Aoki Kawaiola Cael, Smithy Will, Au Stefanie, Bartos Simona
Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA.
Medicine, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, USA.
Cureus. 2024 Nov 26;16(11):e74501. doi: 10.7759/cureus.74501. eCollection 2024 Nov.
Isotretinoin (13-cis-retinoic acid) is a well-established systemic treatment for moderate to severe acne vulgaris, renowned for its ability to target multiple contributors to acne pathogenesis. However, its therapeutic potential extends beyond conventional acne management. This case report highlights its efficacy in treating recalcitrant pustular dermatosis, a condition that proved resistant to standard therapies and posed significant diagnostic challenges. A 25-year-old female patient presented with a diffuse, inflamed pustular rash that was unresponsive to a wide range of conventional treatments, including antibiotics, antifungals, and topical agents. Initially diagnosed as bacterial folliculitis based on clinical appearance, the condition persisted despite these interventions. Multiple punch biopsies and laboratory tests aimed at ruling out other conditions, such as pityriasis folliculorum, eosinophilic folliculitis, and cutaneous mastocytosis, provided inconclusive results. Without a definitive diagnosis and after exhausting standard treatments, the decision to initiate systemic isotretinoin was driven by its unique mechanism of action as a "sebocyte modulator," which targets sebum production, inflammation, and abnormal keratinization-key factors suspected to underlie the patient's condition. Over several months, gradual but consistent improvement was observed, culminating in the complete resolution of pustular lesions. The patient's successful response to isotretinoin highlights the importance of considering this treatment in refractory pustular dermatosis when conventional therapies fail, advocating for its broader clinical application in managing complex pustular skin disorders.
异维A酸（13 - 顺式维甲酸）是治疗中度至重度寻常痤疮的一种成熟的全身治疗方法，以其针对痤疮发病机制中多种因素的能力而闻名。然而，其治疗潜力超出了传统的痤疮管理范畴。本病例报告强调了它在治疗顽固性脓疱性皮肤病方面的疗效，这种疾病对标准疗法耐药且带来了重大的诊断挑战。一名25岁女性患者出现弥漫性、炎症性脓疱疹，对包括抗生素、抗真菌药和外用药物在内的多种传统治疗均无反应。最初根据临床表现诊断为细菌性毛囊炎，尽管采取了这些干预措施，病情仍持续存在。旨在排除其他疾病（如毛囊糠疹、嗜酸性毛囊炎和皮肤肥大细胞增多症）的多次钻孔活检和实验室检查结果均不明确。在没有明确诊断且用尽标准治疗方法后，启动全身异维A酸治疗的决定是基于其作为“皮脂细胞调节剂”的独特作用机制，该机制针对皮脂分泌、炎症和异常角化——这些被怀疑是患者病情潜在原因的关键因素。在几个月的时间里，观察到病情逐渐但持续改善，最终脓疱性皮损完全消退。该患者对异维A酸的成功反应凸显了在传统疗法失败时，考虑将这种治疗用于难治性脓疱性皮肤病的重要性，提倡其在管理复杂脓疱性皮肤疾病方面更广泛的临床应用。
