Leukopenia and neutropenia associated with isotretinoin therapy

Friedman, S. J.

doi:10.1001/archderm.123.3.293b

Cited by 12 publications

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“…In the case reported here, we preferred to use isotretinoin at a dosage of 40 mg/day and the clinical result was similar to that described in the literature 4–7 . Although leukopenia and neutropenia might be associated with isotretinoin therapy, 8 it is noteworthy that it could be used safely in a patient with MDS.…”

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confidence: 66%

A case of generalized granuloma annulare with myelodysplastic syndrome: successful treatment with systemic isotretinoin and topical pimecrolimus 1% cream combination

Baskan

Turan

Tunali

2007

Acad Dermatol Venereol

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been training intensively during the preceding 3 months. Examination revealed markedly indurated skin affecting the extremities. There was a decreased range of movement in the wrists and ankles (bilaterally). He could not fully clench his fist with either hand.A skin punch biopsy revealed prominent thickening of the collagen bundles throughout the dermis with a reduction in fibroblast numbers and a perivascular inflammatory infiltrate with scant eosinophils. There was a blood eosinophilia of 1.49 × 10 9 /L (normal range = 0.04 -0.4 × 10 9 /L). The clinical impression was that of generalized cutaneous scleroderma with features of eosinophilic fasciitis. High-dose prednisolone and hydroxychloroquine were commenced for 6 months. However, indurated patches of scleroderma spread to the trunk and his joints remained as before.Methotrexate at a dose of 15 mg once weekly was then commenced. There was little change after 2 months, and so psoralen-ultraviolet A therapy (PUVA) at a dose of 0.6mg/kg twice weekly was added, based on reports of its effectiveness in the literature. 1-3 The risk of non-melanotic skin cancers when combining immunosuppressive and PUVA therapy was considered. It was felt that this treatment was warranted in light of the significant limitation of mobility and potential for development of contractures. The risks were explained to the patient.PUVA treatment was continued for 20 sessions over 10 weeks at a cumulative dose of 25.4 J/cm 2 . Methotrexate was subsequently administered for 7 months. After this period he was able to make a full fist and normal range of movement in the ankles was achieved. The skin had returned to normal consistency and pigmentation. He has maintained clinical remission for 2 years.Cutaneous scleroderma is caused by the interaction between skin-infiltrating T-helper cells and dermal fibroblasts. The histological pattern includes cellular infiltrates of lymphocytes, plasma cells and eosinophils. The dermis is thickened with dense collagen, scant fibroblasts and reduced elastic tissue. Laboratory investigations may reveal a raised erythrocyte sedimentation rate, eosinophilia and hypocomplementaemia. Contractures and limb atrophy may occur.Eosinophilic fasciitis occurs more commonly in male subjects and can follow strenuous exertion. Haematic eosinophilia occurs frequently. Spontaneous remission may occur. Eosinophilic fasciitis and cutaneous scleroderma have been linked in the literature. One report suggests that eosinophilic fasciitis may be a steroid-responsive variant of scleroderma. 4 This patient had features of both clinical entities. The microscopical findings are compatible with either process. The lack of response to steroids and lack of spontaneous improvement are more suggestive of generalized cutaneous scleroderma.The rapid response to PUVA and methotrexate 2 years after onset of disease indicates that these treatments were highly effective, and successfully reversed generalized cutaneous scleroderma. Methotrexate has also been reported to be therapeutic in widespre...

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confidence: 66%

A case of generalized granuloma annulare with myelodysplastic syndrome: successful treatment with systemic isotretinoin and topical pimecrolimus 1% cream combination

Baskan

Turan

Tunali

2007

Acad Dermatol Venereol

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“…Small numbers of patients treated with isotretinoin have been reported with a variety of hematologic abnormalities such as increased erythrocyte sedimentation rate, decreased haemoglobin concentration and hematocrit, decreased erythrocyte counts, decrease in the number of leukocytes, especially neutrophil counts, 3 leukopenia, 4,5 and increased or decreased platelet counts 5–9 . In many cases, however, sufficient information is not available to accurately assess the role of isotretinoin therapy in the etiology of these conditions.…”

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confidence: 99%

Thrombocytosis induced by low‐dose isotretinoin

Jansen¹,

Altmeyer²

2000

Int J Dermatology

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“…Besides these side effects, isotretinoin is known to cause several laboratory disturbances [ 8 ]. Severe hematological changes were previously reported as case reports [ 9 – 11 ]. However, there are no sufficient studies assessing the effect of the hematological parameters, especially on the platelets.…”

Section: Introductionmentioning

confidence: 99%

Effects of Isotretinoin on the Platelet Counts and the Mean Platelet Volume in Patients with Acne Vulgaris

Ataseven¹,

Bilgin

2014

The Scientific World Journal

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Aim. The aim of this study was to evaluate the platelet counts and the mean platelet volume in patients who received isotretinoin for the treatment of acne vulgaris. Method. A total of 110 patients were included in this retrospective study. Complete blood count parameters were recorded prior to and three-months following the treatment. Results. Both platelet counts and the mean platelet volume were significantly decreased following the treatment. No significant differences were noted on the levels of hemoglobin, hematocrit, and white blood cell count. Conclusion. Platelet counts and mean platelet volume significantly decreased following isotretinoin treatment. Since the decrease of platelet counts and the mean platelet volume was seen concomitantly, it is concluded that the effect of isotretinoin was through the suppression of bone marrow.

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Leukopenia and neutropenia associated with isotretinoin therapy

Cited by 12 publications

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A case of generalized granuloma annulare with myelodysplastic syndrome: successful treatment with systemic isotretinoin and topical pimecrolimus 1% cream combination

A case of generalized granuloma annulare with myelodysplastic syndrome: successful treatment with systemic isotretinoin and topical pimecrolimus 1% cream combination

Thrombocytosis induced by low‐dose isotretinoin

Effects of Isotretinoin on the Platelet Counts and the Mean Platelet Volume in Patients with Acne Vulgaris

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