title: Premature epiphyseal closure in an adolescent treated by retinoids for acne: an unusual cause of anterior knee pain.
abstract: Retinoids are effective and widely prescribed in the treatment of severe acne. However their use can be associated with numerous side effects. Some rare cases of premature epiphyseal closure were reported. We present the case of a sixteen-year-old soccer player referred for progressive anterior pain in both knees, evoking a patellar problem. Careful pharmacological questioning revealed use of isotretinoin for several months. MRI findings showed an irregularity of the growth plate and an important metaphyso-epiphyseal oedema, more noticeable in the left knee. Retinoid-induced premature epiphyseal closure was diagnosed. The treatment was stopped, with a resolution of pain within two months. After recovery a persisting small sequelar thumbprint-like growth plate lesion was observed on the control MRI. Retinoids induce an invasion of the growth plate by osteoclasts and a decrease in proteoglycans synthesis. It seems that the knee is the most affected joint. This complication being rare, a radiological follow-up of the young patients treated by retinoids is not proposed.
authors.affiliation: Clinique Romande de réadaptation suvacare, avenue Grand-Champsec, 90, CH-1951 Sion, Switzerland. francois.luthi@crr-suva.ch
authors.forename: François
authors.initials: F
authors.lastname: Luthi
authors.forename: Yan
authors.initials: Y
authors.lastname: Eggel
authors.forename: Nicolas
authors.initials: N
authors.lastname: Theumann
mesh_terms: D000152:Acne Vulgaris / Q000188:drug therapy*; D000293:Adolescent; D018771:Arthralgia / Q000209:etiology* / Q000473:pathology*; D005269:Femur / Q000187:drug effects* / Q000254:growth & development / Q000473:pathology; D006132:Growth Plate / Q000187:drug effects* / Q000473:pathology; D006801:Humans; D007719:Knee Joint / Q000187:drug effects / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D012176:Retinoids / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D012176:Retinoids