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Background: Although the effects of oral isotretinoin (OI) on acne vulgaris and preventing further acne scars have been well-documented, the specific impact of OI alone on pre-existing atrophic acne scars (AAS) remains unclear. No clinical study has objectively evaluated the effect of OI on AAS yet. Objective: We sought to investigate the OI effect on AAS quantitatively and reliably by shear-wave elastography (SWE). Methods: This work is a single-center, prospective and observational study. Thirty patients with moderate and severe acne vulgaris accompanied by AAS were included. We started the OI with a standard dose regime. On Days 0 and 90 of treatment, patients' global acne grading system (GAGS) and the Goodman and Baron's Qualitative Global Scar Rating System (GSRS) were evaluated. The dermal thickness, subcutaneous tissue thickness, scar size, and scar and subcutaneous tissue's elastic modules were measured on both cheeks of each patient by SWE. Results: The improvement in GSRS stages and GAGS scores in 90 days were statistically significant (respectively; p=0.029, <0.001). Scar size and dermal thickness decreased, while the subcutaneous tissue thickness and the elastic modulus of scar and subcutaneous tissue increased in bilateral cheeks. The thickness changes in the right side dermis, and subcutaneous tissue on both sides were noteworthy (p<0.05). Conclusion: Besides its well-known effect on acne vulgaris, OI also could be an effective treatment option for reducing scar size and severity while improving skin elasticity. SWE may help follow skin and scar properties.
RESUMO
INTRODUCTION: Reactive granulomatous dermatitis (RGD) is a new entity, which is highly associated with systemic disorders. There is scarce data regarding interstitial granulomatous dermatitis (IGD) and palisaded neutrophilic granulomatous dermatitis (PNGD). OBJECTIVES: We aimed to evaluate clinical and histopathological characteristics of IGD and PNGD as unified entities under the term of RGD. METHODS: Observational, retrospective, single-center study of patients diagnosed with IGD and PNGD between 2012 and 2021 were included in the study. RESULTS: Of 16 patients (14 females and 2 males) with RGD, 13 had IGD and 3 had PNGD with a mean age of 62.5 years. The most common clinical presentation was plaques 37.5% (N=6), followed by patches 25% (N=4). The most common localization of involvement was lower extremity 75% (N=12), followed by trunk and upper extremity. Multiple localization of involvement was determined in 75% (N=12) of patients. None of the patients had rope sign. Associated comorbidities such as autoimmune diseases and malignancies were detected in 68.7% (N=11) of patients. In majority of biopsies (87.5%; N=14), there were lymphohistiocytic cell infiltration. Other accompanying cells were scarce neutrophils 31.2% (N=5) and eosinophils 31.2% (N=5). All of the biopsies had interstitially located lymphohistiocytic cell infiltration surrounding with swollen and degenerated collagen. Palisaded pattern was determined in 18.7% (N=3) of patients and floating sign was seen in 18.7% (N=3) of biopsies. CONCLUSIONS: RGD is a rare entity and most patients with RGD had associated disorders such as autoimmunity or malignancy. There is overlapping between IGD and PNGD, therefore supporting the usage of umbrella term as reactive granulomatous dermatitis is compatible with the literature.
