Seborrheic dermatitis-like eruption in patients taking isotretinoin therapy for acne: retrospective study of five patients

Am J Clin Dermatol. 2008;9(4):255-61. doi: 10.2165/00128071-200809040-00005.

Abstract

Background: Isotretinoin therapy for acne is often associated with mucocutaneous reactions that are usually dose dependent.

Objective: To describe the characteristics of five patients who presented with a peculiar facial rash that developed during or after a successful course of isotretinoin therapy for acne.

Methods: In this retrospective study, five patients who were treated with isotretinoin and who developed, during or following treatment, a peculiar facial eruption that has not previously been reported, are described. The clinical characteristics, laboratory findings, therapy, and course of the eruption are presented.

Results: The rash was characterized by small, yellow, adherent, greasy scales, either flat-topped or spiky, mostly on the cheeks, that resembled seborrheic dermatitis. Cultures obtained in one case grew Staphylococcus coagulase-negative, Acinetobacter, and Pityrosporum ovale organisms. In another patient, microscopic study showed hyperkeratotic scales with many spores and Gram-negative coccobacilli. Topical administration of ointments containing chloramphenicol 3% for 2-3 weeks was curative.

Conclusion: Seborrheic dermatitis-like eruption may be another adverse cutaneous effect of isotretinoin treatment. Its pathogenesis probably involves a minimal toxic retinoid effect on epidermal differentiation with overgrowth of commensal microorganisms in susceptible individuals.

MeSH terms

  • Acne Vulgaris / drug therapy*
  • Administration, Topical
  • Adolescent
  • Adult
  • Anti-Bacterial Agents / administration & dosage
  • Chloramphenicol / administration & dosage
  • Dermatitis, Seborrheic / chemically induced*
  • Dermatitis, Seborrheic / drug therapy
  • Dermatologic Agents / adverse effects*
  • Facial Dermatoses / chemically induced*
  • Facial Dermatoses / drug therapy
  • Female
  • Humans
  • Isotretinoin / adverse effects*
  • Male
  • Retrospective Studies
  • Treatment Outcome

Substances

  • Anti-Bacterial Agents
  • Dermatologic Agents
  • Chloramphenicol
  • Isotretinoin