Premature Epiphyseal Closure Secondary to Single‐course Vitamin a Therapy

Steele, Rose; P, Lugg; Richardson, Mark F.

doi:10.1046/j.1440-1622.1999.01706.x

Cited by 17 publications

(7 citation statements)

References 10 publications

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“…Only a single case has been reported in association with isotretinoin administered for acne. 117 Other cases have primarily been reported as a consequence of isotretinoin therapy for disorders of keratinization 118 or neuroblastoma. 113 130 In this casecontrol study, only ulcerative colitis was associated with previous isotretinoin use, and increasing cumulative dose or duration to isotretinoin was associated with an elevated risk of ulcerative colitis (1.5 odds ratio increase per 20 mg increase in dose, and 5.63 overall increased odds ratio in association with longer duration).…”

Section: Bone Effectsmentioning

confidence: 99%

Evidence-Based Recommendations for the Diagnosis and Treatment of Pediatric Acne

et al. 2013

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INTRODUCTION: Acne vulgaris is one of the most common skin conditions in children and adolescents. The presentation, differential diagnosis, and association of acne with systemic pathology differs by age of presentation. Current acknowledged guidelines for the diagnosis and management of pediatric acne are lacking, and there are variations in management across the spectrum of primary and specialty care. The American Acne and Rosacea Society convened a panel of pediatric dermatologists, pediatricians, and dermatologists with expertise in acne to develop recommendations for the management of pediatric acne and evidence-based treatment algorithms. METHODS: Ten major topic areas in the diagnosis and treatment of pediatric acne were identified. A thorough literature search was performed and articles identified, reviewed, and assessed for evidence grading. Each topic area was assigned to 2 expert reviewers who developed and presented summaries and recommendations for critique and editing. Furthermore, the Strength of Recommendation Taxonomy, including ratings for the strength of recommendation for a body of evidence, was used throughout for the consensus recommendations for the evaluation and management of pediatric acne. Practical evidence-based treatment algorithms also were developed. RESULTS: Recommendations were put forth regarding the classification, diagnosis, evaluation, and management of pediatric acne, based on age and pubertal status. Treatment considerations include the use of over-the-counter products, topical benzoyl peroxide, topical retinoids, topical antibiotics, oral antibiotics, hormonal therapy, and isotretinoin. Simplified treatment algorithms and recommendations are presented in detail for adolescent, preadolescent, infantile, and neonatal acne. Other considerations, including psychosocial effects of acne, adherence to treatment regimens, and the role of diet and acne, also are discussed. CONCLUSIONS: These expert recommendations by the American Acne and Rosacea Society as reviewed and endorsed by the American Academy of Pediatrics constitute the first detailed, evidence-based clinical guidelines for the management of pediatric acne including issues of special concern when treating pediatric patients.

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Section: Bone Effectsmentioning

confidence: 99%

Evidence-Based Recommendations for the Diagnosis and Treatment of Pediatric Acne

et al. 2013

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“…Premature epiphyseal growth arrest is not unique to pediatric patients with neuroblastoma and is also reported when isotretinoin is used for treatment of dermatologic conditions 20,21 . This finding emphasizes that the adverse effects of isotretinoin use are independent of the high doses and the cyclic nature of drug administration seen when treating patients with neuroblastoma.…”

Section: Discussionmentioning

confidence: 73%

“…The lower doses and various dosing schedules could explain the wider, less severe, range of skeletal deformities seen in the dermatology patient case reports. However, it appears that after a certain level of isotretinoin use, premature epiphyseal growth arrest tends to be a prevalent toxicity in patients with reported skeletal adverse effects, especially in preadolescent patients with an active growth plate 20‐22,24,25 . Furthermore, it has been reported that patients taking vitamin A, fenretinide, and etretinate have also developed premature epiphyseal growth plate arrest, which suggests that this toxicity is a phenomenon that occurs while taking any vitamin A derivative and indicates a more inclusive “class effect” that these drugs have on growing bone 4,5,26 .…”

Section: Discussionmentioning

confidence: 99%

Premature epiphyseal growth plate arrest after isotretinoin therapy for high‐risk neuroblastoma: A case series and review of the literature

Duvalyan

Cha

Goodarzian

et al. 2020

Pediatric Blood & Cancer

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Background Vitamin A–derived retinoids have been reported to cause skeletal abnormalities ranging from hypercalcemia to premature epiphyseal closure. Isotretinoin is a retinoid used as standard therapy for high‐risk neuroblastoma and has been reported to cause premature epiphyseal growth plate arrest. Procedure We identified patients from the Children's Hospital Los Angeles (CHLA) database with high‐risk neuroblastoma diagnosed from 1991 to 2018 who experienced premature epiphyseal growth plate arrest and compared their characteristics to other patients with high‐risk neuroblastoma. We then performed a literature review of this complication. Data collection included diagnosis age of neuroblastoma, presentation age, agent of exposure, dose, exposure range, and skeletal deformity. Results Among 216 patients, high‐risk neuroblastoma was diagnosed before age of five years (n = 165), between ages of 5 and 10 years (n = 41), and after 10 years of age (n = 13). Three out of 216 patients developed premature epiphyseal growth arrest after isotretinoin exposure (overall incidence = 1.38%). The incidence of bony abnormalities was significantly higher in patients diagnosed in 5‐ to 10‐year age group than in other two groups (P = 0.014). Literature review identified eight additional patients with neuroblastoma who presented with retinoid associated skeletal abnormalities. The median range of isotretinoin exposure for these 11 patients was between 6.5 and 7.625 years (range, 2‐14) with no cases of isotretinoin therapy completion before age 5 years. Conclusion Bone toxicity associated with isotretinoin exposure is a concern. Growth plate arrest is a serious adverse effect that is attributable to isotretinoin therapy. Our findings suggest the prepubescent growth plate may be most at risk, and we recommend special attention to this population.

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“…The typical dosage used in acne treatment showed no increased risk of bone demineralization or fractures [32,33]. However, in a few cases, the premature closure of lower extremity growth plates was reported [34].…”

Section: Resultsmentioning

confidence: 99%

Therapeutic Approaches of Infantile Acne: A Narrative Review Study

et al. 2021

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Background: Acne vulgaris is a skin condition in children and has various presentations and differential diagnoses. Objectives: The purpose of this review was to evaluate the therapeutic approaches of infantile acne. Methods: In this narrative review, we searched articles published in English on infantile acne in Google Scholar, PubMed, and Scopus from 1981 to 2019. Results: A total of 35 articles were selected for review. The treatment of acne often involves various medications that acne lesions. Different factors contribute to the pathogenesis of acne and its severity. The same principle and treatment strategy applies to all age groups diagnosed with acne. Conclusions: The treatment strategy for infantile acne is similar to acne treatment at any age. Treatment is based on the severity of the acne and the risk of a future scar.

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Premature Epiphyseal Closure Secondary to Single‐course Vitamin a Therapy

Cited by 17 publications

References 10 publications

Evidence-Based Recommendations for the Diagnosis and Treatment of Pediatric Acne

Evidence-Based Recommendations for the Diagnosis and Treatment of Pediatric Acne

Premature epiphyseal growth plate arrest after isotretinoin therapy for high‐risk neuroblastoma: A case series and review of the literature

Therapeutic Approaches of Infantile Acne: A Narrative Review Study

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