Ann Dermatol Vener
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We report a case of severe infantile cystic acne, which required a treatment with oral isotretinoin. ⋯ The etiology of infantile acne is not clearly defined, but may result from a persisting androgen-driven stimulation of sebaceous glands. Oral isotretinoin is safe and effective in case of recalcitrant infantile acne, but close monitoring is necessary because of the well-known side effects of oral retinoids.
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The effect of isotretinoin on muscle is considered to be uncommon and benign. We analyzed the files of all our patients given isotretinoin over a 5-year period and determined the incidence and gravity of its effect on muscles. ⋯ Myalgia and elevated CPK signal skeletal muscle involvement. These signs were more frequent in our series than in reports in the literature, probably because we systematically looked for them. Besides use of isotretinoin, one case of viral infection and sports activities, no other explanatory cause could be found. Isotretinoin could have a potentializing effect on other myotoxicity inducers (drugs, infection, fever, muscular exertion...). The benign nature of the muscle effect appears to be validated although there were some patients who had persistent and/or severe signs.
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Saquinavir is a protease inhibitor used for the treatment of HIV infection. Adverse skin reactions have been rare. We report here the first case of erythema multiforme in a patient given saquinavir. ⋯ Adverse skin reactions to saquinavir are exceptional (eruptions, pruritus). We describe here the first case of erythema multiforme caused by saquinavir (imputability criteria 12 BO). Due to the structural analogy of saquinavir with other protease inhibitors (indiravir, ritonavir, nelfinavir) it would be difficult to prescribe a compound of the same class.
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Because of the potential hepatotoxicity of retinoids, prescription of isotretinoin is always very carefully made in healthy subjects, and prohibited in case of concomitant hepatopathy. Gilbert's syndrome consists of chronic, mild, unconjugated hyperbilirubinemia. In this syndrome, isotretinoin has been reported twice to be perfectly tolerated, and once even beneficial. We report here a new case of good tolerance and even improvement of a Gilbert's syndrome during isotretinoin therapy. ⋯ A review of the literature finds only very few cases of hepatic injuries caused by isotretinoin, contrary to etretinate. Safety of isotretinoin in Gilbert's syndrome was first observed in 1984, but its beneficial effects have only recently been described by Wang et al., and we report here a similar case. Pharmacological mechanisms remain hypothetic. However, considering the prevalence of Gilbert's syndrome and its usual first expression during postpubertal period, it seems to us interesting for therapeutic practice to know that isotretinoin is not less safe in these patients.