RESUMEN
Embryonal tumor with multilayered rosettes is a rare and highly malignant early childhood brain tumor. We report a case of embryonal tumor with multilayered rosettes in the parietooccipital region of a 2-year-old girl. Histopathology of the tumor demonstrated amplification of the 19q13.42 locus and strong positivity for LIN28A. Treatment was multimodal and included 3 surgical resections, adjuvant chemotherapy with autologous stem cell rescue, and focal radiotherapy. The use of the agents vorinostat and isotretinoin, and the addition of focal radiation have not been extensively described in this patient population, but may attribute to our patient's sustained remission at 2.5-years follow-up.
Asunto(s)
Neoplasias Encefálicas , Cromosomas Humanos Par 19/genética , Sitios Genéticos , Isotretinoína/administración & dosificación , Neoplasias de Células Germinales y Embrionarias , Trasplante de Células Madre , Vorinostat/administración & dosificación , Autoinjertos , Neoplasias Encefálicas/genética , Neoplasias Encefálicas/patología , Neoplasias Encefálicas/terapia , Quimioradioterapia Adyuvante , Preescolar , Femenino , Humanos , Neoplasias de Células Germinales y Embrionarias/genética , Neoplasias de Células Germinales y Embrionarias/patología , Neoplasias de Células Germinales y Embrionarias/terapiaRESUMEN
BACKGROUND: Acne vulgaris has been a common clinical condition. Due to. high prevalence and unclear etio-pathogenesis of acne vulgaris, large number of treatment options have been available across the globe. Limited work has been done to explore the options which may manage or prevent these adverse effects and improve the adherence to the prescribed medications. We therefore conducted this trial to look for effectiveness of oral omega 3 in reducing mucocutaneous side effects of oral isotretinoin in patients with acne vulgaris. OBJECTIVE: To look for effectiveness of oral omega 3 in reducing mucocutaneous side effects of oral isotretinoin in patients with acne vulgaris. It was a randomized control trial conducted at Department of Dermatology Pak Emirates Military Hospital Rawalpindi. Ten months, June 2019 to May 2020. METHODS: A total of 60 patients of acne vulgaris put on oral isotretinoin by consultant dermatologist were included in the study. Patients were randomized into groups by lottery method. Group A received the placebo along with oral isotretinoin while Group B received oral omega 3 in standard dose in addition to oral isotretinoin. Comparison was made in both the groups regarding common mucocutaneous side effects. RESULTS: Out of 60patients with acne vulgaris and put on isotretinoin included in the study, 26 (43.3%) received placebo in addition to isotretinoin while 34 (56.7%) received omega 3 in addition to isotretinoin. Forty (66.7%) patients were female while 20 (33.3%) were male. Cheilitis 35 (58.3%) was the commonest side effect followed by lip dryness 33 (55%). Application of chi-square test revealed that cheilitis, lip dryness and xerosis were significantly found in more patients who received placebo as compared to those who received omega 3 along with isotretinoin. CONCLUSION: Mucocutaneous side effects were a very common finding among patients of acne vulgaris managed with isotretinoin. Cheilitis was the most reported mucocutaneous side effects among the target population. This RCT demonstrated that omega 3 was superior to placebo in order to prevent or manage cheilitis, xerosis or dry lips.
Asunto(s)
Acné Vulgar/tratamiento farmacológico , Queilitis , Fármacos Dermatológicos/efectos adversos , Ácidos Grasos Omega-3 , Isotretinoína/efectos adversos , Administración Oral , Queilitis/inducido químicamente , Queilitis/tratamiento farmacológico , Fármacos Dermatológicos/administración & dosificación , Fármacos Dermatológicos/uso terapéutico , Ácidos Grasos Omega-3/administración & dosificación , Ácidos Grasos Omega-3/uso terapéutico , Femenino , Humanos , Isotretinoína/administración & dosificación , Isotretinoína/uso terapéutico , MasculinoRESUMEN
BACKGROUND: Anogenital warts are a common human papillomavirus infection. They cause emotional distress, especially when they are in the anogenital region. Cryotherapy is a first-line treatment. Previous clinical trials and case series have reported variable results with retinoids (isotretinoin) as adjuvant therapy. OBJECTIVE: To determine the safety and efficacy of low-dose oral isotretinoin as adjuvant treatment of anogenital warts. METHODS: Forty-six patients with anogenital warts were randomly assigned to isotretinoin + cryotherapy (n = 23) or only cryotherapy (n = 23). Patients were allocated via an interactive web-based randomization system. Evaluators were blinded to treatments. Isotretinoin 20 mg/daily + cryotherapy or cryotherapy were prescribed for 6 weeks. Patients were followed for 4 months. Genotyping of lesions was performed before treatment started. Dermatology Life Quality Index (DLQI) and Columbia-Suicide Severity Rating Scale (C-SSRS) were measured at the beginning and end of therapy. All patients completed the study. RESULTS: Both Groups had 50% clearance at the end of treatment. Recurrence in the combined group was not significantly lower than in the cryotherapy group (P = 0.59). Improvement was observed in the DLQI of all patients in both groups (P = 0.001). No suicidal intention was detected with the C-SSRS. Two patients (one in each group) had liver function test abnormalities after treatment. CONCLUSION: Combined therapy showed a slight not significant efficacy for anogenital warts in Hispanic patients. Low-dose isotretinoin seems to be safe even when it is used with cryotherapy on anogenital warts. TRIAL REGISTRATION: On April 25, 2019 with registration number DE19-00004, CONBIOÉTICA-19-CEI-001-20160404. Prospectively registered.
Asunto(s)
Condiloma Acuminado/terapia , Crioterapia , Isotretinoína/administración & dosificación , Administración Oral , Adulto , Terapia Combinada , Condiloma Acuminado/diagnóstico , Condiloma Acuminado/psicología , Relación Dosis-Respuesta a Droga , Femenino , Humanos , Isotretinoína/efectos adversos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Calidad de Vida , Recurrencia , Índice de Severidad de la Enfermedad , Resultado del Tratamiento , Adulto JovenRESUMEN
Either isotretinoin or intense pulsed light (IPL) proved to be effective to alleviate acne lesions, but the combined treatment has rarely been reported. The study aimed to evaluate the efficacy, safety, and patient satisfaction of isotretinoin and 420 nm IPL combined treatment. Forty-seven patients with facial acne with Global Evaluation Acne (GEA) graded 2-4 were randomized into study group and control group. The patients in the control group received oral isotretinoin for 8 weeks. The patients in the study group were treated with oral isotretinoin for 8 weeks, together with a biweekly 420 nm IPL treatment for 4 weeks. Topical agents included adapalene and fusidic acid. Efficacy was evaluated using digital photographies taken at baseline and week 12 by an independent dermatologist, including GEA grade, lesion count, lesion reduction percentage, and effective rate. All patients completed a questionnaire about dermatology life quality index (DLQI) and satisfaction visual analog scale (VAS) on week 12, and were followed up for another 2 months. Adverse events were recorded. The patients in the study group experienced significant reduction in GEA grade, total lesions, and inflammatory lesions on week 12, compared with the control group (p < 0.05). The patients in the study group reported lower DLQI and higher VAS satisfaction (p < 0.05) and experienced lower incidence of relapse (p < 0.05). No severe adverse event was identified in both groups. Compared with isotretinoin alone, isotretinoin and 420 nm IPL combined treatment proved to be more effective within limited treatment duration. It was well-tolerated and the patients' satisfaction was high.
Asunto(s)
Acné Vulgar/terapia , Pueblo Asiatico , Tratamiento de Luz Pulsada Intensa/efectos adversos , Isotretinoína/efectos adversos , Isotretinoína/uso terapéutico , Satisfacción del Paciente , China , Femenino , Estudios de Seguimiento , Humanos , Isotretinoína/administración & dosificación , Masculino , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios , Resultado del Tratamiento , Escala Visual Analógica , Adulto JovenRESUMEN
BACKGROUND: Case reports have suggested isotretinoin exposure may be associated with adverse cardiac events. There are limited data where the cardiovascular safety of isotretinoin is systematically evaluated. OBJECTIVE: The aim of this study was to determine the strength of association between isotretinoin exposure and adverse cardiovascular events. METHODS: This was a population-based retrospective cohort study within an integrated healthcare delivery system. Adults ≥ 18 years of age with acne between 2009 and 2018 were included. Exposure to isotretinoin was identified using pharmacy records, and propensity score 1:1 matching was performed. The primary outcome was a composite of cardiovascular outcomes, including acute myocardial infarction, heart failure, and all-cause death. RESULTS: The cohort consisted of 12,140 adults (10.5%) exposed to isotretinoin and 103,126 adults who were never exposed. Mean follow-up was 7.1 ± 2.9 years. After propensity score 1:1 matching, 23,844 patients were included. The rates of the composite cardiovascular outcomes were 0.47 versus 0.48 per 1000 person-years in the isotretinoin and non-exposed groups, respectively. No significant association was observed between isotretinoin treatment and the composite cardiovascular outcomes (adjusted hazard ratio [HR] 0.99, 95% confidence interval [CI] 0.62-1.58), all-cause mortality (adjusted HR 1.10, 95% CI 0.62-1.95), acute myocardial infarction (adjusted HR 1.00, 95% CI 0.33-3.09), congestive heart failure (adjusted HR 0.45, 95% CI 0.14-1.40), or atrial fibrillation (adjusted HR 0.44, 95% CI 0.12-1.65). CONCLUSIONS: Among adult patients with acne, no association was found between exposure to isotretinoin and an increased risk of cardiovascular events. Physicians should not be discouraged from prescribing isotretinoin out of concern for cardiovascular effects.
Asunto(s)
Acné Vulgar/tratamiento farmacológico , Insuficiencia Cardíaca/epidemiología , Isotretinoína/efectos adversos , Infarto del Miocardio/epidemiología , Adolescente , Adulto , Anciano , California/epidemiología , Estudios de Casos y Controles , Femenino , Estudios de Seguimiento , Factores de Riesgo de Enfermedad Cardiaca , Humanos , Isotretinoína/administración & dosificación , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos , Factores de Riesgo , Adulto JovenRESUMEN
Vitamin A and its metabolites are key regulators of the development of adipose tissue and associated metabolic complications. The aim of this study was to determine the effect of high fat diet and 13-cis retinoic acid (13 cRA) application on metabolic parameters, adipogenic and inflammatory indicators in female Lewis rats. Female rats of Lewis strain were fed standard laboratory diet (STD) and high fat diet (HFD, 45% of saturated fatty acids) during 30 days. The groups were divided into additional 3 groups (6 rats each): two experimental groups that received 13 cRA orally on a daily basis during 30 days (7.5 mg/kg and 15 mg/kg, respectively) and the control group that was given sunflower oil. Animals were sacrificed after 60 days. Feeding of Lewis rats with chronic HFD diet with 13 cRA supplementation increased weight gain, adiposity index, dyslipidaemia, hyperleptinaemia, insulin resistance, VLDL concentrations, oxidative stress and atherogenic indices. Administration of 13 cRA in Lewis rats fed STD did not change the weight of the animals, but it slightly increased the atherogenic parameters. 13 cRA and HFD affect metabolic parameters, glucose and lipid metabolism in Lewis rats and its administration has a completely different effect on metabolism in rats fed STD, highlighting the complex role of vitamin A supplementation in obesity. Other factors, such as genetics, age, sex, adipose tissue distribution, also must be taken into consideration.
Asunto(s)
Dieta Alta en Grasa , Glucosa/metabolismo , Isotretinoína/farmacología , Metabolismo de los Lípidos/efectos de los fármacos , Estrés Oxidativo/efectos de los fármacos , Adipogénesis/efectos de los fármacos , Animales , Femenino , Resistencia a la Insulina , Isotretinoína/administración & dosificación , Obesidad/metabolismo , Ratas Endogámicas Lew , Aumento de Peso/efectos de los fármacosRESUMEN
Antibiotic resistance in acne was first observed in the 1970s, and since the 1980s has become a major concern in dermatologic daily practice. The mechanisms for this type of resistance include biofilm formation that promotes virulence and the transmission of resistant bacterial strains. Genetic mutations with modification of ribosomal RNA, alteration in efflux pumps, and enzymatic inactivation are able to create resistance to tetracyclines and macrolides. The state of art in acne treatment is no longer to use antimicrobials as monotherapy. There should be a time limit for its use plus the employment of non-antibiotic maintenance. Earlier initiation of oral isotretinoin therapy should be considered in patients with insufficient response to antimicrobials, severe acne, or a history of repeated antimicrobial use. A better understanding of acne pathogenesis, the subtypes of Propionibacterium (also known as Cutibacterium) acnes, homeostasis of the skin microbiota, and the mechanisms of antibiotic resistance would be useful in the selection of narrow-spectrum or species-specific antimicrobials, as well as the non-antimicrobial, anti-inflammatory treatment of acne. A number of novel treatments awaiting clinical proof may include the use of bacteriophages, natural or synthetic antimicrobial peptides, probiotics, and biofilm-targeting agents, as well as the reassessment of phototherapy.
Asunto(s)
Acné Vulgar/terapia , Antibacterianos/farmacología , Bacteriófagos , Fototerapia , Propionibacterium acnes/efectos de los fármacos , Acné Vulgar/diagnóstico , Acné Vulgar/microbiología , Acné Vulgar/patología , Administración Cutánea , Administración Oral , Antibacterianos/uso terapéutico , Antiinflamatorios/administración & dosificación , Biopelículas/efectos de los fármacos , Biopelículas/crecimiento & desarrollo , Terapia Combinada/métodos , Farmacorresistencia Microbiana , Quimioterapia Combinada/métodos , Humanos , Isotretinoína/administración & dosificación , Pruebas de Sensibilidad Microbiana , Propionibacterium acnes/aislamiento & purificación , Índice de Severidad de la Enfermedad , Piel/microbiología , Piel/patología , Resultado del TratamientoAsunto(s)
Arachis/inmunología , Técnicas y Procedimientos Diagnósticos/normas , Glycine max/inmunología , Isotretinoína/uso terapéutico , Hipersensibilidad al Cacahuete/tratamiento farmacológico , Anafilaxia/inmunología , Anafilaxia/prevención & control , Antígenos de Plantas/inmunología , Arachis/efectos adversos , Bases de Datos Factuales , Fármacos Dermatológicos/administración & dosificación , Fármacos Dermatológicos/uso terapéutico , Humanos , Inmunoglobulina E/inmunología , Isotretinoína/administración & dosificación , Monitoreo Fisiológico/métodos , Hipersensibilidad a la Nuez/tratamiento farmacológico , Hipersensibilidad a la Nuez/inmunología , Hipersensibilidad a la Nuez/prevención & control , Hipersensibilidad al Cacahuete/inmunología , Aceite de Soja/metabolismo , Glycine max/efectos adversosRESUMEN
ABSTRACT Purpose: To compare the impact of ocular changes between systemic treatment with doxycycline and low-dose oral isotretinoin in patients with moderate-to-severe papulopustular rosacea. Methods: Patients were randomized to receive either isotretinoin 0.3-0.4 mg/kg (group A) or doxycycline 100 mg/day (group B) for 16 weeks. Ocular symptoms were searched and evaluated, including best-corrected visual acuity (BCVA), Schirmer test, breakup time, rose bengal staining score, and meibomian gland dysfunction grading. The patients were retested at the end of treatment. Results: The present study included 39 patients (30 females and 9 males). Best-corrected visual acuity was > 20/30 in >90% of patients in both groups and did not change after treatment. After treatment, improvement in ocular symptoms and meibomian gland dysfunction was more pronounced in group B (p<0.05); the other parameters did not reach statistical significance. Conclusion: Doxycycline improved meibomian gland dysfunction, ocular symptoms, and ocular surface in patients with rosacea. Even though some patients experienced worsening meibomian gland dysfunction and symptoms, no subject experienced any serious complications after administration of low-dose isotretinoin.
RESUMO Objetivos: Comparar o impacto das alterações oculares entre o tratamento sistêmico de doxiciclina e isotretinoína em baixa dosagem em pacientes com rosácea papulopustulosa moderada a grave. Métodos: Os pacientes form randomizados para receber isotretinoína 0,3 a 0,4 mg/kg (grupo A) ou doxiciclina 100mg/dia (grupo B) por 16 semanas. Os sintomas oculares foram pesquisados e avaliados, incluindo melhor acuidade visual corrigida, teste de Schirmer, tempo de ruptura do filme lacrimal, coloração de rosa bengala e graduação da disfunção de glândula de Meibomius. Os pacientes foram novamente testados no final do tratamento. Resultados: O presente estudo incluiu 39 pacientes (30 mulheres e 9 homens). A melhor acuidade visual corrigida foi >20/30 em >90% dos pacientes em ambos os grupos e não se alterou após o tratamento. A melhora dos sintomas oculares e da disfunção de glândula de Meibomius foi mais pronunciada no grupo B (p<0,05) após o tratamento; as demais variáveis não atingiram significância estatística. Conclusão: A doxiciclina melhorou a disfunção de glândula de Meibomius, os sintomas oculares e a superfície ocular de pa cientes com rosácea. Mesmo que alguns pacientes tenham piorado a disfunção e os sintomas da glândula de Meibomius, nenhum indivíduo apresentou complicações graves após a admi nistração de baixas doses de isotretinoína.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Adulto Joven , Isotretinoína/administración & dosificación , Doxiciclina/administración & dosificación , Rosácea/tratamiento farmacológico , Fármacos Dermatológicos/administración & dosificación , Disfunción de la Glándula de Meibomio/tratamiento farmacológico , Antibacterianos/administración & dosificación , Índice de Severidad de la Enfermedad , Agudeza Visual , Administración Oral , Resultado del Tratamiento , Rosácea/fisiopatología , Ojo/efectos de los fármacos , Disfunción de la Glándula de Meibomio/fisiopatología , Glándulas Tarsales/efectos de los fármacosRESUMEN
BACKGROUND: Fractional microneedle radiofrequency (FMRF) systems are popular options for treating acne scars. However, treatment efficacy when used in combination with traditional ablative fractional laser (AFL) and the safety profile with concomitant use of isotretinoin remain unknown. OBJECTIVE: The aim of this study was to assess the safety and efficacy of an early intervention combination treatment protocol for inflammatory acne and acne scars. MATERIALS AND METHODS: The electronic records of 71 patients with inflammatory acne and acne scars were included in this retrospective observational study. Data were collected for all patients who received combination FMRF and AFL. Within the study group, 43 patients were receiving low-dose isotretinoin or had completed isotretinoin within the past 3 weeks. RESULTS: The mean Scar Global Assessment score significantly decreased after 3 sessions of combination treatment (n = 71). Patients with inflammatory acne showed a significant decrease in the number of inflammatory lesions (n = 30). Patients with concomitant low-dose isotretinoin use reported a further decrease in Scar Global Assessment score (n = 43). There were no reported persistent side effects, including prolonged inflammatory reaction or scarring. CONCLUSION: Combination treatment with FMRF and AFL is an effective and well-tolerated treatment modality for acne scars and inflammatory acne.
Asunto(s)
Acné Vulgar/terapia , Cicatriz/terapia , Punción Seca/métodos , Isotretinoína/administración & dosificación , Terapia por Láser/métodos , Terapia por Radiofrecuencia/efectos adversos , Acné Vulgar/complicaciones , Acné Vulgar/diagnóstico , Administración Oral , Adulto , Cicatriz/diagnóstico , Cicatriz/etiología , Terapia Combinada/efectos adversos , Terapia Combinada/métodos , Relación Dosis-Respuesta a Droga , Punción Seca/efectos adversos , Punción Seca/instrumentación , Femenino , Estudios de Seguimiento , Humanos , Terapia por Láser/efectos adversos , Láseres de Gas/uso terapéutico , Masculino , Agujas/efectos adversos , Ondas de Radio/efectos adversos , Terapia por Radiofrecuencia/instrumentación , Terapia por Radiofrecuencia/métodos , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Resultado del Tratamiento , Adulto JovenRESUMEN
Acne vulgaris is the most common skin disease treated by dermatologists. It can be severe and result in permanent scars. Isotretinoin is the most effective treatment for acne and has the potential for long-term clearance. Prescribing and monitoring protocols can vary widely among prescribers. Recent studies, reports, and consensus statements help shed light on optimizing the use of isotretinoin for acne. A recent literature review is summarized in this article to help the practitioner optimize isotretinoin use for acne. The article outlines the advantages and disadvantages of standard, high-dose, and low-dose isotretinoin regimens; discusses the current status of controversies surrounding isotretinoin (including depression/suicide, pregnancy, and inflammatory bowel disease); reviews monitoring recommendations and treatment for hypertriglyceridemia and elevated transaminase levels; and discusses common adverse effects seen with isotretinoin, along with their treatment and prevention.
Asunto(s)
Acné Vulgar/tratamiento farmacológico , Prescripciones de Medicamentos/normas , Isotretinoína/administración & dosificación , Guías de Práctica Clínica como Asunto , Teratógenos/toxicidad , Anomalías Inducidas por Medicamentos/etiología , Anomalías Inducidas por Medicamentos/prevención & control , Acné Vulgar/psicología , Ansiedad/inducido químicamente , Ansiedad/prevención & control , Ansiedad/psicología , Anticoncepción/normas , Depresión/inducido químicamente , Depresión/prevención & control , Depresión/psicología , Relación Dosis-Respuesta a Droga , Monitoreo de Drogas/normas , Femenino , Humanos , Enfermedades Inflamatorias del Intestino/inducido químicamente , Enfermedades Inflamatorias del Intestino/prevención & control , Isotretinoína/efectos adversos , Isotretinoína/toxicidad , Cooperación del Paciente , Educación del Paciente como Asunto , Embarazo , Suicidio/psicología , Cicatrización de Heridas/efectos de los fármacosRESUMEN
BACKGROUND: While a considerable number of cases with papulopustular rosacea (PPR) are resistant to conventional medications, therapeutic regimens are not currently established. Pulsed dye laser (PDL) and fractional microneedling radiofrequency (FMR) have previously demonstrated satisfactory results for anti-angiogenesis, anti-inflammation, and dermal remodeling. AIMS: To evaluate the efficacy and safety of novel combination regimen with low-dose oral isotretinoin, PDL, and FMR in the treatment of recalcitrant PPR. PATIENTS AND METHODS: A retrospective study was undertaken for recalcitrant PPR patients to evaluate the clinical course of novel combination regimen. Twenty-five PPR patients who had failed in previous first-line therapies were enrolled. They were treated with three sessions of PDL and FMR consecutively at 4-week intervals, maintaining daily oral administration of 10 mg isotretinoin for 8 weeks. Objective assessments, erythema index measurement, and patients' subjective satisfaction were evaluated at each visit and 16 weeks after the final treatment. RESULTS: At the final follow-up visit, the number of papules and pustules decreased by 71%, and erythema index by 54% compared with baseline (P < 0.05 for both). Physician's global assessment based on rosacea severity score and patients' subjective assessments paralleled with these results. No serious side effect was observed during whole study periods. CONCLUSION: This novel combination regimen demonstrated satisfactory efficacy with reasonable safety profiles for the treatment of recalcitrant PPR.
Asunto(s)
Isotretinoína/administración & dosificación , Láseres de Colorantes/uso terapéutico , Terapia por Luz de Baja Intensidad/instrumentación , Terapia por Radiofrecuencia/instrumentación , Rosácea/terapia , Administración Oral , Adulto , Terapia Combinada/efectos adversos , Terapia Combinada/instrumentación , Terapia Combinada/métodos , Relación Dosis-Respuesta a Droga , Femenino , Estudios de Seguimiento , Humanos , Isotretinoína/efectos adversos , Láseres de Colorantes/efectos adversos , Terapia por Luz de Baja Intensidad/efectos adversos , Masculino , Persona de Mediana Edad , Agujas/efectos adversos , Satisfacción del Paciente , Terapia por Radiofrecuencia/efectos adversos , Estudios Retrospectivos , Rosácea/diagnóstico , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
Warts constitute the most frequently observed dermatological manifestations of human papillomavirus (HPV). Although an extensive range of treatments exist for local warts, there is no specific therapy based on high-quality evidence of notable treatment success or high cure rate, or minimal adverse effects. Recalcitrant warts are, therefore, a common therapeutic problem. This case series refer to 14 immunocompetent patients with recalcitrant warts, who experienced full resolution of their warty lesions when treated with addition of low dose isotretinoin, in a dose of 0.1-0.2 mg/kg/day, for a 3-month course, with no significant adverse effects. Long-term remission was noted for up to 3 years with no signs of active lesions. Low dose isotretinoin should be in the priority of the treatment options of recalcitrant warts, alone or in combination.
Asunto(s)
Fármacos Dermatológicos/administración & dosificación , Isotretinoína/administración & dosificación , Verrugas/tratamiento farmacológico , Adolescente , Adulto , Niño , Fármacos Dermatológicos/efectos adversos , Relación Dosis-Respuesta a Droga , Quimioterapia Combinada , Femenino , Humanos , Isotretinoína/efectos adversos , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Adulto JovenRESUMEN
For decades it has been widely accepted that elective procedures should be delayed for at least 6-months following completion of isotretinoin therapy. However, numerous 2017 publications demonstrate the need for change in best practice. The evidence has yet to be succinctly summarized in a single article or in a stand-alone quick reference algorithm for physicians. This article's review of all 2017 publications confirms that the 6-month delay is not necessary for all procedures and provides a simple algorithmic approach to summarize the updated recommendations for procedural delay of cosmetic procedures following systemic isotretinoin therapy. This is a useful tool for clinicians and allows patients to receive the most appropriate and timely cosmetic therapy to minimize the psychosocial impact of the skin condition.
Asunto(s)
Fármacos Dermatológicos/administración & dosificación , Isotretinoína/administración & dosificación , Dermabrasión/métodos , Fármacos Dermatológicos/uso terapéutico , Humanos , Terapia por Luz de Baja Intensidad/métodos , Factores de TiempoRESUMEN
An inappropriate immunologic response has been suggested to play a role in the pathogenesis of hidradenitis suppurativa (HS). Adalimumab was the first TNF-α inhibitor approved for moderate to severe HS. We report on a case of HS (Hurley stage 2) in a 39-year-old man, who had received fusidic acid and isotretinoin treatments without evident benefit during the last 8 years. The patient noticed a reduction in the number of lesions and quality of life (DLQI from 27 to 6) in the 2 months following verapamil initiation for cluster headache. When verapamil was stopped, the lesions recurred within 1.5 months. The patient resumed taking verapamil as before and a remission occurred. Verapamil has been shown to inhibit TNF-α and IL-1ß in vitro and in vivo. We hypothesize that verapamil inhibits the inflammatory process through the TNF-α/IL-1 pathway involved in the HS physiopathology. Compared to biologic agents as anti-TNF-α (adalimumab) and anti-IL1 (anakinra), verapamil is safer and cheaper. Given its possible role on TNF-α/IL-1, verapamil may represent an alternative therapeutic option in mild and moderate HS.
Asunto(s)
Hidradenitis Supurativa/tratamiento farmacológico , Calidad de Vida , Verapamilo/uso terapéutico , Adulto , Bloqueadores de los Canales de Calcio/farmacología , Bloqueadores de los Canales de Calcio/uso terapéutico , Ácido Fusídico/administración & dosificación , Hidradenitis Supurativa/inmunología , Hidradenitis Supurativa/patología , Humanos , Isotretinoína/administración & dosificación , Masculino , Resultado del Tratamiento , Factor de Necrosis Tumoral alfa/antagonistas & inhibidores , Verapamilo/farmacologíaRESUMEN
Laboratory monitoring for patients on isotretinoin should include creatinine kinase in athletic males and the more liver-specific gamma glutamyltransferase. There is mounting evidence that acne pathophysiology includes a barrier defect and subsequent microbiome disruption. Avoidance of acne scars with early and aggressive treatment is a more efficient and cost-effective option than subsequent treatment. Laser and light treatments for acne and acne scars are plentiful but poorly supported by evidence-based medicine. The acne pipeline is rich with new chemical entities, new formulations, and combinations of older agents. The gold standard for acne therapy may be changing its face.
Asunto(s)
Acné Vulgar/complicaciones , Acné Vulgar/terapia , Cicatriz/epidemiología , Fármacos Dermatológicos/administración & dosificación , Isotretinoína/administración & dosificación , Acné Vulgar/microbiología , Antibacterianos/uso terapéutico , Cicatriz/etiología , Cicatriz/terapia , Creatina Quinasa/sangre , Cara , Humanos , Tratamiento de Luz Pulsada Intensa , Pruebas de Función Hepática , Microbiota , Fotoquimioterapia , Prebióticos , Probióticos/uso terapéutico , Retinoides/uso terapéutico , Sebo/efectos de los fármacos , Sebo/metabolismo , Piel/microbiologíaRESUMEN
BACKGROUND: Immunotherapy with the chimeric anti-GD2 monoclonal antibody dinutuximab, combined with alternating granulocyte-macrophage colony-stimulating factor and intravenous interleukin-2 (IL-2), improves survival in patients with high-risk neuroblastoma. We aimed to assess event-free survival after treatment with ch14.18/CHO (dinutuximab beta) and subcutaneous IL-2, compared with dinutuximab beta alone in children and young people with high-risk neuroblastoma. METHODS: We did an international, open-label, phase 3, randomised, controlled trial in patients with high-risk neuroblastoma at 104 institutions in 12 countries. Eligible patients were aged 1-20 years and had MYCN-amplified neuroblastoma with stages 2, 3, or 4S, or stage 4 neuroblastoma of any MYCN status, according to the International Neuroblastoma Staging System. Patients were eligible if they had been enrolled at diagnosis in the HR-NBL1/SIOPEN trial, had completed the multidrug induction regimen (cisplatin, carboplatin, cyclophosphamide, vincristine, and etoposide, with or without topotecan, vincristine, and doxorubicin), had achieved a disease response that fulfilled prespecified criteria, had received high-dose therapy (busulfan and melphalan or carboplatin, etoposide, and melphalan) and had received radiotherapy to the primary tumour site. In this component of the trial, patients were randomly assigned (1:1) to receive dinutuximab beta (20 mg/m2 per day as an 8 h infusion for 5 consecutive days) or dinutuximab beta plus subcutaneous IL-2 (6â×â106 IU/m2 per day on days 1-5 and days 8-12 of each cycle) with the minimisation method to balance randomisation for national groups and type of high-dose therapy. All participants received oral isotretinoin (160 mg/m2 per day for 2 weeks) before the first immunotherapy cycle and after each immunotherapy cycle, for six cycles. The primary endpoint was 3-year event-free survival, analysed by intention to treat. This trial was registered with ClinicalTrials.gov, number NCT01704716, and EudraCT, number 2006-001489-17, and recruitment to this randomisation is closed. FINDINGS: Between Oct 22, 2009, and Aug 12, 2013, 422 patients were eligible to participate in the immunotherapy randomisation, of whom 406 (96%) were randomly assigned to a treatment group (n=200 to dinutuximab beta and n=206 to dinutuximab beta with subcutaneous IL-2). Median follow-up was 4·7 years (IQR 3·9-5·3). Because of toxicity, 117 (62%) of 188 patients assigned to dinutuximab beta and subcutaneous IL-2 received their allocated treatment, by contrast with 160 (87%) of 183 patients who received dinutuximab beta alone (p<0·0001). 3-year event-free survival was 56% (95% CI 49-63) with dinutuximab beta (83 patients had an event) and 60% (53-66) with dinutuximab beta and subcutaneous IL-2 (80 patients had an event; p=0·76). Four patients died of toxicity (n=2 in each group); one patient in each group while receiving immunotherapy (n=1 congestive heart failure and pulmonary hypertension due to capillary leak syndrome; n=1 infection-related acute respiratory distress syndrome), and one patient in each group after five cycles of immunotherapy (n=1 fungal infection and multi-organ failure; n=1 pulmonary fibrosis). The most common grade 3-4 adverse events were hypersensitivity reactions (19 [10%] of 185 patients in the dinutuximab beta group vs 39 [20%] of 191 patients in the dinutuximab plus subcutaneous IL-2 group), capillary leak (five [4%] of 119 vs 19 [15%] of 125), fever (25 [14%] of 185 vs 76 [40%] of 190), infection (47 [25%] of 185 vs 64 [33%] of 191), immunotherapy-related pain (19 [16%] of 122 vs 32 [26%] of 124), and impaired general condition (30 [16%] of 185 vs 78 [41%] of 192). INTERPRETATION: There is no evidence that addition of subcutaneous IL-2 to immunotherapy with dinutuximab beta, given as an 8 h infusion, improved outcomes in patients with high-risk neuroblastoma who had responded to standard induction and consolidation treatment. Subcutaneous IL-2 with dinutuximab beta was associated with greater toxicity than dinutuximab beta alone. Dinutuximab beta and isotretinoin without subcutaneous IL-2 should thus be considered the standard of care until results of ongoing randomised trials using a modified schedule of dinutuximab beta and subcutaneous IL-2 are available. FUNDING: European Commission 5th Frame Work Grant, St. Anna Kinderkrebsforschung, Fondation ARC pour la recherche sur le Cancer.
Asunto(s)
Anticuerpos Monoclonales/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Interleucina-2/administración & dosificación , Neuroblastoma/tratamiento farmacológico , Adolescente , Factores de Edad , Anticuerpos Monoclonales/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Niño , Preescolar , Femenino , Humanos , Lactante , Interleucina-2/efectos adversos , Isotretinoína/administración & dosificación , Masculino , Neuroblastoma/inmunología , Neuroblastoma/mortalidad , Neuroblastoma/patología , Supervivencia sin Progresión , Factores de Riesgo , Factores de Tiempo , Adulto JovenRESUMEN
The continuous low dose (LD) isotretinoin is frequently used in the treatment regimen for acne vulgaris. However, data about its antimicrobial are lacking. The present study aimed to investigate dermcidin expression and the effects of low and conventional dose isotretinoin on its expression in acne vulgaris patients. Skin dermcidin expression was investigated in 30 patients with moderate-severe acne vulgaris and 15 healthy control subjects using ELISA. 15 patients were given continuous low-dose isotretinoin (20 mg/day) and the other 15 given the conventional high dose (0.5 mg/kg/day). Skin biopsies were taken at the start of the study and 6 months later. Dermcidin was significantly lower in acne vulgaris patients (p < .001). Both isotretinoin regimens significantly raised dermcidin levels compared to pre-treatment values (p < .001). Relapse after 12 months was not statistically different among the two isotretinoin regimens (p = .464). Pretreatment global acne grading system score of 28.6 ± 6.4 was reduced to 6 ± 6.1 following isotretinoin treatment (p < .001). Relapse was significantly related to posttreatment dermcidin levels (p = .017). Dermcidin expression is reduced in acne vulgaris. Conventional and LD isotretinoin regimens are associated with increased dermcidin expression.
Asunto(s)
Acné Vulgar/tratamiento farmacológico , Fármacos Dermatológicos/administración & dosificación , Isotretinoína/administración & dosificación , Péptidos/metabolismo , Piel/efectos de los fármacos , Acné Vulgar/diagnóstico , Acné Vulgar/metabolismo , Administración Oral , Adolescente , Adulto , Biomarcadores/metabolismo , Método Doble Ciego , Esquema de Medicación , Femenino , Humanos , Masculino , Índice de Severidad de la Enfermedad , Piel/metabolismo , Piel/patología , Factores de Tiempo , Resultado del Tratamiento , Regulación hacia Arriba , Adulto JovenAsunto(s)
Condiloma Acuminado/tratamiento farmacológico , Fármacos Dermatológicos/administración & dosificación , Isotretinoína/administración & dosificación , Enfermedades del Pene/tratamiento farmacológico , Administración Cutánea , Administración Oral , Quimioterapia Combinada , Humanos , Queratolíticos/administración & dosificación , Masculino , Podofilino/administración & dosificación , RecurrenciaRESUMEN
Patients with high-risk neuroblastoma remain a therapeutic challenge with significant numbers of patients failing to respond sufficiently to initial therapy. These patients with poor response to induction are considered as ultra high-risk and are in need of novel treatment strategies. Isotretinoin is part of the standard of care treatment for patients with high-risk disease who undergo high-dose chemotherapy with autologous stem cell rescue although some have questioned the optimal administration schedule. Prolonged use of isotretinoin was well tolerated and may have contributed to long-term survival in a group of patients with ultra high-risk neuroblastoma.