ABSTRACT
Abstract Introduction Isotretinoin (13 cis-retinoic acid) is the most effective treatment for acne vulgaris and is the only treatment option that can provide either remission or a permanent cure. Objective The aim of this study was to use both subjective and objective methods to assess the nasal complaints of patients with severe acne who received oral isotretinoin therapy. Methods Fifty-four subjects were enrolled in the study. All the subjects were assessed with subjective (NOSE and VAS questionnaires) and objective (rhinomanometry and saccharine) tests to determine the severity of their nasal complaints. Results The mean severity scores (min: 0; max: 100) for nasal dryness/crusting and epistaxis were 0.47 ± 1.48 (0-5); 0.35 ± 1.30 (0-5) at admission, 3.57 ± 4.45 (0-10); 2.26 ± 4.71 (0-20) at the first month, and 4.28 ± 6 (0-20); 2.26 ± 4.71 (0-20) at the third month of the treatment respectively. Total nasal resistance of 0.195 ± 0.079 (0.12-0.56) Pa/cm3/s at admission, 0.21 ± 0.084 (0.12-0.54) Pa/cm3/s at the first month, and 0.216 ± 0.081 (0.14-0.54) Pa/cm3/s at the third month. Conclusion Oral isotretinoin therapy can cause the complaint of nasal obstruction. In addition, nasal complaints, such as dryness/crusting and epistaxis, significantly increase in patients during the therapy schedule.
Resumo Introdução A isotretinoína (ácido-13 cis-retinóico) é o tratamento por via oral mais eficaz para acne vulgar e é a única opção de tratamento que pode produzir remissão ou cura permanente. Objetivo Usar métodos subjetivos e objetivos para avaliar as queixas nasais de pacientes com acne grave que receberam terapia com isotretinoína oral. Método Foram incluídos no estudo 54 indivíduos. Todos os indivíduos foram avaliados por meio de testes subjetivos (questionários NOSE e escala EVA) e objetivos (rinomanometria e teste de sacarina) para determinar a gravidade de suas queixas nasais. Resultados Os escores médios de gravidade (min: 0; max: 100) para ressecamento/crostas e epistaxe nasal foram de 0,47 ± 1,48 (0-5); 0,35 ± 1,30 (0-5) no início, 3,57 ± 4,45 (0-10); 2,26 ± 4,71 (0-20) no primeiro mês e 4,28 ± 6 (0-20); 2,26 ± 4,71 (0-20) no terceiro mês do tratamento, respectivamente. A resistência nasal total foi de 0,195 ± 0,079 (0,12 a 0,56) Pa/cm3/s no início, 0,21 ± 0,084 (0,12 a 0,54) Pa/cm3/s no primeiro mês e 0,216 ± 0,081 (0,14 a 0,54) Pa/cm3/s no terceiro mês. Conclusão A terapia com isotretinoína por via oral pode resultar em queixa de obstrução nasal. Além disso, queixas nasais, tais como ressecamento/formação de crostas e epistaxe, aumentam significativamente nos pacientes durante o esquema terapêutico.
Subject(s)
Humans , Adolescent , Adult , Young Adult , Isotretinoin/pharmacology , Dermatologic Agents/pharmacology , Nasal Cavity/drug effects , Saccharin , Sweetening Agents , Severity of Illness Index , Isotretinoin/adverse effects , Isotretinoin/therapeutic use , Nasal Obstruction/diagnosis , Nasal Obstruction/etiology , Epistaxis/etiology , Prospective Studies , Surveys and Questionnaires , Acne Vulgaris/drug therapy , Rhinomanometry , Dermatologic Agents/adverse effects , Dermatologic Agents/therapeutic use , Symptom AssessmentABSTRACT
Abstract: Background: Isotretinoin is a synthetic analog of vitamin A. Recent studies support a role for retinoic acid in the recovery of olfactory function following injury in mice. Objective: This study aimed at determining the effect of isotretinoin on olfactory function in patients who have acne and are otherwise healthy. Methods: Forty-five patients (aged 25-40 years) with acne were included in the study. All patients underwent a rhinological examination. Olfactory function was assessed by the Sniffin' Sticks Test. The test was assessed at baseline and in the third month of isotretinoin treatment. Results: Isotretinoin improved the performance of patients in the olfactory test. The SST score increased from 8.7±1.09 to 9.5±1.19 (p<0.001), prevalence of hyposmia decreased from 40% to 24% and normosmia increased from 60% to 75% (p=0.059). The percentage of patients whose olfactory function was categorized as "good" increased from 6% to 21.3%. This increase was statistically significant (p<0.05). Study limitations: Absence of a control group is one of the limitations of this study. Also, we did not evaluate patients with smell test after stopping isotretinoin treatment. Conclusion: We examined the effect of systemic isotretinoin on olfactory function. It can be concluded from the present investigation that isotretinoin therapy improves the sense of smell.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Young Adult , Smell/drug effects , Tretinoin/therapeutic use , Isotretinoin/therapeutic use , Acne Vulgaris/drug therapy , Tretinoin/pharmacology , Isotretinoin/pharmacology , Prospective StudiesABSTRACT
The prolonged use of retinoids is associated with changes in bone turnover markers and toxic skeletal effects. Although the effect of short-term oral isotretinoin therapy on bone loss is not well established, caution is recommended when it is used in patients with metabolic bone disease. We examined prospectively the effect of short-term oral isotretinoin therapy on bone turnover markers and bone mineral density [BMD] in women affected by severe acne and vitamin D deficiency. Serum bone Tartrate-resistant Acid Phosphatase [TRACP], bone specific alkaline phosphatase [Bone ALP], calcium, phosphorus, parathyroid hormone [PTH] and 25-hydroxyvitamin D [25[OH]D] were measured in 10 women at baseline, 6 weeks, and end of isotretinoin treatment. BMD was measured in 5 subjects at baseline and end of treatment. Mean serum 25[OH]D at baseline was 16.3 +/- 7.5 nmol/L. Mean TRACP and Bone ALP increased at end of treatment but this was only statistically significant for TRACP [1.18, 1.13, 1.64 U/L; P < 0.001]. Mean calcium decreased slightly at end of treatment but no significant changes occurred in PTH, 25[OH]D and phosphorus. BMD decreased in all studied patients at the femur [range -2.5 to -7.6%], and in all but one patient at the lumbar spine [range +3.2 to -6.8%]. Mean BMD decreased at all measured sites but this was statistically significant only for the femur [-5.3 +/- 1.9%; P=0.002]. Our preliminary study suggests that short-term oral isotretinoin therapy in women with vitamin D deficiency is likely associated with increased bone resorption and decreased BMD. Correction of vitamin D deficiency may be necessary before starting isotretinoin therapy
Subject(s)
Humans , Female , Isotretinoin/pharmacology , Bone Density , Acne Vulgaris , Vitamin D Deficiency , Women , Isotretinoin/adverse effects , Prospective Studies , Acid Phosphatase , Alkaline Phosphatase , Parathyroid Hormone , Calcium , Phosphorus , Bone ResorptionABSTRACT
A acne vulgar é afecçäo inflamatória crônica da unidaded pilossebáceca, dee etiologia multifatorial, sendo particularmente comum entre adolescentes e adultos jovens.Pode levar a importante morbidade física e psicológica, devendo-se atentar para o tratamento mais adequado, considerando-se também a prevençäo de sequelas. O tratamento combinado constitui alternativa comum, principalmente nos casos masi avançados da doença. O tratamento tópico envolve agentes queratolíticos, como os retinóides, o ácido azeláico e os alfa-hidroxiacidos e os bactericidas, incluindo antibióticos como clindamicina e eritromicina, além do peróxido de benzoíla. Já a terapia oral está centrada no uso da isotretinoína, principalmente na acne severa e resistente a tratamentos anteriores, pela excelente melhora do quadro e segurança no uso, comprovados ao longo de mais de 20 anos de estudo. Antibióticos sistêmicos, ,anticoncepcionais orais e antiandrogênicos também constituem alternativas eficazes na terapia oral. Cicatrizes também podem ser tratadas por técnicas mais recentes, como o resurfacing com laser dee CO2 e o preenchimento, além da dermabrasäo e do uso do punch. Diante do enorme arsenal terapêutico, cabe ao dermatologista a escolha do melhor método a seu paciente, o que constitui hoje o grande desafio no tratamento da acne vulgar.(au)
Subject(s)
Acne Vulgaris , Adrenal Cortex Hormones , Isotretinoin/pharmacology , Isotretinoin/therapeutic use , RetinoidsABSTRACT
A isotretinoína quimicamente conhecida como ácido-13-cis-retinóico, faz parte do amplo grupo de compostos relacionados à vitamina A. É empregada particularmente no tratamento da acne cística e nodular e como inibidor da proliferação de células neoplásicas, por exercer efeito regulador sobre a diferenciação celular. Os efeitos adversos envolvendo o uso de isotretinoína estãrelacionados à pele e membranas mucosas, sistemas nervoso, músculo esquelético, linfático, gastrintestinal, cardiorespiratório e geniturinário. A isotretinoína é um composto termo e fotossensível e, por assim se apresentar, desperta o interesse pelo estudo de sua estabilidade...
Subject(s)
Acne Vulgaris , Isotretinoin/analysis , Isotretinoin/adverse effects , Isotretinoin/pharmacokinetics , Isotretinoin/pharmacology , Vitamin A , Chromatography, High Pressure Liquid/methods , Drug StabilitySubject(s)
Humans , Acne Vulgaris , Isotretinoin/adverse effects , Administration, Oral , Cheilitis , Conjunctivitis , Creatine Kinase , Depression/chemically induced , Drug Interactions , Drug-Related Side Effects and Adverse Reactions , Headache , Hyperlipidemias , Isotretinoin/administration & dosage , Isotretinoin/pharmacology , NauseaSubject(s)
Humans , Acne Vulgaris/complications , Acne Vulgaris/diagnosis , Acne Vulgaris/physiopathology , Isotretinoin/pharmacology , Isotretinoin/chemical synthesis , Isotretinoin/therapeutic use , Benzoyl Peroxide , Benzoyl Peroxide/pharmacology , Benzoyl Peroxide/chemical synthesis , Sebaceous Glands/abnormalities , Sebaceous Glands/physiopathologyABSTRACT
No presente estudo, os autores revisam aspectos atuais relacionados ao tratamento da acne vulgar através de uma análise das modalidades farmacológicas nesta entidade clínica, dando ênfase à isotretinoína, a partir de resultados recentes
Subject(s)
Humans , Acne Vulgaris/drug therapy , Isotretinoin/pharmacology , Isotretinoin/therapeutic useABSTRACT
The present study was designed to see the effect of 13-cis retinoic acid [CRA] on albino rats skin tumour initiation by dimethylbenze [a] anthracene [DMBA] and promotion by 12-"o" tetra decanoyl-phorbol. 13 acetate [TPA]. Skin tumour was initiated by 20 [micro] g/2.0 ml DMBA twice a week in one group of rats. In an other group of rats tumour promoter TPA was applied in a dose of 2[micro]/0.2m1, after the application of initiator [DMBA] in the same dose twice a week. This study was continued for 20 weeks. In another groups of rats I 3-cis retinoic acid [CRC] was applied before the application of initiator [DMBA] and promoter [TPA]. Topical application of CRA resulted in 80% tumour inhibition when given before the DMBA and 70% when given before TPA. The results indicate that vitamin 'A" [CRA] inhibits both stages of tumour initiation and promotion
Subject(s)
Animals, Laboratory , Isotretinoin/pharmacology , /pharmacology , Tetradecanoylphorbol Acetate/pharmacology , Rats , Skin Neoplasms/drug therapy , Vitamin AABSTRACT
Este informe comenta la experiencia con el tratamiento oral con isotretinoína en pacientes con acné. El autor explica su punto de vista para la selección de los pacientes, su forma de utilizar el medicamento y la mayoría de los efectos secundarios que pueden presentarse
Subject(s)
Adolescent , Humans , Acne Vulgaris/drug therapy , Isotretinoin , Isotretinoin/pharmacology , Isotretinoin/therapeutic useABSTRACT
La isotretinoína es una droga efectiva para el tratamiento del acné. Su uso puede acompañarse de diversas reacciones adversas, tales como queilitis, xerodermia, epistaxis, prurito, trastornos oculares y cefalea. Presentamos un paciente de 17 años que desarrolló acné fulminans, eritema nodoso y complejos inmunes circulantes, diez días después de haber comenzado el tratamiento con isotretinoína. Se discuten los aspectos etiopatogénicos del acné fulminans