17980 Severe nodulocystic acne in a renal dialysis patient managed successfully with low-dose isotretinoin

Abstract

A 31-year-old woman with a background of a previous simultaneous pancreas-kidney (SPK) transplant with failed kidney, on long-term dialysis, was referred to our dermatology service for management of severe nodulocystic acne. She had type 1 diabetes, with secondary retinopathy, nephropathy and gastroparesis. Examination revealed severe nodulocystic acne affecting her face and neck, with evidence of scarring. Previous treatments included conventional topical treatments, as well as oral oxytetracycline. Her regular medications were mycophenolate mofetil, prednisolone, isoniazid, and paroxetine. Six months of low dose isotretinoin treatment (20 mg daily) resulted in complete resolution of her acne and there have been no adverse side effects reported thus far. Nodulocystic acne is not uncommon in renal dialysis patients. The mechanism of this whilst still largely unknown, has previously been postulated to be related to the toxic effect of uraemia. Nodulocystic acne often has a significantly negative impact on a patient’s quality of life and often fails to respond to conventional acne therapy. The use of low dose isotretinoin to treat acne in haemodialysis patients has been scarcely reported with only Lin et al’s prospective study in 1999 showing significant efficacy and minimal side effects. Renal elimination of isotretinoin and its metabolites is known to be negligible, and isotretinoin is protected from haemodialysis removal through its protein binding. Our case adds to the evidence that low-dose isotretinoin can safely and successfully be used to treat severe nodulocystic acne in renal dialysis patients, leading to a significant improvement in patients’ quality of life.