Oral isotretinoin for treating mucocutaneous human papillomavirus infections: A systematic review and meta-analysis

Introduction: Some viral warts are refractory to treatment, some others tend to recur. Oral isotretinoin is useful against warts to varying degrees. Objective: To determine the efficacy of oral isotretinoin for treating mucocutaneous human papillomavirus infections. Methods: A systematic review and meta-analysis of studies published from the date of inception of the databases to December 30, 2017 were conducted. Randomized controlled trials or case series with ≥10 patients with mucocutaneous human papillomavirus infection who had received oral isotretinoin treatment were analyzed. The meta-analysis estimated the pooled odds ratio and pooled response rate. Results: The review included eight studies. Trials of oral isotretinoin versus placebo treatment revealed that isotretinoin effectively treated mucocutaneous human papillomavirus infections (odds ratio: 43.8, 95% confidence interval: 9.7–198.8). The pooled estimate of the complete response rate of oral isotretinoin to mucocutaneous human papillomavirus was 67.7% (95% confidence interval: 49.5–81.7%). Another pooled estimation revealed that 83.9% (95% confidence interval: 59.7–94.9%) of patients exhibited at least 50% lesion clearance, whereas 12.3% with complete response experienced recurrence. Limitations: This meta-analysis had a small sample size and high inter-study heterogeneity. Conclusion: Oral isotretinoin is superior to placebo for treating mucocutaneous human papillomavirus infections, particularly plane warts. The recurrence rate and risk of severe side effects are low.

A randomized open label comparative study to determine the various side effects and patient satisfaction of low dose continuous versus low dose intermittent oral isotretinoin therapy in moderate to severe acne vulgaris

Background: Acne Vulgaris is chronic inflammatory disease of pilosebaceous units. Oral isotretinoin is recommended for moderate to severe acne vulgaris who are not responding satisfactorily to conventional therapies. Recent reports indicate that acne patients have been benefiting from the low dose treatment protocols. However, long term daily use of this drug results in frequent side effects such mucocutaneous and systemic side effects. Our aim was to assess and compare the various side effects and patient satisfaction of oral isotretinoin in low dose continuous and intermittent treatment of moderate to severe acne vulgaris.Methods: This was a prospective randomized open labeled comparative study carried out at outpatient department in the Department of Dermatology in Mandya Institute of Medical sciences, Mandya. Patients with moderate to severe acne were assigned equally (50 subjects each) to one of the two treatment regimens by using block randomization technique, Group A was given low dose continuous regimen-20 mg oral isotretinoin once daily for 4 months and Group B was given low dose intermittent regimen-20 mg oral isotretinoin once daily for 1 week out of every 4 weeks. The patients were followed up every 4th week during the treatment period. The patients were examined and side effects were noted in each visit. A six month follow-up evaluation was done to analyze patient satisfaction.Results: Muco-cutaneous dryness was most common adverse effect noted in both the groups A and B. Itching (42%), Alopecia (44%), Myalgia (36%) were seen most commonly in group A and Acne flaring (47%) was most common with group B. With regard to patient satisfaction, in group A 42% were satisfied and 20% were very satisfied, in group B 36% were satisfied and 14% were very satisfied.Conclusions: Study suggests that, Muco-cutaneous dryness was most common side effect in both treatment regimens. Side effects were more frequent with low dose continuous than low dose intermittent isotretinoin regimen. Patient satisfaction was better in continuous regimen.

Enfermedad de Darier-White tratada con isotretinoína oral / Darier-White disease treated with oral isotretinoin

La enfermedad de Darier-White (EDW) es un trastorno autosómico dominante; descrita por Darier y White en 1889, se caracteriza por alteraciones de la queratinización de la epidermis, uñas y mucosas. Presentamos el caso de un paciente masculino de 16 años con lesiones cutáneas e histológicas características de la EDW, que realizó tratamiento con isotretinoína oral a una dosis de 0,7 mg/kg/día por seis meses, con respuesta favorable. Se plantea una alternativa terapéutica con retinoides orales para las lesiones fjas, resistentes, crónicas y pruriginosas.

Darier-White Disease (DWD) is an autosomal dominant disorder, described by Darier and White in 1889, characterized by abnormal keratinization in the epidermis, nails and mucosae. We present the case of a 16-year-old, male patient, with clinically and histologically confrmed DWD treated with oral isotretinoin (0.7 mg/kg/day) for six months, with good response. We recommend an optional therapeutic treatment for chronic, itchy, recalcitrant lesions with oral retinoids.

A Case of Acne Fulminans Treated with Oral Isotretinoin and Systemic Corticosteroid / 대한피부과학회지

Acne fulminans is a rare, severe and destructive disease with the acute onset of painful, nodulocystic, ulcerative, acneiform lesions and frequently associated with systemic signs and symptoms including fever, weight loss, myalgia, arthralgia, and leukocytosis. We herein present a 20-year-old male patient with acne fulminans that was successfully treated with combination therapy of oral isotretinoin and systemic corticosteroid.