The influence of isotretinoin upon fibrinolysis in patients with acne

Severe generalised rhabdomyolysis with fatal outcome associated with isotretinoin

Isotretinoin is considered to be a safe and effective therapy in otherwise therapy-resistant acne. Elevated serum creatine phosphokinase values with or without muscle-related symptoms in isotretinoin-treated patients have been reported and interpreted as benign phenomena, lethal cases have not been described yet. We present the case of a 20-year-old male who died from severe generalised rhabdomyolysis associated with isotretinoin treatment.

A cause of unbearably painful breast, diffuse dermal angiomatosis

Diffuse dermal angiomatosis is a rare disorder, considered to be a variant of reactive cutaneous angioendotheliomatosis. The patients commonly present with severe intractable breast pain and characteristic reticular violaceous erythematous plaques with central ulcerations. Histologically, there is infiltration of the recticular dermis by endothelial cells due to excess vascular proliferation. Herein, we report a patient who presented with unbearable bilateral breast pain with characteristic "reticular vascular marking" of her breasts, who was diagnosed with diffuse dermal angiomatosis. We were able to successfully treat our patient with a tapered isoretinoin regimen.

Oral isotretinoin and haemophilia A

The effects of oral isotretinoin on the coagulation system are still not well known: some case reports describe thrombocytopenia or thrombocytosis, others present different effects on fibrinolysis. We report a case of severe acne treated with oral isotretinoin in a patient affected with haemophilia A. In this case, which differs from the only other case reported in the literature, oral isotretinoin did not appear to influence the haemophilic patient's need of factor VIII.

Diffuse dermal angiomatosis of the breast: response to isotretinoin

Dermal angiomatosis of the breast is an extremely rare disorder of unknown origin characterized by increased angiomatosis and ulceration. We report a case of a young woman whose disorder responded to isotretinoin. Our findings have potential relevance to the treatment of skin disorders in which ulceration is a prominent feature.

Safety issues in isotretinoin therapy

Isotretinoin (Accutane, Roche Laboratories Inc, Nutley, NJ) is an important drug, not only for the treatment of severe acne, but also for other diagnoses and in chemoprevention settings. Because the use of isotretinoin is increasing, it is important for physicians to be aware of the adverse events, toxicities, and management issues related to its use. The most important issue is that of congenital defects, which has resulted in new pregnancy prevention policies and programs implemented by the manufacturer. A relatively new concern is that of depression associated with isotretinoin use, also resulting in new policies placed by the manufacturer and the FDA. The most common adverse effects observed during treatment are mucocutaneous and ocular in nature, but laboratory abnormalities and effects in the nervous, musculoskeletal, gastrointestinal, pulmonary, hematologic, and other systems are also described. Additionally, potential drug interactions, follow-up, and toxicity prevention measures are discussed.