The oral adverse effects of isotretinoin treatment in acne vulgaris patients: A prospective, case-control study.

BACKGROUND: Isotretinoin is the most effective therapy to treat severe acne vulgaris and its systemic adverse effects have been well documented, but little is known on dental side effects over the course of treatment. OBJECTIVES: This prospective case-control study aimed to evaluate the oral adverse effects of isotretinoin in Turkish patients with acne vulgaris; compare oral conditions between patients and normal controls; and investigate the association between salivary parameters and International Caries Detection and Assessment System (ICDAS) scores. MATERIALS AND METHODS: For 6 months, the patients (n = 45) received isotretinoin daily (0.5 mg/kg). The age-matched untreated controls (n = 45) were patients without acne. Both groups were examined before the study and at 6 months for salivary flow, buffer capacity, microbiologic tests, and caries status (based on the ICDAS). Salivary parameters and ICDAS scores were analyzed by Spearman's rank correlations. Data were statistically analyzed by the Mann-Whitney U test, Wilcoxon signed rank tests, and McNemar's Chi-square tests (P < 0.05). RESULTS: Twenty-two isotretinoin-treated patients and 18 controls completed the study. At baseline, the groups were not significantly different in the evaluated parameters (P > 0.05). At 6 months in the isotretinoin-treated group, salivary flow and buffer capacity significantly decreased, and the ICDAS scores significantly increased (P < 0.05). The changes in these criteria from baseline were insignificant in the controls (P > 0.05). Intraoral pathogen counts were not significantly different between the groups, compared to baseline (P > 0.05). Stimulated salivary parameters in both groups were not correlated significantly with the ICDAS scores. CONCLUSIONS: Isotretinoin significantly affected salivary flow, buffer capacity, caries lesion activity scores for 6 months. However, salivary parameters and caries lesion activity scores had no significant correlations.

Childhood bullous pemphigoid developed after the first vaccination.

Bullous pemphigoid (BP) typically affects the elderly. There are at least 40 reported cases of BP in childhood, 10 reported cases at 1 year of age or younger. The antigen of this autoimmune disease is localized to the hemidesmosome. Neoplasia, recurrent trauma, some systemic diseases, and psoriasis were previously reported as possible triggering factors of bullous pemphigoid in some cases. In the last 5 years, 10 adult and 2 infantile BP cases with a close relation of vaccination have been reported. Anti-influenza vaccine, tetanus toxoid booster, and tetracoq vaccine were the possible causes of these cases. We report herein a 3.5-month-old BP case in whom the lesions developed 24 hours after the first tetracoq vaccine. We suggest that vaccination may be the triggering factor of BP of any age by stimulating the immune system with an unexplained mechanism.

Nevoid hyperkeratosis of the nipple and areola: treatment with topical retinoic acid.

Nevoid hyperkeratosis of the nipple and areola is a rare dermatosis with unknown etiology, (Perez-Izquierdo JM, Vilata JJ, Sanchez JL, et al. Retinoic acid treatment of nipple hyperkeratosis. Arch Dermatol 1990;126:687-688). Only 40 cases have been reported until 1997 (Alpsoy E, Yilmaz E, Aykol A. Hyperkeratosis of the nipple: report of two cases. J Dermatol 1997;24:43-45). The disease has a benign course and may only be a cosmetic problem. Different modalities have been used in the treatment of NHNA. In our case treatment with topical retinoic acid induced an acceptable response.

Uterus didelphys with unilateral obstructed hemivagina and renal agenesis on the same side.

A rare condition, complete or incomplete duplication of uterus and cervix with unilateral vaginal obstruction, is usually associated with ipsilateral renal agenesis. In such kinds of Müllerian and Wolffian duct anomalies as the one reported here with accumulation of menstrual blood in the obstructed vagina, the patient usually complains of a pelvic mass and associated severe and increasing dysmenorrhea. A case, diagnosed and treated at our Department, is presented.