A Case of Multiple Keratoacanthoma with Intralesional 5-FU and Etretinate Therapy / 대한피부과학회지

Keratoacanthoma is a benign epithelial growth tumor arising from the hair follicle predominantly in elderly patients on sun-exposed skin. Intralesional therapy with 5-fluorouracil is a safe treatment and may be the treatment of choice for multiple keratoacanthoma and solitary lesion which are difficult to remove surgically. We have experienced a case of multiple keratoacanthoma which involved the right nasolabial fold and the left ear. We treated them with oral etretinate and intralesional 5-fluorouracil(5-FU), therefore minimized the scar of the lesion and the possibility of recurrence.

The Efficacy and Sagety of Re-PUVA Combination Therapy for Psoriasis in Comparison with Retinoid and PUVA Monotherapy / 대한피부과학회지

BACKGROUND: Although retinoid and PUVA monotherapy is effective for psoriasis, both treatment regimens have some limitations because of the risk of long-term toxicity. OBJECTIVE: We performed Re-PUVA combination therapy to evaluate the clinical efficacy and safety in comparison with retinoid and PUVA monotherapy. METHODS: Seventy-eight psoriasis patients received Re-PUVA combination therapy as well as conventional retinoid and PUVA monotherapy. Pretreatment with etretinate for 1 week was followed by PUVA therapy in combination with etretinate. RESULTS: 1. Among patients who received Re-PUVA combination therapy, clearing was shown in 77.3% and improvement in 13.6%, which were higher than retinoid, 27.8%/61.1%, and PUVA monotherapy, 65.8%/21.0%.2. In patients who reached grade 4 with Re-PUVA therapy, the duration and total dose of etretinate were 56.4 days and 1616mg. These were significantly lower than retinoid monotherapy, 107.5 days and 2577.5mg.3. In patients who reached grade 4 with Re-PUVA therapy, the number and total dose of UVA were 13.3 and 82.8 J/cm2, which showed no difference compared with those of PUVA monotherapy, 16.2 and 120.2 J/cm2. However, excluding the cases who did not respond to previous monotherapy, the number and total dose of UVA in Re-PUVA were 10.4 and 49.0J/cm2, which were significantly lower than those of PUVA4. The side effects of Re-PUVA were reported in 54.5%, which were similar to PUVA monotherapy, 52.6%, and lower than retinoid monotherapy, 83.3%. There were some side effects of retinoid, such as cheilitis, dry mouth, elevation of sGOT/sGPT and triglycerides, and side effects of PUVA, such as itching, erythema, anorexia, nausea and vomiting. CONCLUSION: Our study suggests that Re-PUVA combination therapy is more effective and tolerable than retinoid and PUVA monotherapy in the treatment of psoriasis, especially in severe and recalcitrant cases.

A Case of Darier's Disease Improved with Oral Etretinate and Isotretinoin, and CO2 Laser Vaporization / 대한피부과학회지

We report a case of Darier's disease with typical cutaneous and nail lesions in a 50-year-old male patient. He has brownish hyperkeratotic papules on the ant.chest, back, both axilla and groins and verrucous surfaced hypertrophic plaques on the scalp, forehead and both postauricular areas, which were accompanied by a severe itching sensation and malodor. Also he has finger nail lesions such as subungual hyperkeratotic papules, distal wedge shaped notching and multiple longitudinal red lines on the nail plates. Histopathologic features taken from the inguinal area revealed hyperkeratosis, suprabasal clefts and lacuna, protruded villi lined with one layer of basal cells into the cavity and dyskeratotic cells such as corps ronds in the epidermis. Hyperkeratotic papules on the ant.chest, back, both axilla and groins disappeared after systemic treatment withe a low dose of oral etretinate but hypertrophic plaques on the scalp and both postauricular areas still remained clinically and histopathologically. We then the treated postauricular hypertrophic plaques with CO2 laser vaporization and severe malodor with oral isotretinoin and it resulted in a marked improvement.

A Case of Confluent and Reticulated Papillomatosis: Treatment with Etretinate / 대한피부과학회지

Confluent and reticulated papillomatosis(CRP) is a rare dermatosis. The lesions are hyperkeratotic, verrucous papules and plaques, resulting in a confluence of lesions centrally and a reticulated pattern at the periphery. It is more common in women and during puberty. The histopathological findings show papillomatosis, hyperkeratosis and a sparse superficial perivascular lymphocytic infiltrate. We report a case of CRP that responded to oral etretinate in an 18-year-old man.

A Case of Inflammatory Linear Verrucous Epidermal Nevus

Inflammatory linear verrucous epidermal nevus(ILVEN) is a relatively rare skin disorder, characterized by chronic inflammatory psoriasiform pattern. This chronic skin disorder is generally believed to be resistant to various treatments, although some authors have reported success with 13-cis-retinoic acid and 585 nm pulsed laser therapy. We experienced a 15-month aged female ILVEN patient who has been suffered from linear erythematous verrucous pathes mainly located on left inguinal area, hand, and foot with persistent itching sense. This skin lesion have been developed at birth, and more spread out toward right extremity after 1 year old age . We initially treated this skin lesion with topical corticosteroids and oral anti-histamines, but this treatment was not successful. So we retreated this patient with etretinate(oral retinoid) and topical 13-cis-retinoic acids, we found that therapeutic responses to these applications were more remarkable. Now, we closely observe this patient's clinical course further more.

Visceral heterotaxy syndrome induced by retinoids in mouse embryo

Visceral heterotaxy syndrome causes abnormal arrangement of thoracoabdominal organs and severe complex cardiac anomalies by abnormal laterality. The purpose of the present study is to analyze the incidence and pattern of heterotaxy syndrome in etretinate and all-tran retinoic acid treated pregnant DDY mice. Pregnant DDY mice were intragastrically given a single dose of 15 mg/kg of etretinate at day 6, 7 of gestation, 30 mg/kg of etretinate at day 7 of gestation and 20 mg/kg of all-trans retinoic acid at day 7 of gestation. The incidence of visceral heterotaxy was highest in the etretinate 15 mg/kg treated group on day 7 of gestation (38.5%). The major cardiovascular anomalies in heterotaxy syndrome were common atrium, common atrioventricular valve, atrioventricular septal defect, transposition of great arteries, pulmonary atresia, pulmonary artery hypoplasia and aortic arch anomalies. Atrial situs of heterotaxy syndrome were right isomerism, solitus-like, inversus-like and left atrial aplasia, but right isomerism was observed most frequently. The results suggest that retinoic acid exerts a significant effect on the determination of atrial situs during the development of mouse embryo.

Changes of Serum Lipid Concentration and Serum Liver Enzyme Levels During Etretinate Treatment in Patients with Psoriasis / 대한피부과학회지

BACKGROUND: Oral etretinate treatment is associated with the changes in serum lipid concentration and the elevation of serum liver enzymes. In Korea, chronic degenerative diseases like diabetes and hypertension are increasing and the prevalences of HBsAg and chronic liver diseases are much higher than those in western countries. Therefore these changes in serum lipids and liver enzymes during etretinate treatrment are important in Korea as risk factors for atherosclerosis and aggravation of preexisting liver diseases. OBJECTIVE: We tried to observe the sequential pattern, frequency, severity, and relationship between pretreatment value and posttreatment values in the changes of serum lipids and liver enzymes in patients with psoriasis luring etretinate treatment. METHODS: Fourty-one patients with psoriasis were studied during etretinate treatment with the starting dose of 0.5-1.0mg/kg/day. The levels of serum triglyceride, serum cholesterol, HDL-cholesterol, and sGOT, sGPT was repeatedly determined until the 16th week of etretinate treatment. RESULTS: l. In serum triglyceride and cholesterol, the average of concentrations in each treatment period was usually higher than pretreatment value during the 16 weeks of treatment, but no sequential pattern of changes was observed 2. The number of patients with the maximum of posttreatment values higher than the normal limit were 12(29.3%) in triglyce side, 6(14.6%) in cholesterol, 0 in sGOT, and 5(12.5%) in sGPT. The number of patients with the minimum of posttreatment values lower than the normal limit were 15(36.6%) in HDL-cholesterol. 3. In serum cholesterol, patients with an abnormal pretreatment value are more prone to elevation above the normal limit duriing etretinate treatment than patients with a normal pretreatment value. CONCLUSION: In patients with psoriasis the increases in serum triglyceride, serum cholesterol, sGOT, sGPT and the decrease in HDL-cholesterol were occurred frequently during etretinate treatment. Therefore monitoring of serum lipid concentration and serum liver enzyme levels on a regular basis during etretinate treatment is essential for its safe use in patients with psoriasis, es- pecially in cases of long term etretinate treatment.

A Case of Darier' s Disease Treated by the Combined Treatment with Oral Etretinate and Topical Tretinoin Cream / 대한피부과학회지

We report a case of Dariers disease which showed a more effective result using a combined treatment with oral etretinate and topical tretinoin cream than treatment with oral etretinate alone in a 17-year old male patient. Oral etretinate 40mg was given daily and topical therapy with tretinoin cream was applied to lesions of neck and face. Two weeks later, lesions of neck and face showed good improvement compared with the not applied lesions. Topical therapy was then extended to other lesions. Six weeks after treatment, there was a marked improvement. Three months after treatment, most of lesions were nearly gon.

A Case of Generalized Acrodermatitis Continua of Hallopeau

Acrodermatitis continua (AC) of Hallopeau is one of the chronic relapsing pustular eruptions of the extremities. Generalization of AC sometimes occurred spontaneously, or induced by withdrawl of drugs such as corticosteroid, or pregnancy. We report a case of generalized AC in a 50-year-old woman who has been treated intermittently with various medications other than systemic retinoids. The histopathologic findings of the pustules on the fingertips and trunk revealed subcomeal abscesses and/or spongiform pustules. The patient was treated with etretinate in the dose of 50mg/day, and UVB exposure. Two months after treatment, skin lesions were markedly improved.

A case of parakeratosis pustulosa / 대한피부과학회지

Parakeratosis pustulrisa occurs most often on the upper cxtiemities of girls and that is considered to be a variant of either eczema or psoriasis. It presents with scaling of the tip of the finger, subungual hyperkeratosis, and irregular t.hickening and rumblirg of the distal nail plate. We report a 4-year-old female child patient, who showed spon.aneous nail extraction with erythematous scaly path with pustule formation on the left thumb, ring finger and right middle finger nails. The microbiologic and mycologic examinaiors revealed negative results. Histopathologic examination showed focal parakeratosis of the nail bed and the lower part of the nail plate. We treated her with etretinate(Tigason, 0.6mg/kg/day).

Two cases of Darier's disease treated with etretinate / 대한피부과학회지

We report two cases of Darier's disease improved with Etretmate in the 44-year-old father and his 18-year-old son. Clinically, multiple dirty brownish, verrucous, discrete or confluent papules and plaques were noted on their back, abdomen, and face. Histopathologically, both of them demonstrated hyperkeratosis, suprabasal acantholysis, acantholytic cells in the lacunae, corpsronds, grains, and dyskeratotic cells. Oral Etretinate 30mg daily was given in both cases with remakable improvement 3 weeks after treatment. Six months later, they showed almost total clearin, of their skin lesions. No specific adverse effect was noted. There has been no evidence of recurrence for 6 months follow up period.

Comparison of clinical efficacy between acitretin and etretinate in psoriasis / 대한피부과학회지

Etretinate, an effective retinoid in the treatment of pustular, erythrodermic and chronic plaque type psoriasis, has the disadvantage of a long terminal elimination half-life. On the other hand, acitretin, the active metabolite of etretinate, has much shorter terminal elimination half-life and is being reported as an agent with good antipsoriatic activity by several authors. To evaluate the clinical efficacy of acitret.in in comparison with etretinate, we treated 10 patients wit,h acitretin at a dose of 30mg per day and 11 patients with etretinate at a same dose for 12 weeks. The PASI score at 12 week was significantly reduced in each group as compared with baseline PASI score. In the acitretin treated group the initial PASI score of 14.5 reduced to 3.9, while the etretinate group PASI score reduced from 12.0 to 3.1. The PASI score differ ences between the acitretin and etretinate groups at each time during therapy and the end of therapy were not statistically significant. The severity of adverse reactions with acitretin was similar to those with etretinate but their incidence was higher. The change in laboratory parameters in the acitretin group was simlar to that of the etretinate group. In view of these results and the known pharmacokinetic advantage of acitretin, that is the short terminal elimination half-life, it is conceivable that acitretin may be a useful alternative to etretinate in the treatment of psoriasis.

Effect of administration of etretinate and fish oil on plasma cholesterol levels in rats / 대한피부과학회지

The authors studied the plasma cholesterol levels in 39 rats (Sprague-Dawley) after 4 weeks administration of etretinate and/or fish oil. The study groups were as follows.'13 rats recieved etretinate only;13, fish oil only;13, both ertetinate and fish oil. Cholesterol levels were determined by standard enzymatic methodology. The results were as follows. Tot,al-cholesterol levels in rats following administration of ertetinate only were increased(p<0.05), but the levels in rats receiving fish oil only and both etretinate and fish oil were markedly decreased(p<0.01). HDL-cholesterol levels in rats following administration of fish oil and both etretinate and fish oil were decreased(p<0.01). The ratio of HDL-cholesterol to total-cholesterol in rats receiving fish oil only and both etretinate and fish oil were increased(p<0.05) because of markedly decreased total-cholesterol levels.

Treatment of Erythrodermic Psoriasis with Etretinate

We have investigated the clinical response of 12 patients with erythrodermic psoriasis to therapy with etretinate. Initial dosage of etretinate was 20-60mg/day. The time for complete disappearance of scales averaged 19.9 days. In 10 of 12 patients(83.3%) satisfactory results were obtained after 2 to 11 months of treatment. Cheilitis was the most common side effect. Three patients had mild elevation of blood lipids, which was corrected by dose reduction. Remission period, of ten patients who showed good result, averaged 4.2 months.

Erythrokeratodermia Variabilis with Alopecia Universalis

We describe a 8-year-old girl with erythrokeratodermia varibilis (EKV). This diagnosis was supported by erythematous, configurate patches over the entire body. Their size, shape and location varyed with enviromental factors and emotional state. In addition, well defined brownish, hyperkeratotic plaques were scattered over the trunk and extremities. Also, this patient had alopecia universalis, which is not typical of EKV. Etretinate therapy resulted in an almost complete clinical clearing of the plaques; however, her alopecia universalis and erythematous lesions were not affected.

A Case of Verruca Vulgaris Treated with Etretinate ( Tigason R ) / 대한피부과학회지

Etretinate is a synthetic retinoic acid which has been reported effective in hyperkeratotic disorders. Recently, it has also been tried, on a limited number, for the treatment of viral wart. A 33-year-old male patient presented with multiple, tender, confluent, verrucous lesions on the scalp, both hands and feet of 4 years duration. Before coming to us, he had been treated with intralesional injection of bleomycin and electrodesiccation with little effect. We started etretinate therapy in a daily dose of 70mg(1mg /kg). After 3 weeks treatment, most of his skin lesions were flattened and softened: but an abrupt elevation of serum aminotransferases was noticed, which was normalized soon after cessation of medication. Unfortunately, the drug stop page aggravated most of skin lesions. After two weeks of withdrawal we started again the drug in a daily dose of 30mg and observed a good response without hepatic dysfunction.

Etretinate Therapy of Epidermal Nevi

Two cases of epidermal nevi treated with systemic etretinate are presented. Case 1, a 21-year-old female, had been suffered from brownish verrucous papules and plaques on the left inguinal area, thigh, lower leg and dorsum of the foot since her first month of life; and case 2, a 4-year-old boy, had been suffered from brownish verrucous papular plaques on the left chest, axilla and back since birth. In both cases, there was no family history of similar disease. On histopathological examination, case 1 showed the findings of epidermolytic. hyperkeratosis but case 2 did not, with the exception of clumping of keratohyaline granules. In the treatment with systemic etretinate, we observed marked clinical improvement in case 1, but not in case 2. Any particular side effects of etretinate were not observed during treatment. We consider that etretinate therapy is useful in treating epidermal nevus with epidermolytic hyperkeratosis histopathologically.

Adverse Reaction to Methotrexate and Etretinate in a Patient with Psoriasis

A 49-year-old Caucasian male patient suffered from fever general weakness and diffuse hair loss on the scalp for 3 days. Skin lesions showed erythematous scaly patches with pustules and erosions on the lower extremities and perianal region, and multiple ulcerations on the labial mucoas. A complete blood cell count revealed thrombocytopenia and leukopenia, which gradually worsened day after day (platelet: 29, 000/mm², WBC: 1,000/mm³). Candida albicans was isolated from the lesions of the oral cavity and lower extremities. Twelve days prior to the visit, he had taken etretinate Tegison®) P.O.25mg/day, prednisolone P.O. 50mg1dy and methotrexate P.O. 15mg/day for 5 days for the treatment of psoriasis. We presume that these adverse reactions may be synergistic adverse reactions, probably due to methotrexate and etretinate in consideration of the patient's history.

Juvenile Generalized Pustular Psorasis Treated with Etretinate and Methotrexate / 대한피부과학회지

A case of generalized pustular psoriasis in a 12 year-old girl is described. She had generalized pustular eruptions on erythematous base, presenting lake of pus, yellowish brown crusts and denudation associated with high fever and chills. With the administration of oral etretinate at a dose of 0.8mg/kg/day for 1 week, rapid and dramatic remission was achieved. About 3 months after her discharge, there developed another wave of new pustules with fever. She was again placed on etretinate therapy. However, there was no expected response as before with developing new pustules continuously. At that time, we tried combination therapy with etretinate and methotrexate. the pustules and erythema began to remit, with eventual clearing of the skin in 6 weeks.

Porokeratosis Plantaris Palmaris et Disseminata ( PPPD ) Associated with Basal Cell Epithelioma / 대한피부과학회지

Porokeratosis may be due to an abnormal clone of cells, predisposing affected individusls to development of malignant neoplssm over involved area. A 58-year old female is prsented with basal cell epithelioma associated with PPPD, exhibiting the classical histopathologic criteria of the disease. Total excision for basal cell epithelioma and oral administration of etretinate for the treatment of porokeratosis plantaris, palmaris et disseminata and for the prevention of cancer developrnent resulted in good response.