Pyoderma Faciale: Manifestation of Inflammatory Bowel Disease

Dessoukey, M. Wagdy; Omar, Mohamed F.; Dayem, H.A.

doi:10.1111/j.1365-4362.1996.tb00647.x

Cited by 12 publications

(11 citation statements)

References 12 publications

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“…Some of these conditions (e.g. pyoderma faciale, pyodermatitis-pyostomatitis vegetans, and hydradenitis suppurativa) are known extra-intestinal manifestations of IBD that may precede its diagnosis (11, 29, 30). To minimize the possibility that isotretinoin use for such conditions were biasing our results (i.e.…”

Section: Methodsmentioning

confidence: 99%

Isotretinoin Use and the Risk of Inflammatory Bowel Disease: A Case–Control Study

Crockett

Porter²,

Martin

et al. 2010

American Journal of Gastroenterology

129

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Introduction Isotretinoin is commonly prescribed for the treatment of severe acne. Though cases of inflammatory bowel disease (IBD) have been reported in isotretinoin users, a causal association remains unproven. Methods We performed a case-control study using a large insurance claims database. Incident cases of IBD were identified and matched to 3 controls on the basis of age, gender, geographical region, health plan, and length of enrollment. Isotretinoin exposure was assessed in a 12 month period prior to case ascertainment. Conditional logistic regression was used to adjust for the matching variables. Results The study population contained 8,189 cases (3,664 CD and 4,428 UC) and 21,832 controls. Sixty subjects (24 cases and 36 controls) were exposed to isotretinoin. Ulcerative colitis was strongly associated with prior isotretinoin exposure (OR 4.36, 95% CI 1.97, 9.66). However, there was no apparent association between isotretinoin and Crohn’s disease (OR 0.68, 95% CI 0.28, 1.68). Increasing dose of isotretinoin was associated with elevated risk of UC (OR per 20 mg increase in dose: 1.50, 95% CI 1.08, 2.09). Compared to non-users, the risk of UC was highest in those exposed to isotretinoin for more than 2 months (OR 5.63, 95% CI 2.10, 15.03). Conclusions Ulcerative colitis but not Crohn’s disease is associated with prior isotretinoin exposure. Higher dose of isotretinoin appears to augment this risk. Though the absolute risk of developing UC after taking isotretinoin is likely quite small, clinicians prescribing isotretinoin as well as prospective patients should be aware of this possible association.

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Section: Methodsmentioning

confidence: 99%

Isotretinoin Use and the Risk of Inflammatory Bowel Disease: A Case–Control Study

Crockett

Porter²,

Martin

et al. 2010

American Journal of Gastroenterology

129

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“…Fortunately, ophthalmic complications of rosacea have not been reported so far. A few cases of rosacea fulminans in association with inflammatory bowel disease have been reported; the significance of this association is unknown at present 3‐5 …”

Section: Discussionmentioning

confidence: 99%

“…The pattern observed was nonspecific: mild parakeratosis, edema and hemorrhage in the dermis, perifollicular and perisebaceous gland abscesses with mixed inflammatory cell infiltration including eosinophils and foreign‐body giant cells, epithelioid granuloma, septal and lobular panniculitis, collagen destruction, and fibrosis. Direct immunofluorescence was negative for immunoglobulin A (IgA), IgG, IgM, C3, and fibrinogen in one case 4 …”

Section: Discussionmentioning

confidence: 99%

Rosacea fulminans (pyoderma faciale): successful treatment of a 3‐year‐old girl with oral isotretinoin

2001

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A 3‐year‐old girl presented with several erythematous papules, pustules, cysts, and purulent discharging sinuses on the face. The lesions suddenly appeared on the cheeks 3 months previously and then rapidly extended to other areas of the face. She had been treated with a variety of topical and systemic antimicrobials (including erythromycin, cephalexin, dicloxacillin, and suIfamethoxazole‐trimethoprim) and topical corticosteroids with no effect. Examination revealed deep red erythema of facial skin with several papules, pustules, cysts, and draining sinuses on the cheeks, chin, perioral, and paranasal areas (Fig. 1). No comedones or signs of hidradenitis suppurativa were observed. The child was otherwise in good health. She did not have a family history of severe acne vulgaris. 1 Patient before treatment Routine laboratory tests, including complete blood count, blood chemistry, and urinalysis, were within normal limits. Bacterial cultures showed negative results. Her parents refused to give consent to perform a biopsy. She was initially treated with oral erythromycin, 250 mg four times daily, oral prednisolone, 7.5 mg (0.5 mg/kg body weight) daily, tapered to zero in 2 weeks, 0.025% fluocinolone acetonide cream, and warm compresses for 2 weeks with moderate improvement. Then oral isotretinoin, 10 mg (0.75 mg/kg body weight) daily, was instituted. The lesions showed marked improvement after 4 weeks and disappeared completely after 8 weeks, leaving only a few pitted scars (Fig. 2). The treatment with isotretinoin was continued for a total of 24 weeks. She tolerated isotretinoin very well. She was followed for 1 year after completion of treatment with no relapse. 2 Patient after 8 weeks of treatment with oral isotretinoin

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“…We must also consider the possibility of reverse causation: that IBD resulted in exposure to isotretinoin. Pyoderma faciale is a dermatologic condition that may mimic severe acne, but is in fact a known extra-intestinal manifestation of IBD that may precede its diagnosis (Figure 4)(24). Neutrophilic dermatoses such as Sweet’s syndrome may also associated with IBD(25).…”

Section: Causal Criteriamentioning

confidence: 99%

A Causal Association Between Isotretinoin and Inflammatory Bowel Disease Has Yet to Be Established

et al. 2009

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Objectives-A number of case reports have been published describing a possible association between isotretinoin (Accutane) and inflammatory bowel disease (IBD). We critically appraised the published literature on this association to assess whether the current literature supports a causal relationship between isotretinoin and IBD.Methods-We systematically searched the literature for case reports, case series, and clinical trials assessing the association between isotretinoin and IBD. We then applied the nine Bradford Hill criteria in order to evaluate causality of this association.Results and discussion-We identified 12 case reports and 1 case series that reported an association between isotretinoin use and subsequent development of IBD. Cases occurred in 7 different countries over a 23 year time period (1986 to 2008). Cases differed with respect to dose of isotretinoin reported, duration of treatment prior to development of disease, whether disease developed on or off medication, and clinical presentation of disease. To date, no prospective or retrospective case control or cohort studies have examined the relationship between isotretinoin exposure and the outcome of IBD. An estimated 59 coincident cases of IBD would be expected in Accutane users each year, assuming no increased risk. Application of the Bradford-Hill criteria reveals that the temporality criterion of causation is fulfilled, though a number of alternative explanations may account for the observed sequence of events seen in case reports. Strength, specificity, and consistency of the association are lacking.Conclusions-Current evidence is insufficient to confirm or refute a causal association between isotretinoin and IBD. Additional prospective or well-designed retrospective (e.g. case-control) pharmacoepidemiologic studies are needed to definitively establish causality.

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Pyoderma Faciale: Manifestation of Inflammatory Bowel Disease

Cited by 12 publications

References 12 publications

Isotretinoin Use and the Risk of Inflammatory Bowel Disease: A Case–Control Study

Isotretinoin Use and the Risk of Inflammatory Bowel Disease: A Case–Control Study

Rosacea fulminans (pyoderma faciale): successful treatment of a 3‐year‐old girl with oral isotretinoin

A Causal Association Between Isotretinoin and Inflammatory Bowel Disease Has Yet to Be Established

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