Oral isotretinoin in photoaging: objective histological evidence of efficacy and durability

Bravo, Bruna Souza Félix; Azulay, David Rubem; Luiz, Ronir Raggio; Mandarim-de-Lacerda, Carlos Alberto; Cuzzi, Tullia; Azulay, Mônica Manela

doi:10.1590/abd1806-4841.20153703

Cited by 19 publications

(22 citation statements)

References 22 publications

(18 reference statements)

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“…At the end of this period, the FP had either completely disappeared or were considered minimal. We believe that improvement of FP was due, at least in part, to sebaceous gland atrophy and improvement of the elastic fiber framework, which are well-known effects of the drug [14,15]. It is not our conclusion that sebaceous glands seem prominent merely because of the biopsied site (face).…”

Section: Discussionmentioning

confidence: 98%

Facial Papules in Frontal Fibrosing Alopecia: Beyond Vellus Hair Follicle Involvement

Pirmez¹,

Barreto²,

Duque‐Estrada³

et al. 2017

Skin Appendage Disord

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Background: Frontal fibrosing alopecia (FFA) is considered a variant of lichen planopilaris affecting mainly the frontotemporal hairline. Since the first report in 1994, several other clinical features have been associated with the disease, such as facial papules (FP). Even though FP have been linked to facial vellus hair follicle involvement, how this finding alone could lead to the formation of clinically evident FP in FFA patients had not yet been addressed. Objective: To describe histopathological findings of FP in the context of FFA and to highlight features that may be linked to their clinical formation. Methods: Cutaneous FP biopsies of FFA patients performed between January 2016 and May 2017 were retrieved from our pathology database and reexamined by 2 pathologists. Results: Histological sections of thirteen 3.0-mm punch biopsy specimens (2 horizontally and 11 vertically oriented) were collected from 7 patients. Eleven specimens demonstrated prominent sebaceous glands and 10 dilated sebaceous ducts. Pinkus acid orcein staining revealed reduction and fragmentation of the elastic fibers in 12 samples and, in 7 of these, this finding was observed in both the papillary and reticular dermis, particularly around sebaceous lobules. Vellus hair follicle involvement was only seen in 2 samples. Conclusions: Prominent sebaceous lobules with dilated ducts associated with an abnormal elastic framework seem to be the main explanation for the formation of FP in the context of FFA.

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Section: Discussionmentioning

confidence: 98%

Facial Papules in Frontal Fibrosing Alopecia: Beyond Vellus Hair Follicle Involvement

Pirmez¹,

Barreto²,

Duque‐Estrada³

et al. 2017

Skin Appendage Disord

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“… 159 Another five studies were published by Brazilian authors (details in Table 4 ). 160 , 161 , 162 , 163 , 164 One of them, which included 188 patients, only compared the clinical and histological effects of doses of 10 or 20 mg, on alternate days for two to six months, and found no differences. 161 The two randomized studies used isotretinoin, at a dose of 20 mg, on alternate days, for three and six months, and were compared to the use of only photoprotector and moisturizer or topical tretinoin, respectively.…”

Section: Resultsmentioning

confidence: 99%

Consensus on the use of oral isotretinoin in dermatology - Brazilian Society of Dermatology

Bagatin

Costa

Rocha

et al. 2020

Anais Brasileiros de Dermatologia

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Background Isotretinoin is a synthetic retinoid, derived from vitamin A, with multiple mechanisms of action and highly effective in the treatment of acne, despite common adverse events, manageable and dose-dependent. Dose-independent teratogenicity is the most serious. Therefore, off-label prescriptions require strict criteria. Objective To communicate the experience and recommendation of Brazilian dermatologists on oral use of the drug in dermatology. Methods Eight experts from five universities were appointed by the Brazilian Society of Dermatology to develop a consensus on indications for this drug. Through the adapted DELPHI methodology, relevant elements were listed and an extensive analysis of the literature was carried out. The consensus was defined with the approval of at least 70% of the experts. Results With 100% approval from the authors, there was no doubt about the efficacy of oral isotretinoin in the treatment of acne, including as an adjunct in the correction of scars. Common and manageable common adverse events are mucocutaneous in nature. Others, such as growth retardation, abnormal healing, depression, and inflammatory bowel disease have been thoroughly investigated, and there is no evidence of a causal association; they are rare, individual, and should not contraindicate the use of the drug. Regarding unapproved indications, it may represent an option in cases of refractory rosacea, severe seborrheic dermatitis, stabilization of field cancerization with advanced photoaging and, although incipient, frontal fibrosing alopecia. For keratinization disorders, acitretin performs better. In the opinion of the authors, indications for purely esthetic purposes or oil control are not recommended, particularly for women of childbearing age. Conclusions Approved and non-approved indications, efficacy and adverse effects of oral isotretinoin in dermatology were presented and critically evaluated.

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“…Retinoids, which suppress the immune system by normalizing the Toll-like receptor 2-mediated immune response, have also been effective in some cases [58,59]. Retinoids also have the added benefit of reestablishing the collagen content in the dermis and thus promoting proper wound healing [60,61]. EPD patients may also benefit from topical and systemic estrogen therapy.…”

Section: Treatmentmentioning

confidence: 99%

Erosive Pustular Dermatosis: A Manifestation of Immunosenescence A Report of 8 Cases

Thuraisingam

Mirmirani

2017

Skin Appendage Disord

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Erosive pustular dermatosis (EPD) is a rare condition of the scalp and legs that is marked by crusted erosions or superficial ulcerations that may result in scarring alopecia and chronic wounds. The condition predominantly affects elderly female as compared to male patients. Its pathogenesis remains poorly understood. The majority of the cases in the literature are from the United Kingdom and continental Europe. In this series, we present 8 North American patients with EPD of the scalp, one of whom also had involvement of the legs and another with the involvement of the face. All our patients were advanced in age and had a predisposition to chronic actinic damage, which are common characteristics of EPD previously reported in the literature. We hypothesize that immunosenescence leads to an aberrant immune response to wound healing and, along with other factors such as a loss of the normal epidermal barrier, ultraviolet damage, and hormonal factors, may contribute to the development of this condition.

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Oral isotretinoin in photoaging: objective histological evidence of efficacy and durability

Cited by 19 publications

References 22 publications

Facial Papules in Frontal Fibrosing Alopecia: Beyond Vellus Hair Follicle Involvement

Facial Papules in Frontal Fibrosing Alopecia: Beyond Vellus Hair Follicle Involvement

Consensus on the use of oral isotretinoin in dermatology - Brazilian Society of Dermatology

Erosive Pustular Dermatosis: A Manifestation of Immunosenescence A Report of 8 Cases

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