposure during pregnancy. Because a distinct pattern of malformation had already been described for isotretinoin, we also compared exposed (n = 62) and unexposed (n = 191) infants on the prevalence of a specific subset of minor malformations selected to represent the spectrum of defects comprising the retinoic acid embyopathy. There were no significant differences between groups in the proportion of pregnancies ending in spontaneous abortion (6.6% in exposed vs. 8.5% in unexposed; P = 0.53), or infants with major structural defects (2.2% in exposed vs. 1.2% in unexposed; P = 0.62). In addition, the groups were similar in birth weight, length and head circumference, and there were no significant differences between groups in length of gestation. Furthermore, the prevalence of one or more retinoic acid-specific minor malformations did not differ significantly between groups (12.9% in exposed vs. 9.9% in unexposed; P = 0.51). First-trimester topical tretinoin exposure in this study was not associated with an increased risk of any adverse pregnancy outcome evaluated. Specifically, there was no indication that topical tretinoin is associated with an increased risk for minor malformations that are consistent with the retinoic acid embryopathy. Although it is impossible to exclude the possibility that some women/infants may be uniquely susceptible to topical tretinoin exposure

  18. Systematic review on the rapidity of the onset of action of topical treatments in the therapy of mild-to-moderate acne vulgaris.

    PubMed

    Jacobs, A; Starke, G; Rosumeck, S; Nast, A

    2014-03-01

    The time until a patient achieves a relevant improvement during the treatment of a skin disease is important for selecting a therapy, but has been largely neglected in reviews and guidelines. The aim of this systematic review was to determine the time until the onset of action (TOA) of topical acne treatments. The primary outcome was the TOA defined as the time until a 25% reduction in the mean number of inflammatory lesions had been achieved. A systematic literature search in Medline and Embase was carried out. Clinical trials that evaluated head-to-head comparisons of treatments in patients suffering from mild-to-moderate papulopustular acne were included. Abstract and full-text screening and data extraction were done independently by two investigators. With respect to inflammatory lesions, different concentrations of benzoyl peroxide (BPO) or adapalene did not seem to influence the TOA. BPO seemed to act more quickly than isotretinoin and tretinoin. Adapalene showed a shorter TOA than isotretinoin. Conflicting results were seen when comparing adapalene with tretinoin, with a tendency for adapalene to be faster. Clindamycin/BPO seemed to act more quickly than adapalene. Inconsistent results were seen for the comparison of clindamycin/BPO and BPO alone with a slight indication of a shorter TOA for clindamycin/BPO. Adapalene/BPO and clindamycin/BPO showed comparable TOA. When interpreting the data, the different study designs and the limited study quality need to be taken into account. Further research is needed to identify treatments that offer an early onset of action and possibly help to optimize patients' adherence. TOA should be considered as an additional outcome in acne trials.

  19. Memory disorders associated with consumption of drugs: updating through a case/noncase study in the French PharmacoVigilance Database

    PubMed Central

    Chavant, Francois; Favrelière, Sylvie; Lafay-Chebassier, Claire; Plazanet, Caroline; Pérault-Pochat, Marie-Christine

    2011-01-01

    AIMS To investigate putative associations of reports of memory disorders and suspected drugs. METHODS We used the case/noncase method in the French PharmacoVigilance Database (FPVD). Cases were reports of memory loss in the FPVD between January 2000 and December 2009. Noncases were all other reports during the same period. To assess the association between memory impairment and drug intake, we calculated an odds ratio with its 95% confidence interval. RESULTS Among the 188 284 adverse drug reactions recorded, we identified 519 cases of memory loss. The sex ratio was 0.6 and the median age was 54 years (range 4–93). The maximal number of cases occurred between 40–49 and 50–59 years. Evolution was favourable in 63% of the cases. We found significant odds ratios for benzodiazepines (alprazolam, bromazepam, prazepam, clonazepam etc.), benzodiazepine-like hypnotics (zolpidem and zopiclone), antidepressants (fluoxetine, paroxetine and venlafaxine), analgesics (morphine, nefopam and tramadol), anticonvulsants (topiramate, pregabalin, levetiracetam etc.), antipsychotics (aripiprazole and lithium) and other drugs, such as trihexyphenidyl, ciclosporin and isotretinoin. CONCLUSIONS Our study confirmed an association between memory disorders and some drugs, such as benzodiazepines and anticonvulsants. However, other drugs, such as benzodiazepine-like hypnotics, newer anticonvulsants, serotonin reuptake inhibitor antidepressants, isotretinoin and ciclosporin were significantly associated with memory disorders, although this was not described or poorly described in the literature. Taking account of the limits of this study in the FPVD (under-reporting, notoriety bias etc.), the case/noncase method allows assessment and detection of associations between exposure to drugs and a specific adverse drug reaction, such as memory disorders, and could thus generate signals and orientate us to further prospective studies to confirm such associations. PMID:21557759

  20. Perception of teratogenic and foetotoxic risk by health professionals: a survey in Midi-Pyrenees area

    PubMed Central

    Damase-Michel, Christine; Pichereau, Juliette; Pathak, Atul; Lacroix, Isabelle; Montastruc, Jean Louis

    2007-01-01

    Counselling or prescribing drugs during pregnancy requires health professionals to assess risk/benefit ratio for women and their baby. A misperception of the risk may lead to inappropriate decisions for pregnancy outcomes. The aim of the present study was to assess teratogenic and/or foetotoxic risk perception of common medications by general practitioners (GPs) and community pharmacists (CPs) from the Midi-Pyrenees area. Methods 103 GPs and 104 CPs were interviewed. For 21 given drugs, a visual-analogue scale was used to evaluate the risk to give birth to a malformed infant if the mother had taken the drug during first trimester of pregnancy. For 9 drugs, health professionals had to say if they thought there was a potential foetotoxic and/or neonatal risk when drugs were administered during late pregnancy. Results 97% and 91% of GPs and CPs respectively thought that isotretinoin and thalidomide are teratogenic and more than 80% thought that amoxicillin and acetaminophen are safe in early pregnancy. However, 19% of the GPs and 33% of CPs answered there were no teratogenic risk for valproate. Around 11% of both GPs and CPs said that warfarin was safe during pregnancy. For 22% of GPs and for 13% and 27% of CPs respectively, ibuprofen and enalapril were safe on late pregnancy. For each drug, mean value of perceived teratogenic risk by health professionals was higher than values that can be found in scientific references. Concerning isotretinoin, thalidomide and metoclopramide, perceived teratogenic risk was higher for CPs. Conclusion These data show that the potential teratogenic and foetotoxic risk of several commonly used drugs is unknown by health professionals. Conversely, GPs and CPs who think that a risk exists, overestimate it. This misperception can lead to inappropriate decisions for pregnancy outcomes. PMID:25170360

  1. The impact of rosacea on quality of life: effects of demographic and clinical characteristics and various treatment modalities.

    PubMed

    Aksoy, B; Altaykan-Hapa, A; Egemen, D; Karagöz, F; Atakan, N

    2010-10-01

    Rosacea has a major psychosocial impact on a patient's life. To determine the impact of rosacea on patient quality of life, the relationship of quality of life scores to clinical and demographic variables, and the change in quality of life following various treatments. Patients' demographic and clinical characteristics were recorded at their initial examination and their response to treatment and side-effects were recorded additionally at their follow-up examination. Rosacea severity was scored for each of four signs from 0 to 3. Patients were requested to complete Dermatology Life Quality Index (DLQI) questionnaires. A total of 308 patients took part in this study. Mean ± SD DLQI total score at the initial visit was 6·93 ± 5·18 and was related to patients' age, sex, age at disease onset, subjective symptoms, triggering factors, previous treatments, rosacea severity scores and patients' self-assessment of ease of living with rosacea. Of these 308 patients, 164 completed the DLQI following treatment. Mean ± SD post-treatment DLQI score was 4·36 ± 4·82. Post-treatment scores were also related to sex, type of treatment modality, development of side-effects, improvement of rosacea, rosacea severity scores and patients' self-reported ease of living with rosacea. Topical metronidazole, oral tetracycline and oral isotretinoin were observed to reduce signs and symptoms of rosacea and DLQI scores significantly at this repeat examination. Rosacea affects patients' lives to a moderate extent, and this can be assessed by using DLQI. DLQI is also sensitive to quality of life changes brought about by treatment of rosacea. As a preliminary result we can say that topical metronidazole, oral tetracycline and oral isotretinoin seem to improve quality of life of patients by improving lesions of rosacea more efficiently than other therapeutic agents. © 2010 The Authors. Journal Compilation © 2010 British Association of Dermatologists.

  2. [Methotrexate to treat SAPHO syndrome with keloidal scars].

    PubMed

    Azevedo, V F; Dal Pizzol, V I; Lopes, H; Coelho, S P; Czeczko, L E A

    2011-01-01

    SAPHO syndrome is an uncommon clinical entity, recently described in literature, which usually affects children, young adults and middle-aged people. It is defined by the association of skin lesions (severe acne, palmo-plantar pustulosis, supurative hidradenitis), synovitis, hiperosthosis and osteitis; however, not all manifestations are required for correct diagnosis. We report a currently forty-two year-old man who initiated follow-up in 1992 for severe acne. His diagnosis changed along the years and has been treated with antibiotics many times to control pustule formation and hidrosadenitis, which evolved to keloidal scars, requiring neck zethaplasty due to limitation of mobility. In 1996 isotretinoin was started, with good response to treatment but recurrence after its completion. Ten years later, isotretinoin was being used again due to worsening clinical picture when the patient developed polyarthritis, lost 11kg in 3 months and was found to have an elevated erythrocyte sedimentation rate. SAPHO syndrome was then diagnosed by the Rheumatology clinic, which started methotrexate at 10mg per week to a good clinical response. Several cutaneous and articular flares have occurred since, however he is now clinically stable with methotrexate 20mg per week and finasteride 5mg per day. SAPHO syndrome is a rare disease and its diagnosis is often late and difficult. In this case, skin lesions preceded arthritis in several years and have been resistant to other common treatments. The patient had a better improve after initiation of methotrexate. Although the skin disease has evolved to keloids, the patient has had excellent treatment response.

  3. Distressing cutaneous lesion among bipolar affective disorder patients on lithium therapy: A retrospective cross-sectional study

    PubMed Central

    Ummar, Syed; Dorai, B. Lakshmi; Ramanathan, Shree Aarthi

    2016-01-01

    Aim: To assess the incidence of cutaneous lesion in bipolar affective disorder (BPAD) patients on lithium therapy. To evaluate the relationship between duration of lithium therapy, dosage of lithium, serum lithium level, and cutaneous lesions. To assess whether reduction/stoppage of dose of lithium has any change in the course of cutaneous side effects. To look for a relationship between addition of isotretinoin and the course of mood disorder. Methodology: We retrospectively collected hospital case records of 125 consecutive BPAD patients initiated lithium therapy, assessed with inclusion and exclusion criteria. We follow up them for 2½ years for the assessment of above said aims. Results: The prevalence of skin reaction in BPAD patients with lithium therapy was 19.8%. Among patients on lithium therapy, cutaneous lesion emerged in initial 6 months and later after 1 year of treatment. Nearly 55% of patients on higher doses of lithium (1200 mg) had a cutaneous lesion. Patient on therapeutic serum level of lithium had a higher incidence of skin lesion. Out of six patients in whom dosage of lithium was reduced, three of them had reduced lesions (P = 0.6), in two patients, skin lesion increased, and one patient had no change. Among 11 patients treated with isotretinoin, only two patients had emergence of depressive symptoms. Conclusion: Lithium continues to increase the incidence of multiple cutaneous lesions among BPAD patients on lithium therapy. Incidence of cutaneous side effects directly correlates with the dose of lithium and therapeutic range of serum lithium level. Altering the dose of lithium does not statistically influence the cutaneous lesion. PMID:28196994

  4. Reporting of drug induced depression and fatal and non-fatal suicidal behaviour in the UK from 1998 to 2011

    PubMed Central

    2014-01-01

    Background Psychiatric adverse drug reactions (ADRs) are distressing for patients and have important public health implications. We identified the drugs with the most frequent spontaneous reports of depression, and fatal and non-fatal suicidal behaviour to the UK’s Yellow Card Scheme from 1998 to 2011. Methods We obtained Yellow Card data from the Medicines and Healthcare products Regulatory Agency for the drugs with the most frequent spontaneous reports of depression and suicidal behaviour from 1964 onwards. Prescribing data were obtained from the NHS Information Centre and the Department of Health. We examined the frequency of reports for drugs and estimated rates of reporting of psychiatric ADRs using prescribing data as proxy denominators from 1998 to 2011, as prescribing data were not available prior to 1998. Results There were 110 different drugs with ≥ 20 reports of depression, 58 with ≥10 reports of non-fatal suicidal behaviour and 33 with ≥5 reports of fatal suicidal behaviour in the time period. The top five drugs with the most frequent reports of depression were the smoking cessation medicines varenicline and bupropion, followed by paroxetine (a selective serotonin reuptake inhibitor), isotretinoin (used in acne treatment) and rimonabant (a weight loss drug). Selective serotonin reuptake inhibitors, varenicline and the antipsychotic medicine clozapine were included in the top five medicines with the most frequent reports of fatal and non-fatal suicidal behaviour. Medicines with the highest reliably measured reporting rates of psychiatric ADRs per million prescriptions dispensed in the community included rimonabant, isotretinoin, mefloquine (an antimalarial), varenicline and bupropion. Robust denominators for community prescribing were not available for two drugs with five or more suicide reports, efavirenz (an antiretroviral medicine) and clozapine. Conclusions Depression and suicide-related ADRs are reported for many nervous system and non

  5. Dietary intervention in acne

    PubMed Central

    Melnik, Bodo

    2012-01-01

    The purpose of this paper is to highlight the endocrine signaling of Western diet, a fundamental environmental factor involved in the pathogenesis of epidemic acne. Western nutrition is characterized by high calorie uptake, high glycemic load, high fat and meat intake, as well as increased consumption of insulin- and IGF-1-level elevating dairy proteins. Metabolic signals of Western diet are sensed by the nutrient-sensitive kinase, mammalian target of rapamycin complex 1 (mTORC1), which integrates signals of cellular energy, growth factors (insulin, IGF-1) and protein-derived signals, predominantly leucine, provided in high amounts by milk proteins and meat. mTORC1 activates SREBP, the master transcription factor of lipogenesis. Leucine stimulates mTORC1-SREBP signaling and leucine is directly converted by sebocytes into fatty acids and sterols for sebaceous lipid synthesis. Over-activated mTORC1 increases androgen hormone secretion and most likely amplifies androgen-driven mTORC1 signaling of sebaceous follicles. Testosterone directly activates mTORC1. Future research should investigate the effects of isotretinoin on sebocyte mTORC1 activity. It is conceivable that isotretinoin may downregulate mTORC1 in sebocytes by upregulation of nuclear levels of FoxO1. The role of Western diet in acne can only be fully appreciated when all stimulatory inputs for maximal mTORC1 activation, i.e., glucose, insulin, IGF-1 and leucine, are adequately considered. Epidemic acne has to be recognized as an mTORC1-driven disease of civilization like obesity, type 2 diabetes, cancer and neurodegenerative diseases. These new insights into Western diet-mediated mTORC1-hyperactivity provide a rational basis for dietary intervention in acne by attenuating mTORC1 signaling by reducing (1) total energy intake, (2) hyperglycemic carbohydrates, (3) insulinotropic dairy proteins and (4) leucine-rich meat and dairy proteins. The necessary dietary changes are opposed to the evolution of

  6. Dietary intervention in acne: Attenuation of increased mTORC1 signaling promoted by Western diet.

    PubMed

    Melnik, Bodo

    2012-01-01

    The purpose of this paper is to highlight the endocrine signaling of Western diet, a fundamental environmental factor involved in the pathogenesis of epidemic acne. Western nutrition is characterized by high calorie uptake, high glycemic load, high fat and meat intake, as well as increased consumption of insulin- and IGF-1-level elevating dairy proteins. Metabolic signals of Western diet are sensed by the nutrient-sensitive kinase, mammalian target of rapamycin complex 1 (mTORC1), which integrates signals of cellular energy, growth factors (insulin, IGF-1) and protein-derived signals, predominantly leucine, provided in high amounts by milk proteins and meat. mTORC1 activates SREBP, the master transcription factor of lipogenesis. Leucine stimulates mTORC1-SREBP signaling and leucine is directly converted by sebocytes into fatty acids and sterols for sebaceous lipid synthesis. Over-activated mTORC1 increases androgen hormone secretion and most likely amplifies androgen-driven mTORC1 signaling of sebaceous follicles. Testosterone directly activates mTORC1. Future research should investigate the effects of isotretinoin on sebocyte mTORC1 activity. It is conceivable that isotretinoin may downregulate mTORC1 in sebocytes by upregulation of nuclear levels of FoxO1. The role of Western diet in acne can only be fully appreciated when all stimulatory inputs for maximal mTORC1 activation, i.e., glucose, insulin, IGF-1 and leucine, are adequately considered. Epidemic acne has to be recognized as an mTORC1-driven disease of civilization like obesity, type 2 diabetes, cancer and neurodegenerative diseases. These new insights into Western diet-mediated mTORC1-hyperactivity provide a rational basis for dietary intervention in acne by attenuating mTORC1 signaling by reducing (1) total energy intake, (2) hyperglycemic carbohydrates, (3) insulinotropic dairy proteins and (4) leucine-rich meat and dairy proteins. The necessary dietary changes are opposed to the evolution of

  7. Effect of competition bias in safety signal generation: analysis of a research database of spontaneous reports in France.

    PubMed

    Pariente, Antoine; Avillach, Paul; Salvo, Francesco; Thiessard, Frantz; Miremont-Salamé, Ghada; Fourrier-Reglat, Annie; Haramburu, Françoise; Bégaud, Bernard; Moore, Nicholas

    2012-10-01

    Automated disproportionality analysis of spontaneous reporting is increasingly used routinely. It can theoretically be influenced by a competition bias for signal detection owing to the presence of reports related to well-established drug-event associations. The aim of the study was to explore the effects of competition bias on safety signals generated from a large spontaneous reporting research database. Using the case/non-case approach in the French spontaneous reporting research database, which includes data of reporting in France from January 1986 to December 2001, the effects of the competition bias were explored by generating safety signals associated with six events of interest (gastric and oesophageal haemorrhages, central nervous system haemorrhage and cerebrovascular accidents, ischaemic coronary disorders, migraine headaches, muscle pains, and hepatic enzymes and function abnormalities) before and after removing from the database reports relating to drugs known to be strongly associated with these events, whether they constituted cases or non-cases. As this study was performed on a closed database (last data entered 31 December 2001), potential signals unmasked by removal were considered as real signals if no or only incomplete knowledge about the association was available from the literature before 1 January 2002. For gastric and oesophageal haemorrhages, after removing reports involving antithrombotic agents or NSAIDs, three potential signals were unmasked (prednisone, rivastigmine and isotretinoin). For central nervous system haemorrhage and cerebrovascular accidents, after removing reports involving antithrombotic agents, three potential signals were unmasked (ethinylestradiol, interferon-α-2B and methylprednisolone). For ischaemic coronary disorders, after removing reports involving anthracyclines, bleomycine, anti-HIV drugs or triptans, one potential signal was unmasked (ondansetron). For migraine headaches, after removing reports involving

  8. Are therapeutic effects of antiacne agents mediated by activation of FoxO1 and inhibition of mTORC1?

    PubMed Central

    Melnik, Bodo C; Schmitz, Gerd

    2013-01-01

    Acne pathogenesis has recently been linked to decreased nuclear FoxO1 levels and increased mTORC1 activity. This hypothesis postulates that antiacne agents either enhance nuclear FoxO activity or inhibit mTORC1. Benzoyl peroxide (BPO), by activation of oxidative stress-inducible kinases, increases nuclear FoxO levels promoting Sestrin3-mediated AMPK activation. Furthermore, BPO-derived ROS may activate AMPK via ataxia–telangiectasia mutated. Isotretinoin and all-trans retinoic acid may stimulate FoxO gene expression. Doxycycline may enhance FoxOs nuclear retention by inhibiting the expression of exportin 1. Suppression of TNFα signalling by tetracyclines, erythromycin and other macrolides may attenuate IKKβ-TSC1-mediated mTORC1 activation. Erythromycin attenuates ERK1/2 activity and thereby increases TSC2. Azelaic acid may decrease mTORC1 by inhibiting mitochondrial respiration, increasing cellular ROS and nuclear FoxO levels. Antiandrogens may attenuate mTORC1 by suppressing mTORC2-mediated Akt/TSC2 signalling. This hypothesis unmasks a common mode of action of antiacne agents as either FoxO enhancers or mTORC1 inhibitors and thus provides a rational approach for the development of new antiacne agents. PMID:23800068

  9. Acne vulgaris.

    PubMed

    Aydemir, Ertuğrul H

    2014-03-01

    Acne vulgaris is a chronic inflammatory disease of the pilosebaceous unit and it is observed equally in both sexes and nearly all races. It generally begins at puberty, but the healing period is variable. There is no known etiological factor, except genetic tendency. Androgens play a very limited role in some female patients. The effects of cosmetics, foods and drinks are also discussible and too limited. There are four factors in acne pathogenesis: Increase of the sebum excretionKeratinization of infrainfundibulumBacterial colonization of the follicleInflammation It is mainly observed on the face and back, shoulders and chest. Initial lesions are comedons. Papules, pustules and cysts of severe types follow it. The most important factor in treatment is a very good patient-physician communication. Topical or systemic treatment or both can be used depending on the severity of acne. Benzoyl peroxyde, azelaic acid, AHA's antibiotics, retinoic acid and derivatives are the topical choices. For systemic treatment antibiotics are the most commonly used medicines, but isotretinoine has a very spesific place with the possibility of permanent healing. All kind of treatments need approximately six months for a good result.

  10. Nutritional aspects regarding lung cancer chemoprevention.

    PubMed

    Thanopoulou, E; Baltayiannis, N; Lykogianni, V

    2006-01-01

    Lung cancer is still one of the major causes of cancer-related deaths and its mortality figures argue powerfully for new approaches to control this leading cancer threat. Chemoprevention can be defined as the use of specific agents to reverse, or prevent premalignancy from progressing to invasive cancer. The use of foods and dietary supplements present a safe chemopreventive strategy. Data for this review were identified by searches of PubMed and references from relevant articles. Articles were identified by use of the search terms "lung cancer", "chemoprevention", "carcinogenesis", and "retinoids". Only papers published in English were included. Trials in lung cancer chemoprevention have so far produced either neutral or harmful primary endpoint results, whether in the primary, secondary, or tertiary settings. Lung cancer was not prevented by beta-carotene, alpha-tocopherol, retinol, retinyl palmitate, N-acetylcysteine, or isotretinoin in smokers. Ongoing trials may help define new avenues for chemoprevention. The concept of chemoprevention in lung cancer is still in its infancy, but in the future it may have a significant impact on the incidence and mortality of lung cancer. In addition to epidemiologic studies, basic science research to detect mechanisms and evaluate the chemopreventive potential of food components is necessary. The overwhelming evidence of a major role of nutrition in carcinogenesis, the many leads that nutritional intervention may reduce cancer incidence, and the growth and increasing sophistication of clinical trials networks point to a very promising future for nutritional intervention trials leading to substantial public benefit.

  11. International inter-rater agreement in scoring acne severity utilizing cloud-based image sharing of mobile phone photographs.

    PubMed

    Foolad, Negar; Ornelas, Jennifer N; Clark, Ashley K; Ali, Ifrah; Sharon, Victoria R; Al Mubarak, Luluah; Lopez, Andrés; Alikhan, Ali; Al Dabagh, Bishr; Firooz, Alireza; Awasthi, Smita; Liu, Yu; Li, Chin-Shang; Sivamani, Raja K

    2017-09-01

    Cloud-based image sharing technology allows facilitated sharing of images. Cloud-based image sharing technology has not been well-studied for acne assessments or treatment preferences, among international evaluators. We evaluated inter-rater variability of acne grading and treatment recommendations among an international group of dermatologists that assessed photographs. This is a prospective, single visit photographic study to assess inter-rater agreement of acne photographs shared through an integrated mobile device, cloud-based, and HIPAA-compliant platform. Inter-rater agreements for global acne assessment and acne lesion counts were evaluated by the Kendall's coefficient of concordance while correlations between treatment recommendations and acne severity were calculated by Spearman's rank correlation coefficient. There was good agreement for the evaluation of inflammatory lesions (KCC = 0.62, P < 0.0001), noninflammatory lesions (KCC = 0.62, P < 0.0001), and the global acne grading system score (KCC = 0.69, P < 0.0001). Topical retinoid, oral antibiotic, and isotretinoin treatment preferences correlated with photographic based acne severity. Our study supports the use of mobile phone based photography and cloud-based image sharing for acne assessment. Cloud-based sharing may facilitate acne care and research among international collaborators. © 2017 The International Society of Dermatology.

  12. Investigational drugs in phase II clinical trials for the treatment of neuroblastoma.

    PubMed

    Amoroso, Loredana; Haupt, Riccardo; Garaventa, Alberto; Ponzoni, Mirco

    2017-11-01

    Neuroblastoma (NB) is an embryonal tumor originating from undifferentiated neural crest cell, highly heterogeneous ranging from spontaneous regression to progression despite multimodal treatments. Approximately, 20% of patients are refractory to frontline therapy and 50% will relapse/progress after an initial response. The overall five year survival for high-risk neuroblastoma ranges from 35-45%. Despite enhanced understanding of NB biology and the addition of myeloablative chemotherapy, isotretinoin and immunotherapy, survival for high risk NB remains less than 50%. Areas covered: This review summarizes and gives a critical overview of phase II trials investigating therapies for relapsed-refractory and high risk neuroblastoma. Expert opinion: Several novel molecules have been developed and are currently under investigation for the treatment of NB. The trend of novel targeted agents is one towards individualized, tailored therapy, based on the molecular and biological differences that characterize tumors that seem similar based solely on histological analysis. The task of developing new molecules is particularly difficult for NB, given the recurrent development of new patterns of drug resistance. However, even if current research is focused towards identifying the best treatments for each children and young adult with a NB defined disease, a deeper knowledge of the molecular biology and genetics is needed.

  13. Consensus-Based Acne Classification System and Treatment Algorithm for Spain.

    PubMed

    López-Estebaranz, J L; Herranz-Pinto, P; Dréno, B

    2017-03-01

    Acne is a chronic inflammatory disease whose psychosocial effects can greatly impair quality of life. Various scales are used to classify the severity of acne, and several treatment algorithms are currently applied: no consensus on a common scale or treatment guidelines has been reached. A group of Spanish experts therefore met to identify a scale the majority could accept as the most appropriate for classifying severity and treating accordingly. The group chose the following classifications: comedonal acne, mild or moderate papulopustular acne, severe papulopustular acne, moderate nodular acne, and nodular-cystic acne (or acne tending to leave scars). Consensus was reached on first- and second-choice treatments for each type and on maintenance treatment. The experts also issued specific recommendations on antibiotic use (starting with mild or moderate papulopustular acne), always in combination with retinoids and/or benzoyl peroxide. The use of isotretinoin (starting at severe papulopustular or moderate nodular acne) was also covered. Copyright © 2016 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.

  14. [Treatment of rosacea].

    PubMed

    Parodi, A; Drago, F; Paolino, S; Cozzani, E; Gallo, R

    2011-09-01

    A range of treatment options are available in rosacea, which include several topical (mainly metronidazole, azelaic acid, other antibiotics, sulfur, retinoids) and oral drugs (mainly tetracyclines, metronidazole, macrolides). In some cases, the first choice is a systemic therapy because patients may have sensitive skin and topical medications can be irritant. Isotretinoin can be used in resistant cases of rosacea. Unfortunately, the majority of studies on rosacea treatments are at high or unclear risk of bias. A recent Cochrane review found that only topical metronidazole, azelaic acid, and oral doxycycline (40 mg) had some evidence to support their effectiveness in moderate to severe rosacea and concluded that further well-designed, adequately-powered randomised controlled trials are required. In our practice, we evaluate our patients for the presence of two possible triggers, Helicobacter pylori infection and small intestinal bacterial overgrowth. When they are present we use adapted antibiotic protocols. If not, we use oral metronidazole or oral tetracycline to treat papulopustolar rosacea. We also look for Demodex folliculorum infestation. When Demodex concentration is higher than 5/cm(2) we use topical crotamiton 10% or metronidazole.

  15. Treatment of rosacea.

    PubMed

    Parodi, A; Drago, F; Paolino, S; Cozzani, E; Gallo, R

    2011-11-01

    A range of treatment options are available in rosacea, which include several topical (mainly metronidazole, azelaic acid, other antibiotics, sulfur, retinoids) and oral drugs (mainly tetracyclines, metronidazole, macrolides). In some cases, the first choice is a systemic therapy because patients may have sensitive skin and topical medications can be irritant. Isotretinoin can be used in resistant cases of rosacea. Unfortunately, the majority of studies on rosacea treatments are at high or unclear risk of bias. A recent Cochrane review found that only topical metronidazole, azelaic acid, and oral doxycycline (40 mg) had some evidence to support their effectiveness in moderate to severe rosacea and concluded that further well-designed, adequately-powered randomised controlled trials are required. In our practice, we evaluate our patients for the presence of two possible triggers, Helicobacter pylori infection and small intestinal bacterial overgrowth. When they are present we use adapted antibiotic protocols. If not, we use oral metronidazole or oral tetracycline to treat papulopustolar rosacea. We also look for Demodex folliculorum infestation. When Demodex concentration is higher than 5/cm(2) we use topical crotamiton 10% or metronidazole.

  16. Synergy between loss of NF1 and overexpression of MYCN in neuroblastoma is mediated by the GAP-related domain.

    PubMed

    He, Shuning; Mansour, Marc R; Zimmerman, Mark W; Ki, Dong Hyuk; Layden, Hillary M; Akahane, Koshi; Gjini, Evisa; de Groh, Eric D; Perez-Atayde, Antonio R; Zhu, Shizhen; Epstein, Jonathan A; Look, A Thomas

    2016-04-27

    Earlier reports showed that hyperplasia of sympathoadrenal cell precursors during embryogenesis in Nf1-deficient mice is independent of Nf1's role in down-modulating RAS-MAPK signaling. We demonstrate in zebrafish that nf1 loss leads to aberrant activation of RAS signaling in MYCN-induced neuroblastomas that arise in these precursors, and that the GTPase-activating protein (GAP)-related domain (GRD) is sufficient to suppress the acceleration of neuroblastoma in nf1-deficient fish, but not the hypertrophy of sympathoadrenal cells in nf1 mutant embryos. Thus, even though neuroblastoma is a classical "developmental tumor", NF1 relies on a very different mechanism to suppress malignant transformation than it does to modulate normal neural crest cell growth. We also show marked synergy in tumor cell killing between MEK inhibitors (trametinib) and retinoids (isotretinoin) in primary nf1a-/- zebrafish neuroblastomas. Thus, our model system has considerable translational potential for investigating new strategies to improve the treatment of very high-risk neuroblastomas with aberrant RAS-MAPK activation.

  17. IgA pemphigus showing IgA antibodies to desmoglein 1 and 3

    PubMed Central

    Hegazy, Salama; Bouchouicha, Sana; Khaled, Aida; Laadher, Lilia; Sellami, Maryem Kallel; Zeglaoui, Faten

    2016-01-01

    Background IgA pemphigus is a rare autoimmune vesiculo-pustular skin disease. Only approximately 70 cases have been reported to date. We report a case of IgA pemphigus with IgA antibodies to desmoglein 1 (Dsg1) and desmoglein 3 (Dsg3). Case report We report the case of an 60-year-old man with intraepidermal neutrophilic IgA pemphigus with IgA antibodies to Dsg1 and Dsg3. Histologic examination revealed subcorneal neutrophilic pustules with few acantholytic cells. The disease was not effectively controlled by conventional therapeutic regimens (colchicine, dapsone). Systemic treatment with isotretinoin 25 mg/d and prednisone 20 mg/d achieved only a slight effect after six months. Conclusions Our case confirmed the recalcitrant nature of IgA pemphigus in response to distinct therapies, indicating that further research focusing on therapeutic approaches for this type of pemphigus is needed. Physicians should keep IgA pemphigus in mind when approaching patients with bullous eruption. PMID:27867744

  18. Cost of Medications Recommended by Canadian Acne Clinical Practice Guidelines.

    PubMed

    Czilli, Tiffany; Tan, Jerry; Knezevic, Sanja; Peters, Colin

    2016-11-01

    Acne affects a large proportion of the Canadian population and has psychosocial and financial consequences. We provide cost information for treatments recommended by the Canadian acne guidelines. Highest level recommendations were selected for 3-month usage cost. Three-month estimated treatment costs were as follows: topical retinoids ($14.40-$73.80), benzoyl peroxide (BPO; $6.75), fixed-dose BPO-clindamycin ($40.95-$44.10) and BPO-adapalene ($73.80), oral antibiotics ($25.20 for tetracycline 250 mg qid; $52.20 and $52.74 for doxycycline 50 mg bid and 100 mg od, respectively), and hormonal therapy ($26.46-$37.80 for ethinyl estradiol [EE] 0.030 mg/drospirenone 3mg and $75.60-108.99 for EE 0.035 mg/cyproterone acetate 2 mg). Oral isotretinoin 3-month costs ranged from $393.96 to $478.80. Awareness of costs of recommended treatments may facilitate improved outcomes by increasing procurement and adherence. © The Author(s) 2016.

  19. Infantile acne: a retrospective study of 16 cases.

    PubMed

    Hello, Muriel; Prey, Sorilla; Léauté-Labrèze, Christine; Khammari, Amir; Dreno, Brigitte; Stalder, Jean-François; Barbarot, Sébastien

    2008-01-01

    Infantile acne is a rare and poorly understood disorder. The objective of this study was to improve our knowledge about the epidemiology and clinical course of infantile acne, and evaluate approaches to treatment. This two-center retrospective study covered the period between 1985 and 2007. Inclusion criteria were: (i) age less than 24 months when lesions appeared; (ii) presence of both inflammatory and noninflammatory lesions; (iii) persistence of lesions for at least 2 months. The data were drawn from clinical and photographic records, followed by administration of a telephone questionnaire to parents. It was proposed that each case be reviewed on the basis of the child's appearance and score on an acne scar clinical grading scale. Sixteen children were included. Nine had a family history of severe adolescent acne. The average duration of disease was 22 months. Two patients had been effectively treated with oral isotretinoin. More than half of the patients exhibited scars. We re-examined five children (average acne scar clinical grading scale score = 12/540). On the basis of the frequency of scarring, and the severity and average duration of lesions, the use of oral retinoids in severe infantile acne warrants evaluation.

  20. Life quality of patients with metastatic renal cell carcinoma and chemo-immunotherapy--a pilot study.

    PubMed

    Kröger, M J; Menzel, T; Gschwend, J E; Bergmann, L

    1999-01-01

    Renal cell cancer (RCC) accounts for 2-3% of all malignant tumors in adults. Due to the indolent course of disease and the few signs and symptoms in early stages the majority of patients presents with metastatic disease when diagnosed. The aims of systemic therapy of RCC are therefore palliative. Recent research shows the key role of immune mechanisms in the course of RCC. The therapeutic use of cytokines, mainly interleukin-2 (IL-2) and interferon-alpha (IFN) results in improvement of remission rates. To date it is unknown to what extent multiple cycles of chemo-immunotherapy alter the life quality (LQ) of patients with metastatic RCC. We monitored life quality during therapy in a three-armed protocol with interferon-alpha 2a, interleukin-2, 5-fluorouracil (5-FU), isotretinoin (ISO) and vinblastin (VBL). Life quality was impaired by two factors: response to chemo-immunotherapy and therapy side effects. A steep decrease of LQ-scores was seen in week 1 of therapy, LQ improved then for patients with stable disease (SD) and partial remission (PR) but not for those with progressive disease (PD).

  1. Therapeutic use of selective synthetic ligands for retinoic acid receptors: a patent review.

    PubMed

    Marchwicka, Aleksandra; Cunningham, Alan; Marcinkowska, Ewa; Brown, Geoffrey

    2016-08-01

    Differentiation therapy using all-trans retinoic acid (ATRA) revolutionised the treatment of acute promyelocytic leukaemia to such an extent that it is now one of the most curable types of leukaemia, with ATRA and anthracycline-based chemotherapy providing cure rates above 80%. Isotretinoin is used to treat chronic acne. Here, we examine the information described in recent patents and the extent to which new findings are influencing extending retinoid-based differentiation therapy to other cancers, as well as the development of new therapies for other disorders. A search has been performed on the literature and worldwide patents filed during 2014 to the present time, focusing on synthetic agonists and antagonists of retinoic acid receptors and novel compositions for the delivery of these agents. New potential therapeutic applications have been described, including lung, breast and head and neck cancers, T cell lymphoma and neurodegenerative, metabolic, ophthalmic, muscle, and inflammatory disorders. Recent patents have described the means to maximise retinoid activity. Two decades of efforts to extend retinoid-based therapies have been disappointing and new synthetic retinoids, target diseases and modes of delivery may well resolve this long standing issue.

  2. Non-psychotropic medication and risk of suicide or attempted suicide: a systematic review

    PubMed Central

    Gorton, Hayley C; Webb, Roger T; Kapur, Navneet; Ashcroft, Darren M

    2016-01-01

    Objectives To establish which non-psychotropic medications have been assessed in relation to risk of suicide or attempted suicide in observational studies, document reported associations and consider study strengths and limitations. Design Systematic review. Methods Four databases (Embase, Medline, PsycINFO and International Pharmaceutical Abstracts) were searched from 1990 to June 2014, and reference lists of included articles were hand-searched. Case–control, cohort and case only studies which reported suicide or attempted suicide in association with any non-psychotropic medication were included. Outcome measures The outcomes eligible for inclusion were suicide and attempted suicide, as defined by the authors of the included study. Results Of 11 792 retrieved articles, 19 were eligible for inclusion. Five studies considered cardiovascular medication and antiepileptics; two considered leukotriene receptor antagonists, isotretinoin and corticosteroids; one assessed antibiotics and another assessed varenicline. An additional study compared multiple medications prescribed to suicide cases versus controls. There was marked heterogeneity in study design, outcome and exposure classification, and control for confounding factors; particularly comorbid mental and physical illness. No increased risk was associated with cardiovascular medications, but associations with other medications remained inconclusive and meta-analysis was inappropriate due to study heterogeneity. Conclusions Whether non-psychotropic medications are associated with increased risk of suicide or attempted suicide remains largely unknown. Robust identification of suicide outcomes and control of comorbidities could improve quantification of risk associated with non-psychotropic medication, beyond that conferred by underlying physical and mental illnesses. PMID:26769782

  3. High-dose Chemotherapy With Autologous Stem Cell Rescue in Saudi Children Less Than 3 Years of Age With Embryonal Brain Tumors.

    PubMed

    Alsultan, Abdulrahman; Alharbi, Musa; Al-Dandan, Sadeq; Bayoumi, Yasser; Alharbi, Talal; Alsudairy, Reem; Alomari, Ali; Aljamaan, Khalid; Musleh, Othman; Alharbi, Qasim; Jarrar, Mohammed

    2015-04-01

    High-dose chemotherapy with autologous stem cell rescue (HDC/ASCR) has been used in children under the age of 3 years with embryonal brain tumors to avoid or delay the use of radiation. We reviewed the medical records of 10 Saudi children less than 3 years of age with embryonal brain tumors who underwent HDC/ASCR. All 10 patients underwent surgical resection followed by 3 to 5 cycles of induction chemotherapy and 1 to 3 cycles of HDC/ASCR using carboplatin and thiotepa. Isotretinoin was used as a maintenance therapy in 4 patients. Five patients had medulloblastoma, 3 had atypical teratoid/rhabdoid tumors, 1 had an embryonal tumor with abundant neuropil and true rosettes, and 1 had pineoblastoma. The median age of the patients was 1.9 years. A total of 19 HDC/ASCR procedures were performed. Radiotherapy (RT) was administered to 5 patients after HDC/ASCR and as a salvage therapy in 1 patient. The progression-free survival rate was 50% at 1 year and at 2 years, with a median follow-up of 24 months. All 5 patients with medulloblastoma are still alive without evidence of disease, but the other patients died secondary to tumor progression. This experience suggests that strategies combining myeloablative chemotherapy and autologous stem cell rescue appear to be feasible for children with embryonal brain tumors in the Middle East.

  4. Vitamin A--a pregnancy hazard alert.

    PubMed Central

    Kizer, K. W.; Fan, A. M.; Bankowska, J.; Jackson, R. J.; Lyman, D. O.

    1990-01-01

    Vitamin A is essential to human health, but concerns have arisen recently regarding its potential teratogenicity. Human and animal birth defects have been associated with the use of the vitamin A analogue, isotretinoin, or Accutane, for acne treatment, although the association of such defects with vitamin A itself is unclear. The federal Food and Drug Administration is evaluating the health issues surrounding vitamin A and, together with the manufacturer, has developed restrictions and label warnings to ensure the appropriate use of Accutane. We also have evaluated these issues, with concerns about the possible teratogenicity of high vitamin A intake during pregnancy. Practitioners should be familiar with the possible hazard of excessive dosages of vitamin A and its analogues. Vitamin A daily doses of higher than 8,000 IU for pregnant woman are not necessary for good health and are not recommended. Foods high in beta-carotene can provide the necessary amounts of vitamin A and, in contrast to the synthetic analogues, their use has not been associated with vitamin A toxicity or teratogenicity in humans or animals. PMID:2309485

  5. IgA pemphigus showing IgA antibodies to desmoglein 1 and 3.

    PubMed

    Hegazy, Salama; Bouchouicha, Sana; Khaled, Aida; Laadher, Lilia; Sellami, Maryem Kallel; Zeglaoui, Faten

    2016-10-01

    IgA pemphigus is a rare autoimmune vesiculo-pustular skin disease. Only approximately 70 cases have been reported to date. We report a case of IgA pemphigus with IgA antibodies to desmoglein 1 (Dsg1) and desmoglein 3 (Dsg3). We report the case of an 60-year-old man with intraepidermal neutrophilic IgA pemphigus with IgA antibodies to Dsg1 and Dsg3. Histologic examination revealed subcorneal neutrophilic pustules with few acantholytic cells. The disease was not effectively controlled by conventional therapeutic regimens (colchicine, dapsone). Systemic treatment with isotretinoin 25 mg/d and prednisone 20 mg/d achieved only a slight effect after six months. Our case confirmed the recalcitrant nature of IgA pemphigus in response to distinct therapies, indicating that further research focusing on therapeutic approaches for this type of pemphigus is needed. Physicians should keep IgA pemphigus in mind when approaching patients with bullous eruption.

  6. Mutations in KDSR Cause Recessive Progressive Symmetric Erythrokeratoderma.

    PubMed

    Boyden, Lynn M; Vincent, Nicholas G; Zhou, Jing; Hu, Ronghua; Craiglow, Brittany G; Bayliss, Susan J; Rosman, Ilana S; Lucky, Anne W; Diaz, Luis A; Goldsmith, Lowell A; Paller, Amy S; Lifton, Richard P; Baserga, Susan J; Choate, Keith A

    2017-06-01

    The discovery of new genetic determinants of inherited skin disorders has been instrumental to the understanding of epidermal function, differentiation, and renewal. Here, we show that mutations in KDSR (3-ketodihydrosphingosine reductase), encoding an enzyme in the ceramide synthesis pathway, lead to a previously undescribed recessive Mendelian disorder in the progressive symmetric erythrokeratoderma spectrum. This disorder is characterized by severe lesions of thick scaly skin on the face and genitals and thickened, red, and scaly skin on the hands and feet. Although exome sequencing revealed several of the KDSR mutations, we employed genome sequencing to discover a pathogenic 346 kb inversion in multiple probands, and cDNA sequencing and a splicing assay established that two mutations, including a recurrent silent third base change, cause exon skipping. Immunohistochemistry and yeast complementation studies demonstrated that the mutations cause defects in KDSR function. Systemic isotretinoin therapy has achieved nearly complete resolution in the two probands in whom it has been applied, consistent with the effects of retinoic acid on alternative pathways for ceramide generation. Copyright © 2017 American Society of Human Genetics. Published by Elsevier Inc. All rights reserved.

  7. Utilizing non-ablative fractional photothermolysis prior to ALA-photodynamic therapy in the treatment of acne vulgaris: a case series.

    PubMed

    Qureshi, Sarah; Lin, Jennifer Y

    2017-04-01

    Aminolevulinic acid (ALA) photodynamic therapy (PDT) is an emerging modality in the treatment of acne. While ablative fractional lasers have been used to enhance drug delivery into the epidermis, recent evidence suggests that non-ablative fractional photothermolysis may also improve uptake of ALA. We explored the use of non-ablative 1550 nm laser as a safe alternative in the delivery of ALA prior to red-light PDT for refractory inflammatory and cystic acne. Subjects referred for treatment of acne refractory to several topical and oral regimens, including isotretinoin, were pre-treated with non-ablative fractional photothermolysis (NAFP). This was followed by 20 % ALA application with an incubation time of 1-3 h and then exposure to 50-100 J/cm(2) red light. Follow-up was at 1, 3, and 6 months. In all three cases, patients demonstrated marked reduction in inflammatory lesions. Two subjects had remission of acne after a single combination treatment. Non-ablative fractional laser applied immediately prior to PDT may be used in the treatment of acne with minimal side effects and fewer sessions needed than PDT alone. This may be due to enhanced delivery of ALA from pre-treating the skin with non-ablative fractional photothermolysis.

  8. Therapy of acne.

    PubMed

    Olsen, T G

    1982-07-01

    Today acne vulgaris is a disease which can be well controlled using a combination of topical, systemic, and physical therapeutic modalities. However, successful acne management depends to a large extent on physician interest and the ability of the physician to apply therapy to the evolutionary stage of the disease and to the disturbed pathogenetic mechanisms. It is this author's opinion that grades I and II comedonal and papulopustular acne can be effectively treated solely with topical preparations, particularly the concurrent use of tretinoin with benzoyl peroxide or topical antibiotics. The majority of patients with grades III and IV inflammatory disease require oral antibiotics in addition to aggressive topical treatments. Intralesional steroids can be effective in all grades of acne when lesions develop an inflammatory nodulocystic quality. The physician should consider the use of estrogen (in females) or oral vitamin A in the small group of patients with grades III and IV inflammatory-cystic acne that has been unresponsive to conventional therapy. Combined systemic therapies of high-dose antibiotics, systemic corticosteroids, and sulfones clearly take precedence over topical preparations in conglobate acne and acne fulminans. Finally, oral isotretinoin, alone and perhaps in combination with more conventional modalities, should play an important role in the future management of severe inflammatory-cystic acne.

  9. Update on the management of rosacea

    PubMed Central

    Weinkle, Allison P; Doktor, Vladyslava; Emer, Jason

    2015-01-01

    Refining diagnostic criteria has identified key characteristics differentiating rosacea, a chronic skin disorder, from other common cutaneous inflammatory conditions. The current classification system developed by the National Rosacea Society Expert Committee consists of erythematotelangiectatic, papulopustular, phymatous, and ocular subtypes. Each subtype stands as a unique entity among a spectrum, with characteristic symptoms and physical findings, along with an intricate pathophysiology. The main treatment modalities for rosacea include topical, systemic, laser, and light therapies. Topical brimonidine tartrate gel and calcineurin inhibitors are at the forefront of topical therapies, alone or in combination with traditional therapies such as topical metronidazole or azelaic acid and oral tetracyclines or isotretinoin. Vascular laser and intense pulsed light therapies are beneficial for the erythema and telangiectasia, as well as the symptoms (itching, burning, pain, stinging, swelling) of rosacea. Injectable botulinum toxin, topical ivermectin, and microsecond long-pulsed neodymium-yttrium aluminum garnet laser are emerging therapies that may prove to be extremely beneficial in the future. Once a debilitating disorder, rosacea has become a well known and manageable entity in the setting of numerous emerging therapeutic options. Herein, we describe the treatments currently available and give our opinions regarding emerging and combination therapies. PMID:25897253

  10. Xeroderma pigmentosum: man deprived of his right to light.

    PubMed

    Mareddy, Subhash; Reddy, Jithendra; Babu, Subhas; Balan, Preethi

    2013-01-01

    Xeroderma pigmentosum (XP) is a hereditary autosomal recessive disorder characterized by photo hypersensitivity of sun exposed tissues and subsequent several-fold increased risk for malignant changes resulting from impaired ability to repair UV-induced DNA damage. Estimated incidences vary from 1 in 20,000 in Japan to 1 in 250,000 in the USA, and approximately 2.3 per million live births in Western Europe. Diagnosis is made clinically by the presence of unusual sunburns or lentiginosis or onset of cancers at an early age. It is confirmed by cellular tests for defective DNA repair. Although there is no cure for XP as of now, skin problems can be ameliorated with the use of sunscreens, sun avoidance methods, and recurrent tumor excisions. Oral isotretinoin and topical application of 5-fluorouracil to treat actinic keratoses are other therapeutic options. T4N5 and photolyase liposomal lotions are innovations in the therapy of XP. Genetic counselling implicating the effect of consanguineous marriages should be considered in the management of XP patients.

  11. Current state of acne treatment: highlighting lasers, photodynamic therapy, and chemical peels.

    PubMed

    Kim, Randie H; Armstrong, April W

    2011-03-15

    Acne vulgaris continues to be a challenge to dermatologists and primary care physicians alike. The available treatments reflect the complex and multifactorial contributors to acne pathogenesis, with topical retinoids as first-line therapy for mild acne, topical retinoids in combination with anti-microbials for moderate acne, and isotretinoin for severe nodular acne. Unfortunately, these conventional therapies may not be effective against refractory acne, can lead to antibiotic resistance, and is associated with adverse effects. With the rise of new technologies and in-office procedures, light and laser therapy, photodynamic therapy, chemical peels, and comedo extraction are growing in popularity as adjunctive treatments and may offer alternatives to those who desire better efficacy, quicker onset of action, improved safety profile, reduced risk of antibiotic resistance, and non-systemic administration. Whereas adjunctive therapies are generally well-tolerated, the number of randomized controlled trials are few and limited by small sample sizes. Furthermore, results demonstrating efficacy of certain light therapies are mixed and studies involving photodynamic therapy and chemical peels have yet to standardize and optimize application, formulation, and exposure times. Nevertheless, adjunctive therapies, particularly blue light and photodynamic therapy, show promise as these treatments also target factors of acne pathogenesis and may potentially complement current conventional therapy.

  12. Hidradenitis Suppurativa in Children Treated with Finasteride-A Case Series.

    PubMed

    Mota, Fernando; Machado, Susana; Selores, Manuela

    2017-09-01

    Hidradenitis suppurativa (HS) is rare in childhood, with only 2% of cases in patients younger than 11 years. It is a chronic, recurrent, debilitating condition for which no universally effective treatment has been developed. We present five cases of children with HS diagnosed between the ages of 6 and 11 years. Patients were treated with oral finasteride 1 to 5 mg/day. All had entered puberty at the time of treatment initiation. All had normal laboratory results before starting treatment. The maximum duration of treatment was 24 months. Four patients were female. Two were overweight. Three had been previously treated with oral antibiotics, and two of these with oral isotretinoin, with partial or no improvement. Overall improvement of the disease was observed in all patients, with a reduction of the frequency and intensity of the flares. No adverse effects were observed or reported during treatment. Treatment of HS can be challenging. The options available include antimicrobials, immunosuppressants, hormonal therapies, lasers, and surgery. The authors report the largest series of children with HS treated with finasteride. The results support the use of finasteride as monotherapy for the treatment of this disease in children. Further studies are necessary to fully understand the role of this drug in the management of this disease. © 2017 Wiley Periodicals, Inc.

  13. Synthetic retinoids in dermatology

    PubMed Central

    Heller, Elizabeth H.; Shiffman, Norman J.

    1985-01-01

    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 nontoxic 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. ImagesFig. 3 PMID:3158386

  14. Acne vulgaris in children and adolescents.

    PubMed

    Schnopp, C; Mempel, M

    2011-08-01

    Acne vulgaris is a very common inflammatory skin disease originating from the pilosebaceous unit. Peak incidence is at puberty, but acne can affect all age groups. Prepubertal acne is rare, but important to recognize as diagnostic and therapeutic procedures differ from pubertal acne. Acne neonatorum is a mild, self-limiting disease, whereas acne infantum commonly presents with moderate to severe lesions and high risk of scarring thus requiring early intervention. Mid-childhood or prepubertal acne raises the suspicion of hyperandrogenemia, further investigations are indicated to rule out underlying disease. The same applies to any patient with very severe acne, acne not responding to therapy or unusual clinical presentation. Etiopathogenesis of acne is not yet fully understood. Familiy history is the most important risk factor to develop severe acne and scarring. The relevance of life style factors such as smoking or diet is controversial. Lately high carbohydrate diet and dairy products have been implicated as aggravating factors. Mild acne normally responds to topical monotherapy, in moderate disease combination of two synergistically acting substances (e.g. benzoyl peroxid plus antibiotic, benzoyl peroxid plus retinoid, retinoid plus antibiotic, benzoyl peroxid plus azelaic acid) will improve clinical response. Retinoids and/or benzoylperoxid have been shown to be effective in maintenance therapy. In patients with severe disease or high risk of scarring systemic therapy with antibiotics, oral contraceptives with antiandrogenic properties and in particularly isotretinoin as most effective acne treatment should be considered early to avoid physical and emotional scars.

  15. Acne and its management beyond the age of 35 years.

    PubMed

    Marks, Ronnie

    2004-01-01

    Although acne is not usually considered to be a disorder that affects the elderly, the disorder occurs sufficiently often in mature individuals to be noteworthy. The variety known as 'persisting acne' is, as its name suggests, ordinary acne that continues into adult life. 'Chin acne' is a curious type that occurs premenstrually in mature women, while 'sporadic acne' describes the sudden development of significant acne in later life for no apparent reason. When acne develops in an individual outside the usual susceptible age group precipitating causes such as exposure to comedogenic substances or drugs must be excluded. Similarly, endocrine causes such as androgen-secreting tumors and the administration of anabolic steroids need to be considered. All inflammatory processes are decreased in the elderly and this may be one reason for the persistence and intransigence of acne lesions in older age groups. The principles of treatment of acne in the elderly do not differ from those in other age groups, although the emphasis during counseling needs to focus on explanation and reassurance rather than prognosis. Topical retinoids and benzoyl peroxide easily irritate elderly skin, so azelaic acid and even sulfur preparations are preferable. Low-dose systemic isotretinoin is reported to be helpful to patients in this age group and is certainly worth a trial.

  16. South-East Asia study alliance guidelines on the management of acne vulgaris in South-East Asian patients.

    PubMed

    Goh, Chee Leok; Abad-Casintahan, Flordeliz; Aw, Derrick Chen Wee; Baba, Roshidah; Chan, Lee Chin; Hung, Nguyen Thanh; Kulthanan, Kanokvalai; Leong, Hoe Nam; Medina-Oblepias, Marie Socouer; Noppakun, Nopadon; Sitohang, Irma Bernadette; Sugito, Titi Lestari; Wong, Su-Ni

    2015-10-01

    The management of acne in South-East Asia is unique, as Asian skin and local variables require a clinical approach unlike that utilized in other parts of the world. There are different treatment guidelines per country in the region, and a group of leading dermatologists from these countries convened to review these guidelines, discuss current practices and recent advances, and formulate consensus guidelines to harmonize the management of acne vulgaris in the region. Emphasis has been placed on formulating recommendations to impede the development of antibiotic resistance in Propionibacterium acnes. The group adopted the Acne Consensus Conference system for grading acne severity. The group recommends that patients may be treated with topical medications including retinoids, benzoyl peroxide (BPO), salicylic acid, a combination of retinoid and BPO, or a combination of retinoids and BPO with or without antibiotics for mild acne; topical retinoid with topical BPO and a oral antibiotic for moderate acne; and oral isotretinoin if the patient fails first-line treatment (a 6- or 8-week trial of combined oral antibiotics and topical retinoids with BPO) for severe acne. Maintenance acne treatment using topical retinoids with or without BPO is recommended. To prevent the development of antibiotic resistance, topical antibiotics should not be used as monotherapy or used simultaneously with oral antibiotics. Skin care, comprised of cleansing, moisturizing and sun protection, is likewise recommended. Patient education and good communication is recommended to improve adherence, and advice should be given about the characteristics of the skin care products patients should use.

  17. Clinical practice guidelines for treatment of acne vulgaris: a critical appraisal using the AGREE II instrument.

    PubMed

    Sanclemente, Gloria; Acosta, Jorge-Luis; Tamayo, Maria-Eulalia; Bonfill, Xavier; Alonso-Coello, Pablo

    2014-04-01

    A significant number of clinical practice guidelines (CPGs) about the treatment of acne vulgaris in adolescents and adults have been published worldwide. However, little is known about the quality of CPGs in this field. The aim of this study was to appraise the methodological quality of published acne vulgaris CPGs. We performed a systematic review of published CPGs on acne vulgaris therapy from July 2002 to July 2012. Three reviewers independently assessed each CPG using the AGREE II instrument. A standardized score was calculated for each of the six domains. Our search strategy identified 103 citations but just six met our inclusion criteria. Agreement among reviewers was very good: 0.981. The domains that scored better were: "scope and purpose" and "clarity and presentation". Those that scored worse were "stakeholder involvement", "rigor of development", and "applicability". The European and the Malaysian CPGs were the only recommended with no further modifications. In addition, the Mexican, Colombian and the United States guidelines were recommended with provisos, with lower scores regarding stakeholder involvement, rigor of development and applicability. Only two guidelines clearly reported outcome measures for evaluating efficacy or included quality of life outcomes. CPGs varied regarding the consideration of light/laser therapy or consideration of complementary/alternative medicines. None of them included cost considerations of drugs such as systemic isotretinoin. In conclusion, published acne vulgaris CPGs for acne therapy vary in quality with a clear need to improve their methodological rigor. This could be achieved with the adherence to current CPGs development standards.

  18. Recently approved systemic therapies for acne vulgaris and rosacea.

    PubMed

    Del Rosso, James Q

    2007-08-01

    Until recently, with the exception of oral isotretinoin for the treatment of severe recalcitrant nodular acne, systemic therapy for acne vulgaris and rosacea has been based on anecdotal support, clinical experience, and small clinical trials. Tetracycline derivatives are the predominant systemic agents that have been used for both disease states, prescribed in dose ranges that produce antibiotic activity. Anti-inflammatory dose doxycycline, a controlled-release (CR) 40-mg capsule formulation of doxycycline that is devoid of antibiotic activity when administered once daily, was US Food and Drug Administration (FDA)-approved for the treatment of inflammatory lesions (papules and pustules) of rosacea, based on large-scale phase 3 pivotal trials and long-term microbiologic and safety data. Also, an extended-release (ER) tablet formulation of minocycline was approved by the FDA for the treatment of inflammatory lesions of moderate to severe acne vulgaris in patients 12 years and older based on large-scale phase 3 clinical trials that evaluated efficacy and safety, dose-response analysis, and long-term data. This article discusses the studies and clinical applications related to the use of these agents.

  19. Methylprednisolone for acute spinal cord injury: an increasingly philosophical debate.

    PubMed

    Bowers, Christian A; Kundu, Bornali; Hawryluk, Gregory W J

    2016-06-01

    Following publication of NASCIS II, methylprednisolone sodium succinate (MPSS) was hailed as a breakthrough for patients with acute spinal cord injury (SCI). MPSS use for SCI has since become very controversial and it is our opinion that additional evidence is unlikely to break the stalemate amongst clinicians. Patient opinion has the potential to break this stalemate and we review our recent findings which reported that spinal cord injured patients informed of the risks and benefits of MPSS reported a preference for MPSS administration. We discuss the implications of the current MPSS debate on translational research and seek to address some misconceptions which have evolved. As science has failed to resolve the MPSS debate we argue that the debate is an increasingly philosophical one. We question whether SCI might be viewed as a serious condition like cancer where serious side effects of therapeutics are tolerated even when benefits may be small. We also draw attention to the similarity between the side effects of MPSS and isotretinoin which is prescribed for the cosmetic disorder acne vulgaris. Ultimately we question how patient autonomy should be weighed in the context of current SCI guidelines and MPSS's status as a historical standard of care.

  20. Heredity: a prognostic factor for acne.

    PubMed

    Ballanger, F; Baudry, P; N'Guyen, J M; Khammari, A; Dréno, B

    2006-01-01

    The role of heredity in acne severity and therapeutic response remains unclear. A prospective epidemiologic study was performed to compare clinical and evolutive features of acne and response to treatment in 151 patients with acne with (A+) or without (A-) family history of acne. A+ and A- patients were compared on clinical and therapeutic criteria. A+ patients were then distributed into subgroups (M+, F+, M+F+) following the origin of family history (father: F, mother: M). The clinical profile was similar in the A+ and A- populations. Acne occurred earlier and more often before puberty in the A+ population, in which oral treatments and relapse after isotretinoin were more frequent. Retentional lesions (number and extent) were more important in the M+ and M+F+ populations. This study confirms the importance of heredity as a prognostic factor for acne. Family history of acne is associated with earlier occurrence of acne, increased number of retentional lesions and therapeutic difficulties. Copyright (c) 2006 S. Karger AG, Basel.

  1. SAPHO syndrome with acne fulminans and severe polyosteitis involving axial skeleton.

    PubMed

    Divya, B Lakshmi; Rao, P Narasimha

    2016-01-01

    SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis, osteitis), a rare inflammatory disorder, is an association of distinct skin disorders with pustules with osteoarticular inflammation. Its etiology remains unclear, and various treatment regimens frequently fail to control the disease. An 18-year-old male patient presented to the outpatient department with severe nodulocystic acne on the face with pain at both the wrists and lower back associated with high-grade fever and chills. On physical examination, he had severe tenderness at both wrist joints and lower back, along with swelling of right wrist. Magnetic resonance imaging revealed osteitis of the distal end of the right radius. Technetium-99m-MDP Whole Body Bone Scan revealed increased metaphyseal uptake in distal radius on both sides and prominent uptake at the sacroiliac joints, vertebral end plate, left 7(th) costo-vertebral joint and bilateral sternoclavicular joints and manubrium sternum (resulting in "bull's head" sign, which is characteristic of SAPHO syndrome). He responded very well to a combination therapy of nonsteroid anti-inflammatory drugs, antibiotics, colchicine, and isotretinoin over a 12-week period.

  2. The Role of Photodynamic Therapy in Acne: An Evidence-Based Review.

    PubMed

    Boen, Monica; Brownell, Joshua; Patel, Priyanka; Tsoukas, Maria M

    2017-06-01

    Acne vulgaris is a highly prevalent skin disorder that affects almost all adolescents and can persist into adulthood. Photodynamic therapy (PDT) is an emerging treatment for acne that involves the use of a photosensitizer in combination with a light source and oxygen. We performed a systematic review of the literature and critically evaluated the studies. Sixty-nine clinical trials, four case reports, and two retrospective studies met the inclusion criteria, and seven of the studies were high quality. The most common photosensitizers used were 5-aminolevulinic acid and methyl aminolevulinate, and both showed similar response. Red light was the most frequently used light source, followed by intense pulsed light, and showed comparable results. Inflammatory and non-inflammatory lesions both responded to treatment, with inflammatory lesions showing greater clearance in most studies. Adverse events associated with PDT for acne were mild and included pain on illumination and post-procedural erythema and edema. PDT has been safely used in higher Fitzpatrick skin types (III-IV), although these patients had a higher risk of transient hyperpigmentation. This review supports PDT as an efficacious treatment for acne and a good adjunctive treatment for mild to severe acne, especially in patients who have not responded to topical therapy and oral antibacterials, and are not great candidates for isotretinoin. Further studies are warranted to evaluate the optimal photosensitizers, light sources, incubation times, and number of treatments for PDT use in acne.

  3. ACNE VULGARIS TREATMENT : THE CURRENT SCENARIO

    PubMed Central

    Rathi, Sanjay K

    2011-01-01

    Acne Vulgaris is one of the most common skin disorders which dermatologists have to treat. It mainly affect adolescent, though may present at any age. In recent years, due to better understanding of the pathogenesis of acne, new therapeutic modalities and various permutation and combinations have been designed. In topical agents; benzoyl peroxide, antibiotics, retinoids, etc are the mainstay of treatment; can be given in combinations. While systemic therapy includes oral antibiotics, hormonal therapy, and isotretinoin, depending upon the need of patients it has to be selected. Physical treatment in the form of lesion removal, photo-therapy is also helpful in few of them. Since various old and new topical and systemic agents are available to treat acne, it sometime confuse treating dermatologist. To overcome this, panel of physicians and researchers worked together as a global alliance and task force to improve outcomes in acne treatment. They have tried to give consensus recommendation for the treatment of acne. Successful management of acne needs careful selection of anti-acne agents according to clinical presentation and individual patient needs. PMID:21572783

  4. Normal vitamin D levels can be maintained despite rigorous photoprotection: six years' experience with xeroderma pigmentosum.

    PubMed

    Sollitto, R B; Kraemer, K H; DiGiovanna, J J

    1997-12-01

    Although sun protection is advocated for skin cancer prevention, sunlight is also important in generation of vitamin D in the skin. There is concern that sun protection may result in an abnormally low level of vitamin D. To assess the risk of vitamin D deficiency in a sunlight-deprived population, we studied eight ambulatory patients with xeroderma pigmentosum (XP) who practiced intensive sun protection during a chemoprevention study of oral isotretinoin. We surveyed the patients to determine the extent of sun protection and vitamin D intake and measured the serum levels of two vitamin D metabolites (25-hydroxyvitamin D [25-OHD] and 1,25-dihydroxyvitamin D [1,25-(OH)2D]), calcium, and parathyroid hormone during 6 years. The patients all wore protective clothing and sunscreens when outdoors. Estimated mean vitamin D intake was normal. The mean values of serum 25-OHD were low normal, but 1,25-(OH)2D, calcium, ionized calcium and parathyroid hormone levels were normal. Lack of seasonal variation in serum 25-OHD indicated rigorous photoprotection. Despite rigorous sun protection normal vitamin D levels can be maintained in ambulatory patients with XP.

  5. Premature epiphyseal closure in an adolescent treated by retinoids for acne: an unusual cause of anterior knee pain.

    PubMed

    Luthi, François; Eggel, Yan; Theumann, Nicolas

    2012-05-01

    Retinoids are effective and widely prescribed in the treatment of severe acne. However their use can be associated with numerous side effects. Some rare cases of premature epiphyseal closure were reported. We present the case of a sixteen-year-old soccer player referred for progressive anterior pain in both knees, evoking a patellar problem. Careful pharmacological questioning revealed use of isotretinoin for several months. MRI findings showed an irregularity of the growth plate and an important metaphyso-epiphyseal oedema, more noticeable in the left knee. Retinoid-induced premature epiphyseal closure was diagnosed. The treatment was stopped, with a resolution of pain within two months. After recovery a persisting small sequelar thumbprint-like growth plate lesion was observed on the control MRI. Retinoids induce an invasion of the growth plate by osteoclasts and a decrease in proteoglycans synthesis. It seems that the knee is the most affected joint. This complication being rare, a radiological follow-up of the young patients treated by retinoids is not proposed.

  6. Acne and systemic disease.

    PubMed

    Lolis, Margarita S; Bowe, Whitney P; Shalita, Alan R

    2009-11-01

    Acne is the most common disease of the skin. It affects 85% of teenagers, 42.5% of men, and 50.9% of women between the ages of 20 and 30 years.96,97 The role of hormones, particularly as a trigger of sebum production and sebaceous growth and differentiation, is well known. Excess production of hormones, specifically androgens, GH, IGF-1, insulin, CRH, and glucocorticoids, is associated with increased rates of acne development. Acne may be a feature in many endocrine disorders, including polycystic ovary disease, Cushing syndrome, CAH, androgen-secreting tumors, and acromegaly. Other nonendocrine diseases associated with acne include Apert syndrome, SAPHO syndrome, Behçet syndrome and PAPA syndrome. Acne medicamentosa is the development of acne vulgaris or an acneiform eruption with the use of certain medications. These medications include testosterone, progesterone,steroids, lithium, phenytoin, isoniazid, vitamins B2, B6, and B12, halogens, and epidermal growth factor inhibitors. Management of acne medicamentosa includes standard acne therapy. Discontinuation of the offending drug may be necessary in recalcitrant cases. Basic therapeutic interventions for acne include topical therapy, systemic antibiotics,hormonal agents, isotretinoin, and physical treatments. Generally, the severity of acne lesions determines the type of acne regimen necessary. The emergence of drug-resistant P acnes and adverse side effects are current limitations to effective acne management.

  7. Long-term treatment of severe SAPHO syndrome with adalimumab: case report and a review of the literature.

    PubMed

    Garcovich, Simone; Amelia, Rosanna; Magarelli, Nicola; Valenza, Venanzio; Amerio, Pierluigi

    2012-02-01

    SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) syndrome defines an association of inflammatory cutaneous disorders with osteoarticular manifestations and represents a clinical and therapeutic challenge. We report a case of severe SAPHO syndrome with acne conglobata and a diffuse involvement of the anterior chest wall and sacroiliac joints that required treatment with isotretinoin and adalimumab, a new fully human anti-tumor necrosis factor (TNF)-α monoclonal antibody. Combination treatment determined a complete clinical remission of cutaneous and osteoarticular manifestations after 48 weeks. Despite maintenance of clinical remission, follow-up imaging studies after 24 months of adalimumab monotherapy revealed osteoarticular disease progression, with features of inflammatory osteitis. TNFα antagonists have been used as third-line therapy for SAPHO syndrome in single case reports or case series, but these lack consistent long-term follow-up. SAPHO syndrome can present an intermittent-favorable course in the majority of cases as well as a chronic-progressive course, the latter requiring aggressive combination treatment with TNFα antagonists and conventional systemic agents.

  8. Hormonal correlates of acne and hirsutism.

    PubMed

    Lucky, A W

    1995-01-16

    Acne is a multifactorial disorder reflecting the role of infection, abnormal keratinization and immunologic reaction, as well as hormonal influences, on the pilosebaceous unit. Clinical studies have correlated elevated levels of androgens, originating in both the adrenal glands and ovaries, with acne. These include total and free testosterone, delta 4-androstenedione, dehydroepiandrosterone and its sulfate, and low levels of sex hormone binding globulin. The pathogenesis of acne initiation in childhood has been linked to rising serum levels of dehydroepiandrosterone sulfate. Hirsutism has been more directly correlated with increased levels of serum androgens, notably free testosterone. Underlying causes of elevated androgens in both disorders include very rare tumors, partial or late-onset forms of congenital adrenal hyperplasia, developmental adrenal abnormalities and, most commonly, polycystic ovary syndrome. Early acne treatment may include topical benzoyl peroxide, antibiotics, and tretinoin. More severe disease can be treated systemically (with antibiotics and/or isotretinoin). Very-low-dose corticosteroids can be used to eliminate the adrenal component of hyperandrogenism. Oral contraceptives, especially those that contain low-androgenic progestins, can reduce excessive androgens from any source and specifically suppress the ovary in polycystic ovary syndrome. Gonadotropin-releasing hormone agonists, with or without estrogen supplementation, and systemic or topical antiandrogens may play a more important role in the future.

  9. Clinical, ultrasound and hormonal markers of androgenicity in acne vulgaris.

    PubMed

    Walton, S; Cunliffe, W J; Keczkes, K; Early, A S; McGarrigle, H H; Katz, M; Reese, R A

    1995-08-01

    Androgenic stimulation of sebaceous glands is an important factor in the development of acne. We examined 36 females (aged 14-34 years), selected because none had received oral contraceptives, anti-androgen therapy, or systemic antibiotics during the previous year, or isotretinoin therapy, prior to their participation in the study. Subjects were divided into groups on the basis of acne severity, as follows: physiological, mild and moderate. Only two patients had polycystic ovaries on ultrasound examination. Seven patients had irregular menses; none had evidence of hirsutism. We found that the severity of acne, based on the acne grade, was highly correlated with the inflammatory lesion count, and less correlated with the sebum excretion rate. Either acne grade or inflammatory lesion count could be related to some of the five androgenic hormone determinants; free testosterone (TESTOS), delta 4 androstenedione (DELTA 4), sex hormone binding globulin (SHBG), dehydroepiandrostenedione sulphate (DHEAS) and dihydrotestosterone (DHT). Multiple linear regression analysis determined the best model for predicting ACNE scores as involving DELTA 4 and DHEAS (positive effects), and SHBG (negative effect), P < 0.005, R2 = 0.36). In none of the patients were the levels of DHEAS or SHBG outside the normal range. The findings in the two patients with polycystic ovaries did not differ significantly from those in the remainder of the patients.

  10. PERIORAL DERMATITIS: STILL A THERAPEUTIC CHALLENGE.

    PubMed

    Mokos, Zrinka Bukvić; Kummer, Ana; Mosler, Elvira Lazić; Čeović, Romana; Basta-Juzbašić, Aleksandra

    2015-06-01

    Perioral dermatitis is a common and often chronic dermatosis. In its classic form, it primarily affects women aged 15 to 45 years, but there are also variants including lupus-like and granulomatous perioral dermatitis, where granulomatous form is more common in childhood and affects mostly prepubescent boys. The etiopathogenesis of the disease remains unclear, but there is a frequent finding of prolonged use of topical products, especially corticosteroids, in the treatment of rosacea and seborrheic dermatitis, preceding the clinical manifestation of perioral dermatitis. Other causes important for the occurrence of the disease include various skin irritants, as well as other physical and hormonal factors, which all share the epidermal barrier dysfunction as an underlying main pathogenic factor. Clinical presentation of papulovesicular eruption in the perioral region with a typical narrow spared zone around the edge of the lips is characteristic. Therapeutic approach should be individually addressed, depending on the severity of clinical presentation and patient's age, with special attention to patient's education and continuous psychological support. In mild forms of perioral dermatitis, 'zero therapy' is the treatment of choice. In the initial treatment period, patients with steroid-induced perioral dermatitis should be closely followed up because the rebound phenomenon usually develops after cessation of previous topical treatment. In moderate disease, treatment includes topical metronidazole, erythromycin, and pimecrolimus, whereas in more severe cases the best validated choice is oral tetracycline in a subantimicrobial dose until complete remission is achieved. Systemic isotretinoin should be considered as a therapeutic option for patients refractory to all standard therapies.

  11. Recent advances in the use of adapalene 0.1%/benzoyl peroxide 2.5% to treat patients with moderate to severe acne.

    PubMed

    Leyden, James

    2016-01-01

    The central role of inflammation in acne is now more clearly understood. Adapalene, a third-generation topical retinoid, down-regulates toll-like receptor 2 expression and inhibits activator protein-1 activity. In a fixed-dose combination, adapalene and benzoyl peroxide (BPO) act synergistically on inflammatory patterns through regulation of innate immunity. In addition to reducing inflammatory and non-inflammatory lesions, adapalene/BPO helps prevent lesion and microcomedone formation. The combination of a topical retinoid and antimicrobial agent remains the preferred approach for almost all patients with acne. In cases of more severe disease, there is a clinical benefit in combining adapalene/BPO with an oral antibiotic for 12 weeks. Most recently, adapalene/BPO plus doxycycline 200 mg was found to be highly effective when compared with isotretinoin in the treatment of patients with severe acne with nodules. Long-term maintenance therapy is needed for most patients. Retinoids are the preferred agents, with BPO added in patients with more severe disease if needed. Adapalene is anticomedogenic, reduces comedones and has anti-inflammatory properties, while BPO is a unique antimicrobial agent not shown to induce microbial resistance after more than 50 years of use. Maintenance therapy for 6 months with adapalene/BPO prevents relapse among patients with severe acne and continues to reduce disease symptoms.

  12. Porokeratosis palmaris et plantaris disseminata or a disseminated late-onset variant of porokeratotic eccrine ostial and dermal ductal nevus (PEODDN) with follicular involvement.

    PubMed

    Hartman, Rachael; Rizzo, Carina; Patel, Rishi; Kamino, Hideko; Shupack, Jerome L

    2009-08-15

    A 48-year-old woman presented with a four-year history of pruritic, hyperkeratotic, spiny papules that began on her chest and spread to her extremities, groin, palms, face, and scalp where it caused non-scarring alopecia. Histopathologic features included cornoid lamella, which is the hallmark of porokeratosis. However, the patient's constellation of findings does not meet diagnostic criteria for any of the five clinical variants of porokeratosis. Her presentation is most compatible with either porokeratosis palmaris et plantaris disseminata (PPPD), which is a rare variant of punctate porokeratosis that can involve any area of the body or late-onset porokeratotic eccrine ostial and dermal ductal nevus (PEODDN), which is a rare, benign hamartoma of the eccrine sweat glands with porokeratotic histopathologic features that has been reported to occasionally have systemic involvement. Treatment of either condition is difficult although there have been reported successes with cryotherapy, surgical excision, and CO2 laser. Since porokeratosis is a disorder of keratinization and our patient has prominent follicular involvement, isotretinoin may be another reasonable therapeutic option.

  13. Synergy between loss of NF1 and overexpression of MYCN in neuroblastoma is mediated by the GAP-related domain

    PubMed Central

    He, Shuning; Mansour, Marc R; Zimmerman, Mark W; Ki, Dong Hyuk; Layden, Hillary M; Akahane, Koshi; Gjini, Evisa; de Groh, Eric D; Perez-Atayde, Antonio R; Zhu, Shizhen; Epstein, Jonathan A; Look, A Thomas

    2016-01-01

    Earlier reports showed that hyperplasia of sympathoadrenal cell precursors during embryogenesis in Nf1-deficient mice is independent of Nf1’s role in down-modulating RAS-MAPK signaling. We demonstrate in zebrafish that nf1 loss leads to aberrant activation of RAS signaling in MYCN-induced neuroblastomas that arise in these precursors, and that the GTPase-activating protein (GAP)-related domain (GRD) is sufficient to suppress the acceleration of neuroblastoma in nf1-deficient fish, but not the hypertrophy of sympathoadrenal cells in nf1 mutant embryos. Thus, even though neuroblastoma is a classical “developmental tumor”, NF1 relies on a very different mechanism to suppress malignant transformation than it does to modulate normal neural crest cell growth. We also show marked synergy in tumor cell killing between MEK inhibitors (trametinib) and retinoids (isotretinoin) in primary nf1a-/- zebrafish neuroblastomas. Thus, our model system has considerable translational potential for investigating new strategies to improve the treatment of very high-risk neuroblastomas with aberrant RAS-MAPK activation. DOI: http://dx.doi.org/10.7554/eLife.14713.001 PMID:27130733

  14. Treatment of adult female acne: a new challenge.

    PubMed

    Dréno, B

    2015-06-01

    Acne is affecting an increasing number of adult females and so can no longer be considered as a disease of adolescence. The disease has a greater negative impact on the quality of life of adult females than their younger counterparts. Adult female acne may persist from adolescence or may have its first occurrence once adulthood has been reached. The clinical presentation and pathogenesis of adult female acne may be somewhat different to that of adolescent acne and this may require a different treatment approach. Genetic and hormonal factors are thought to play key roles in the pathogenesis of adult female acne and the disease is characterized by a chronic evolution with frequent relapses requiring long-term maintenance therapy. Fixed-dose retinoid/antimicrobial combinations may be of interest for the treatment of adult female acne given that subgroup analysis of clinical trials has indicated that they are effective against both inflammatory and non-inflammatory lesions in these patients. These treatments may also be of interest, given the chronic course of the disease in adult females, the high likelihood of the presence of antibiotic-resistant P. acnes and the poor adherence of patients to other long-term therapies. Oral hormonal treatment or isotretinoin may be required in patients with severe acne or disease that is refractory to other treatments. Additional clinical studies of acne treatments specifically conducted in adult female patients are required to increase the evidence base on which future treatment recommendations can be based.

  15. SAPHO syndrome with acne fulminans and severe polyosteitis involving axial skeleton

    PubMed Central

    Divya, B Lakshmi; Rao, P Narasimha

    2016-01-01

    SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis, osteitis), a rare inflammatory disorder, is an association of distinct skin disorders with pustules with osteoarticular inflammation. Its etiology remains unclear, and various treatment regimens frequently fail to control the disease. An 18-year-old male patient presented to the outpatient department with severe nodulocystic acne on the face with pain at both the wrists and lower back associated with high-grade fever and chills. On physical examination, he had severe tenderness at both wrist joints and lower back, along with swelling of right wrist. Magnetic resonance imaging revealed osteitis of the distal end of the right radius. Technetium-99m-MDP Whole Body Bone Scan revealed increased metaphyseal uptake in distal radius on both sides and prominent uptake at the sacroiliac joints, vertebral end plate, left 7th costo-vertebral joint and bilateral sternoclavicular joints and manubrium sternum (resulting in “bull's head” sign, which is characteristic of SAPHO syndrome). He responded very well to a combination therapy of nonsteroid anti-inflammatory drugs, antibiotics, colchicine, and isotretinoin over a 12-week period. PMID:27730042

  16. Rosacea Management

    PubMed Central

    Abokwidir, Manal; Feldman, Steven R.

    2016-01-01

    Background Rosacea is a chronic inflammatory skin condition associated with four distinct subtypes: erythematotelangiectatic, papulopustular, phymatous, and ocular. Purpose To review the different kinds of management for all subtypes. Methods We divided rosacea management into three main categories: patient education, skin care, and pharmacological/procedural interventions. Results Flushing is better prevented rather than treated, by avoiding specific triggers, decreasing transepidermal water loss by moisturizers, and blocking ultraviolet light. Nonselective β-blockers and α2-adrenergic agonists decrease erythema and flushing. The topical α-adrenergic receptor agonist brimonidine tartrate 0.5% reduces persistent facial erythema. Intradermal botulinum toxin injection is almost safe and effective for the erythema and flushing. Flashlamp-pumped dye, potassium-titanyl-phosphate and pulsed-dye laser, and intense pulsed light are used for telangiectasias. Metronidazole 1% and azelaic acid 15% cream reduce the severity of erythema. Both systemic and topical remedies treat papulopustules. Systemic remedies include metronidazole, doxycycline, minocycline, clarithromycin and isotretinoin, while topical remedies are based on metronidazole 0.75%, azelaic acid 15 or 20%, sodium sulfacetamide, ivermectin 1%, permethrin 5%, and retinoid. Ocular involvement can be treated with oral or topical antibacterial. Rhinophyma can be corrected by dermatosurgical procedures, decortication, and various types of lasers. Conclusion There are many options for rosacea management. Patients may have multiple subtypes, and each phase has its own treatment. PMID:27843919

  17. Papular Acne Scars of the Nose and Chin: An Under-recognised Variant of Acne Scarring

    PubMed Central

    Ali, Faisal R; Kirk, Michael; Madan, Vishal

    2016-01-01

    Background: Scarring following acne vulgaris is common and can be of profound psychosocial consequence. Aims and Objectives: We have clinically noted a variant of acne scarring, overlooked by previous categorisation schemes, which we have denominated as papular acne scars of the nose and chin. We sought to characterise these novel entities further. Materials and Methods: Initially, we identified 14 patients with papular acne scars of the nose and chin in a cosmetic dermatology clinic, of whom two were female and rest were male. We then prospectively evaluated 100 consecutive patients attending our tertiary referral acne isotretinoin clinic and 49 patients attending a general dermatology clinic. Results: Amongst 149 patients, from a general dermatology and tertiary acne clinic, soft papular scars were noted in four patients, distributed on the nose and chin. Three of the four patients were male, three patients had additional acne scars and the median age was 23.5. Conclusions: We have identified 18 patients with papular acne scars of the nose and chin and propose that this new category should be added to acne scarring classification schemes. Future work should be directed at corroborating the epidemiology of such lesions and describing effective treatment modalities. PMID:28163455

  18. Evidence-based therapy for cutaneous sarcoidosis.

    PubMed

    Doherty, Christy B; Rosen, Ted

    2008-01-01

    , but early reports are promising. Infliximab is administered via intravenous infusion at doses of 3-10 mg/kg at 0, 2 and 6 weeks and as indicated thereafter, whereas adalimumab is injected subcutaneously at doses of 40 mg either weekly or every 2 weeks. Because adalimumab is not approved for the management of sarcoidosis, the optimum dose administration interval is uncertain. However, it has been given in both weekly and every other week regimens. Isotretinoin, 0.5-2 mg/kg/day, has been used successfully in a handful of reported cases. However, the teratogenic potential of isotretinoin is often prohibitive considering that the primary demographic group likely to develop sarcoidosis is women of childbearing potential. Thalidomide at dosages of 50 to >400 mg/day has limited, albeit promising, supporting data. However, access is restricted in many countries because of a deserved pregnancy category X rating. Melatonin (20 mg/day) and allopurinol (100-300 mg/day) are not well studied in cutaneous sarcoidosis, and the clinical experience with tetracycline derivatives has been mixed. That said, there are compelling reports of therapeutic benefit with both doxycycline and minocycline. Because neither of these agents is associated with the severe toxicity of cytotoxic drugs, they may serve as effective therapy in some patients. Pentoxifylline (400 mg three times daily) has been of use in a small number of reported cases of pulmonary sarcoidosis, but there are no reports on its use in patients with primarily cutaneous disease. Both ciclosporin and chlorambucil have been largely abandoned given their associated toxicity and disappointingly unreliable efficacy. Finally, laser therapy is a newer modality that may provide patients with a quick and non-invasive treatment option for cutaneous sarcoidosis.

  19. Documentation of Contraception and Pregnancy When Prescribing Potentially Teratogenic Medications for Reproductive-Age Women

    PubMed Central

    Schwarz, Eleanor Bimla; Postlethwaite, Debbie A.; Hung, Yun-Yi; Armstrong, Mary Anne

    2010-01-01

    Background Certain medications are identified by the U.S. Food and Drug Administration (FDA) as class D or X because they increase the risk for birth defects if used during pregnancy. Objective To assess pregnancy rates and the frequency of contraceptive counseling documented with prescriptions for class D or X drugs filled by women of reproductive age. Design Description of prescriptions filled in 2001. Setting A large health maintenance organization in northern California in 2001. Patients 488 175 women age 15 to 44 years who filled a total of 1 011 658 class A, B, D, or X prescriptions. Measurements Medications dispensed, contraceptive counseling, and pregnancy testing. Results A class D or X prescription was filled by 1 of every 6 women studied. Women who filled a prescription for class D or X medications were no more likely than women who filled prescriptions for safer, class A or B medications to have received contraceptive counseling, filled a contraceptive prescription, or been sterilized (48% vs. 51% of prescriptions). There was little variation by clinical indication in rates of contraceptive counseling with class D or X prescriptions, except for isotretinoin. Women who filled a class D or X prescription were only slightly less likely to have a pregnancy documented within 3 months than women filling a class A or B prescription (1.0% vs. 1.4% of prescriptions). Limitations International Classification of Diseases, Ninth Revision, codes underestimate contraceptive counseling. Documentation of a positive pregnancy test after filling a prescription may overestimate medication use in early pregnancy. Women who filled several prescriptions are overrepresented in prescription analyses. Conclusion Prescriptions for potentially teratogenic medications are frequently filled by women of childbearing age without documentation of contraceptive counseling. PMID:17876020

  20. Large-scale survey to describe acne management in Brazilian clinical practice

    PubMed Central

    Seité, Sophie; Caixeta, Clarice; Towersey, Loan

    2015-01-01

    Background Acne is a chronic disease of the pilosebaceous unit that mainly affects adolescents. It is the most common dermatological problem, affecting approximately 80% of teenagers between 12 and 18 years of age. Diagnosis is clinical and is based on the patient’s age at the time the lesions first appear, and on its polymorphism, type of lesions, and their anatomical location. The right treatment for the right patient is key to treating acne safely. The aim of this investigational survey was to evaluate how Brazilian dermatologists in private practice currently manage acne. Materials and methods Dermatologists practicing in 12 states of Brazil were asked how they manage patients with grades I, II, III, and IV acne. Each dermatologist completed a written questionnaire about patient characteristics, acne severity, and the therapy they usually prescribe for each situation. Results In total, 596 dermatologists were interviewed. Adolescents presented as the most common acneic population received by dermatologists, and the most common acne grade was grade II. The doctors could choose more than one type of treatment for each patient, and treatment choices varied according to acne severity. A great majority of dermatologists considered treatment with drugs as the first alternative for all acne grades, choosing either topical or oral presentation depending on the pathology severity. Dermocosmetics were chosen mostly as adjunctive therapy, and their inclusion in the treatment regimen decreased as acne grades increased. Conclusion This survey illustrates that Brazilian dermatologists employ complex treatment regimens to manage acne, choosing systemic drugs, particularly isotretinoin, even in some cases of grade I acne, and heavily prescribe antibiotics. Because complex regimens are harder for patients to comply with, this result notably raises the question of adherence, which is a key factor in successful treatment. PMID:26609243

  1. The management of rosacea.

    PubMed

    Rebora, Alfredo

    2002-01-01

    Rosacea is a multiphasic disease which is associated with flushing, erythrosis, papulopustular rosacea and phymas; each phase is likely to have its own treatment. Flushing is better prevented rather than treated, and its etiology investigated. Beta-blockers, atenolol in particular, are worthy of prophylactic trials examining their efficacy in treating the flushing associated with rosacea. Currently, clonidine is the only drug available for the treatment of flushing. Treatment for erythrosis includes topical and systemic therapies. Metronidazole 1% cream and azelaic acid 20% cream have been reported to reduce the severity score of erythema. The systemic treatment of erythrosis is based on the association of Helicobacter pylori with rosacea. However, this role is still being debated. Eradication of H. pylori can be achieved using a triple therapy regimen lasting 1 to 2 weeks [omeprazole and a combination of two antibacterials (a choice from clarithromycin, metronidazole or amoxicillin)]. Both the flashlamp-pumped long-pulse dye laser and the potassium-titanyl-phosphate laser may be used in the treatment of facial telangiectases. Both systemic and topical remedies may be used to treat the papulopustules of rosacea. Systemic treatment includes metronidazole, doxycycline, minocycline, clarithromycin and isotretinoin, while topical treatment is based on metronidazole cream and gel. The presence of Demodex folliculorum is important in the inflammatory reaction, whether it is pathogenetic or not. Crotamiton 10% cream or permethrin 5% cream may be useful medications for papulopustular rosacea, although they are rarely successful in eradicating D. folliculorum. Oral or topical ivermectin may also be useful in such cases. Ocular involvement is common in patients with cutaneous rosacea and can be treated with orally administered or topical antibacterials. Once rhinophyma starts to be evident, the only way to correct it is by aggressive dermatosurgical procedures. Decortication

  2. Drug-induced panic attacks: Analysis of cases registered in the French pharmacovigilance database.

    PubMed

    Abadie, Delphine; Essilini, Anaïs; Fulda, Virginie; Gouraud, Aurore; Yéléhé-Okouma, Mélissa; Micallef, Joëlle; Montastruc, François; Montastruc, Jean Louis

    2017-07-01

    The potential role of drugs in the onset of panic attacks (PAs) is poorly understood. The objective of our study was to characterize drug-induced PAs. We performed an analysis of PAs registered in the French pharmacovigilance database between 01/01/1985 and 05/11/2014. Among the 163 recorded cases, 136 (83.4%) were directly related to drugs, mainly antidepressants (11.3%, mainly serotonin reuptake inhibitors), mefloquine (7.2%), isotretinoin (5.2%), rimonabant (3.6%) and corticosteroids (4.7%). PAs are labelled in the Summary of Product Characteristics (SmPC) for a minority (8.6%) of these drugs. In 31.4% of these cases, withdrawal of the suspected drug was performed more than a week after the onset of PAs. PAs could also be secondary to another adverse drug reaction (ADR; n = 14, 8.6%), mainly an allergy to antineoplastic or immunomodulating agents. In 13 cases (8.0%), PAs occurred during a drug-withdrawal syndrome, mainly after benzodiazepines or opioids. Most cases (73%) involved patients without any previous psychiatric disorder. This is the first pharmacoepidemiological study about iatrogenic PAs. Beside antidepressants, the most often encountered drugs are not indicated for psychiatric diseases. This study also reveals that iatrogenic PAs mostly occur in patients without any psychiatric medical history and that PAs can be triggered by another ADR. Lastly, the many cases with delayed management underline the need to raise awareness of this relatively unknown ADR among physicians, especially since PAs are generally not labelled in SmPCs of the suspected drugs. Copyright © 2017 Elsevier Ltd. All rights reserved.

  3. [Signs and symptoms of rosacea].

    PubMed

    Schmutz, J-L

    2014-09-01

    Rosacea is a chronic inflammatory dermatosis characterized by outbreaks of exacerbation and remission. The diagnosis of rosacea based on specific clinical criteria, mainly centrofacial erythema occurring between 30 and 50 years. The disease predominates in women, in light phototype, especially from Northern Europe. Several classifications of the disease exist. In France, Edouard Grosshans described four stages. Stage I is that of flushing, stage II is that of erythrocouperosis, stage III papules and pustules and stage IV rhinophyma. German schools described only 3 stages, like experts from the National Rosacea Society (NRS), who described four subtypes: • 1. erythematotelangiectatic rosacea; • 2. papulopustular rosacea; • 3. phymas; • 4. ocular rosacea. The patient can enter the disease at any stage. CLINICAL ASPECTS OF ROSACEA: Stage I (flushes) sometimes starts very early at the age of 20 years by the occurrence of paroxysmal facial erythema that might be associated with conjunctival hyperemia. Flushes occur after meals, sudden change in temperature or absorption of alcohol or hot drinks. Stage II or erythrocouperosis comprises permanent facial erythema with telangiectasia. Stage III is the most characteric of the disease. On the erythematous background patient develop outbreak of papules and pustules. Stage IV is mainly observed in males and is characterized mainly by rhinophyma. There is no consensus regarding the description of the other variants. NRS describe a particular subtype, granulomatous or lupoid rosacea, characterized by yellowish or brownish papules of the cheeks and peri-orificial areas. Ocular rosacea is common and should be systematically looked for in all patients with rosacea. Steroid rosacea is a complication of topical corticosteroids use on the face. Fulminant rosacea occurs abruptly in young women, who develop papules, pustules and deep purulent sinuses. Treatment includes the combination of systemic corticosteroids and isotretinoin

  4. Interventions for rosacea: abridged updated Cochrane systematic review including GRADE assessments.

    PubMed

    van Zuuren, E J; Fedorowicz, Z

    2015-09-01

    Rosacea is a common chronic facial dermatosis. This update of our Cochrane review on interventions for rosacea summarizes the evidence, including Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group assessments, of the effects of the currently available treatments. Searches included the following: Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library, MEDLINE, EMBASE, LILACS and the Science Citation Index, and ongoing trials registries (July 2014). We included 106 randomized controlled trials (RCTs) with 13 631 participants, a more than 80% increase since the last update in 2011. Pooling of data was feasible for a few outcomes, for topical metronidazole and azelaic acid and both appeared to be more effective than placebo (moderate and high-quality evidence, respectively). Topical ivermectin was more effective than placebo based on two studies (high-quality evidence), and slightly more effective than metronidazole in one study. Brimonidine was more effective than vehicle in reducing erythema in rosacea (high-quality evidence). Ciclosporin ophthalmic emulsion was effective for ocular rosacea (low-quality evidence). For oral treatments there was moderate-quality evidence for the effectiveness of tetracycline based on two old studies, and high-quality evidence for doxycycline 40 mg compared with placebo according to physician assessments. One study at high risk of bias demonstrated equivalent effectiveness for azithromycin and doxycycline 100 mg. Minocycline 45 mg may be effective for papulopustular rosacea (low-quality evidence). Low-dose isotretinoin appeared to be slightly more effective than doxycycline 50-100 mg (high-quality evidence). Laser and light-based therapies for erythema in rosacea were effective (low-quality evidence). Further RCTs are required for ocular rosacea.

  5. Lichen planopilaris in a Latin American (Chilean) population: demographics, clinical profile and treatment experience.

    PubMed

    Mardones, F; Shapiro, J

    2017-10-01

    Lichen planopilaris (LPP) is characterized by lymphocytic infiltrate, fibrosis and potential destruction of the hair follicle. Demographic and clinical studies in LPP are limited, and racial differences have not been thoroughly investigated. To analyse epidemiological data and clinical profiles of Chilean adults with LPP, and report on the treatments used. This was a retrospective review of medical records and clinical follow-up of Chilean adults with a clinical and histopathological diagnosis of LPP. Treatment response was categorized clinically as none (with progression of condition), mild or satisfactory. The study assessed 103 patients with LPP [67 women (mean age 54.1 years) and 36 men (mean age 39.1 years)]. Of the 103 patients, 41 women and 34 men were diagnosed with classic LPP (CLPP) and 26 women and 1 man with frontal fibrosing alopecia (FFA), while Graham-Little-Piccardi-Lassueur syndrome (GLPLS) was identified in 1 man. Men with CLPP had a significantly (P < 0.001) earlier age of onset than women. Scalp dysaesthesia, erythema and peripilar hyperkeratosis were common findings, and 51 (66%) of patients with CLPP had cicatricial patches, most of which were circumscribed in the vertex area. All patients with FFA had band-like scarring in the frontal and temporal hairlines. Morbidities associated with LPP were hypothyroidism, dyslipidaemia, hypertension and depression. For most patients, treatment halted or improved their inflammatory/scarring condition. A sustained combination of at least one topical (clobetasol, minoxidil and salicylic acid) and one systemic (cetirizine, hydroxychloroquine, finasteride, methotrexate and isotretinoin) medication was necessary in all of our patients with LPP. This investigation is one of the first to describe the demographic, clinical and therapeutic features of LPP in a Latin American population. Similar profiles to previous reports may encourage research in larger multicentre international studies. © 2017 British

  6. [Case reports of drug-induced liver injury in a reference hospital of Zulia state, Venezuela].

    PubMed

    Mengual-Moreno, Edgardo; Lizarzábal-García, Maribel; Ruiz-Soler, María; Silva-Suarez, Niniveth; Andrade-Bellido, Raúl; Lucena-González, Maribel; Bessone, Fernando; Hernández, Nelia; Sánchez, Adriana; Medina-Cáliz, Inmaculada

    2015-03-01

    Drug-induced liver injury (DILI) is an important cause of morbidity and mortality worldwide, with varied geographical differences. The aim of this prospective, descriptive, cross-sectional study was to identify and characterize cases of DILI in a hospital of Zulia state, Venezuela. Thirteen patients with a presumptive diagnosis of DILI attended by the Department of Gastroenterology, Hospital Universitario, Zulia state, Venezuela, from December-2012 to December-2013 were studied. Ibuprofen (n = 3; 23.1%), acetaminophen (n = 3; 23.1), isoniazid (n = 2; 15.4%) and Herbalife products (n = 2; 15.4%) were the main drugs involved with DILI. Acetaminophen and ibuprofen showed a mixed pattern of liver injury (n = 3; 23.1%) and isoniazid presented a hepatocellular pattern (n = 2; 15.4%). The CIOMS/RUCAMS allowed the identification of possible (n = 7; 53.9%), probable (n = 4; 30.8%) and highly-probable cases (n = 2; 15.4%) of DILI. Amoxicillin/clavulanate, isoniazid, isotretinoin, methotrexate and Herbalife nutritional products were implicated as highly-probable and probable agents. The highest percentage of DILI corresponded to mild cases that recovered after the discontinuation of the agent involved (n = 9; 69.3%). The consumption of Herbalife botanical products is associated with probable causality and fatality (n = 1; 7.7%). In conclusion, the frequency of DILI cases controlled by the Department of Gastroenterology of the Hospital Universitario of Maracaibo was low, being ibuprofen, acetaminophen, isoniazid and products Herbalife the products most commonly involved. It is recommended to continue with the prospective registration of cases, with an extended follow up monitoring period and to facilitate the incorporation of other hospitals in the Zulia State and Venezuela.

  7. [Pharmacoeconomy in acne--evaluation of benefit and economics].

    PubMed

    Radtke, Marc A; Schäfer, Ines; Augustin, Matthias

    2010-03-01

    Acne belongs to the most common skin diseases and has a prevalence in the adolescence of nearly 100% and in adults of about 4%. The quality of life indes is significantly reduced und has impact on daily activities and social life and physical and psychological well being as well. The socioeconomic relevance is based not only on its prevalence but on direct and indirect costs. For acne therapy the knowledge on therapeutic costs is of importance but the cost benefit ratio as well. Evidence of therapeutic costs in acne and economic benefit of the therapy. Systematic review of Cochrane data. Calculations reveal general costs of acne treatment in Germany over 400 Mill.Euro per year. For the treatment with topical retinoids, BPO and antibiotics as well as systemic drugs only a few studies on costeffectiveness are available. For topical treatments results are not conclusive and dependent on the different health systems. New topical combinations may have a better economic outcome, however, more studies are needed. With regard to systemic therapies of moderate to severe acne based on the international references the costbenefit ratio favours the treatment with oral isotretinoin on the longterm outcome. Superiority is based on the relationship of costs and clinical outcome and the increased quality of life as well (cost-benefit ratio). It has to be emphazised that only longterm observations over years will lead to a valid calculation of costs and benefit. FACIT: Taking the high social and quality of life impact into consideration an early, well targeted and effective therapy is prevailing. Initial higher cost are balanced by a high quality of outcome under experienced dermatological supervision. The patients benefit is ranked over the final costs because of its medical, social and ethical aspects. To sample more differentiated data on pharmacoeconomic aspects well designed new clinical studies are to be set up.

  8. Zolav®: a new antibiotic for the treatment of acne

    PubMed Central

    Dinant, Alexa; Boulos, Ramiz A

    2016-01-01

    Background Acne is a prominent skin condition affecting >80% of teenagers and young adults and ~650 million people globally. Isotretinoin, a vitamin A derivative, is currently the standard of care for treatment. However, it has a well-established teratogenic activity, a reason for the development of novel and low-risk treatment options for acne. Objective To investigate the effectiveness of Zolav®, a novel antibiotic as a treatment for acne vulgaris. Materials and methods Minimum inhibitory concentration of Zolav® against Propionibacterium acnes was determined by following a standard protocol using Mueller-Hinton broth and serial dilutions in a 96-well plate. Cytotoxicity effects on human umbilical vein endothelial cells and lung cells in the presence of Zolav® were investigated by determining the growth inhibition (GI50) concentration, total growth inhibition concentration, and the lethal concentration of 50% (LC50). The tryptophan auxotrophic mutant of Escherichia coli strain, WP2 uvrA (ATCC 49979), was used for the AMES assay with the addition of Zolav® tested for its ability to reverse the mutation and induce bacterial growth. The in vivo effectiveness of Zolav® was tested in a P. acnes mouse intradermal model where the skin at the infection site was removed, homogenized, and subjected to colony-forming unit (CFU) counts. Results Susceptibility testing of Zolav® against P. acnes showed a minimum inhibitory concentration of 2 µg/mL against three strains with no cytotoxicity and no mutagenicity observed at the highest concentrations tested, 30 µM and 1,500 µg/plate, respectively. The use of Zolav® at a concentration of 50 µg/mL (q8h) elicited a two-log difference in CFU/g between the treatment group and the control. Conclusion This study demonstrates the potential of Zolav® as a novel treatment for acne vulgaris. PMID:27042015

  9. Oil-cyclodextrin based beads for oral delivery of poorly-soluble drugs.

    PubMed

    Hamoudi, M C; Bochot, A

    2014-01-01

    The main interest of cyclodextrins results from their ability to form inclusion complexes with hydrophobic molecules. This property is employed in pharmaceutical industry to facilitate the formulation of poorly-soluble and/or fragile drugs. Cyclodextrins are also used to form or stabilise dispersed systems. An original multiparticulate system named "beads" is obtained thanks to the interactions occurring between the molecules of α cyclodextrin and the triglycerides of vegetable oils. Beads are prepared by a simple process involving the external shaking of a mixture of an aqueous solution of α cyclodextrin with soybean oil. This is done without any organic solvent or surface-active agent. Once freezedried, beads have a diameter of 1.6 mm and a high lipid content. They consist in a partially crystalline matrix of cyclodextrin surrounding microdomains of oil. The coating of beads with a layer of α cyclodextrin improves their resistance in gastro- intestinal fluids and prolongs the release of drugs. Beads can also be manufactured from mineral oils with α cyclodextrin and from silicone oils with γ cyclodextrin. Poorly-soluble drugs which do not form inclusion complexes with α cyclodextrin are encapsulated in beads with high efficiency and drug loading. In rats, the oral bioavailability of isotretinoin is twofold enhanced with uncoated beads as compared to the lipid content of a soft capsule. The relative oral bioavailability of indomethacin is improved with both coated and uncoated beads versus a commercial hard capsule. Beads demonstrate an important potential for the encapsulation of poorly-soluble and/or fragile compounds and their delivery by oral route.

  10. Role of FGFR2-signaling in the pathogenesis of acne

    PubMed Central

    2009-01-01

    It is the purpose of this review to extend our understanding of the fibroblast growth factor (FGF) receptor-2b-signaling network in the pathogenesis of acne. A new concept of the role of FGFR2b-signaling in dermal-epithelial interaction for skin appendage formation, pilosebaceous follicle homeostasis, comedogenesis, sebaceous gland proliferation and lipogenesis is presented. The FGFR2-gain-of-function mutations in Apert syndrome and unilateral acneiform nevus are most helpful model diseases pointing the way to androgen-dependent dermalepithelial FGFR2-signaling in acne. Androgen-mediated upregulation of FGFR2b-signaling in acne-prone skin appears to be involved in the pathogenesis of acne vulgaris. In organotypic skin cultures, keratinocyte-derived interleukin-1α stimulated fibroblasts to secrete FGF7 which stimulated FGFR2b-mediated keratinocyte proliferation. Postnatal deletion of FGFR2b in mice resulted in severe sebaceous gland atrophy. The importance of FGFR2b in sebaceous gland physiology is further supported by the mode of action of anti-acne agents which have been proposed to attenuate FGFR2b-signaling. Downregulation of FGFR2b-signaling by isotretinoin explains its therapeutic effect in acne. Downregulation of FGFR2b-signaling during the first trimester of pregnancy disturbs branched morphogenesis and explains retinoid embryotoxicity. Insulin-like growth factor-1 (IGF-1), the mediator of growth hormone during puberty, intracts with androgen-dependent FGFR2b-signaling and links androgen- and FGF-mediated signal transduction important in sebaceous gland homeostasis. The search for a follicular defect in the dermalepithelial regulation of growth factor-signaling in acne-prone skin appears to be a most promising approach to clarify the pathogenesis of acne. PMID:20436882

  11. [Rosacea: New data for better care].

    PubMed

    Cribier, B

    In the last 10 years, numerous studies have been published that throw new light on rosacea, in all areas of the disease. This overview summarises all the key developments, based on the indexed bibliography appearing in Medline between 2007 and 2017. Recent epidemiological data show that the prevalence of the disease is doubtless greater than estimated hitherto (more than 10% of adults in some countries) and that we should not overlook rosacea in subjects with skin phototypes V or VI, a condition that exists on all continents. A new classification of rosacea by phenotype comprising major and minor signs has been put forward; it provides a more rational approach to suitable management based upon symptoms, the severity of which may be graded into 5 classes. The treatments with the best-demonstrated efficacy (updated Cochrane study) are topical metronidazole, azelaic acid and ivermectin, and oral doxycycline; isotretinoin is effective against resistant forms but is off-label. In ocular rosacea, the reference treatment is doxycycline in combination with topical therapy of the eyelids. The physiopathology is complex and involves several factors: vascular (vasodilatation, vascular growth factors), neurovascular (hypersensitivity, neuropathic pain, neuropeptides), infectious (Demodex folliculorum and its microbiota) and inflammatory (abnormal production of pro-inflammatory peptides of the innate immune system). In addition, there is a genetic predisposition as demonstrated by the weight of familial history and comparison of homozygous and heterozygous twins. There is also activation of several genes involved in immunity, inflammation and lipid metabolism; the theory of hydrolipid film anomalies has been posited once more. There has thus been a tremendous leap forward in the field of rosacea research, with therapeutic progress and improved understanding of the underlying mechanisms, which should enable the future development of more targeted treatments as well as global

  12. Contraceptive Provision to Adolescent Females Prescribed Teratogenic Medications.

    PubMed

    Stancil, Stephani L; Miller, Melissa; Briggs, Holley; Lynch, Daryl; Goggin, Kathy; Kearns, Gregory

    2016-01-01

    Rates of adult women receiving contraceptive provision when simultaneously prescribed a known teratogen are alarmingly low. The prevalence of this behavior among pediatric providers and their adolescent patients is unknown. The objective of this study was to describe pediatric provider behaviors for prescribing teratogens concurrently with counseling, referral, and/or prescribing of contraception (collectively called contraceptive provision) in the adolescent population. A retrospective review was conducted examining visits in 2008-2012 by adolescents aged 14 to 25 years in which a known teratogen (US Food and Drug Administration pregnancy risk category D or X) was prescribed. The electronic medical records were queried for demographic information, evidence of contraceptive provision, and menstrual and sexual histories. The data were analyzed using standard statistical methods. Within 4172 clinic visits, 1694 females received 4506 prescriptions for teratogenic medications. The most commonly prescribed teratogens were topiramate, methotrexate, diazepam, isotretinoin, and enalapril. The subspecialties prescribing teratogens most frequently were neurology, hematology-oncology, and dermatology. Overall, contraceptive provision was documented in 28.6% of the visits. Whites versus nonwhites and older versus younger girls were more likely to receive contraceptive provision. The presence of a federal risk mitigation system for the teratogen also increased the likelihood of contraceptive provision. Our data demonstrate female adolescents prescribed teratogens receive inadequate contraception provision, which could increase their risk for negative pregnancy outcomes. Although the presence of a federal risk mitigation system appears to improve contraceptive provision, these systems are costly and, in some instances, difficult to implement. Efforts to improve provider practices are needed. Copyright © 2016 by the American Academy of Pediatrics.

  13. Evidence-based recommendations for the diagnosis and treatment of pediatric acne.

    PubMed

    Eichenfield, Lawrence F; Krakowski, Andrew C; Piggott, Caroline; Del Rosso, James; Baldwin, Hilary; Friedlander, Sheila Fallon; Levy, Moise; Lucky, Anne; Mancini, Anthony J; Orlow, Seth J; Yan, Albert C; Vaux, Keith K; Webster, Guy; Zaenglein, Andrea L; Thiboutot, Diane M

    2013-05-01

    Acne vulgaris is one of the most common skin conditions in children and adolescents. The presentation, differential diagnosis, and association of acne with systemic pathology differs by age of presentation. Current acknowledged guidelines for the diagnosis and management of pediatric acne are lacking, and there are variations in management across the spectrum of primary and specialty care. The American Acne and Rosacea Society convened a panel of pediatric dermatologists, pediatricians, and dermatologists with expertise in acne to develop recommendations for the management of pediatric acne and evidence-based treatment algorithms. Ten major topic areas in the diagnosis and treatment of pediatric acne were identified. A thorough literature search was performed and articles identified, reviewed, and assessed for evidence grading. Each topic area was assigned to 2 expert reviewers who developed and presented summaries and recommendations for critique and editing. Furthermore, the Strength of Recommendation Taxonomy, including ratings for the strength of recommendation for a body of evidence, was used throughout for the consensus recommendations for the evaluation and management of pediatric acne. Practical evidence-based treatment algorithms also were developed. Recommendations were put forth regarding the classification, diagnosis, evaluation, and management of pediatric acne, based on age and pubertal status. Treatment considerations include the use of over-the-counter products, topical benzoyl peroxide, topical retinoids, topical antibiotics, oral antibiotics, hormonal therapy, and isotretinoin. Simplified treatment algorithms and recommendations are presented in detail for adolescent, preadolescent, infantile, and neonatal acne. Other considerations, including psychosocial effects of acne, adherence to treatment regimens, and the role of diet and acne, also are discussed. These expert recommendations by the American Acne and Rosacea Society as reviewed and

  14. What's new in acne? An analysis of systematic reviews published in 2009-2010.

    PubMed

    Smith, E V; Grindlay, D J C; Williams, H C

    2011-03-01

    This review highlights clinically important findings about acne treatment identified in nine systematic reviews published or indexed in the period March 2009 to February 2010. A systematic review of dietary influences on acne suggested that a possible role of dietary factors in acne cannot be dismissed, as the studies to date have not been sufficiently large or robust. Another review looked at benzoyl peroxide, which may be enjoying a comeback because of increasing bacterial resistance to antibiotics, and suggested that there was a lack of evidence that stronger preparations were more effective than weaker ones. The same team also carried out a systematic review addressing the question of whether topical retinoids cause an initial worsening of acne. They found no evidence to suggest initial worsening of acne severity, although there was evidence of skin irritation that typically settled by 8-12 weeks. A review of oral isotretinoin and psychiatric side-effects reinforced a possible link between the two, although it pointed out that the better-quality primary studies were still inconclusive. An updated Cochrane Review confirmed the efficacy of combined oral contraceptives (COCs) in reducing acne lesion counts. It also found that the evidence to support COCs containing cyproterone acetate over others was very limited. Another Cochrane Review failed to show any benefit of spironolactone for acne, based on limited studies. Three reviews examined laser and light therapies, and found some evidence of superiority only for blue or blue/red light treatment over placebo light, but a general absence of comparisons against other acne treatments. Photodynamic therapy had consistent benefits over placebo but was associated with significant side-effects and was not shown to be better than topical adapalene. © 2010 The Author(s). © 2010 British Association of Dermatologists.

  15. Acne vulgaris.

    PubMed

    Williams, Hywel C; Dellavalle, Robert P; Garner, Sarah

    2012-01-28

    Acne is a chronic inflammatory disease of the pilosebaceous unit resulting from androgen-induced increased sebum production, altered keratinisation, inflammation, and bacterial colonisation of hair follicles on the face, neck, chest, and back by Propionibacterium acnes. Although early colonisation with P acnes and family history might have important roles in the disease, exactly what triggers acne and how treatment affects the course of the disease remain unclear. Other factors such as diet have been implicated, but not proven. Facial scarring due to acne affects up to 20% of teenagers. Acne can persist into adulthood, with detrimental effects on self-esteem. There is no ideal treatment for acne, although a suitable regimen for reducing lesions can be found for most patients. Good quality evidence on comparative effectiveness of common topical and systemic acne therapies is scarce. Topical therapies including benzoyl peroxide, retinoids, and antibiotics when used in combination usually improve control of mild to moderate acne. Treatment with combined oral contraceptives can help women with acne. Patients with more severe inflammatory acne usually need oral antibiotics combined with topical benzoyl peroxide to decrease antibiotic-resistant organisms. Oral isotretinoin is the most effective therapy and is used early in severe disease, although its use is limited by teratogenicity and other side-effects. Availability, adverse effects, and cost, limit the use of photodynamic therapy. New research is needed into the therapeutic comparative effectiveness and safety of the many products available, and to better understand the natural history, subtypes, and triggers of acne. Copyright © 2012 Elsevier Ltd. All rights reserved.

  16. What's new in acne? An analysis of systematic reviews published in 2011-2012.

    PubMed

    Bhate, K; Williams, H C

    2014-04-01

    This review summarizes important clinical developments in acne vulgaris identified from 17 systematic reviews published between February 2011 and August 2012. Regarding causes, Demodex mites have been shown to be associated with both acne vulgaris and rosacea, although it is unclear if their eradication improves either disease. Some weak evidence has emerged that suggests a possible link between dairy produce and acne, which warrants further research. With reference to the effects of acne, there is good evidence that acne negatively affects quality of life, self-esteem and mood in adolescents. Acne is also associated with an increased risk of anxiety, depression and suicidal ideation, highlighting the importance of asking patients with acne directly about psychological issues in order to identify those who might benefit from early psychiatric support. Regarding treatment, there seems to be no additional benefit to using higher strengths of benzoyl peroxide, and lower strengths such as 2.5% have fewer side effects. Despite earlier concerns of increased mortality in those using topical tretinoin for skin cancer prevention, a systematic review on this topic has not found any convincing evidence of a link between such non-cutaneous events and once-daily application of 0.02-0.05% tretinoin. Combined oral contraceptives are of benefit in both inflammatory and non-inflammatory acne. Current surveys suggest that implementation of the pregnancy prevention programme for isotretinoin may not be stringent, and a high level of monitoring and audit is recommended. Ablative and non-ablative laser resurfacing for the treatment of acne scars may be beneficial, but further studies with a longer follow-up period are required.

  17. Food-drug interactions.

    PubMed

    Schmidt, Lars E; Dalhoff, Kim

    2002-01-01

    Interactions between food and drugs may inadvertently reduce or increase the drug effect. The majority of clinically relevant food-drug interactions are caused by food-induced changes in the bioavailability of the drug. Since the bioavailability and clinical effect of most drugs are correlated, the bioavailability is an important pharmacokinetic effect parameter. However, in order to evaluate the clinical relevance of a food-drug interaction, the impact of food intake on the clinical effect of the drug has to be quantified as well. As a result of quality review in healthcare systems, healthcare providers are increasingly required to develop methods for identifying and preventing adverse food-drug interactions. In this review of original literature, we have tried to provide both pharmacokinetic and clinical effect parameters of clinically relevant food-drug interactions. The most important interactions are those associated with a high risk of treatment failure arising from a significantly reduced bioavailability in the fed state. Such interactions are frequently caused by chelation with components in food (as occurs with alendronic acid, clodronic acid, didanosine, etidronic acid, penicillamine and tetracycline) or dairy products (ciprofloxacin and norfloxacin), or by other direct interactions between the drug and certain food components (avitriptan, indinavir, itraconazole solution, levodopa, melphalan, mercaptopurine and perindopril). In addition, the physiological response to food intake, in particular gastric acid secretion, may reduce the bioavailability of certain drugs (ampicillin, azithromycin capsules, didanosine, erythromycin stearate or enteric coated, and isoniazid). For other drugs, concomitant food intake may result in an increase in drug bioavailability either because of a food-induced increase in drug solubility (albendazole, atovaquone, griseofulvin, isotretinoin, lovastatin, mefloquine, saquinavir and tacrolimus) or because of the secretion of

  18. Retinoids--which dermatological indications will benefit in the near future?

    PubMed

    Zouboulis, C C

    2001-01-01

    Retinoids are compounds with pleiotropic functions and a relatively selective targeting of certain skin structures. They are vitamins, because retinol (vitamin A) is not synthesized in the body and must be derived from diet, but also hormones with intracrine activity, because retinol is transformed into molecules that bind to nuclear receptors, exhibit their activity, and are subsequently inactivated. Retinoids exert their effects on target cells by binding and activating nuclear retinoid receptors. Retinoid receptors bind their ligands in form of dimers. Heterodimers can be formed between two different retinoid receptor molecules but also between retinoid X receptors and the vitamin D receptor as well as the triiodothyronin receptor. This fact indicates complex interactions between retinoids and further hormonal signal transduction molecules. Interaction of retinoid receptors with transcriptional factors activated by other signal transduction mechanisms, e.g. AP-1, may provide dissociation of the retinoid effects. Retinoids can exhibit agonistic activity but also be neutral antagonists and inverse agonists. Topical and oral retinol, tretinoin, isotretinoin, and bexarotene, topical alitretinoin, retinaldehyde, motretinide, adapalene, tazarotene, and systemin acitretin compose the list of launched retinoids. Psoriasis and related disorders, congenital disorders of keratinization, acne, photoaging and hypovitaminosis A are classical approved indications of retinoid treatment, whereas cutaneous T-cell lymphoma, AIDS-associated Kaposi's sarcoma, acute promyelocytic leukemia and actinic lentigines were currently confirmed. In addition, retinoids have been successfully used in several other dermatoses, e.g. epithelial precanceroses and tumors, seborrhea, rosacea and acneiform dermatoses, lichen planus, eosinophilic folliculitis, condylomata accuminata, lichen sclerosus and atrophicus. Highly receptor selective molecules, retinoic acid receptor-beta-inducers, AP-1 complex

  19. Effects of topical acne treatment on the ocular surface in patients with acne vulgaris.

    PubMed

    Aslan Bayhan, Seray; Bayhan, Hasan Ali; Çölgeçen, Emine; Gürdal, Canan

    2016-12-01

    To assess the ocular side effects during topical retinoid-antibiotic combination treatment in patients with facial acne vulgaris. Forty-three patients applying topical isotretinoin+erythromycin combination (isotrexin gel, GlaxoSmithKline) once daily for the treatment of acne vulgaris were enrolled. Full ophthalmologic examination, Schirmer test (with topical anesthesia), fluorescein break-up time (BUT), corneal fluorescein staining and tear osmolarity measurement with the TearLab system (TearLab Corporation) were carried out before and at the end of the first month of the treatment. For evaluation of symptoms participants completed the ocular surface disease index (OSDI) questionnaire at each visit. The mean age of the patients was 23.16±3.03 (18-30) years. Mean tear osmolarity increased significantly from 282.09±8.95 mOsm/L at baseline to 300.39±16.65 mOsm/L after the treatment (p<0.001). BUT decreased from an average of 11.93±1.12s at baseline to 6.65±3.03s at the end of the first month (p<0.001). The OSDI score worsened significantly (5.41±3.65 vs 21.53±12.95, p<0.001) and punctate epitheliopathy was seen in 51% of eyes after the treatment. The average Schirmer values were 13.09±1.90 and 12.41±2.44mm/5min before and at the end of the first month of the treatment, respectively (p=0.117). The findings of this study indicate that topical retinoid-antibiotic combination treatment causes significant signs and symptoms of dry eye. Patients receiving topical treatment for acne should be evaluated regularly to ensure the timely detection and treatment of pathologic signs on the ocular surface. Copyright © 2016 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.

  20. Lasers for vascular lesions: standard guidelines of care.

    PubMed

    Srinivas, C R; Kumaresan, M

    2011-01-01

    Lasers are a good therapeutic tool for congenital and acquired vascular lesions. Technological advances in lasers have reduced the adverse effects and increased the efficacy. MACHINES: Among the various lasers used for treating vascular lesions, pulsed dye laser (PDL) has the best efficacy and safety data. The other machines that are widely available are Nd:YAG laser and intense pulse light (IPL). RATIONALE AND SCOPE OF GUIDELINE: Much variation exists in different machines and techniques, and therefore, establishing standard guidelines has limitations. The guidelines recommended here indicate minimum standards of care for lasers on vascular lesions based on current evidence. Laser may be administered by a dermatologist, who has received adequate background training in lasers during post-graduation or later at a center that provides education and training in lasers, or in focused workshops, which provide such trainings. He/she should have adequate knowledge of the lesions being treated, machines, parameters, cooling systems, and aftercare. The procedure may be performed in the physician's minor procedure room with adequate laser safety measures. PWS, hemangioma, facial telangiectasia, rosacea, spider angioma, pyogenic granuloma, venous lakes, leg veins. Absolute: Active local infection, photo-aggravated skin diseases, and medical conditions. Relative: Unstable vitiligo, psoriasis, keloid and keloidal tendencies, patient on isotretinoin, patient who is not cooperative or has unrealistic expectation. Patient selection should be done after detailed counseling with respect to the course of lesions, different treatment options, possible results, cost, need for multiple treatments, and possible postoperative complications. TREATMENT SESSIONS: The number of treatments per lesion varies from 2 to 12 or more at 6-8 week intervals. All lesions may not clear completely even after multiple sessions in many cases. Hence, a realistic expectation and proper counseling is very

  1. [Feminine acne: dermatologic disease or endocrine disease?].

    PubMed

    Vexiau, P; Chivot, M

    2002-01-01

    Acne is a problem of the pilo-sebaceous follicle caused by the conjunction of three factors: seborrhea, follicle obstruction, and follicle inflammation. The key element, seborrhea, is under androgenic control. Acne in women is also influenced by developments and modifications in genital life, as well as by hormonal contraceptive and replacement therapies. Acne is rare prior to puberty, when it may indicate endocrine disease. At puberty, acne is quasi-physiological, because of the relative hyperandrogenism induced by the andrenarche preceding pubarche, as well as by the relative shortage of estrogens and progesterone during the first menstrual cycles. Other signs of hyperandrogenism, such as menstrual cycle difficulties and excess weight, which favor a hormonal origin, must be sought in cases of persistent or late-onset acne in adults. There is a mirror image of puberty during the peri-menopausal period, but with decreased seborrhea, so acne is rare. Finally, a tumoral origin must be sought in the rare cases of acne occurring after menopause. Hormonal investigation of acne should not be systematic, but is justified during prepuberty when other symptoms are associated with acne that resists well-conducted dermatological treatment. The therapeutic approach should be primarily dermatological, but hormone-oriented treatment should be considered when such therapy fails, or in the presence of other signs of hyperandrogenism. Sometimes the association of isotretinoin and an anti-androgen treatment are necessary to effectively treat such acne. Finally, particular attention must be paid to contraceptive therapies and hormone treatments, which can induce or aggravate acne, especially during the peri-menopausal period.

  2. Management of acne vulgaris: an evidence-based update.

    PubMed

    Ingram, J R; Grindlay, D J C; Williams, H C

    2010-06-01

    This review summarizes clinically important findings from 3 systematic reviews, 1 updated guideline and a selection from the 62 randomized controlled trials (RCTs) published between February 2007 and January 2009 on the topic of acne vulgaris. Low glycaemic-load diets might reduce acne severity but this remains unproven. Written patient information leaflets have not been surpassed by other communication methods. New combination topical treatments have not shown convincing advantages over current combination products such as clindamycin/benzoyl peroxide. Topical dapsone is superior to placebo but has yet to be compared with standard topical treatments. Long-term topical tretinoin to prevent nonmelanoma skin cancer in elderly men was associated with higher all-cause mortality, but there is currently no evidence of increased mortality for topical retinoid use when treating acne. All oral tetracyclines have similar efficacy, yet minocycline is the most costly. Oral isotretinoin monotherapy remains the gold-standard treatment for severe acne. Flutamide plus the oral contraceptive pill is beneficial for acne associated with polycystic ovary syndrome. Photodynamic therapy, phototherapy and laser therapy cannot be recommended universally for acne until minimal postinflammatory pigmentation and longer-term benefit can be shown, especially with current high costs. Development of non-antibiotic therapies is preferable to minimize the risk of community antibiotic resistance. Future trials should use active comparators at optimum doses and avoid noninferiority comparisons unless appropriately powered. Trials need to shift from using multiple, unvalidated outcome measures to including patient-reported and quality-of-life outcomes, and all trials should be registered on a public clinical-trials database.

  3. Pruritic porokeratotic peno-scrotal plaques: porokeratosis or porokeratotic epidermal reaction pattern? A report of 10 cases.

    PubMed

    Joshi, Rajiv; Mehta, Sudhanshu G

    2014-01-01

    Porokeratosis restricted to the genital region is rare with few cases described in the literature. Cases of porokeratosis restricted to the genital region are similar to plaque type of porokeratosis of Mibelli seen elsewhere on the body. We encountered 10 young males with pruritic plaques restricted to the peno-scrotal region, which clinically were not diagnosed as porokeratosis, but on biopsy revealed multiple cornoid lamellae, some of which were seen to arise from eccrine and follicular structures. The aim of this study is to study lesions restricted to the peno-scrotal region in males, which on biopsy showed cornoid lamellae suggestive of porokeratosis. Retrospective analysis of available data of patients who were rendered a histological diagnosis of genital porokeratosis. The database consisted of biopsies received in private consultation by the first author in the period January 2000 to March 2013. Ten young men, 8 in their third decade, presented with pruritic plaques restricted to the peno-scrotal region of variable duration. The lesions were well-demarcated on the penis, but ill-defined with a rough granular surface on the scrotum. None of patients were diagnosed clinically as porokeratosis. The lesions were poorly responsive to topical steroid/antifungal treatment, but two patients showed partial improvement with oral isotretinoin. Biopsy in nine patients revealed multiple cornoid lamellae involving epidermis (6) and adnexal structures (3). One patient had a single cornoid lamella. The clinical and histological presentation of these patients is different from typical genital porokeratosis described in the literature and we postulate that these patients have an unusual porokeratotic reaction pattern of the epidermis with multiple cornoid lamellae.

  4. Differential diagnosis of facial acne on black skin.

    PubMed

    Poli, Florence

    2012-11-01

    The diagnosis of acne is usually easy, but there are some pitfalls to be avoided. 'Keloid acne of the neck' and beard folliculitis are not acnes in the usual sense: both are inflammatory and fibrous reactions of the hair follicles and frizzy hair; no retentional lesions, blackheads and microcysts--are visible. Gram negative folliculitis classically occurs in acneic male subjects who have undergone extensive treatment with general antibiotics or local antiseptics, but 'de novo' cases do exist. On black skin, this condition is not exceptional, it occurs in both sexes and usually takes the nodular form. The diagnosis should be considered if there is any aggravation of acne which is resistant to classic treatment, with painful nodules on the cheeks. Treatment is based on appropriate antibiotherapy for several weeks and possibly, in a second phase, on Isotretinoin. Pityrosporum folliculitis occurs mainly on the trunk. More frequent in men than in women, it is chiefly observed in subjects living in a hot, humid climate. Demodicidosis is manifested by outbreaks of papular or papulopustular lesions of the face. On black skin the principal differential diagnosis is acne. The presence of numerous parasites is necessary for diagnosis. Clinically speaking, an important sign is when the eyelids are affected. Ivermectin is effective. Acneiform dermatitis may be induced by depigmenting preparations containing powerful dermocorticoids. It is therefore important, in cases of very inflammatory acne, to look for the other clinical signs of voluntary depigmentation. In countries where it is endemic, lepromatous leprosy should be considered. Other common dermatitis may simulate acne or else be associated with it, such as eruptive hidradenoma or molluscum contagiosum. Analysis of the different elementary lesions and the absence of retentional lesions generally enable a diagnosis to be established.

  5. Drug-induced Depression: a Case/Non Case Study in the French Pharmacovigilance Database.

    PubMed

    Lafay-Chebassier, Claire; Chavant, François; Favrelière, Sylvie; Pizzoglio, Véronique; Pérault-Pochat, Marie-Christine

    2015-01-01

    Depression is a complex disorder with heterogeneous clinical anomalies whose neurobiological understanding still remains unclear. Medications have been implicated as potential causes of depression but for many of them, data are controversial. The present study aims to investigate association bet ween drugs and reports of depression. We used the case/non case method in the French pharmacovigilance database (FPVD) to identify drugs associated with depression. Cases were reports of depression in the FPVD between January 2007 and December 2011. Non cases were all other reports during the same period. Data were expressed as reporting odds ratio (ROR) with their 95% confidence interval. Of the 114,692 reports recorded in the FPVD during the studied period, we identified 474 cases of depression. For the majority of the patients, they were considered as "non serious" (56%) and evolution was favorable (64%). Significant RORs were found for antiepileptics (topiramate, levetiracetam), anti-infective and especially anti-retroviral drugs (efavirenz, emtricitabine, tenofovir, etravirine, raltegravir), interferons and other agents including isotretinoin, methylphenidate, sodium oxybate, varenicline, montelukast, flunarizine, adalimumab, anastrozole. Taking into account the limits of the methodology, the present study described associations with mainly expected drugs belonging to various therapeutic classes but it also found a signal with some anti-retrovirals. On the contrary, we did not find some assumed associations like cardiovascular medications, antimalarial. For most of the drugs, one or more mechanisms were found to explain these depressogenic effects on the basis of animal and human literature. Even if such associations need to be confirmed by further prospective studies, cautions are necessary for many drugs to early detect depressive symptoms.

  6. Interventions for rosacea.

    PubMed

    van Zuuren, Esther J; Fedorowicz, Zbys; Carter, Ben; van der Linden, Mireille M D; Charland, Lyn

    2015-04-28

    Rosacea is a common chronic skin condition affecting the face, characterised by flushing, redness, pimples, pustules and dilated blood vessels. The eyes are often involved and thickening of the skin with enlargement (phymas), especially of the nose, can occur in some people. A range of treatment options are available but it is unclear which are most effective. To assess the efficacy and safety of treatments for rosacea. We updated our searches, to July 2014, of: the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library (2014, Issue 6), MEDLINE (from 1946), EMBASE (from 1974) and Science Citation Index (from 1988). We searched five trials registers and checked reference lists for further relevant studies. Randomised controlled trials in people with moderate to severe rosacea. Study selection, data extraction, risk of bias assessment and analyses were carried out independently by two authors. We included 106 studies, comprising 13,631 participants. Sample sizes of 30-100 and study duration of two to three months were most common. More women than men were included, mean age of 48.6 years, and the majority had papulopustular rosacea, followed by erythematotelangiectatic rosacea.A wide range of comparisons (67) were evaluated. Topical interventions: metronidazole, azelaic acid, ivermectin, brimonidine or other topical treatments. Systemic interventions: oral antibiotics, combinations with topical treatments or other systemic treatments, i.e. isotretinoin. Several studies evaluated laser or light-based treatment.The majority of studies (57/106) were assessed as 'unclear risk of bias', 37 'high risk ' and 12 'low risk'. Twenty-two studies provided no usable or retrievable data i.e. none of our outcomes were addressed, no separate data reported for rosacea or limited data in abstracts.Eleven studies assessed our primary outcome 'change in quality of life', 52 studies participant-assessed changes in rosacea severity and almost all studies addressed

  7. Topical aminolaevulinic acid-photodynamic therapy for the treatment of acne vulgaris: a study of clinical efficacy and mechanism of action.

    PubMed

    Pollock, B; Turner, D; Stringer, M R; Bojar, R A; Goulden, V; Stables, G I; Cunliffe, W J

    2004-09-01

    Acne affects 83-95% of 16-year-olds of both sexes, and many seek help from a clinician. Emerging problems with conventional acne treatments, specifically antibiotic resistance of Propionibacterium acnes and fears over the safety and tolerance of oral isotretinoin, create a demand for novel treatment modalities in acne. To study the efficacy of aminolaevulinic acid-photodynamic therapy (ALA-PDT) in the treatment of acne and to identify the mode of action, looking specifically at the effects on surface numbers of P. acnes and on sebum excretion. Ten patients (nine men and one woman, age range 16-40 years) with mild to moderate acne on their backs were recruited. Each patient's back was marked with four 30-cm2 areas of equal acne severity. Each site was then randomly allocated to either ALA-PDT treatment, light alone, ALA alone or an untreated control site. At baseline, numbers of inflammatory and noninflammatory acne lesions were counted, sebum excretion measured by Sebutapes (CuDerm, Dallas, TX, U.S.A.) and surface P. acnes swabs performed. ALA cream (20% in Unguentum Merck) was applied under occlusion to the ALA-PDT and ALA alone sites for 3 h. Red light from a diode laser was then delivered to the ALA-PDT and light alone sites (635 nm, 25 mW cm(-2), 15 J cm(-2)). Each patient was treated weekly for 3 weeks. At each visit acne lesion counts were performed and 3 weeks following the last treatment sebum excretion rates and P. acnes swabs were repeated. There was a statistically significant reduction in inflammatory acne lesion counts from baseline after the second treatment at the ALA-PDT site but not at any of the other sites. No statistically significant reduction in P. acnes numbers or sebum excretion was demonstrated at any sites including the ALA-PDT site. ALA-PDT is capable of clinically improving acne. An alternative mode of action for ALA-PDT other than direct damage to sebaceous glands or photodynamic killing of P. acnes is suggested from the results of this

  8. Pityriasis rubra pilaris in a HIV-positive patient (Type 6 PRP).

    PubMed

    De, Dipankar; Dogra, Sunil; Narang, Tarun; Radotra, Bishan Dass; Kanwar, Amrinder Jit

    2008-01-01

    different kits was found to be positive for HIV-1. The patient denied any risk factors associated with acquiring HIV infection, and laboratory values for complete blood cell count, routine serum biochemical profile, and lipid profile were normal. The patient was prescribed oral isotretinoin and asked to come for follow-up for CD4 T-cell count, but did not return.

  9. Prolonged Inner Retinal Photoreception Depends on the Visual Retinoid Cycle

    PubMed Central

    Zhao, Xiwu; Pack, Weston; Khan, Naheed W.

    2016-01-01

    In addition to rods and cones, mammals have inner retinal photoreceptors called intrinsically photosensitive retinal ganglion cells (ipRGCs), which use the photopigment melanopsin and mediate nonimage-forming visual responses, such as pupil reflexes and circadian entrainment. After photic activation, photopigments must be reverted to their dark state to be light-sensitive again. For rods and to some extent cones, photopigment regeneration depends on the retinoid cycle in the adjacent retinal pigment epithelium (RPE). By contrast, ipRGCs are far from the RPE, and previous work suggests that melanopsin is capable of light-dependent self-regeneration. Here, we used in vitro ipRGC recording and in vivo pupillometry to show that the RPE is required for normal melanopsin-based responses to prolonged light, especially at high stimulus intensities. Melanopsin-based photoresponses of rat ipRGCs were remarkably sustained when a functional RPE was attached to the retina, but became far more transient if the RPE was removed, or if the retinoid cycle was inhibited, or when Müller glia were poisoned. Similarly, retinoid cycle inhibition markedly reduced the steady-state amplitude of melanopsin-driven pupil reflexes in both mice and rats. However, melanopsin photoresponses in RPE-separated rat retinas became more sustained in the presence of an 11-cis-retinal analog. In conclusion, during prolonged illumination, melanopsin regeneration depends partly on 11-cis-retinal from the RPE, possibly imported via Müller cells. Implications for RPE-related eye diseases and the acne drug isotretinoin (a retinoid cycle inhibitor) are discussed. SIGNIFICANCE STATEMENT Intrinsically photosensitive retinal ganglion cells (ipRGCs) contain the photopigment melanopsin and drive subconscious physiological responses to light, e.g., pupillary constriction and neuroendocrine regulation. In darkness, each photopigment molecule in ipRGCs, as well as rod/cone photoreceptors, contains 11-cis-retinal (a

  10. Post-surgical treatment of thyroid carcinoma in dogs with retinoic acid 9 cis improves patient outcome

    PubMed Central

    Castillo, V.; Pessina, P.; Hall, P.; Blatter, M.F. Cabrera; Miceli, D.; Arias, E. Soler; Vidal, P.

    2016-01-01

    The objective of the present study was to compare the effects of isotretinoin 9-cis (RA9-cis) as a post-surgery treatment of thyroid carcinoma to a traditional treatment (doxorubicin) and no treatment. Owners who did not want their dogs to receive treatment were placed into the control group A (GA; n=10). The remaining dogs were randomly placed into either group B (GB; n=12) and received doxorubicin at a dose of 30 mg/m2 every three weeks, for six complete cycles or group C (GC; n=15) and treated with RA9-cis at a dose of 2 mg/kg/day for 6 months. The time of the recurrence was significantly shorter in the GA and GB compared to GC (P=0.0007; P=0.0015 respectively), while we did not detect differences between GA and GB. The hazard ratio of recurrence between GA and GB compared to GC were 7.25 and 5.60 times shorter, respectively. We did not detect any differences between the other groups. The risk ratio of recurrence was 2.0 times higher in GA compared to GC and 2.1 times higher in GB compared to GC. The type of carcinoma had an effect on time of survival with follicular carcinomas having an increased mean survival time than follicular-compact carcinomas (P<0.0001) and follicular-compact carcinomas had a longer mean survival time than compact carcinomas. The interaction among treatment and type was significant, but survival time in follicular carcinomas did not differ between treatments. In follicular-compact carcinomas the survival time of GC was greater than GB (P<0.05), but we did not detect a difference between GA and GB. In conclusion, this study shows that the use of surgery in combination with RA9-cis treatment significantly increases survival rate and decreases the time to tumor recurrence when compared to doxorubicin treated or untreated dogs. The histological type of carcinoma interacted with treatment for time to recurrence and survival time, with more undifferentiated carcinomas having a worse prognosis than differentiated carcinomas. PMID:26862515

  11. Refractory Hailey-Hailey disease successfully treated with sandpaper dermabrasion.

    PubMed

    LeBlanc, Keith G; Wharton, Joshua B; Sheehan, Daniel J

    2011-01-01

    A 53-year-old woman presented with a 20-year history of pruritic dermatitis on the groin, axillae, inframammary folds, posterior aspect of the neck, and popliteal fossae. She was referred to our clinic by an outside facility after results from a punch biopsy diagnosed Hailey-Hailey disease (HHD). The patient had previously attempted treatment with many traditional noninvasive options with no success. Topical treatment modalities included corticosteroids, immunomodulators, antifungals, retinoids, and antibiotic preparations. Intralesional corticosteroids, as well as botulinum toxin and carbon dioxide laser, were also unsuccessful. Failed systemic treatment modalities included antibiotics, antihistamines, prednisone, azathioprine, mycophenolate mofetil, acitretin, isotretinoin, adalimumab, and etanercept. Of note, cyclosporine was successful in clearing the cutaneous involvement in our patient, but elevation ofcreatinine and exacerbated hypertension precluded continued use. The decision was made to treat the patient by dermabrasion with sandpaper. The patient was prepped in a sterile fashion, and a field block with 1% lidocaine with epinephrine was performed. This was followed by abrasion down to the superficial dermis with 3M Sandblaster fine sandpaper (3M, St. Paul, MN) and hyfrecation between rounds ofdermabrasion. The treated areas were then covered with petrolatum and sterile gauze, and antibiotics and pain medication were prescribed. This treatment was initially performed on the patient's posterior aspect of the neck and later to the bilateral popliteal fossae and axillae. Three months post-treatment, desirable functional and cosmetic results of the treated areas had been achieved (Figure 1 and Figure 2). While no recurrence of clinically active HHD has been seen in the dermabraded areas of the neck and popliteal fossae, the patient continues to have active disease in the axillae despite sandpaper dermabrasion. To quantify our results, we performed two biopsies

  12. A case of a patient with stage III familial hidradenitis suppurativa treated with 3 courses of infliximab and died of metastatic squamous cell carcinoma.

    PubMed

    Scheinfeld, Noah

    2014-03-17

    had also taken isotretinoin years before without substantial long-term benefit. The various treatments were palliative but the HS always returned. He expressed that the pain from his HS was not bearable. He decided in consultations with his doctors to try infliximab owing to the positive clinical data for its efficacy in HS. He took 3 courses of infliximab 500mg, each of which was followed by surgical debridement of the perineal and anal areas. At the 3rd surgical debridement his physician noted the presence of squamous cell carcinoma (SCC) on July 28, 2008. The infliximab was stopped. However, the patient developed the patient underwent scanning soon after that showed soon after that the SCC had metastasized. He expired in June of 2009.

  13. [Teledermatology in a prison setting: A retrospective study of 500 expert opinions].

    PubMed

    Khatibi, B; Bambe, A; Chantalat, C; Resche-Rigon, M; Sanna, A; Fac, C; Bagot, M; Guibal, F

    2016-01-01

    Fresnes prison is one of the largest penitentiary centres in France (around 2300 inmates). Since dermatological consultations are not possible on site, a teledermatology agreement was signed in 2008 between the Kremlin-Bicêtre hospital, used by the Fresnes consultation unit and outpatient care (UCSA) and the Saint-Louis hospital for remote dermatological expertise. We report the results of the last 3 years of teledermatology activity in this prison. All teledermatology consultations from September 2010 to September 2013 were analysed. The teledermatological consultations requested by UCSA doctors included photos of lesions, patient history and disease history. Applications were sent by e-mail via the secure AP-HP (Paris Hospitals) intranet. In all instances, patients had consented to being photographed and these photos were transmitted for remote expertise. The answers were given in a maximum period of 5 working days. The following data were studied: sex, age, phototype, medical history, diagnoses, assessments requested and treatment received. Five hundred teledermatological consultations were analysed. Among the patients, 94.1% were male with a mean age of 34 years. Phototypes IV and VI constituted the majority, with respective percentages of 30.6% and 28.6%. The dermatoses diagnosed were for the most part mild and varied: cutaneous infections (20.2%), monitoring of nevi (11.5%), genital warts (10%), eczema (8.5%), acne (8.1%) and psoriasis (4.2%). Two cases (basal cell carcinoma and lupus) required ablation. Systemic treatments such as methotrexate and isotretinoin were initiated and monitored remotely. The most frequently observed diagnoses were not significantly different from those observed in the general population with comparable characteristics. The high phototype of patients requires extensive experience of the dermatology of black skin. Teledermatology is also important in monitoring nevi among prisoners. The low incidence of scabies is due to its

  14. Zileuton, a new efficient and safe systemic anti-acne drug

    PubMed Central

    2009-01-01

    Zileuton over 2weeks and—after a wash-out phase—low-dose isotretinoin (10 mg/2nd d) over 5 weeks. These data are in agreement with a phase II multicenter, clinical study in 101 patients with mild to moderate inflammatory facial acne conducted in the US, which showed a significant efficacy of Zileuton in a subset of patients with moderate acne, whereas those patients treated with Zileuton showed a significant mean decrease in inflammatory lesions compared to the placebo group. In all clinical studies, Zileuton was found to be safe and well tolerated. PMID:20436887

  15. Severe teenage acne and risk of endometriosis

    PubMed Central

    Xie, Jing; Kvaskoff, Marina; Li, Yunhui; Zhang, Mingfeng; Qureshi, Abrar A.; Missmer, Stacey A.; Han, Jiali

    2014-01-01

    STUDY QUESTION Is there a relationship between severe teenage acne and endometriosis? SUMMARY ANSWER Endometriosis is positively associated with severe teenage acne. WHAT IS KNOWN ALREADY No studies have specifically explored a possible association between severe acne in adolescence and risk of endometriosis. STUDY DESIGN, SIZE, DURATION This prospective cohort study used data collected from 88 623 female nurses from September 1989 to June 2009 as part of the Nurses' Health Study II (NHS II) cohort. PARTICIPANTS/MATERIALS, SETTING, METHODS Regression models were used to calculate hazard ratios (HRs) and confidence intervals (CIs) for endometriosis among women with and without severe teenage acne. Multivariate models were adjusted for established risk factors of endometriosis. MAIN RESULTS AND THE ROLE OF CHANCE A total of 4 382 laparoscopically confirmed endometriosis cases were documented during 1 132 272 woman-years of follow-up. Compared with women without a history of severe teenage acne, women who had severe teenage acne had a 20% increased risk of endometriosis (HR = 1.20, 95% CI: 1.08–1.32). The association was not affected by adjusting for use of tetracycline or isotretinoin. LIMITATIONS AND REASONS FOR CAUTION The HR is likely to be underestimated since we only included endometriosis cases confirmed by laparoscopy. Although geographically diverse, the NHS II cohort is primarily Caucasian, which may limit generalization to more ethnically diverse populations. WIDER IMPLICATIONS OF THE STUDY The results of this study suggest that severe teenage acne is associated with an increased risk of endometriosis. As a visible and non-invasive clinical indicator, severe teenage acne may be useful for early detection of endometriosis. We bring this counter-intuitive association to the attention of clinicians for the benefit of the patient and an early diagnosis of endometriosis. STUDY FUNDING/COMPETING INTEREST This study was funded by research grant CA176726 from the

  16. Prolonged Inner Retinal Photoreception Depends on the Visual Retinoid Cycle.

    PubMed

    Zhao, Xiwu; Pack, Weston; Khan, Naheed W; Wong, Kwoon Y

    2016-04-13

    In addition to rods and cones, mammals have inner retinal photoreceptors called intrinsically photosensitive retinal ganglion cells (ipRGCs), which use the photopigment melanopsin and mediate nonimage-forming visual responses, such as pupil reflexes and circadian entrainment. After photic activation, photopigments must be reverted to their dark state to be light-sensitive again. For rods and to some extent cones, photopigment regeneration depends on the retinoid cycle in the adjacent retinal pigment epithelium (RPE). By contrast, ipRGCs are far from the RPE, and previous work suggests that melanopsin is capable of light-dependent self-regeneration. Here, we used in vitro ipRGC recording and in vivo pupillometry to show that the RPE is required for normal melanopsin-based responses to prolonged light, especially at high stimulus intensities. Melanopsin-based photoresponses of rat ipRGCs were remarkably sustained when a functional RPE was attached to the retina, but became far more transient if the RPE was removed, or if the retinoid cycle was inhibited, or when Müller glia were poisoned. Similarly, retinoid cycle inhibition markedly reduced the steady-state amplitude of melanopsin-driven pupil reflexes in both mice and rats. However, melanopsin photoresponses in RPE-separated rat retinas became more sustained in the presence of an 11-cis-retinal analog. In conclusion, during prolonged illumination, melanopsin regeneration depends partly on 11-cis-retinal from the RPE, possibly imported via Müller cells. Implications for RPE-related eye diseases and the acne drug isotretinoin (a retinoid cycle inhibitor) are discussed. Intrinsically photosensitive retinal ganglion cells (ipRGCs) contain the photopigment melanopsin and drive subconscious physiological responses to light, e.g., pupillary constriction and neuroendocrine regulation. In darkness, each photopigment molecule in ipRGCs, as well as rod/cone photoreceptors, contains 11-cis-retinal (a vitamin A derivative

  17. Chronic cutaneous lupus erythematosus presenting as atypical acneiform and comedonal plaque: case report and literature review.

    PubMed

    Vieira, M L; Marques, E R M C; Leda, Y L A; Noriega, L F; Bet, D L; Pereira, G A A M

    2017-01-01

    Introduction Chronic cutaneous lupus erythematosus (CCLE) usually presents as characteristic erythematous patches and infiltrated coin-shaped plaques. However, there are some atypical clinical variants that may mimic other dermatological conditions. Haroon et al. reported in 1972 an unusual presentation of CCLE with hypertrophic follicular scars seen in acne vulgaris. Acneiform presentation is one of the most rarely reported and one of the most confusing, as it resembles a very common inflammatory skin disease. A brief review of the literature using PubMed found only nine other reports. Case report A 32-year-old woman presented with two-year pruritic infiltrated acneiform and comedonal eruption on the right chin treated as acne with isotretinoin without improvement. On examination the patient presented with erythematous-infiltrated plaque, papules, open comedones, pitting scars and hypopigmented atrophic scars on the right chin area and scalp hair loss. An incisional skin biopsy on the chin and scalp lesions was performed and the anatomopathological and immunofluorescence exam showed findings that are consistent with CCLE. Additional tests ruled out systemic involvement. The patient was treated with prednisone and chloroquine diphosphate with great improvement. After four years the lesion is stable, with some scarring. Discussion In a literature review we found nine other cases of acneiform presentation of lupus erythematosus: Three cases were systemic lupus erythematosus (SLE) and seven others were diagnosed as CCLE (including our patient). All three patients who had SLE tested positive for antinuclear antibodies (ANA), and only one patient with CCLE, had a low titer of positive ANA (1:80). Ages varied from 24 to 60 years old, with a median of 32 years old, the same as our patient's age and consistent with the literature. Seven were females and three were males, with a ratio of 2.3:1. Most cases, such as our patient, showed acneiform lesions mainly on the face, a

  18. Post-surgical treatment of thyroid carcinoma in dogs with retinoic acid 9 cis improves patient outcome.

    PubMed

    Castillo, V; Pessina, P; Hall, P; Blatter, M F Cabrera; Miceli, D; Arias, E Soler; Vidal, P

    2016-01-01

    The objective of the present study was to compare the effects of isotretinoin 9-cis (RA9-cis) as a post-surgery treatment of thyroid carcinoma to a traditional treatment (doxorubicin) and no treatment. Owners who did not want their dogs to receive treatment were placed into the control group A (GA; n=10). The remaining dogs were randomly placed into either group B (GB; n=12) and received doxorubicin at a dose of 30 mg/m(2) every three weeks, for six complete cycles or group C (GC; n=15) and treated with RA9-cis at a dose of 2 mg/kg/day for 6 months. The time of the recurrence was significantly shorter in the GA and GB compared to GC (P=0.0007; P=0.0015 respectively), while we did not detect differences between GA and GB. The hazard ratio of recurrence between GA and GB compared to GC were 7.25 and 5.60 times shorter, respectively. We did not detect any differences between the other groups. The risk ratio of recurrence was 2.0 times higher in GA compared to GC and 2.1 times higher in GB compared to GC. The type of carcinoma had an effect on time of survival with follicular carcinomas having an increased mean survival time than follicular-compact carcinomas (P<0.0001) and follicular-compact carcinomas had a longer mean survival time than compact carcinomas. The interaction among treatment and type was significant, but survival time in follicular carcinomas did not differ between treatments. In follicular-compact carcinomas the survival time of GC was greater than GB (P<0.05), but we did not detect a difference between GA and GB. In conclusion, this study shows that the use of surgery in combination with RA9-cis treatment significantly increases survival rate and decreases the time to tumor recurrence when compared to doxorubicin treated or untreated dogs. The histological type of carcinoma interacted with treatment for time to recurrence and survival time, with more undifferentiated carcinomas having a worse prognosis than differentiated carcinomas.

  19. Cardiovascular pharmacogenetics in the SNP era.

    PubMed

    Mooser, V; Waterworth, D M; Isenhour, T; Middleton, L

    2003-07-01

    In the past pharmacological agents have contributed to a significant reduction in age-adjusted incidence of cardiovascular events. However, not all patients treated with these agents respond favorably, and some individuals may develop side-effects. With aging of the population and the growing prevalence of cardiovascular risk factors worldwide, it is expected that the demand for cardiovascular drugs will increase in the future. Accordingly, there is a growing need to identify the 'good' responders as well as the persons at risk for developing adverse events. Evidence is accumulating to indicate that responses to drugs are at least partly under genetic control. As such, pharmacogenetics - the study of variability in drug responses attributed to hereditary factors in different populations - may significantly assist in providing answers toward meeting this challenge. Pharmacogenetics mostly relies on associations between a specific genetic marker like single nucleotide polymorphisms (SNPs), either alone or arranged in a specific linear order on a certain chromosomal region (haplotypes), and a particular response to drugs. Numerous associations have been reported between selected genotypes and specific responses to cardiovascular drugs. Recently, for instance, associations have been reported between specific alleles of the apoE gene and the lipid-lowering response to statins, or the lipid-elevating effect of isotretinoin. Thus far, these types of studies have been mostly limited to a priori selected candidate genes due to restricted genotyping and analytical capacities. Thanks to the large number of SNPs now available in the public domain through the SNP Consortium and the newly developed technologies (high throughput genotyping, bioinformatics software), it is now possible to interrogate more than 200,000 SNPs distributed over the entire human genome. One pharmacogenetic study using this approach has been launched by GlaxoSmithKline to identify the approximately 4% of

  20. Zolav(®) (a p-carboethoxy-tristyrylbenzene derivative) [corrected]: a new antibiotic for the treatment of acne.

    PubMed

    Dinant, Alexa; Boulos, Ramiz A

    2016-01-01

    Acne is a prominent skin condition affecting >80% of teenagers and young adults and ~650 million people globally. Isotretinoin, a vitamin A derivative, is currently the standard of care for treatment. However, it has a well-established teratogenic activity, a reason for the development of novel and low-risk treatment options for acne. To investigate the effectiveness of Zolav(®), (a p-carboethoxy-tristyrylbenzene derivative) [corrected] a novel antibiotic as a treatment for acne vulgaris. Minimum inhibitory concentration of Zolav(®) (a p-carboethoxy-tristyrylbenzene derivative) against Propionibacterium acnes was determined by following a standard protocol using Mueller-Hinton broth and serial dilutions in a 96-well plate. Cytotoxicity effects on human umbilical vein endothelial cells and lung cells in the presence of Zolav(®) (a p-carboethoxy-tristyrylbenzene derivative) were investigated by determining the growth inhibition (GI50) concentration, total growth inhibition concentration, and the lethal concentration of 50% (LC50). The tryptophan auxotrophic mutant of Escherichia coli strain, WP2 uvrA (ATCC 49979), was used for the AMES assay with the addition of Zolav(®) (a p-carboethoxy-tristyrylbenzene derivative) tested for its ability to reverse the mutation and induce bacterial growth. The in vivo effectiveness of Zolav(®) (a p-carboethoxy-tristyrylbenzene derivative) was tested in a P. acnes mouse intradermal model where the skin at the infection site was removed, homogenized, and subjected to colony-forming unit (CFU) counts. Susceptibility testing of Zolav(®) (a p-carboethoxy-tristyrylbenzene derivative) against P. acnes showed a minimum inhibitory concentration of 2 µg/mL against three strains with no cytotoxicity and no mutagenicity observed at the highest concentrations tested, 30 µM and 1,500 µg/plate, respectively. The use of Zolav(®) (a p-carboethoxy-tristyrylbenzene derivative) at a concentration of 50 µg/mL (q8h) elicited a two

  1. Systemic medications used in treatment of common dermatological conditions: Safety profile with respect to pregnancy, breast feeding and content in seminal fluid.

    PubMed

    Brown, S M; Aljefri, K A; Waas, R; Hampton, P J

    2017-01-16

    the relevant section. Methotrexate is completely contraindicated in male patients actively trying for children and needs to be suspended for at least 3 months prior to contraception. The following medications are felt to be low risk: biologics, ciclopsorin and retinoids, there are some concerns however regarding isotretinoin use in males when their female partner is already pregnant and recent advice recommends contraception. There is insufficient information regarding the use of mycophenolate, fumaric acid esters, azathioprine, hydroxychloroquine, dapsone and ustekinumab in order to consider their safety profile.

  2. Targeted immunotherapy for high-risk neuroblastoma--the role of monoclonal antibodies.

    PubMed

    Parsons, Kerry; Bernhardt, Brooke; Strickland, Brandy

    2013-02-01

    To systematically review clinical trials evaluating anti-disialoganglioside (GD2) antibodies in treating high-risk neuroblastoma in children. A literature search was conducted in PubMed/MEDLINE, International Pharmaceutical Abstracts, and Cumulative Index of Nursing and Allied Health Literature (all searches 1990-August 2012) using the terms neuroblastoma, immunotherapy, 3F8, ch14.18, and hu14.18. Meeting abstracts presented between 1990 and 2012 from the American Society of Clinical Oncology, European Society for Medical Oncology, the American Society of Pediatric Hematology Oncology, Society of Surgical Oncology, and the American Society of Hematology were also evaluated. All completed and ongoing clinical trials of anti-GD2 antibodies in neuroblastoma were included. References from selected articles were also reviewed to identify additional citations. In 1999, the results of a Children's Cancer Group trial established that consolidation therapy after induction, surgery, and radiation should include purged autologous stem cell rescue followed by maintenance with isotretinoin. Overall survival at 7 years with this regimen remains below 30%. Over the following decade, antibodies targeting GD2, a surface antigen found on the surface of neuroblastoma cells, have emerged as a major therapeutic development for high-risk neuroblastoma. Anti-GD2 antibodies incite immune-mediated cytotoxicity toward neuroblastoma cells when given as monotherapy or in combination with cytokines such as sargramostim (granulocyte-macrophage colony-stimulating factor) or aldesleukin (interleukin-2). Responses to anti-GD2 agents appear most notable in patients with minimal residual disease following standard therapy. A chimeric preparation, ch14.18, is the only anti-GD2 antibody to be evaluated in a large controlled clinical trial, in which it demonstrated overall survival of 86% at 2 years in patients with high-risk neuroblastoma. Older nonrandomized studies of ch14.18 monotherapy and 3F8, a

  3. Severe teenage acne and risk of endometriosis.

    PubMed

    Xie, Jing; Kvaskoff, Marina; Li, Yunhui; Zhang, Mingfeng; Qureshi, Abrar A; Missmer, Stacey A; Han, Jiali

    2014-11-01

    Is there a relationship between severe teenage acne and endometriosis? Endometriosis is positively associated with severe teenage acne. No studies have specifically explored a possible association between severe acne in adolescence and risk of endometriosis. This prospective cohort study used data collected from 88 623 female nurses from September 1989 to June 2009 as part of the Nurses' Health Study II (NHS II) cohort. Regression models were used to calculate hazard ratios (HRs) and confidence intervals (CIs) for endometriosis among women with and without severe teenage acne. Multivariate models were adjusted for established risk factors of endometriosis. A total of 4 382 laparoscopically confirmed endometriosis cases were documented during 1 132 272 woman-years of follow-up. Compared with women without a history of severe teenage acne, women who had severe teenage acne had a 20% increased risk of endometriosis (HR = 1.20, 95% CI: 1.08-1.32). The association was not affected by adjusting for use of tetracycline or isotretinoin. The HR is likely to be underestimated since we only included endometriosis cases confirmed by laparoscopy. Although geographically diverse, the NHS II cohort is primarily Caucasian, which may limit generalization to more ethnically diverse populations. The results of this study suggest that severe teenage acne is associated with an increased risk of endometriosis. As a visible and non-invasive clinical indicator, severe teenage acne may be useful for early detection of endometriosis. We bring this counter-intuitive association to the attention of clinicians for the benefit of the patient and an early diagnosis of endometriosis. This study was funded by research grant CA176726 from the National Institute of Health. M.K. is supported by a Marie Curie International Outgoing Fellowship within the 7th European Community Framework Programme (#PIOF-GA-2011-302078). The funding agencies had no role in the design of the study, in the analysis and

  4. Minocycline for acne vulgaris: efficacy and safety.

    PubMed

    Garner, S E; Eady, E A; Popescu, C; Newton, J; Li Wan Po, A

    2000-01-01

    ), oxytetracycline (1), tetracycline (6), doxycycline (7), lymecycline (2), topical clindamycin (3), topical erythromycin/zinc (1), cyproterone acetate/ ethinyloestradiol (1), oral isotretinoin (2), topical fusidic acid (1) and there was one dose response study. One study is ongoing and it remains to be clarified whether one further study is a RCT. Major outcome measures used in the trials included lesion counts, acne grades/severity scores, doctors' and patients' global assessments, adverse drug reactions and drop out rates. The quality of each study was assessed independently by two assessors and an effect size calculated where possible. The trials were generally small and of poor quality and in many cases the published reports were inadequate for our purpose. Pooling of the studies was not attempted due to the lack of common outcome measures and endpoints and the unavailability of some primary data. Although minocycline was shown to be an effective treatment for acne vulgaris, in only two studies was it found to be superior to other tetracyclines. Both of these were conducted under open conditions and had serious methodological problems. A third study showed it to be more effective than 2% fusidic acid, applied topically, against inflammatory lesions in mild to moderate acne. Differences in the way adverse drug reactions were identified could have accounted for the wide variation between studies in numbers of events reported. This meant that no overall evaluation could be made of incidence rates of adverse events associated with minocycline therapy. No RCT evidence was found to support the benefits of minocycline in acne resistant to other therapies and the dose response has only been evaluated up to eight weeks of therapy. (ABSTRACT TRUNCATED)

  5. Mobile phone-based interventions for improving contraception use.

    PubMed

    Smith, Chris; Gold, Judy; Ngo, Thoai D; Sumpter, Colin; Free, Caroline

    2015-06-26

    both users and non-users of contraception. No trials were at low risk of bias in all areas assessed.One trial in the USA reported improved self reported oral contraceptive (OC) continuation at six months from an intervention comprising a range of uni-directional and interactive text messages (RR 1.19, 95% CI 1.05 to 1.35). One trial in Cambodia reported increased self reported use of effective contraception at four months post abortion from an intervention comprising automated interactive voice messages and phone counsellor support (RR 1.39, 95% CI 1.17 to 1.66).One feasibility trial in the USA reported a lower mean number of days between scheduled and completed attendance for the first but not subsequent Depo-Provera appointments using clinic records from an intervention comprising reminders and healthy self management text messages (mean difference (MD) -8.60 days, 95% CI -16.74 to -0.46). Simple text message OC reminders had no effect on missed pills as assessed by electronic medication monitoring in a small trial in the USA (MD 0.5 missed pills, 95% CI -1.08 to 2.08). No effect on self reported contraception use was noted amongst isotretinoin users from an intervention that provided health information via two uni-directional text messages and mail (RR 1.26, 95% CI 0.84 to 1.89). One trial assessed potential adverse effects of the intervention and reported no evidence of road traffic accidents or domestic abuse. Our review provides limited evidence that interventions delivered by mobile phone can improve contraception use. Whilst evidence suggests that a series of interactive voice messages and counsellor support can improve post-abortion contraception, and that a mixture of uni-directional and interactive daily educational text messages can improve OC adherence, the cost-effectiveness and long-term effects of these interventions remain unknown. Further high-quality trials are required to robustly establish the effects of interventions delivered by mobile phone to

  6. Gestational Pityriasis Rosea: Suggestions for Approaching Affected Pregnant Women.

    PubMed

    Monastirli, Alexandra; Pasmatzi, Efstathia; Badavanis, George; Tsambaos, Dionysios

    2016-12-01

    pityriasis rosea, for intrauterine fetal death. All miscarrying women reportedly revealed an aggressive course of widespread eruption and severe constitutional symptoms; all of them had HHV-6 DNA in the plasma, placenta, skin lesions, and fetal tissues, whereas HHV-7 DNA was detected in the plasma and skin lesions in 3 out of 8 (37.5%) miscarrying women. HHV-6 DNA was found only in the plasma of 2 out of 31 women (6.45%) with normal pregnancy, whereas HHV-7 DNA was detected in the plasma of 3 (9.45%) and in the skin lesions of 2 women (6.45%) with normal pregnancy. The total abortion rate in women who developed pityriasis rosea during their pregnancy (13%) does not differ from that observed in the general population. Nevertheless, it is markedly higher in cases affected during the first 15 gestational weeks (57%) (4,5). Surprisingly, this devastating impact of pityriasis rosea on the outcome of pregnancy is almost completely unknown not only to the public but also to many members of the medical community. It is also largely unknown that, particularly during the first 15 gestational weeks, all pregnant women should avoid any contact with patients known to have pityriasis rosea. Since we have received a considerable number of requests for consultation with pregnant women with pityriasis rosea over the last few years, our group has compiled suggestions approaching the affected patients: 1. If an eruption suggestive for pityriasis rosea occurs in a pregnant woman, the following factors should be excluded: a. Exposure to drugs prior to the development of the rash (biologic agents, captopril, clonidine, hydrochlorothiazide, atenolol, lamotrigine, nortriptyline, barbiturates, metronidazole, terbinafine, omeprazole, non-steroidal anti-inflammatory drugs, and isotretinoin), which are capable of inducing a pityriasis rosea-like eruption (6) and b. Disorders included in the differential diagnosis (syphilis and infections due to parvovirus, herpes virus, cytomegalovirus, and Epstein

  7. Minocycline for acne vulgaris: efficacy and safety.

    PubMed

    Garner, S E; Eady, E A; Popescu, C; Newton, J; Li, W A

    2003-01-01

    comparators used were placebo (2 studies), oxytetracycline (1), tetracycline (6), doxycycline (7), lymecycline (2), topical clindamycin (3), topical erythromycin/zinc (1), cyproterone acetate/ ethinyloestradiol (1), oral isotretinoin (2), topical fusidic acid (1) and there was one dose response study. Two studies are ongoing and it remains to be clarified whether one further study is a RCT. Major outcome measures used in the trials included lesion counts, acne grades/severity scores, doctors' and patients' global assessments, adverse drug reactions and drop out rates. The quality of each study was assessed independently by two assessors and an effect size calculated where possible. An additional three RCTs and three safety studies were identified by searches conducted in November 2002; these will be reviewed for a major update in early 2003 when it is anticipated that the results of the two ongoing studies will be available. The trials were generally small and of poor quality and in many cases the published reports were inadequate for our purpose. Pooling of the studies was not attempted due to the lack of common outcome measures and endpoints and the unavailability of some primary data. Although minocycline was shown to be an effective treatment for acne vulgaris, in only two studies was it found to be superior to other tetracyclines. Both of these were conducted under open conditions and had serious methodological problems. A third study showed it to be more effective than 2% fusidic acid, applied topically, against inflammatory lesions in mild to moderate acne. Differences in the way adverse drug reactions were identified could have accounted for the wide variation between studies in numbers of events reported. This meant that no overall evaluation could be made of incidence rates of adverse events associated with minocycline therapy. No RCT evidence was found to support the benefits of minocycline in acne resistant to other therapies and the dose response has only been

  8. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS, AMERICAN COLLEGE OF ENDOCRINOLOGY, AND ANDROGEN EXCESS AND PCOS SOCIETY DISEASE STATE CLINICAL REVIEW: GUIDE TO THE BEST PRACTICES IN THE EVALUATION AND TREATMENT OF POLYCYSTIC OVARY SYNDROME--PART 1.

    PubMed

    Goodman, Neil F; Cobin, Rhoda H; Futterweit, Walter; Glueck, Jennifer S; Legro, Richard S; Carmina, Enrico

    2015-11-01

    , alopecia, and acne. Cycle length >35 days suggests chronic anovulation, but cycle length slightly longer than normal (32 to 35 days) or slightly irregular (32 to 35-36 days) needs assessment for ovulatory dysfunction. Ovulatory dysfunction is associated with increased prevalence of endometrial hyperplasia and endometrial cancer, in addition to infertility. In PCOS, hirsutism develops gradually and intensifies with weight gain. In the neoplastic virilizing states, hirsutism is of rapid onset, usually associated with clitoromegaly and oligomenorrhea. Girls with severe acne or acne resistant to oral and topical agents, including isotretinoin (Accutane), may have a 40% likelihood of developing PCOS. Hair loss patterns are variable in women with hyperandrogenemia, typically the vertex, crown or diffuse pattern, whereas women with more severe hyperandrogenemia may see bitemporal hair loss and loss of the frontal hairline. Oral contraceptives (OCPs) can effectively lower androgens and block the effect of androgens via suppression of ovarian androgen production and by increasing sex hormone-binding globulin. Physiologic doses of dexamethasone or prednisone can directly lower adrenal androgen output. Anti-androgens can be used to block the effects of androgen in the pilosebaceous unit or in the hair follicle. Anti-androgen therapy works through competitive antagonism of the androgen receptor (spironolactone, cyproterone acetate, flutamide) or inhibition of 5α-reductase (finasteride) to prevent the conversion of T to its more potent form, 5α-dihydrotestosterone. The choice of antiandrogen therapy is guided by symptoms. The diagnosis of PCOS in adolescents is particularly challenging given significant age and developmental issues in this group. Management of infertility in women with PCOS requires an understanding of the pathophysiology of anovulation as well as currently available treatments. Many features of PCOS, including acne, menstrual irregularities, and hyperinsulinemia