Impetigo herpetiformis is a rare and severe pustular disorder which primarily occurs in pregnancy. Etretinate and acitretin are effective in impetigo herpetiformis with systemic steroid. A major concern with the use of systemic retinoids is their high teratogenic potential. Isotretinoin is another retinoid but its teratogenic potential lasts only for two months. Hence, isotretinoin may be used to treat women of childbearing years with impetigo herpetiformis. We report a case of impetigo herpetiformis in a 26-year-old woman whose condition was improved with isotretinoin.
Acitretin ; Adult ; Etretinate ; Female ; Humans ; Impetigo ; Isotretinoin ; Pregnancy ; Retinoids

Impetigo herpetiformis is a rare, severe dermatologic disorder that is similar to a type of pustular psoriasis that predominantly occurs during the 3rd trimester of pregnancy. This condition usually resolves after delivery and it rarely continues until the postpartum period. Systemic corticosteroids have proven to be the drug of choice for the management of impetigo herpetiformis. In the postpartum period, oral retinoids such as isotretinoin, etretinate and acitretin can be used to control impetigo herpetiformis, but their side effect such as teratogenicity is a big issue to women of child-bearing age. We report here on a case of impetigo herpetiformis in a 28-year-old woman who did not respond to oral corticosteroids, but she was treated successfully with cyclosporine. To the best of our knowledge this is the first case of impetigo herpetiformis treated with cyclosporine in the Korean medical literature.
Acitretin ; Adrenal Cortex Hormones ; Adult ; Cyclosporine ; Etretinate ; Female ; Humans ; Impetigo ; Isotretinoin ; Postpartum Period ; Pregnancy ; Psoriasis ; Retinoids

BACKGROUND: Retinoids exert a wide range of effects on cell growth and development and have important effects on keratinocytes differentiation in vvc and in vitro. Besides the effects on epithelial differeotiation, modulation of cellular and amoral responses of lymphocytes, changes in natural killer and T-killer cell activities and riodulation of antigen presenting properties were shown by retionds. OBJECTIVE: We studied to investigate the immunologic role of etinoids. METHODS: With foreskin. the effects of 13-cis retinoic acid and etretinate on interferony induced HLA-DR and ICAM-1 expression of kratinocytes were!ev luated. RESULTS: 1. When keratinocytes were grown in low calcium media, priliferation was inhibited only with 8 x 10 M of 13-cis retinoic acid. 8 x 10 , 8 x 10 M of 13-cis retinoic acid and 8 x 10 , 8 x 10, 8 x 10 M of etretinate had no effect on keratinocytes roiferation. When cultured in 0.15 mM calcium media or 1.0 mM calcium media, 13-cis retino acid and etretinate had no effection keratinocytes proliferation. 2. Keratinocytes HLA-DR expression was decreased with 8 x 10 , 8 x 10 M of 13-cis retinoic acid in 0.15 mM carcium media and 8 x 10 , 8 x 10 M of 13-cis retinoic acid in 1.0 mM calcium media. Etretinate had no effect on keratinocytes HLA-DR expression. 3. Keratinocytes ICAM- 1 expression was increased with 8 x 10 M of 13-cis retinoic acid in low calcium. media. When cultured on 0.15 mM carcium media, ICAM-1 expression was increased with 8 x 10 M of 13-cis retinoic acid and tetinate. When cultured in 1.0 mM calcium media, ICAM-1 expression was increased with 8 x 10, 8 x 10 , 8 x 10 M of 13-cis retinoic acid and 8 x 10, 8 x 10 , 8 x 10 M of etretinate. CONCLUSION: These results suggest that retiniods have an immunomodulating effect as well as effects on epithelial differentiation. Clarification of the mechanism of increased expression of ICAM-1 and decreased expression of HLA-DR remains to the proved.
Acitretin ; Calcium ; Etretinate ; Foreskin ; Growth and Development ; HLA-DR Antigens ; Intercellular Adhesion Molecule-1 ; Interferons* ; Keratinocytes* ; Lymphocytes ; Retinoids* ; Tretinoin

Retinoids are effective systemic agents in the treatment of psoriasis. Acitretin, a synthetic aromatic derivative of retinoic acid, has replaced etretinate in retinoid therapy of psoriasis because of its more favorable pharmacokinetic profile, including a significantly shorter half-life. Most of the adverse effects associated with acitretin are teratogenicity, hepatotoxicity, pseudotumor cerebri, pancreatitis, hyperlipidemia, hyperostosis, and mucocutaneous side effects. There are two reports worldwide describing patients who developed acute respiratory distress syndrome associated with acitretin. This suggests the possibility of serious lung complications associated with acitretin. We report a case of a 61-year-old man who developed interstitial pneumonitis that might have been induced by acitretin during the treatment of pustular psoriasis. In these cases, immediate withdrawal of retinoic acid is necessary, and corticosteroid therapy should be considered.
Acitretin ; Etretinate ; Half-Life ; Humans ; Hyperlipidemias ; Hyperostosis ; Lung ; Lung Diseases, Interstitial ; Middle Aged ; Pancreatitis ; Pseudotumor Cerebri ; Psoriasis ; Respiratory Distress Syndrome, Adult ; Retinoids ; Tretinoin

BACKGROUND: Apoptoss plays a major role in cellular proliferation and differentiation in tumor cells. Bcl-2, proto-oncogene, is known to inhibit apoptotic cell death of tumor cells. The high expression of bcl-2 in human melanoma cells over transforrned keratinocytes has been reported. The Loton group indicated that the growth of human melanoma cells exposed to retinoids was inhibit ed and their cellular melanin content incrensed over that of the untreated ce1Ls. The Veis group reported that bcl-2 defieient mice showed hypopigmented hair. Which suggests that bcl-2 may in volve melanogenesis. The Above mentioned findings may suggest that. bcl-2 and retinoids may play a role in melanoms biology. OBJECTIVE: We under ook this study to elucidate a possible relationship between retinoids and bcl-2 expvessions in human melanoma cell lines. METHODS: We analysed bcl-2 expressions from SK 28 cells(melanoma cell lines) after pretreat ment with retinoids using flow cytometry and imtnunoblotting. RESULTS: 1. In the results of the preliminary studies, we found that cultured human keratinocytes, fibro blasts and melanocytes n the resting state showed expressions of bcl-2. The latter showed a four fold expression of bcl-2. 2. Expression of bcl-2 was detected in SK 28, a human melanoma cell line, in the resting state. 3. After incubation with isotretinoin or etretinate treatment at 37 degrees C, for 48 hours, this treated group showed a more ir creased expression of bcl-2 than the control group. CONCLUSION: Our data may explain that the mechanism of ret.inoids indur,ing inhibition of mela noma cell growth may be partly due to upregulation of bcl-2 expression. The high base-line ex pression of bcl-2 in melanoma cells may tell us why these pigment cells can survive against oxi dative products generated during melanogenesis.
Acitretin ; Animals ; Biology ; Cell Death ; Cell Line* ; Cell Proliferation ; Etretinate ; Flow Cytometry ; Hair ; Humans* ; Isotretinoin ; Keratinocytes ; Melanins ; Melanocytes ; Melanoma* ; Mice ; Noma ; Proto-Oncogenes ; Retinoids* ; Up-Regulation

Acrodermatitis continua (AC) of Hallopeau is one of the chronic relapsing pustular eruptions of the extremities. Generalization of AC sometimes occurred spontaneously, or induced by withdrawl of drugs such as corticosteroid, or pregnancy. We report a case of generalized AC in a 50-year-old woman who has been treated intermittently with various medications other than systemic retinoids. The histopathologic findings of the pustules on the fingertips and trunk revealed subcomeal abscesses and/or spongiform pustules. The patient was treated with etretinate in the dose of 50mg/day, and UVB exposure. Two months after treatment, skin lesions were markedly improved.
Abscess ; Acitretin ; Acrodermatitis* ; Etretinate ; Extremities ; Female ; Generalization (Psychology) ; Humans ; Middle Aged ; Pregnancy ; Retinoids ; Skin

BACKGRUOND: Although treatment with etretinate or modified Ingram method is effective for psoriasis, both regimens have limitations beeause of the risk of long-term toxicity. OBJECTIVE: We performed retinoid-modified Ingram combination therapy expecting greater therapeutic efficacy and less side effect. METHODS: Thirty three plaque-form psoriasis patients were included. Pretreatment with etretinate for 1 to 2 weeks was followed by modified Ingram therapy in combination with etretinate. RESULTS: l. Among 33 patients, clearing was shown in 26 patients(78.8%), 4 patients(12.1%) was improved, and 3 patients(9.1%) showed failure. The number of cleared patient was 13/15 (86.7% ) in moderate group, and 13/18 (72.2%) in severe group. 2. In cleared patients, the mean numbers, duration, and total dose of UVB therapy reaching grade 4 were 11.9, 24.5 days, 1348.5 mJ/cm in trunk, and 13.5, 29.1 days, 1733.3 mJ/cm in extremities. Their differences between trunk and extremities were not statistically significant (p>0.05). 3. In cleared patients, the mean numbers, duration, total dose of phototherapy, and total close of etretinate reaching grade 4 in severe group were not significantly higher than them in moderate group (p>0.05). 4. There were some side effects of etretinate such as cheilitis, dry mouth, and side effects of modified Ingram therapy such as erythema, pruritus. But there was no discontinuation of therapy due to side effect. 5. In 22 patients who were followed up at least,one year, the mean remission time was 149 months in moderate group and 6.9 months in severe group. CONCLUSION: Our study suggests that retinoid-modified Ingram regimen is effective and tolerable in the treatment of psoriasis, especially in severe group.
Acitretin ; Cheilitis ; Erythema ; Etretinate ; Extremities ; Humans ; Mouth ; Phototherapy ; Pruritus ; Psoriasis* ; Retinoids

BACKGRUOND: Although treatment with etretinate or modified Ingram method is effective for psoriasis, both regimens have limitations beeause of the risk of long-term toxicity. OBJECTIVE: We performed retinoid-modified Ingram combination therapy expecting greater therapeutic efficacy and less side effect. METHODS: Thirty three plaque-form psoriasis patients were included. Pretreatment with etretinate for 1 to 2 weeks was followed by modified Ingram therapy in combination with etretinate. RESULTS: l. Among 33 patients, clearing was shown in 26 patients(78.8%), 4 patients(12.1%) was improved, and 3 patients(9.1%) showed failure. The number of cleared patient was 13/15 (86.7% ) in moderate group, and 13/18 (72.2%) in severe group. 2. In cleared patients, the mean numbers, duration, and total dose of UVB therapy reaching grade 4 were 11.9, 24.5 days, 1348.5 mJ/cm in trunk, and 13.5, 29.1 days, 1733.3 mJ/cm in extremities. Their differences between trunk and extremities were not statistically significant (p>0.05). 3. In cleared patients, the mean numbers, duration, total dose of phototherapy, and total close of etretinate reaching grade 4 in severe group were not significantly higher than them in moderate group (p>0.05). 4. There were some side effects of etretinate such as cheilitis, dry mouth, and side effects of modified Ingram therapy such as erythema, pruritus. But there was no discontinuation of therapy due to side effect. 5. In 22 patients who were followed up at least,one year, the mean remission time was 149 months in moderate group and 6.9 months in severe group. CONCLUSION: Our study suggests that retinoid-modified Ingram regimen is effective and tolerable in the treatment of psoriasis, especially in severe group.
Acitretin ; Cheilitis ; Erythema ; Etretinate ; Extremities ; Humans ; Mouth ; Phototherapy ; Pruritus ; Psoriasis* ; Retinoids

This is a case of a 20-year-old female with no known comorbidities presenting with verrucous plaques arranged in a unilateral blaschkoid distribution at birth. Biopsy was consistent with epidermal nevus hence patient was diagnosed as systematized epidermal nevus, Nevus Unius Lateris type. Gold standard treatment is full thickness surgical excision however, due to the extensive involvement, treatment of this condition remains a challenge. Hence, non-surgical combination of ablative CO2 laser and topical tretinoin 0.1% were done. Thinner lesions (1-3 mm) showed lower recurrence (50%) as compared to thicker lesions (>3 mm) showing 100% recurrence after six months. Hence, another CO2 laser session is needed. Quality of life was measured using the Dermatologic Life Quality Index (DLQI) with noted 35% improvement post-treatment.
CO2 laser ; lasers, gas ; tretinoin ; retinoids

We investigated the effect of topical application of retimids on the corneal neovascularization in the rat induced by chemical cauterization. The center of corneas of Wistar rats were Cauterized with a silver/potassium nitrate applicator for 5 seconds. And then they were treated topically with 0.1%, 0.2%, 0.5%, 2.0% all-trans retimids (retinol, retinoic acid, retinaldehyde) and dimethyl sulfoxide as a control four times a day. After appiications of eye drops for 5 days, each rat was kined and then perfused with a mixture of 11% gelatin 10% India ink-lactated Ringer's solution. Corneal flat preparation were made, and then the percent of the corneal area occupied by blood vessels were analized by computerized image analyzer. Percent vascularization of 0.1% and 0.2% retnoids were not significantly different from control group(p>0.05). Percent vascu1arization of 0.5% retinaldehyde and all 2.0% retnoids were significantly lower than the contml group(p>0.5). These naturally occurring retinoids were effective in antiarlgiogenesis of rat cornea at relatively high concentrations (>0.5%), when treated topicany, It will be necessary to further study on more potent antiangiogenic, at lower concentration, synthetic retimids for the treatment of angiogenic diseases.
Animals ; Blood Vessels ; Cautery ; Cornea ; Corneal Neovascularization* ; Dimethyl Sulfoxide ; Gelatin ; India ; Ophthalmic Solutions ; Rats ; Rats, Wistar ; Retinaldehyde ; Retinoids* ; Tretinoin