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Paronychia induced by isotretinoin. Isotretinoin |
Paronychia induced by isotretinoin
- Paronychia induced by isotretinoin
These are commonly observed and generally do not limit its use. Rarely patients may have stimulation of granulation tissue, leading to pyogenic granuloma eruptions of acne lesions in areas of trauma and in nail folds; paronychia may also occur. Pyogenic granuloma-like acne lesions during isotretinoin therapy. Arch Dermatol. Preventing and managing the side effects of isotretinoin. Semin Cutan Med Surg. Knowing these unusual adverse events is important for the clinical management of patients, but its exact pathogenesis remains unclear.
Man, aged 19 years, with acne grade III, without comorbidities, pre-existing nail problems or prior use of medication. In the sixth month of treatment, the patient presented edema, erosion and periungual erythema with serous discharge in 20 nails and onychocryptosis with excessive granulation tissue on toes. Upon returning to our service, the patient showed lesions in the first and second toes bilaterally and on the right toe Figures 1 , 2 and 3.
Figure 1 Paronychia and granulation tissue in feet, secondary to the use of isotretinoin. Figure 2 Pyogenic-like granuloma and paronychia in lateral edge of the first and second right toes.
Figure 3 Excess of periungueal granulation tissue and paronychia, located in the first left toe. After the end of treatment with isotretinoin, the patient evolved with improvement of paronychia and granulation tissue on toes, but with persistence of onychocryptosis in hallux valgus. Subsequently, the patient was submitted to matricectomy with complete resolution of the disease Figure 4.
Figure 4 Two months after the completion of matricectomy: patient presented resolution of onicocriptosis without recurrence of the lesions on toes. Isotretinoin was first introduced in the United States in for the treatment of nodulocystic acne, being the only medication that affects all of the major etiological factors involved in acne. Although isotretinoin is a highly effective drug, its clinical use has always been associated with reports of adverse events with several implications for the patient.
It is therefore essential that physicians be aware of the adverse events that may occur during therapy with isotretinoin. Safety and side effects of the acne drug, oral isotretinoin.
Expert Opin Drug Saf. Exuberant granulation tissue is described in the literature in patients using isotretinoin for acne treatment, but its occurrence is rare with few reports described.
The largest series conducted in reported 4 cases of paronychia caused by excessive growth of the lateral and distal nail folds, with an excess of granulation tissue associated. Adverse reactions to isotretinoin. J Am Acad Dermatol. Multiple fingers were involved in all patients and the attempt to restart isotretinoin in one patient led to the resurgence of previous lesions, suggesting causality.
The exact mechanism by which retinoids may lead to the development of granulation tissue in skin is not well known. Baran et al suggest that, in susceptible patients, excess retinoids would lead to exacerbation of their functions in epithelial level of the nail matrix, generating local exfoliative dermatitis, with accumulation of scales in the nail folds. Etretinate and the nails study of cases possible mechanisms of some side-effects. Clin Exp Dermatol. The scales would act as foreign bodies, causing inflammation and formation of granulation tissue.
The nail fragility may also lead to the formation of nail spicules that, when introduced in the periungual tissue, would stimulate the appearance of granulation tissue and the ingrown toenail. Isotretinoin is also known to cause exuberant granulation tissue or pyogenic-like granuloma lesions in acne sites between the 3 rd and 12 th week of treatment.
Facial pyogenic granuloma-like lesions under isotretinoin therapy. Int J Dermatol. Reuben et al. They observed the occurrence of exuberant granulation tissue in 3 patients out of a total of 16 who used the drug. An Bras Dermatol. Therefore, it is reasonable to suggest that it would cause such changes in other parts of the body. Gefitinib is an epidermal growth factor receptor EGFR inhibitor used for various cancers, especially lung cancer.
It is known to affect epidermal keratinocyte of skin and commonly induce variable dermatologic reactions including follicular and pustular rash, paronychia and fissuring, hair changes, dry skin, hypersensitivity reactions, and mucositis 1 Nail abnormalities with paronychia induced by EGFR inhibitors have been reported but there are no evidence-based treatments clinically recommended.
A year-old female presented with paronychia of all fingernails and both great toenails for eight months which developed after treatment with gefitinib mg daily for her underlying lung cancer. She also had chronic vesicular hand eczema on both palms and soles and was treated with alitretinoin 10 mg daily. After six months for alitretinoin, the patient showed substantial improvement of hand eczema, paronychia and onychodystropy Fig. The patient took alitretinoin with gefitinib for one year and showed improvement with no sign of recurrence.
We received the patient's consent form about publishing all photographic materials. Click for larger image Download as PowerPoint slide. It has anti-inflammatory, immunomodulatory effects on the proliferation, and differentiation of keratinocytes.
It is approved for treatment of chronic hand eczema which is unresponsive to topical steroids 2. Some studies reported alitretinoin treatment for nail lichen planus or nail dystrophy, and the presence of retinoid receptor on the nail matrix has been evaluated as well 2 , 3 , 4.
However, the treatment mechanism for alitretinoin on the nail apparatus diseases has not yet been fully elucidated. We report a case of nail dystrophy with paronychia which was successfully treated with alitretinoin. In an epidermal reaction induced by EGFR inhibitor which is prescribed in many patients who have cancer—especially in paronychia—alitretinoin is more effective than other retinoid agents.
Patients with acneiform eruption induced by EGFR inhibitor have been treated with isotretinoin which, however, induces paronychia 5. On the other hand, alitretinoin improves paronychia and therefore can be treated as a better alternative for nail dystrophy.
Brief Report Open Access. Ann Dermatol. Published online May 01, Tel: , Fax: , Email: lyb80 catholic. This article has been cited by 1 article in This article has been cited by G o o g l e Scholar.
❾-50%}- Isotretinoin | SpringerLink
I then went on antibiotics and used only antiobiotics which would clear it up and then another one would come in. Then last year I disappointed getting it on my slut. I have serious every product under the sun. One day I was in priceline and seen the 3 pack of wash, spot treatment and moisturiser and other, why not. I read the eyes and.
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.
Use of cis-retinoic acid in cystic acne. Can Med Assoc J. Adverse events of isotretinoin are well known as teratogenicity, myalgias and arthralgias, hypertriglyceridemia, hypercholesterolemia and elevated transaminases. It is also associated with numerous adverse events including skin cheilitis, facial dermatitis, xerosis, rash, conjunctivitis, epistaxis, photosensitivity and dryness of mucous membranes. These are commonly observed and generally do not limit its use.
Rarely patients may have stimulation of granulation tissue, leading to pyogenic granuloma eruptions of acne lesions in areas of trauma and in nail folds; paronychia may also occur. Pyogenic granuloma-like acne lesions during isotretinoin therapy. Arch Dermatol. Preventing and managing the side effects of isotretinoin. Semin Cutan Med Surg. Knowing these unusual adverse events is important for the clinical management of patients, but its exact pathogenesis remains unclear.
Man, aged 19 years, with acne grade III, without comorbidities, pre-existing nail problems or prior use of medication. In the sixth month of treatment, the patient presented edema, erosion and periungual erythema with serous discharge in 20 nails and onychocryptosis with excessive granulation tissue on toes. Upon returning to our service, the patient showed lesions in the first and second toes bilaterally and on the right toe Figures 12 and 3. Figure 1 Paronychia and granulation tissue in feet, secondary to the use of isotretinoin.
Figure 2 Pyogenic-like granuloma and paronychia in lateral edge of the first and second right toes. Figure 3 Excess of periungueal granulation tissue and paronychia, located in the first left toe. After the end of treatment with isotretinoin, the patient evolved with improvement of paronychia and granulation tissue on toes, but with persistence of onychocryptosis in hallux valgus. Subsequently, the patient was submitted to matricectomy with complete resolution of the disease Figure 4.
Figure 4 Two months after the completion of matricectomy: patient presented resolution of onicocriptosis without recurrence of the lesions on toes. Isotretinoin was first introduced in the United States in for the treatment of nodulocystic acne, being the only medication that affects all of the major etiological factors involved in acne. Although isotretinoin is a highly effective drug, its clinical use has always been associated with reports of adverse events with several implications for the patient.
It is therefore essential that physicians be aware of the adverse events that may occur during therapy with isotretinoin. Safety and side effects of the acne drug, oral isotretinoin. Expert Opin Drug Saf. Exuberant granulation tissue is described in the literature in patients using isotretinoin for acne treatment, but its occurrence is rare with few reports described.
The largest series conducted in reported 4 cases of paronychia caused by excessive growth of the lateral and distal nail folds, with an excess of granulation tissue associated. Adverse reactions to isotretinoin. J Am Acad Dermatol. Multiple fingers were involved in all patients and the attempt to restart isotretinoin in one patient led to the resurgence of previous lesions, suggesting causality.
The exact mechanism by which retinoids may lead to the development of granulation tissue in skin is not well known. Baran et al suggest that, in susceptible patients, excess retinoids would lead to exacerbation of their functions in epithelial level of the nail matrix, generating local exfoliative dermatitis, with accumulation of scales in the nail folds.
Etretinate and the nails study of cases possible mechanisms of some side-effects. Clin Exp Dermatol. The scales would act as foreign bodies, causing inflammation and formation of granulation tissue. The nail fragility may also lead to the formation of nail spicules that, when introduced in the periungual tissue, would stimulate the appearance of granulation tissue and the ingrown toenail. Isotretinoin is also known to cause exuberant granulation tissue or pyogenic-like granuloma lesions in acne sites between the 3 rd and 12 th week of treatment.
Facial pyogenic granuloma-like lesions under isotretinoin therapy. Int J Dermatol. Reuben et al. They observed the occurrence of exuberant granulation tissue in 3 patients out of a total of 16 who used the drug. An Bras Dermatol. Therefore, it is reasonable to suggest that it would cause such changes in other parts of the body.
In addition, periungual exuberant granulation tissue of both fingers and toes is a documented adverse event of other retinoids therapies. Campbell et al reported 6 patients who develop this complication during therapy with etretinate for psoriasis.
Retinoid therapy is associated with excess granulation tissue responses. These lesions appear to be idiosyncratic and unrelated to the daily dose or total cumulative dose. Similar comment can be made regarding our patient who developed the first lesions with 6 months of treatment without having any change in the dosages used. Thus, the knowledge of this unusual adverse event is important for the clinical management of patients treated with isotretinoin, and it seems that it is not necessary to discontinue it for the resolution of the lesion.
Thus, advantages and disadvantages of discontinuing therapy for this problem should be carefully weighed. According to the literature, a course of weeks of topical steroid and antibiotic on the occlusion is the first line of treatment for periungual pyogenic granuloma. Periungual and subungual pyogenic granuloma.
Br J Dermatol. In cases where the local treatment is insufficient, surgical removal becomes necessary. Open menu Brazil. Anais Brasileiros de Dermatologia. Open menu. Text EN Text English. Brazil Email: danifigueiras hotmail. Abstract 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.
Keywords: Paronychia; Granulation tissue; Retinoids. Financial Support: None. Brelsford M, Beute TC. Bigby M, Stern RS. Baran R. Publication Dates Publication in this collection Mar-Apr History Received 05 July Accepted 04 Nov This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License which permits unrestricted non-commercial use, distribution, and reproduction in any medium provided the original work is properly cited.
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PDF English. Google Google Scholar. Paronychia and granulation tissue formation during treatment with isotretinoin.
Here, we report a case of periungual pyogenic granuloma with associated paronychia in a patient taking oral isotretinoin. A review of the. Discussion: Paronychia and pyogenic granuloma are very rarely related with isotretinoin and may occur separately or associated. The resolution of these lesions. In addition, treatment with isotretinoin may result in the appearance of paronychia and excess granulation tissue in the nail furrows. An year-old man developed periungual pyogenic granuloma with associated paronychia during treatment with isotretinoin for nodulocystic. Isotretinoin is also known to cause exuberant granulation tissue or pyogenic-like granuloma lesions in acne sites between the 3rd and 12th week of treatment. An Bras Dermatol. Text EN Text English.Gefitinib is an epidermal growth factor receptor EGFR inhibitor used for various cancers, especially lung cancer. It is known to affect epidermal keratinocyte of skin and commonly induce variable dermatologic reactions including follicular and pustular rash, paronychia and fissuring, hair changes, dry skin, hypersensitivity reactions, and mucositis 1 Nail abnormalities with paronychia induced by EGFR inhibitors have been reported but there are no evidence-based treatments clinically recommended.
A year-old female presented with paronychia of all fingernails and both great toenails for eight months which developed after treatment with gefitinib mg daily for her underlying lung cancer. She also had chronic vesicular hand eczema on both palms and soles and was treated with alitretinoin 10 mg daily. After six months for alitretinoin, the patient showed substantial improvement of hand eczema, paronychia and onychodystropy Fig. The patient took alitretinoin with gefitinib for one year and showed improvement with no sign of recurrence.
We received the patient's consent form about publishing all photographic materials. Click for larger image Download as PowerPoint slide. It has anti-inflammatory, immunomodulatory effects on the proliferation, and differentiation of keratinocytes.
It is approved for treatment of chronic hand eczema which is unresponsive to topical steroids 2. Some studies reported alitretinoin treatment for nail lichen planus or nail dystrophy, and the presence of retinoid receptor on the nail matrix has been evaluated as well 2 , 3 , 4. However, the treatment mechanism for alitretinoin on the nail apparatus diseases has not yet been fully elucidated. We report a case of nail dystrophy with paronychia which was successfully treated with alitretinoin.
In an epidermal reaction induced by EGFR inhibitor which is prescribed in many patients who have cancer—especially in paronychia—alitretinoin is more effective than other retinoid agents. Patients with acneiform eruption induced by EGFR inhibitor have been treated with isotretinoin which, however, induces paronychia 5.
On the other hand, alitretinoin improves paronychia and therefore can be treated as a better alternative for nail dystrophy. Brief Report Open Access. Ann Dermatol. Published online May 01, Tel: , Fax: , Email: lyb80 catholic. This article has been cited by 1 article in This article has been cited by G o o g l e Scholar.
Dear Editor: Gefitinib is an epidermal growth factor receptor EGFR inhibitor used for various cancers, especially lung cancer. Go to:. Dermatologic side effects associated with the epidermal growth factor receptor inhibitors. J Am Acad Dermatol ;— Successful treatment of nail lichen planus with alitretinoin: report of 2 cases and review of the literature.
Dermatology ;— Iorizzo M. Nail lichen planus-a possible new indication for oral alitretinoin. J Eur Acad Dermatol Venereol ;— Nail improvement during alitretinoin treatment: three case reports and review of the literature.
Clin Exp Dermatol ;— Paronychia and granulation tissue formation during treatment with isotretinoin. An Bras Dermatol ;— MeSH Terms. Figures Show all Download Citation. National Research Foundation of Korea. Download as Excel file. Alitretinoin Treatment for Gefitinib-Induced Paronychia.
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