Greater trochanter enthesopathy: an example of "short course retinoid enthesopathy": a case report.
Irreversible skeletal changes have been described in patients with dermatologic disorders treated with isotretinoin (Accutane), a synthetic vitamin A derivative. Although retinoids were developed to avoid toxicity associated with vitamin A, skeletal lesions and rheumatologic consequences are possible hazards of isotretinoin treatment. Enthesopathy is one of the potential musculoskeletal sequelae and is characterized by pathologic, sometimes painful changes at the insertion sites (entheses) of tendons, ligaments, and articular capsules into bone. We report a patient who was referred secondary to an extended history of bilateral hip region pain. She was subsequently found to have a greater trochanteric enthesopathy. A detailed patient history revealed past use of Accutane for cystic acne. The subsequent treatment course, including medications, corticosteroid injections, physical therapy, and activity modifications, is described and the pertinent literature is reviewed. We believe that patients who are prescribed isotretinoin should be warned about this potential pathologic condition at the initiation of treatment and that physicians who are treating patients with a history of Accutane use should be suspicious of underlying enthesopathies as the etiology behind pain of musculoskeletal origin.
Stitik
T P
TP
Department of Physical Medicine and Rehabilitation, UMDNJ-New Jersey Medical School, West Orange, New Jersey, USA.
Nadler
S F
SF
Foye
P M
PM
Juvan
L
L
D000152:Acne Vulgaris / Q000188:drug therapy; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004008:Diclofenac / Q000627:therapeutic use; D005260:Female; D006621:Hip Joint / Q000473:pathology*; D006801:Humans; D015474:Isotretinoin / Q000009:adverse effects*; D007641:Keratolytic Agents / Q000009:adverse effects*; D026741:Physical Therapy Modalities; D011187:Posture / Q000502:physiology; D012216:Rheumatic Diseases / Q000139:chemically induced* / Q000188:drug therapy / Q000534:rehabilitation; D013177:Sports / Q000502:physiology
D000305:Adrenal Cortex Hormones; D000894:Anti-Inflammatory Agents, Non-Steroidal; D007641:Keratolytic Agents; D004008:Diclofenac; D015474:Isotretinoin