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


CONCLUSIONS
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.
Barzilai
Aviv
A
Department of Dermatology, Sheba Medical Center, Tel-Hashomer, IsraelSackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. avivb@post.tau.ac.il
David
Michael
M
Trau
Henri
H
Hodak
Emmilia
E
D000152:Acne Vulgaris / Q000188:drug therapy*; D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D002701:Chloramphenicol / Q000008:administration & dosage; D012628:Dermatitis, Seborrheic / Q000139:chemically induced* / Q000188:drug therapy; D003879:Dermatologic Agents / Q000009:adverse effects*; D005148:Facial Dermatoses / Q000139:chemically induced* / Q000188:drug therapy; D005260:Female; D006801:Humans; D015474:Isotretinoin / Q000009:adverse effects*; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D003879:Dermatologic Agents; D002701:Chloramphenicol; D015474:Isotretinoin