Ectrodactyly, Soft‐Tissue Syndactyly, and Nodulocystic Acne: Coincidence or Association?

Abstract

We report severe nodulocystic acne in a 21-year-old man associated with ectrodactyly of the right foot and soft-tissue syndactyly of the third and fourth left fingers, and the first to fourth left toes. His acne was resistant to conventional topical (clindamycin phosphate, erythromycin, tretinoin, peeling agents) and systemic (tetracycline, erythromycin) antiacne medications. Moderate improvement was achieved with systemic isotretinoin. Apart from presenting this case, we imply the disparity of the clinical characteristics of our case and those of Apert syndrome, a rare congenital condition with craniofacial anomalies, symmetric syndactyly of the digits, and acneiform eruption. We discuss the possible explanation for the association of acne lesions and bone deformities based on recent reports of mutations of fibroblast growth factor receptor 2 in the great majority of patients with this syndrome, as well as current experimental data on the involvement of the keratinocyte growth factor in the process of hair follicle growth, development, and differentiation.

Isotretinoin Treatment of Acne in a Patient with Apert Syndrome

“…On the basis of our experience and those of other authors in previously published cases (3–8), isotretinoin should be considered as a first‐line treatment for acne in Apert syndrome. Even though the response of acne to isotretinoin in our patient did not differ from that in otherwise healthy patients, a slightly higher cumulative dose was planned, according to the experience of other authors with Apert syndrome patients (3,4).…”

“…The development of widespread acne involving the face, chest, back, and forearms is a characteristic finding in puberty. Isotretinoin has been reported to be useful in controlling the acne in Apert syndrome (3–8).…”