Paronychia and granulation tissue formation during treatment with isotretinoin

Abstract

This paper describes the association of two unusual side effects of treatment with isotretinoin for severe acne: paronychia and excess granulation tissue in the nails furrows. We report a case of male patient aged 19 years, who in the course of the 36th week of treatment with isotretinoin for acne grade III showed erythema, edema, excess granulation tissue and onychocryptosis in various nail beds of hands and feet, with no history of trauma associated. A literature review revealed few reports of these adverse events, and two clinical patterns of exuberant granulation tissue has been described: one in periungual location and other in lesions of previous acne. The rarity and lack of knowledge on the best treatment for granuloma-like reactions make this theme a considerable challenge.

Onychocryptosis and asymptomatic external urethritis as complications of oral isotretinoin therapy

“…Herein we report the case of a single patient who experienced both onychocryptosis and external urethritis while on isotretinoin therapy for acne vulgaris. Similar to previously documented cases,6–8 his asymptomatic external urethritis spontaneously resolved on completion of his isotretinoin regimen, but his onychocryptosis required surgical intervention. His story helps shed light on a potential treatment paradigm for these uncommon adverse events.…”

“…While his paronychia and granulation tissue resolved after completing his isotretinoin regimen, onychocryptosis in his hallux persisted and required matrixectomy for complete resolution. Excessive development of granulation tissue was suggested to be a mechanism for his symptoms 6. One theory suggests that excess retinoids may disrupt the nail matrix at the epithelial level generating local dermatitis with accumulation of scales in the nail folds.…”

“…It is also a well-known teratogen 5. Rarely, patients taking isotretinoin experience onychocryptosis6 and external urethritis,7 8 but the true incidence of these reactions remains unclear. Herein we report the case of a single patient who experienced both onychocryptosis and external urethritis while on isotretinoin therapy for acne vulgaris.…”

Pyogenic Granuloma in an Atypical Location Following Isotretinoin Treatment

“…2 It has also been reported after treatment with topical and/or systemic retinoids-such as isotretinoin-between two weeks and six months after the initiation of treatment. 3,4 Most cases reported in the literature are located in the periungual area (i.e. lateral and distal nail folds), although it can also affect the chest, back, face, scalp and, less frequently, the genital area, as in the present case.…”

Isotretinoin induced nail fold pyogenic granuloma resolution with combination therapy: A case report and review of the literature

“…[6] It has been reported that the resolution of excess granulation tissue secondary to systemic retinoid therapy occurs on withdrawal of isotretinoin. [7] Unfortunately for our patient, discontinuation of isotretinoin and prevention of secondary infection in areas of excess granulation tissue was insufficient in resolving these lesions. To date, there is no consensus evidence based approach to the treatment of isotretinoin induced pyogenic granulomas.…”