Angiodema due to oral acitretin and isotretinoin

Abstract

Angioedema may be caused by nonsteroidal antiinflammatory drugs, angiotensin-converting enzyme inhibitors, radiocontrast media, antibiotics, sea food etc. It can involve an allergic (IgE-mediated) or non-allergic hypersensitivity reaction, both with a similar clinical presentation. While angioedema due to isotretionin has been described previously, this is the first description of angiodema due to acitretin. We report two uncommon cases of palpebral and labial angiodema due to retinoids, by acitretin and oral isotretinoin respectively: a 48-year-old man with psoriasis and a 24-year-old woman with severe acne resistant to antibiotics and topical drugs. In both cases the reaction persisted throughout treatment with these drugs, but resolved quickly after discontinuation. Reintroduction of the drugs brought on angioedema again. Keywords: Acitretin; Angioedema; Edema; Isotretinoin Resumo: Angioedema pode ser causado por diversos fármacos como : antiinflamatórios não-esteroidais, inibidores da ECA, contrastes, antibióticos e frutos do mar, entre outras causas. Pode ser uma reação alérgica, mediada por IgE, ou não-alérgica, com apresentações clínicas semelhantes. Angioedema por isotretinoína já foi relatado, mas não por acitretina. Relatamos dois casos, uma com angioedema palpebral e um labial, por acitretina e isotretinoína, respectivamente: um paciente de 48 anos com psoríase e uma paciente de 24 anos com acne resistente à terapia convencional. Em ambos casos a afecção persistiu durante o tratamento, resolveu com a interrupção e recidivou com reexposição.

Angioedema due to Systemic Isotretinoin Therapy

“…Angioedema has only been reported in 3 cases due to the use of isotretinoin and in 1 case due to the use of acitretin to date [3–5] (Table 1). In one of these cases, both urticaria and angioedema were reported due to systemic isotretinoin treatment in an 18-year-old female referred with facial nodulocystic acne of two years duration [5].…”

“…Furthermore, perioral abscess formation in patients taking isotretinoin may also masquerade as angioedema or severe mucositis [8]. However, to date only one case of a 48-year-old man with bilateral periorbital oedema related to acitretin 25 mg/day use has been reported [3]. …”

“…6, D&C Yellow No. 10, and La Roche-type titanium dioxide [3]. However, these additives in drugs and foods have not been found to produce angioedema [3].…”

“…While cheilitis, mucositis, xerophthalmia, xerosis, retinoid dermatitis, dyslipidemia, photosensitivity, pyogenic granuloma, onycholysis, and paronychia are the well-known, frequent adverse effects of isotretinoin [2], angioedema due to the use of isotretinoin has only been reported in 3 cases to date [3–5]. …”

Angioedema–Urticaria Due to Acitretin

“…Of these, 1 occurred from acitretin and the other from isotretinoin. 4 In addition, Saray et al 5 have reported a case of angioedema and urticaria due to isotretinoin.…”