Second joint position paper: Use of isotretinoin in severe acne / Segunda declaración de posición conjunta: uso de isotretinoína en acné severo

Background: The use of isotretinoin is indicated in the treatment of severe acne; however, its adverse effects are important. Objective: To update the first Mexican Consensus on the use of isotretinoin in severe acne vulgaris, which took place in 2009. Methods: It was carried out a literature search between June 2009, and February 2015, in order to evaluate topics to be discussed; materials were sent to the experts to promote the debate among participants. The topics of interest were analyzed during the consensus with the Delphi modified method, using an instrument previously validated. 15 certified dermatologists with experience in handling acne with isotretinoin took part in the study; seven of them were involved in the previous consensus. Results: Several cases of isolated adverse events were identified. Neither systematic reviews, meta-analyses nor comparative, randomized, controlled clinical trials were published during the observation period. Conclusions: Isotretinoin is still the best treatment for severe nodulocystic acne. However, it must be taken into consideration its teratogenic effect on pregnant women and its association with inflammatory bowel disease, depression and suicidal ideas. Monitoring with laboratory tests is a tool for identifying possible adverse events.

Introducción: el uso de la isotretinoína está indicado en el tratamiento del acné severo; sin embargo, sus efectos adversos son importantes. Objetivo: actualizar el primer Consenso Mexicano sobre el uso de isotretinoína en acné vulgar severo. Métodos: se realizó una búsqueda de la literatura especializada entre junio de 2009 y febrero de 2015, con el fin de evaluar los temas que se iban a discutir; el material fue enviado a los expertos con el objetivo de promover el debate entre los participantes. Los temas de interés fueron analizados durante el consenso mediante el método Delphi modificado, utilizando un instrumento previamente validado. Participaron 15 dermatólogos certificados y con experiencia en el manejo de acné con isotretinoína; siete de los especialistas intervinieron en el primer consenso. Resultados: se identificaron múltiples reportes de caso de eventos adversos aislados. Ninguna revisión sistemática o metaanálisis fueron publicados en el periodo de observación. Tampoco se identificaron estudios comparativos clínicos aleatorios controlados. Conclusiones: la isotretinoína todavía es el mejor tratamiento para el acné noduloquístico severo. Sin embargo, se debe considerar su potencial teratogénico sobre el feto en mujeres embarazadas y la asociación con enfermedad inflamatoria intestinal, depresión e ideas suicidas. La monitorización con exámenes de laboratorio es el instrumento para identificar posibles eventos adversos.

An investigation into the MMP1 gene promoter region polymorphism--1607 2G with recessive dystrophic epidermolysis bullosa disease severity in northeastern Mexican patients.

BACKGROUND: Recessive dystrophic epidermolysis bullosa (RDEB) is a severe genetic skin blistering disorder caused by mutations in the gene COL7A1 encoding type VII collagen. Most of the patients' clinical severity depends in part on the nature and location of the mutations, ranging from the mild form described as RDEBother-generalized (RDEB-O) to the more aggressive phenotype described as RDEBsevere-generalized (RDEB-sev gen). However, interfamilial and interindividual differences in subjects with identical COL7A1 mutations suggest the presence of modifier elements, which may influence severity. There is a single nucleotide polymorphism (SNP) at the promoter of the MMP1 gene-encoding matrix metalloproteinase type 1, which has been studied as a genetic disease modifier in different patient cohorts with different findings. METHODS: We tested the SNP in 30 patients with RDEB and 130 controls whose four grandparents were born in northeastern Mexico. Patients were clinically classified as RDEB-sev gen and RDEB-O by three dermatologists. The SNPStats, RXC, and SPSS software were used to perform statistical testing. RESULTS: The allele frequencies for 2G were 0.607, 0.562, and 0.642 for RDEB-O, RDEB-sev gen, and the control group, respectively. When the genotype frequencies were compared, there was no significant difference between RDEB-sev gen (OR = 0.38, CI 95% 0.12-1.21), RDEB-O (OR = 1.03, CI 95% 0.21-4.96), and the control group. CONCLUSION: We found no significant association in relation to the severity of the study subjects and the SNP at the promoter of the MMP1 gene.

[Position paper about isotretinoin on acne vulgaris]. / Declaración de posición conjunta. Uso de isotretinoína en acné común.

Isotretinoin was authorized since 1982 for the treatment of acne vulgaris associated to severe cutaneous lesions. It has been used in others clinical conditions in various plans of prescription. Since the Isotretinoin was launched, it caused controversies in our country and around the world, especially in relation with the security. Isotretinoin is proscribed in pregnant patient. As a security rule we must measure serum lipids and hepatic enzymes. The aim of the consensus was to spread information worked by a group of Mexican experienced dermatologists to the health professionals about the use and the specific indications about isotretinoin.