Dermatology : international journal for clinical and investigative dermatology
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Dermatology (Basel) · Jan 1997
Letter Case ReportsAcute arthritis during isotretinoin treatment for acne conglobata.
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A consensus meeting was held in Brussels in 1995 to review current oral isotretinoin (Roaccutane/Accutane) treatment policies among internationally renowned experts and to improve service to needy patients by proposing treatment guidelines based upon a review of 1,000 acne patients who received this therapy. The group agreed that acne conditions warranting oral isotretinoin treatment include severe acne and poorly responsive acne which improves less than 50% after 6 months of therapy with combined oral and topical antibiotics. Furthermore, acne which relapses, scars or induces consequential psychological distress should be treated with oral isotretinoin. ⋯ The same dosage guidelines were applied to repeated courses of oral isotretinoin therapy with no evidence of increased risk. Mucocutaneous side-effects were predictable; dose-dependent and systemic side-effects were rarely problematic. Acne patients gain immeasurable physical and emotional relief from isotretinoin treatment and society benefits from limiting bacterial resistance evolution and reducing health care costs.
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Dermatology (Basel) · Jan 1997
ReviewDoes oral isotretinoin prevent Propionibacterium acnes resistance?
Oral and topical antibiotics play a major role in acne therapy. Physicians base treatment choices on personal perceptions of efficacy, cost-effectiveness or risk-benefit ratios and rarely take bacterial resistance into account. Propionibacterium acnes isolates resistant to one or more anti-acne antibiotics have been reported in Europe, the USA, Japan and New Zealand. ⋯ Recommendations for the use of antibiotics in acne therapy to help prevent the emergence of resistance in P. acnes include the implementation of antibiotic usage policies and the encouragement of improved prescribing habits. Strategies to reduce the resistant P. acnes population are necessary. This paper reports preliminary data demonstrating that oral isotretinoin (Roaccutane/Accutane) significantly reduces total numbers of resistant P. acnes on the skin of all patients.
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Dermatology (Basel) · Jan 1997
Review Case ReportsErosive pustular dermatosis of the scalp in skin grafts: report of three cases.
Three patients developed erosive pustular dermatosis of the scalp (EPDS). Two of them, both males, had previously undergone surgical excision for squamous cell carcinoma and basal cell carcinoma, and a female experienced avulsive trauma of the scalp. The erosive lesions and crusts were located at the site of a skin graft; microbiological cultures were negative for bacterial and fungal growth. ⋯ The third case showed a tendency to recur despite numerous therapeutic attempts with oral dapsone and isotretinoin. We conclude that surgical trauma is a possible cause of EPDS. Our patients seem to be the first reported cases of EPDS in skin grafts following plastic surgical procedures.
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Since oral isotretinoin (Roaccutane/Accutane) is the only therapy to address all major acne causes, it remains the most effective antiacne therapy available. Due to this unique efficacy and its potential side effects that are predictable and can be managed easily and effectively, it is widely used also in acne patients suffering from serious systemic diseases. As the primary mechanism of action of oral isotretinoin is suppression of sebaceous gland activity, mucocutaneous side effects such as dry lips, nasal passages and eyes are predictable. ⋯ Severe side effects are rare, the most common being aches and pains requiring no therapy, aspirin or paracetamol. As with other retinoids, reliable contraception is mandatory for women of childbearing potential. Acne patients with serious concomitant systemic disease, such as insulin-dependent diabetes, epilepsy or spina bifida, transplant patients, patients with renal failure, multiple sclerosis motor neuron disease and other can also safe be treated with a standard cumulative dose of 120 mg/kg per treatment course.