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Taudorf EH, Jensen MB, Bouazzi D, Sand C, Thomsen SF, Jemec GBE, Saunte DML. Tumor necrosis factor-α inhibitor treatment of acne fulminans - a clinical and literature review. J Dtsch Dermatol Ges 2024; 22:23-27. [PMID: 38128111 DOI: 10.1111/ddg.15234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 07/27/2023] [Indexed: 12/23/2023]
Abstract
Acne fulminans (AF) is a rare, serious, sudden-onset and long-lasting skin disease that causes scarring of face and body. Standard treatment with combined long-term isotretinoin and prednisolone is not always sufficient and has a well-known propensity for adverse effects leaving an unmet need for improved therapy. Case reports suggest that tumor necrosis factor (TNF)-α inhibitors may play a role in the management of AF. In a 3-year retrospective data collection from two dermatology centers and literature review of clinical cases of acne fulminans treated with anti-TNF-α therapy, three clinical cases and twelve literature cases were identified. A total of five different TNF-α inhibitors have been tested, with adalimumab being the most commonly used. Clinical response was seen after 1 month in 2/3 (67%) clinical cases and 5/12 (42%) literature cases, respectively, and treatment was successful in 2/3 (67%) and 11/12 (92%) after a median 3-7 months. All reported adverse effects were mild and reversible. Anti-TNF-α treatment may provide rapid improvement in patients with AF when initial treatment with isotretinoin and prednisolone fails. However, randomized controlled trials are lacking, and exact dosage and timing need to be explored before clinical implementation.
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Affiliation(s)
| | - Mikkel Bak Jensen
- Department of Dermatology, Zealand University Hospital Roskilde, Roskilde, Denmark
| | - Dorra Bouazzi
- Department of Dermatology, Zealand University Hospital Roskilde, Roskilde, Denmark
| | - Carsten Sand
- Department of Dermatology, Bispebjerg Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Simon Francis Thomsen
- Department of Dermatology, Bispebjerg Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Gregor Borut Ernst Jemec
- Department of Dermatology, Zealand University Hospital Roskilde, Roskilde, Denmark
- Department of Clinical Medicine, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - Ditte Marie Lindhardt Saunte
- Department of Dermatology, Zealand University Hospital Roskilde, Roskilde, Denmark
- Department of Clinical Medicine, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
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2
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Nasseh J, Brun A, Theret V, Ramspacher J, Severino-Freire M, Coustou D, Bulai Livideanu C, Tauber M, Marguery MC, Paul C. Efficacy of tumor necrosis factor-alpha inhibitors in the treatment of isotretinoin-induced acne fulminans. J Eur Acad Dermatol Venereol 2024; 38:e96-e98. [PMID: 37595985 DOI: 10.1111/jdv.19446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 08/14/2023] [Indexed: 08/20/2023]
Affiliation(s)
- J Nasseh
- Department of Dermatology and Allergology, Toulouse University Hospital, Toulouse, France
| | - A Brun
- Department of Dermatology and Allergology, Toulouse University Hospital, Toulouse, France
| | - V Theret
- Department of Dermatology and Allergology, Toulouse University Hospital, Toulouse, France
| | - J Ramspacher
- Department of Dermatology and Allergology, Toulouse University Hospital, Toulouse, France
| | - M Severino-Freire
- Department of Dermatology and Allergology, Toulouse University Hospital, Toulouse, France
| | - D Coustou
- Clinique Capio La Croix du Sud Ringgold standard institution - Dermatologie Quint-Fonsegrives, Occitanie, France
| | - C Bulai Livideanu
- Department of Dermatology and Allergology, Toulouse University Hospital, Toulouse, France
| | - M Tauber
- Department of Dermatology and Allergology, Toulouse University Hospital, Toulouse, France
| | - M C Marguery
- Department of Dermatology and Allergology, Toulouse University Hospital, Toulouse, France
| | - C Paul
- Department of Dermatology and Allergology, Toulouse University Hospital, Toulouse, France
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3
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Taudorf EH, Jensen MB, Bouazzi D, Sand C, Thomsen SF, Jemec GBE, Saunte DML. Behandlung der Acne fulminans mit Tumornekrosefaktor-α-Inhibitoren - eine Übersicht klinischer Fälle und der Literatur: Tumor necrosis factor-α inhibitor treatment of acne fulminans - a clinical and literature review. J Dtsch Dermatol Ges 2024; 22:23-28. [PMID: 38212919 DOI: 10.1111/ddg.15234_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 07/27/2023] [Indexed: 01/13/2024]
Abstract
ZusammenfassungAcne fulminans (AF) ist eine seltene, schwerwiegende, plötzlich auftretende und lang andauernde Hauterkrankung, die Vernarbungen im Gesicht und am Körper verursacht. Die Standardbehandlung mit langfristiger Verabreichung einer Kombination aus Isotretinoin und Prednisolon reicht nicht immer aus und kann unerwünschten Wirkungen haben. Es gibt daher einen ungedeckten Bedarf an besseren Therapien. Fallberichte lassen darauf schließen, dass Tumornekrosefaktor‐α (TNF‐α)‐Inhibitoren eine Rolle bei der Behandlung von AF spielen könnten. In einer 3 Jahre abdeckenden retrospektiven Datenerhebung aus zwei dermatologischen Zentren sowie einer Literaturübersicht klinischer Fälle von Acne fulminans, die mit Anti‐TNF‐α‐Therapie behandelt wurden, konnten drei klinische Fälle und zwölf Literaturfälle ermittelt werden. Insgesamt wurden fünf verschiedene TNF‐α‐Inhibitoren eingesetzt, am häufigsten Adalimumab. Klinisches Ansprechen wurde nach 1 Monat bei 2/3 (67%) der klinischen Fälle beziehungsweise 5/12 (42%) der Literaturfälle beobachtet. Nach einer medianen Dauer von 3–7 Monaten war die Behandlung bei 2/3 (67%) und 11/12 (92%) der Betroffenen erfolgreich. Alle berichteten unerwünschten Wirkungen waren leicht und reversibel. Die Anti‐TNF‐α‐Behandlung kann zu schneller Verbesserung bei Patienten mit AF führen, wenn die Erstbehandlung mit Isotretinoin und Prednisolon versagt. Allerdings fehlen randomisierte, kontrollierte Studien, und die exakte Dosierung sowie der exakte Zeitablauf müssen vor der klinischen Umsetzung genauer geprüft werden.
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Affiliation(s)
| | - Mikkel Bak Jensen
- Department of Dermatology, Zealand University Hospital Roskilde, Roskilde, Dänemark
| | - Dorra Bouazzi
- Department of Dermatology, Zealand University Hospital Roskilde, Roskilde, Dänemark
| | - Carsten Sand
- Department of Dermatology, Bispebjerg Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Kopenhagen, Dänemark
| | - Simon Francis Thomsen
- Department of Dermatology, Bispebjerg Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Kopenhagen, Dänemark
| | - Gregor Borut Ernst Jemec
- Department of Dermatology, Zealand University Hospital Roskilde, Roskilde, Dänemark
- Department of Clinical Medicine, Faculty of Health Science, University of Copenhagen, Kopenhagen, Dänemark
| | - Ditte Marie Lindhardt Saunte
- Department of Dermatology, Zealand University Hospital Roskilde, Roskilde, Dänemark
- Department of Clinical Medicine, Faculty of Health Science, University of Copenhagen, Kopenhagen, Dänemark
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4
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Sandoval AGW, Vaughn LT, Huang JT, Barbieri JS. Role of Tumor Necrosis Factor-α Inhibitors in the Treatment and Occurrence of Acne: A Systematic Review. JAMA Dermatol 2023; 159:504-509. [PMID: 36930143 PMCID: PMC10024242 DOI: 10.1001/jamadermatol.2023.0269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/24/2023] [Indexed: 03/18/2023]
Abstract
Importance Tumor necrosis factor-α inhibitors (TNFis) approved to treat several inflammatory diseases are sometimes used off label to treat severe forms of acne that are refractory to conventional therapies. However, use of TNFis can also be followed by acne occurrence, suggesting an association between TNFis and acne. Most of the literature on the topic comprises case reports and series that have not been reviewed in a systematic manner. Objective To characterize the demographic characteristics, clinical presentations, treatments, and outcomes of patients receiving TNFis to treat acne and patients who develop acne following treatment of other conditions with TNFis. Evidence Review A systematic literature review was performed and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guidelines. PubMed and Web of Science were searched from inception through October 17, 2022. Included studies reported on patients of any sex or age who received TNFis whose treatment was followed by resolution or occurrence of acne. Two independent reviewers screened studies based on predefined criteria and extracted data from each study, which were quantitatively combined. Findings A total of 53 studies reporting on 64 patients who received TNFis for the treatment of acne (n = 47) or who experienced acne after treatment with TNFis for a different condition (n = 17) (mean age, 28.7 years; range, 12-64 years; 6 female individuals [8.8%]) were included. The TNFis used included adalimumab, infliximab, and etanercept. Among the 47 patients treated for acne with TNFis, most had previously received antibiotics (31 [66.0%]) or isotretinoin (32 [68.1%]). Most (44 [93.6%]) experienced partial improvement (25 [53.2%]) or clearance (19 [40.4%]) with very few adverse effects reported (3 [6.4%]). Acne manifested as part of an inflammatory syndrome for 30 patients (63.8%). Among the 17 patients treated TNFis for a different condition followed by the occurrence of acne, only 1 patient (5.9%) reported having a history of acne. Therapy with TNFis was either discontinued (8 [47.1%]) or altered (6 [35.3%]) in most patients due to acne occurrence, typically with improvement in symptoms. Conclusions and Relevance The results of this systematic review suggest that TNFis can be effective in treating refractory acne but can also be associated with the occurrence of acne in certain instances. Further studies elucidating the role that TNF plays in treating and inducing acne could yield insight into off-label TNFi use and acne pathogenesis, potentially guiding clinical care of patients with acne treated or induced by TNFis.
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Affiliation(s)
| | | | - Jennifer T. Huang
- Department of Dermatology, Boston Children’s Hospital, Boston, Massachusetts
| | - John S. Barbieri
- Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts
- Associate Editor, JAMA Dermatology
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Kontochristopoulos G, Agiasofitou E, Platsidaki E, Kapsiocha A, Gregoriou S, Rigopoulos D. Successful Treatment of Coexistent Acne Fulminans and Severe Hidradenitis Suppurativa with Adalimumab. Skin Appendage Disord 2021; 7:329-332. [PMID: 34307485 DOI: 10.1159/000515002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 01/31/2021] [Indexed: 12/30/2022] Open
Abstract
The coexistence of hidradenitis suppurativa (HS) and acne fulminans (AF) has only recently been reported in the literature. We present a case of a 17-year-old man who presented with a 2 years history of severe acne and HS. He was initially started on oral clindamycin and rifampicin for 3 months with no clinical improvement. Acne lesions became worse with the presence of nodules and necrotic ulcers, while weight loss, low-grade fever, back and knee pain, and psychological distress were noted. We prescribed adalimumab in its standard dosing regimen. Remission of AF was achieved in 3 months, whereas adalimumab has not been as effective in treating the HS lesions. Its dosage was increased to 80 mg weekly and more than 80% clinical improvement of HS lesions was obtained in 2 months. The patient maintained on this dosage till this day and efficacy is sustained. TNF-α inhibitors are considered an effective option in the treatment of HS, while it has been also suggested as a treatment option in AF. Our patient was successfully treated with adalimumab. Since the coexistence of HS and AF has a devastating emotional effect on the patient, there is an urgent need to implement therapeutic approaches.
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Affiliation(s)
| | - Efthymia Agiasofitou
- Department of Dermatology and Venereology, Andreas Sygros Hospital, Athens, Greece
| | - Eftychia Platsidaki
- Department of Dermatology and Venereology, Andreas Sygros Hospital, Athens, Greece
| | - Anastasia Kapsiocha
- Department of Dermatology and Venereology, Andreas Sygros Hospital, Athens, Greece
| | - Stamatios Gregoriou
- National and Kapodistrian University of Athens, Faculty of Medicine, 1st department of Dermatology-Venereology, Andreas Sygros Hospital, Athens, Greece
| | - Dimitrios Rigopoulos
- National and Kapodistrian University of Athens, Faculty of Medicine, 1st department of Dermatology-Venereology, Andreas Sygros Hospital, Athens, Greece
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6
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Marasca C, Fabbrocini G, Abategiovanni L, Camela E, Nocerino M, Di Guida A, De Fata Salvatores G. Adalimumab in the Management of Isotretinoin-Induced Acne Fulminans: Report of a Case. Skin Appendage Disord 2021; 7:115-119. [PMID: 33796557 DOI: 10.1159/000512032] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 10/05/2020] [Indexed: 01/26/2023] Open
Abstract
Acne fulminans (AF) is a rare, acute, and severe form of acne vulgaris often associated with systemic symptoms. Its treatment is challenging and controversial. We report a case of isotretinoin-induced AF (IIAF) in a 12-year-old boy resistant to traditional therapies (oral steroids and isotretinoin). The patient was successfully treated with adalimumab that can be considered an effective off-label option in the treatment of resistant IIAF in children.
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Affiliation(s)
- Claudio Marasca
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Luisa Abategiovanni
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Elisa Camela
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Mariateresa Nocerino
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Adriana Di Guida
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Gaia De Fata Salvatores
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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7
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Abstract
Acne fulminans (AF) is a rare and severe form of inflammatory acne presenting clinically with an abrupt outburst of painful, hemorrhagic pustules and ulceration, that may or may not be associated with systemic symptoms, such as fever, polyarthritis, and laboratory abnormalities. It typically affects male teenagers with a pre-existing acne. Although the pathogenetic mechanism has not been established yet, a role of genetic, abnormal immunologic response, drugs intake, hormonal imbalance and viral infection, as causal factors, has been identified. AF may occur as a single disease or may be associated with other disorders. Traditionally, AF has been classified, on the basis of the presence of systemic involvement, in "acne fulminans" and acne fulminans "sine fulminans," when no systemic involvement is present. Recently, four clinical variants have been proposed: acne fulminans with systemic symptoms (AF-SS), acne fulminans without systemic symptoms (AF-WOSS), isotretinoin-induced acne fulminans with systemic symptoms (IIAF-SS), isotretinoin-induced acne fulminans without systemic symptoms (IIAF-WOSS). The diagnosis of AF is usually based on clinical history and physical examination. No specific laboratory abnormalities are generally found. In selected cases, biopsy and/or radiologic imaging are helpful for a correct diagnosis. The treatment significantly differs from severe acne according to severity of clinical presentation and possible systemic involvement. Currently, systemic corticosteroids (prednisolone) and retinoids (isotretinoin) represent the first choice of treatment. Dapsone, cyclosporine A, methotrexate, azathioprine, levamisole, and biological agents such as anakinra, infliximab, adalimumab may be considered as alternative therapies in selected cases. Adjunctive topical and physical therapies may also be considered.
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Affiliation(s)
| | | | - Maria R Nasca
- Dermatology Clinic, University of Catania, Catania, Italy
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8
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Ozdel S, Baglan E, Kargın Cakıcı E, Yazılıtas F, Celikkaya E, Bulbul M. Two pediatric cases of isotretinoin-induced sacroiliitis successfully treated with adalimumab. Pediatr Dermatol 2020; 37:929-931. [PMID: 32757332 DOI: 10.1111/pde.14321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 06/16/2020] [Accepted: 07/19/2020] [Indexed: 11/30/2022]
Abstract
Isotretinoin is widely used in severe acne. Isotretinoin has many side effects. Sacroiliitis is one of these side effects and has been rarely reported in the children. Herein, we present two children with isotretinoin-induced sacroiliitis resistant to anti-rheumatic drugs and successfully treated with adalimumab.
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Affiliation(s)
- Semanur Ozdel
- Department of Pediatric Rheumatology, Dr Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Esra Baglan
- Department of Pediatric Rheumatology, Dr Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Evrim Kargın Cakıcı
- Department of Pediatric Rheumatology, Dr Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Fatma Yazılıtas
- Department of Pediatric Rheumatology, Dr Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Evra Celikkaya
- Department of Pediatric Rheumatology, Dr Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Mehmet Bulbul
- Department of Pediatric Rheumatology, Dr Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
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9
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Mülkoğlu C, Nacır B. A patient with chronic sacroiliitis undiagnosed for three years after isotretinoin use. BMC Musculoskelet Disord 2020; 21:300. [PMID: 32410688 PMCID: PMC7227041 DOI: 10.1186/s12891-020-03290-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 04/14/2020] [Indexed: 12/24/2022] Open
Abstract
Background Isotretinoin (ISO) is a synthetic vitamin A derivative which has been used for treatment-resistant acne vulgaris. Although most musculoskeletal side effects of ISO are common, including myalgia, arthralgia, and back pain, sacroiliitis is one of the uncommon side effects. ISO-induced sacroiliitis usually completely resolves within a few months by the cessation of the drug. Case presentation In this paper, we present a 26-year-old female patient with chronic sacroiliitis that was probably induced by ISO and not resolved by the discontinuation of the drug. Conclusion In this patient, sacroiliitis was overlooked for three years. Therefore, ISO usage should be considered in the differential diagnosis of sacroiliitis and low back pain.
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Affiliation(s)
- Cevriye Mülkoğlu
- Department of Physical Medicine and Rehabilitation, Health Sciences University Ankara Training and Research Hospital, Ankara, Turkey.
| | - Barış Nacır
- Department of Physical Medicine and Rehabilitation, Health Sciences University Ankara Training and Research Hospital, Ankara, Turkey
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10
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Mülkoğlu C, Karaosmanoğlu N. Effect of Serum 25 Hydroxy Vitamin D Level on Isotretinoin-Induced Musculoskeletal Symptoms: A Cross-Sectional Study. Sci Rep 2020; 10:2245. [PMID: 32042004 PMCID: PMC7010655 DOI: 10.1038/s41598-020-59167-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 01/19/2020] [Indexed: 12/20/2022] Open
Abstract
Isotretinoin (ISO) is a drug which is used for the treatment of severe and refractory acne vulgaris (AV), over the last few decades. The drug has various musculoskeletal side effects. The aim of this study was to investigate relationship between serum 25 hydroxy (OH) vitamin D levels and the ISO-induced musculoskeletal side effects in patients with AV. We included 87 patients receiving ISO and had musculoskeletal symptoms as adverse effect (AE) group. Another 90 patients receiving ISO for AV and had any musculoskeletal complaints were recruited as control (C) group. Locomotor system examination of the patients was performed by the same clinician. Serum 25 OH vitamin D levels of the all participants were measured. Patients in the AE group were divided into three subgroups by serum 25 OH vitamin D levels. Patients with serum 25 OH vitamin D level lower than 10 ng/ml was classified as Group I, the ones between 10-20 ng/ml as Group II and those higher than 20 ng/ml were classified as Group III. AE and C groups were similar in terms of age and sex (p > 0.05). There was no statistically significant difference in the mean serum vitamin D levels between two groups (p = 0.17). Also, there was no significant difference in number of arthralgia (p = 0.30), myalgia (p = 0.29), low back pain (p = 0.10) and sacroiliitis (p = 0.17) between three subgroups in AE group. In addition, we found no statistically significant correlation between the serum vitamin D levels and age, cumulative dose of ISO, arthralgia, myalgia and sacroiliitis parameters in AE group (p > 0.05). Serum 25 OH vitamin D levels between the AE and C groups were similar. We also found that no significant difference in musculoskeletal adverse events between AE subgroups. Therefore, it can be concluded that vitamin D deficiency has no effect on the musculoskeletal adverse events in patients receiving ISO.
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Affiliation(s)
- Cevriye Mülkoğlu
- Department of Physical Medicine and Rehabilitation, Health Sciences University Ankara Training and Research Hospital, Ankara, Turkey.
| | - Nermin Karaosmanoğlu
- Department of Dermatology, Health Sciences University Ankara Training and Research Hospital, Ankara, Turkey
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11
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Elnady B, Elkhouly T, Dawoud NM, Desouky DE, Kewan HH, Dawoud DM, Ritchlin C. New onset of axial spondyloarthropathy in patients treated with isotretinoin for acne vulgaris: incidence, follow-up, and MRI findings. Clin Rheumatol 2020; 39:1829-1838. [DOI: 10.1007/s10067-020-04957-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 01/17/2020] [Accepted: 01/22/2020] [Indexed: 12/18/2022]
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12
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Karadağ ŞG, Sönmez HE, Tanatar A, Çakan M, Aktay Ayaz N. Isotretinoin-induced sacroiliitis: Case series of four patients and a systematic review of the literature. Pediatr Dermatol 2020; 37:171-175. [PMID: 31765029 DOI: 10.1111/pde.14035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Isotretinoin is the mainstay treatment in severe acne; however, its musculoskeletal adverse effects such as lower-back pain can be disabling. Herein, we present four cases of isotretinoin-induced sacroiliitis with variable severity. We also present a review of the literature of isotretinoin-induced sacroiliitis. All our cases were male and human leukocyte antigen (HLA)-B27 negative. Sacroiliitis was detected a median of 55 (10-120) days after isotretinoin initiation. Two patients were responsive to baseline sulfasalazine and indomethacin treatment, while the other two patients required more intensive treatments: adalimumab in one and methotrexate in the other. We also identified 15 articles describing 33 patients (17 of whom were female) with isotretinoin-induced sacroiliitis. Most of them were responsive to low-to-medium doses of systemic steroids or non-steroidal anti-inflammatory drugs (NSAIDs). Our patients illustrate that severity of isotretinoin-induced sacroiliitis varies from patient to patient.
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Affiliation(s)
- Şerife Gül Karadağ
- Department of Pediatric Rheumatology, Kanuni Sultan Süleyman Research and Training Hospital, University of Health Science, Istanbul, Turkey
| | - Hafize Emine Sönmez
- Department of Pediatric Rheumatology, Kanuni Sultan Süleyman Research and Training Hospital, University of Health Science, Istanbul, Turkey
| | - Ayşe Tanatar
- Department of Pediatric Rheumatology, Kanuni Sultan Süleyman Research and Training Hospital, University of Health Science, Istanbul, Turkey
| | - Mustafa Çakan
- Department of Pediatric Rheumatology, Kanuni Sultan Süleyman Research and Training Hospital, University of Health Science, Istanbul, Turkey
- Department of Pediatric Rheumatology, Şanlıurfa Research and Training Hospital, Şanlıurfa, Turkey
| | - Nuray Aktay Ayaz
- Department of Pediatric Rheumatology, Kanuni Sultan Süleyman Research and Training Hospital, University of Health Science, Istanbul, Turkey
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13
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Coskun BN, Yagiz B, Pehlivan Y, Dalkilic E. Isotretinoin-induced sacroiliitis in patients with hidradenitis suppurativa: a case-based review. Rheumatol Int 2019; 39:2159-2165. [DOI: 10.1007/s00296-019-04434-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 08/22/2019] [Indexed: 12/13/2022]
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