Keratosis pilaris in pregnancy: an unrecognized dematosis of pregnancy?

Keratosis pilaris (KP) is a common hyperkeratotic condition that most commonly presents as skin-colored follicular papules surrounded by erythema. These lesions often appear grouped together on the lateral aspect of the arms, thighs, and buttocks. Although the etiology of KP is uncertain, it is thought to be the result of the formation of an orthokeratotic plug, which blocks and dilates the orifice and upper portion of the follicular infundibulum (Figure 1). Histologically, mild perivascular mononuclear cell infiltrates are usually present in the adjacent dermis. Studies have indicated a role for hormonal influences in the development of KP. The five cases presented in this study demonstrate keratosis pilaris as a condition in which the onset or severity of the dermatosis may be linked to the hormonal changes of pregnancy.

Prolonged thrombocytopenia associated with isotretinoin.

OBJECTIVE: To report a case of severe prolonged thrombocytopenia possibly associated with isotretinoin. CASE SUMMARY: A 27-year-old white woman developed severe thrombocytopenia and elevated transaminases after 3(1/2) months of treatment with isotretinoin. Prior to the onset of thrombocytopenia, the patient had also received a 10-day course of cephalexin. Rectal bleeding was reported by the patient, who was otherwise asymptomatic. Liver enzyme values returned to normal approximately 1 week after discontinuation of isotretinoin; however, platelet counts required approximately 2 months to normalize. Based on the Naranjo probability scale, possible causality exists between isotretinoin and thrombocytopenia. DISCUSSION: The exact mechanism by which isotretinoin caused thrombocytopenia in this patient is not clearly understood. To our knowledge, only 3 previous cases of isotretinoin-associated thrombocytopenia have been reported. The long recovery process that occurred in our patient is possibly a direct result of the long elimination half-life of both the parent compound and active metabolites of isotretinoin. CONCLUSIONS: Clinicians prescribing isotretinoin should be aware of the potential life-threatening consequence of thrombocytopenia, and a complete blood cell count with platelets should be part of the routine monthly monitoring in all patients receiving isotretinoin therapy.