Isotretinoin
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Isotretinoin Acne fulminans: case report
A 19-year-old man developed acne fulminans during treatment with isotretinoin for papules and pustules (dermatosis). The man started to develop papules and pustules (dermatosis) in August 2014, which were treated with soap, salicylic acid, betamethasone, gentamicin and clotrimazole for a year. In February 2018, he started receiving clindamycin and isotretinoin [route not stated] 20mg every 24 hours, with a total cumulative dose of 15.6 mg/kg. Two months (8 weeks) following the initiation of therapy, he developed multiple abscesses and yellow-brown scabs on the trunk, burning pain (VAS 8/10), asthenia, general malaise, hyperthermia and adynamia, for which he visited hospital. The physical examination showed disseminated dermatosis on the neck on the anterior aspect, the face in the frontal, bimalar and chin regions, the trunk in the V area of the neck and the entire posterior aspect. The dermatosis comprised of multiple papules, pustules, abscesses, nodular-like lesions, fistulous tracts with seropurulent exudate, exulcerations with an erythematous background (+) covered by yellow-brown/blood-red crusts and multiple depressed punctate scars, boxcar-shaped and some keloid. Laboratory studies revealed hyperfibrinogenaemia, thrombocytosis, WHO grade I normochromic normocytic anaemia, neutrophilia and leucocytosis. Chest X-ray was normal. Owing to the clinical data, biochemical alterations and systemic manifestations, the diagnosis of acne fulminans was made. The man was treated with a taper of prednisone and pentoxifylline, alongside unspecified analgesia and thromboembolic prophylaxis. Isotretinoin was continued at a dose of 20mg. He also received zinc sulfate, copper sulfate and camphor. However, he subsequently presented with suicidal ideation and crying easily. The Mental Health department diagnosed him with depressive episode, and sertraline and psychotherapy were added to his treatment. Thereafter, he exhibited significant improvement and completed 150 mg/kg of isotretinoin. He experienced sequelae due to multiple, predominantly keloid scars and some retractable scars. Jaramillo-Manzur SC, et al. Acne fulminans, induced by isotretinoin? Dermatologia Revista Mexicana 63 (Suppl. 1): S84-S88, 2019. Available from: URL: https:// dermatologiarevistamexicana.org.mx/volumen-63-suplemento-1-2019/ [Spanish; summarised from a translation]
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Reactions 5 Sep 2020 No. 1820
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