Isotretinoin Use in a Case of Chronic Granulomatous Disease

Abstract

Chronic granulomatous disease (CGD) is a rare, inherited disorder, in which phagocytic cells, through an enzyme defect, are unable to produce microbicidal oxidants; affected individuals are thereby unduly susceptible to certain life-threatening bacterial and fungal infections and require lifelong antibiotic and antifungal prophylaxis. We present the case of an adolescent CGD patient whose recalcitrant acne vulgaris and subsequent recurrent facial abscesses were successfully treated with isotretinoin; swift resolution of this and similar patients' acne lesions is paramount, as these lesions may serve as a portal of entry for systemic infections and may pose a significant risk for scarring. Isotretinoin is associated with an increased rate of cutaneous Staphylococcus aureus carriage as well as exuberant granulation responses, both of theoretical concern in CGD patients. The therapeutic outcome of isotretinoin in treatment-resistant cases of acne in CGD patients has not been reported in the literature; we present this case to advocate an underreported use of isotretinoin in the prevention of acne, its subsequent cyst formation, and scarring patients with CGD.

A case of chronic granulomatous disease and acne: is isotretinoin a safe treatment?

“…In literature are reported five subjects with CGD and acne treated with isotretinoin (Table 1). Three patients [6][7][8] were treated with isotretinoin at different dosages (ranging 0.5-1 mg/kg/die) without any adverse event, while one patient 9 had to promptly interrupt the treatment because of hypertriglyceridemia. Conversely, the last one 10 reported an episode of invasive pulmonary aspergillosis after only two weeks of treatment.…”

Safe and Successful Treatment of Acne Vulgaris with Isotretinoin in a Patient with Chronic Granulomatous Disease

“…However, including ours, four cases of acne vulgaris treated with isotretinoin in CGD patients with a successful, adverse effect‐free outcome have been reported (4,5). We emphasize that the benefits of its use must be considered along with the potential risks in each patient.…”