Use Of Systemic Retinoids Research Articles

A CASE OF TREATMENT OF CONGENITAL ICHTHYOSIS IN A NEWBORN CHILD

Congenital ichthyoses (CI) are a group of rare inherited disorders that cause keratinization defects. This group includes hereditary ichthyosis and hereditary syndromes with ichthyosiform lesions. Offi cial statistics are not yet available in Ukraine. The most common clinical manifestation is nonbullous hyperkeratosis characterized by thick hyperkeratotic scales, skin thickening, severe skin dryness and erythema. In more severe forms – ectropion, eclabion. Skin permeability is increased in CI patients, resulting in increased fl uid and calorie loss, diffi culty in thermoregulation, and reduced elasticity, which limits mobility. Symptoms can vary in severity, but severe manifestations at birth are not always indicative of a more severe course later in life. Challenges in defi nitive diagnosis are due to the need for karyotyping, which is quite expensive. Currently available treatment modalities include continuous moisturization, reduction of transepidermal water loss, control of hyperkeratotic layer thickness (reducing it to a minimum) with local keratolytics, emollients, and systemic retinoids in severe cases. The article presents a clinical case of successful local treatment of CI with a pronounced eff ect without the use of systemic retinoids. The publication of the materials has been approved by the Bioethics Commission of the CI «Regional Medical Center for Family Health» DRC». All anamnestic data, examination results and photographs are provided with prior written consent of the parents. Conclusion. Congenital ichthyoses require careful monitoring. The initial clinical manifestations can not be a marker for the severity of the disease course.

Comparative Study Between Tacrolimus 0.1% Ointment Versus Topical White Soft Petrolatum Jelly in the Treatment of Oral Retinoid-Induced Cheilitis.

Retinoids are used topically as well as orally, and the most commonly used oral retinoids are isotretinoin and acitretin. Mucocutaneous adverse effects are frequently seen with the use of systemic retinoids, the most common being cheilitis, which is dose-dependent and seen in almost all patients using it. To study the comparative effect of topical tacrolimus 0.1% ointment versus topical white soft petrolatum jelly in the treatment of cheilitis due to retinoids. A total of 26 patients with cheilitis post-treatment with isotretinoin were enrolled in this cross-sectional study conducted over a period of 6 months. They were randomized into two groups of 13 patients each to receive topical tacrolimus 0.1% ointment and soft petrolatum jelly twice daily, respectively. Patients were followed up weekly with clinical photographs. Resolution of cheilitis was assessed on the basis of photograph and ICGS score. About 84.6% of patients of group A and 53.8% of patients of group B showed resolution of symptoms within 1 week of treatment. A significant difference was seen in duration for complete cheilitis resolution and relapse rate in the two groups. Our study concludes that oral retinoid-induced cheilitis shows faster and more significant resolution with twice-daily topical tacrolimus 0.1% ointment application compared to twice-daily topical petrolatum jelly.

A systematic review of oral retinoids for treatment of acneiform eruptions induced by epidermal growth factor receptor inhibitors.

Epidermal growth factor receptor inhibitors (EGFRi) are now standard of care in patients with EGFR mutations in non-small cell lung cancer (NSCLC) and are increasingly being used in other EGFR mutated cancers, including gastrointestinal, and head and neck. However, EGFRi are well known to cause acneiform eruptions, which are shown to positively correlate with tumor response to treatment, but may be severe enough to cause interruption of their treatment. Although most guidelines call for the use of tetracyclines to treat these acneiform eruptions, there is mounting evidence for the use of systemic retinoids instead. The objective of this review is to summarize available data on the use of systemic retinoids for management of acneiform eruptions on EGFRi. This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. MEDLINE and EMBASE were searched from database inception until December 10th, 2021. All articles were screened and relevant data extracted independently in duplicate by two reviewers. In total, 16 case reports, case series and retrospective reviews were included. Forty-three patients were treated with retinoids for their acneiform eruption due to EGFRi. The majority (77%) noted moderate to significant improvement after treatment initiation with minimal adverse events (16%). The findings of this systematic review suggest that systemic retinoids are a safe and effective therapy for the management of acneiform eruptions induced by EGFRi.

Retinoids-phobia — main aspects of the problem and facts of evidence-based medicine as tool for its solution

The review focuses on the problem of phobias in the use of systemic retinoids in the treatment of patients with acne and is intended to provide dermatologists with necessary information on effective solution of this problem. The article describes scientific facts of evidence-based medicine that will help the doctor to give reasoned answers to frequently asked questions from patients before prescribing a course of systemic retinoids. Isotretinoin systemic therapy remains the golden standard in treating patients with severe forms of acne. Only comprehensive medical information to patients about all possible side effects due to the use of isotretinoin can prevent the development of retinoids-phobia.

Treatment of Pityriasis Rubra Pilaris with Adalimumab: A Case Report

Pityriasis Rubra Pilaris (PRP) is a rare inflammatory dermatosis of unknown etiology and variable presentation. Common clinical features include hyperkeratotic follicular papules, palmoplantar hyperkeratosis and well-demarcated red-orange scaly plaques interspersed with islands of unaffected skin. A limited body of anecdotal evidence predominantly supports the use of systemic retinoids and/or methotrexate in treating the disease. In a subset of these patients, there has been a documented role for biologic tumor necrosis factor (TNF) inhibitors, especially in patients who have failed retinoid or antimetabolite therapy. We present a case of a woman whose PRP responded favorably to adalimumab, highlighting the role of TNF inhibitors and the need for their continued exploration in the treatment of PRP.

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

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.

Ichthyosis congenita, harlequin type: A case report and a brief review of literature

Harlequin ichthyosis (HI) is the most severe type of congenital ichthyosis, and it is extremely rare. It is inherited in an autosomal recessive fashion. Although previously thought to be lethal, recently there have been increased reports of prolonged survival, following improved supportive care and judicious use of systemic retinoids. We report a new case of HI in an infant born of a consanguineous marraige who succumbed on the 5th day of birth despite intensive supportive care, a short review of literature regarding the condition is also presented.

Prescribing oral isotretinoin: understanding the need for caution

Acne is a common inflammatory disorder that can occur in both adolescents and adults. Isotretinoin is used in severe forms of acne which are resistant to adequate courses of therapy with systemic antibacterials and topical solutions. It has a serious side-effect profile and is associated with a number of significant cautions and contraindications. Therefore, isotretinoin should only be prescribed by or under the supervision of physicians with both expertise in the use of systemic retinoids for the treatment of severe acne and a full understanding of the risks of isotretinoin therapy and its monitoring requirements. Isotretinoin is highly teratogenic and is therefore contraindicated in pregnancy. Oral isotretinoin causes increased skin fragility and can result in scarring, and therefore, its summary of product characteristics recommends that wax epilation, laser skin treatment and microdermabrasion should be avoided during and for at least 6 months after treatment. Thorough patient medical history records should be taken and close monitoring is required owing to the effects of isotretinoin on mental function, serum lipid levels and hepatobiliary function.

Isotretinoin for the treatment of squamous cell carcinoma arising on an epidermoid cyst

A 63-year-old man showed multiple concentric erythemato-nodular lesions of approximately 1.5-3 cm in diameter, located in the parietal and temporal region. The skin biopsy allowed histological diagnosis of infundibular epidermal cyst associated with chronic granulomatous flogosis; in one of these, a well-differentiated squamous cell carcinoma arising from the cyst wall was found. The patient received isotretinoin at the daily dosage of 0.5 mg/kg/day for 5 months. During 1-year follow-up, laboratory tests, computed tomography scans, and control histology were all in the normal range, with a good improvement of the lesions. Epidermal cysts and squamous cell carcinoma are both commonly encountered in practice. However, the association of epidermal inclusion cysts and squamous cell carcinoma in the skin is very rare. In some cases, including the present one, more potent chemopreventive strategies, such as the use of systemic retinoids, must be considered. Systemic retinoids are the most heavily researched chemopreventive agents and have shown promise for multiple types of cancer, including bladder and head and neck carcinomas. We would like to recommend the possibility to administer retinoids in a squamous cell carcinoma, achieving very satisfactory results; in our case, a complete remission of malignant lesion and an improvement of epidermal cysts were made, without the development of side effects associated with retinoids.

Randomized controlled trial of acitretin versus placebo in patients at high‐risk for basal cell or squamous cell carcinoma of the skin (North Central Cancer Treatment Group Study 969251)

Chemoprevention with systemic retinoids has demonstrated promise in decreasing the incidence of new primary nonmelanoma skin cancers (NMSCs) in immunocompromised post-transplantation recipients. There is limited evidence for the use of systemic retinoids in the nontransplantation patient. To the authors' knowledge, this is the first randomized controlled trial to assess the efficacy of acitretin as a chemopreventive agent in nontransplantation patients at high-risk for NMSC. The study was designed as a prospective, randomized, double-blind, placebo-controlled clinical trial. To test the possible skin cancer-preventing effect of a 2-year treatment with acitretin, 70 nontransplantation patients aged ≥18 years who had a history of ≥2 NMSCs within 5 years of trial onset were randomized to receive either placebo or acitretin 25 mg orally 5 days per week. The primary outcome measure was the rate of new NMSC development. Seventy patients were randomized to receive either acitretin alone (N = 35) or placebo (N = 35). During the 2-year treatment period, the patients who received acitretin did not have a statistically significant reduction in the rate of new primary NMSCs (odds ratio, 0.41; 95% confidence interval, 0.15-1.13; 54% vs 74%; P = .13). However, using the incidence of new NMSC, the time to new NMSC, and total NMSC counts, an umbrella test indicated a significant trend that favored the use of acitretin (chi-square statistic, 3.94; P = .047). The patients who received acitretin reported significantly more mucositis and skin toxicities compared with the patients who received placebo. Although there was not a statistically significant benefit observed with the use of acitretin, this may have been the result of low statistical power.

Use of Oral Isotretinoin in Photoaging Therapy

Many drugs are being used for prevention and treatment of photoaging, especially topical retinoids. The use of systemic retinoids, more specifically, isotretinoin, for this purpose has not been properly addressed to date. Our study was designed to assess the systemic use of isotretinoin used alone for the therapy of cutaneous photoaging. To demonstrate that isotretinoin is converted into retinoid and improves the appearance of the photoaged skin. Fifty women aged 40 to 60 years, phototype I, II, or III according Fitzpatrick, were selected to receive 20 mg of isotretinoin orally 3 times a week for a 3-month period. Patients underwent clinical and laboratory evaluation. Two biopsies and photographic control were performed. Patients were requested to use only topical photoprotecting agents during the treatment. Improvement in photoaging clinical parameters were evaluated through pictures taken and also through an evaluation form. Anatomopathologic parameters were obtained by comparing collagen degeneration and skin trophism. Results. Thirty patients fully complied with study requirements and were adequately analyzed. From the anatomopathologic data, an improvement of photoaging in 20 patients was observed. Isotretinoin improves photoaging with few adverse events because of the low dose used and to the short treatment duration.

Chemoprevention of Nonmelanoma Skin Cancer with Systemic Retinoids: Practical Dosing and Management of Adverse Effects

In patients with nonmelanoma skin cancer that is high risk or characterized by numerous tumors, chemoprevention with systemic retinoids may effectively decrease the number of new tumors whereas the chemosuppressive effects may reduce the risk of recurrence or disease progression. A patient's intolerance of the mucocutaneous effects of retinoid therapy or abnormal laboratory findings may hamper continuous therapy. To present a method for optimizing tolerance of systemic retinoids for chemoprevention and for monitoring and managing adverse events. After reviewing the data on the use of systemic retinoids for chemoprevention, we developed a simplified approach for administering oral retinoids for chemoprevention of nonmelanoma skin cancer as well as basic guidelines for the prevention and management of adverse effects and appropriate laboratory monitoring. Chemoprevention with systemic retinoids in patients with a history of numerous tumors or high-risk skin cancer can be optimized with graduated dose escalation and preventive strategies for the most common adverse effects. Routine laboratory monitoring may assist in detecting adverse effects, which can be managed in most cases. In our experience, the effective use of systemic retinoids for chemoprevention of nonmelanoma skin cancer in high-risk patients can be optimized through a standardized, proactive approach.

Chemoprevention of Nonmelanoma Skin Cancer with Systemic Retinoids

BACKGROUND In patients with nonmelanoma skin cancer that is high risk or characterized by numerous tumors, chemoprevention with systemic retinoids may effectively decrease the number of new tumors whereas the chemosuppressive effects may reduce the risk of recurrence or disease progression. A patient's intolerance of the mucocutaneous effects of retinoid therapy or abnormal laboratory findings may hamper continuous therapy. OBJECTIVE To present a method for optimizing tolerance of systemic retinoids for chemoprevention and for monitoring and managing adverse events. METHODS After reviewing the data on the use of systemic retinoids for chemoprevention, we developed a simplified approach for administering oral retinoids for chemoprevention of nonmelanoma skin cancer as well as basic guidelines for the prevention and management of adverse effects and appropriate laboratory monitoring. RESULTS Chemoprevention with systemic retinoids in patients with a history of numerous tumors or high-risk skin cancer can be optimized with graduated dose escalation and preventive strategies for the most common adverse effects. Routine laboratory monitoring may assist in detecting adverse effects, which can be managed in most cases. CONCLUSION In our experience, the effective use of systemic retinoids for chemoprevention of nonmelanoma skin cancer in high-risk patients can be optimized through a standardized, proactive approach.

Interventions for chronic palmoplantar pustulosis

Chronic palmoplantar pustulosis (PPP) is a chronic inflammatory skin condition characterised by crops of sterile pustules (yellow pus spots) on the palms and soles which erupt repeatedly over months or years. The affected areas tend to become red and scaly; cracks may form and these are often painful. Many different treatments have been used for palmoplantar pustulosis but none is generally accepted as being reliably effective. To assess the effects of treatments for palmoplantar pustulosis, both in reducing disease severity and in maintaining remission once achieved. We searched the Cochrane Skin Group Specialised Register (January 2003), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2003), MEDLINE (1966 to February 2003), EMBASE (1988 to February 2003). We also cross-checked with the Salford Database of Psoriasis Trials and reference lists of articles. We also contacted authors included trials, members of the Cochrane Skin Group and dermatologists interested in psoriasis. Any randomised controlled trial in which patients with chronic palmoplantar pustulosis were randomised to receive one or more interventions. At least two reviewers independently assessed trial eligibility and quality. Study authors were contacted for additional information. Adverse effects information was collected from the trials. Twenty-three trials involving 724 people were included. There is evidence supporting the use of systemic retinoids (improvement rate difference 44%, 95 CI 28 to 59%), oral PUVA (improvement rate difference 44%, 95 CI 26 to 62%). However, a combination of PUVA and retinoids is better than the individual treatments. The use of topical steroid under hydrocolloid occlusion is beneficial. It would also appear that low dose ciclosporin, tetracycline antibiotics and Grenz Ray Therapy may be useful in treating PPP. Colchicine has a lot of side effects and it is unclear if it is effective and neither was topical PUVA (rate difference of 0.00, 95% CI -0.04 to +0.04). There is no evidence to suggest that short-term treatment with hydroxycarbamide (hydroxyurea) is effective. Many different interventions were reported to produce "improvement" in PPP. There is, however, no standardised method for assessing response to treatment, and reductions in pustule counts or other empirical semi-quantitative scoring systems may be of little relevance to the patient. This review has shown that the ideal treatment for PPP remains elusive and that the standards of study design and reporting need to be improved to inform patients and those treating them of the relative merits of the many treatments available to them.

Manifestations of HPV in transplant patients

S13 Iatrogenic systemic and topical immunosuppression is maintained for a wide range of clinical problems, particularly prolonged and profound in transplant recipients. The consequences of such treatment are becoming apparent with increasing time from transplantation. Recent interest has focused on a 50-100 fold increased risk of cutaneous and mucosal squamous cell carcinomas (SCC) ranging from 12-95% long term survivors, dependent on geographical location. 90% of long term renal transplant recipients (RTRs) have mucocutaneous warts and the observed clinicopathological progression through dysplastic keratoses to frank tumours has prompted a search for the involvement of Human Papillomaviruses (HPVs). In contrast to anogenital cancers where oncogenic mucosal HPVs 16/18 (and related viruses) are clearly implicated and the genodermatosis epidermodysplasia verruciformis (EV) where EV-HPVs (HPV5,8 and related viruses) are found, historical studies of RTR SCCs have shown inconsistent results. Recent studies using degenerate PCR techniques have shown a high prevalence (65-80%) of HPV DNA in lesions from RTRs. Our group has designed a comprehensive and sensitive HPV detection and genotyping method employing a panel of degenerate and nested primers capable of detecting a broad range of cutaneous, mucosal and EV HPVs. HPV can be detected in 95% viral warts, 80% SCCs and 95% of dysplastic lesions from RTRs and also in tumours from patients receiving PUVA. The spectrum of HPVs is broadly similar for all lesions: EV and cutaneous HPVs are found more frequently than mucosal HPVs and are often codetected. Multiple novel EV related HPVs genotypes have been identified. In an attempt to define a role for these HPVs we have focused on one novel HPV type (HPV77) which appears restricted to RTRs. We show that HPV77 gene transcription is activated in cells following UV irradiation and this is mediated through binding of the p53 tumour suppressor protein to viral regulatory sequences. This is the first identification of a p53 responsive element within a viral genome, and suggests novel mechanisms by which HPV and UV radiation might act as cofactors in cutaneous carcinogenesis. Most significantly, analysis of a common polymorphic variant of p53 revealed striking differences in the susceptibility of p53 inactivation by the HPV E6 protein. Further results suggest that p53 polymorphic variants are a genetic determinant of susceptibility to the development of HPV associated cutaneous and cervical cancers. Long term survival of patients with AIDS may increase the prevalence of HPV associated tumours in mucocutaneous sites. A comprehensive screening for unusual HPVs is required for their detection and an analysis of p53 polymorphisms relevant. Novel treatment approaches to HPVs and the use of systemic retinoids may become relevant to the management of AIDS.

Systemic Retinoids for Psoriasis

This article reviews the use of systemic retinoids in the treatment of psoriasis. Various retinoids are discussed in the treatment of generalized pustular psoriasis, exfoliative psoriasis, and plaque psoriasis, both in combination therapy and monotherapy. Dosing outlines, side effects, and recommended monitoring guidelines are reviewed.

Treating Pityriasis Rubra Pilaris

The use of systemic retinoids has been a major advance in the treatment of classic adult-type pityriasis rubra pilaris. Without aggressive therapy, the

Generalized eruptive keratoacanthoma of Grzybowski

A patient with generalized eruptive keratoacanthoma of Grzybowski is described. Our findings, along with those of the 21 reported cases from the world literature, are summarized. This rare variant of keratoacanthoma most commonly affects patients in the fifth to seventh decades of life and appears as a generalized eruption of hundreds to thousands of follicular papules. These small papules often have a keratotic center and demonstrate the microscopic features of keratoacanthoma. Marked facial involvement is characteristic and can lead to masked facies with ectropion. Severe pruritus, mucosal lesions, and koebnerization are features of the disease. The course is chronic and the response to therapy is poor, although a few patients have improved with the use of systemic retinoids.