Flare of cystic acne from oral isotretinoin

Katz, Ronald A.; Jorgensen, Hildegard; Nigra, Thomas P.

doi:10.1016/s0190-9622(83)80302-8

Cited by 16 publications

(6 citation statements)

References 4 publications

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“…The pathogenesis of acne fulminans occurring during isotretinoin therapy as proposed by Blanc et al (21) tapering. Also, the reports of Katz et al (25) and Stary (22) were supportive of our way of treatment. Explosive type III and/ Hyperreactivity to chemoor type IV systemic im-attractants associated with mune reaction to P. a specific decreased phagoacnes antigens (28) cytosis of P. ames (29) I~-----r-_I osteolytic cysts, such lesions have been described uncommonly (24).…”

Section: Discussionsupporting

confidence: 79%

Section: Discussionsupporting

confidence: 79%

“…Kellett et al (5) experienced two cases of acne fulminans after treatment with isotretinoin, but they continued isotretinoin with systemic steroid and achieved excellent 'results in three to four months. Katz et al (25) reported that three patients with severe cystic acne unresponsive to conventional therapy developed explosive cystic flares within one week of isotretinoin therapy, which were maximal during the second week, and subsided by the third week of therapy. Stary (22) also continued treatment in spite of acne fulminans developing after four weeks of 13-cis-retinoic acid therapy and eventually observed total healing.…”

Section: Discussionmentioning

confidence: 99%

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Acne Fulminans and 13‐Cis‐Retinoic Acid

Choi

Bang

1992

The Journal of Dermatology

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Section: Discussionsupporting

confidence: 79%

Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 99%

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Acne Fulminans and 13‐Cis‐Retinoic Acid

Choi

Bang

1992

The Journal of Dermatology

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“…There may be systemic complaints, such as musculoskeletal aching, insomnia, fatigue, headaches, and double vision. Flares of cystic acne after initiation of 13‐ cis ‐retinoic acid may occur and be due to antibiotic withdrawal before the drug effects are seen 5 . Laboratory abnormalities 2 include lowering of previously elevated white blood cells, abnormal liver function studies, and transient elevation of triglycerides 2,6 .…”

Section: Commentsmentioning

confidence: 99%

Acne, Retinoids, and Dermabrasion

Roenigk

Pinski

Robinson

et al. 1985

The Journal of Dermatologic Surgery and Oncology

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“…Additionally, oral isotretinoin can induce an acne flare-up in the early stages of treatment, resulting in increased comedone formation and worsening of the disorder. [8][9][10][11] While the underlying mechanism for acne flare-up is poorly understood, sebocytes rely on de novo lipogenesis for sebum production 12 and isotretinoin has been shown to acutely activate lipogenesis in sebocytes exacerbating existing acne conditions. 13 The onset of acne typically begins during puberty where the increase in hormones and growth factors stimulate de novo lipogenesis and increase sebum production.…”

Section: Introductionmentioning

confidence: 99%

<p>Biguanides Induce Acute de novo Lipogenesis in Human Primary Sebocytes</p>

Nicoll

Buehrer

2020

CCID

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Introduction: Acne arises during puberty, in part, due to elevated hormones and growth factors which stimulate de novo lipogenesis (DNL) in primary sebocytes to significantly increase sebum production. Oral isotretinoin is an effective acne therapy, reducing sebum production through inducing apoptosis in sebocytes. However, isotretinoin is teratogenic and has additional unwanted side effects, including an initial acne flare-up, which limits its utility. The biguanide, metformin has been found to alleviate severe acne in women with polycystic ovary syndrome (PCOS) through normalization of their insulin and androgen hormone levels. Metformin's broader effectiveness to improve acne in non-PCOS populations lacks significant clinical support. In an effort to determine whether biguanides directly affect sebogenesis, we investigated their ability to alter DNL in cell-based assays in vitro. Methods: De novo lipogenesis was measured in human primary sebocytes using [14C]acetate labeling. Lipid species analysis was performed by extracting newly synthesized lipids and subjecting them to thin layer chromatography. Gene expression changes in sebocytes were identified through qPCR analysis of isolated RNA. Metabolic parameters including oxygen consumption rate, lactate production and activation of adenosine monophosphatedependent protein kinase (AMPK) were assessed in human primary sebocytes. Results: Using human primary sebocytes, we found that biguanides, isotretinoin and azithromycin induced an acute dose and time-dependent increase in [14C]-acetate labeling of neutral lipids, while AICAR, an AMPK activator, inhibited this DNL response. Biguanides did not activate AMPK in sebocytes, however, they significantly reduced oxygen consumption rate and increased lactate production. Treatment with biguanides, but not isotretinoin, significantly upregulated ACSS2 gene expression in primary sebocytes and showed synergism with lipogenic activators to induce DNL genes. Discussion: These changes are consistent with an acute increase in sebocyte lipogenesis and support the potential of biguanides to cause an initial flare-up in patients suffering from severe acne.

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Flare of cystic acne from oral isotretinoin

Cited by 16 publications

References 4 publications

Acne Fulminans and 13‐Cis‐Retinoic Acid

Acne Fulminans and 13‐Cis‐Retinoic Acid

Acne, Retinoids, and Dermabrasion

<p>Biguanides Induce Acute de novo Lipogenesis in Human Primary Sebocytes</p>

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