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      Severe hyperpigmentation and scarring following glycolic acid peel treatment in combination with low-dose isotretinoin

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          Abstract

          Background

          The application of systemic isotretinoin in the treatment of cutaneous photoaging has been well investigated. In addition, well-recognized topical antiaging therapies such as superficial chemical peeling (CP) with α-hydroxy acids have been shown to be more helpful when combined with low-dose oral isotretinoin. Even though the combination of systemic isotretinoin and medium to deep CP has been associated with serious side effects such as delayed wound healing and enlarged incidence of scarring, to date superficial CP and concomitant systemic isotretinoin have been considered safe.

          Case presentation

          In this report, we present the case of a patient receiving low-dose oral isotretinoin therapy who developed severe painful erythema and erosions that led to permanent hyperpigmentation and scarring of her face and neck after undergoing superficial CP with glycolic acid.

          Conclusions

          There is a potential risk of hyperpigmentation and scarring with the use of a combination of low-dose oral isotretinoin and glycolic acid peeling.

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          Most cited references23

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          Retinoids in cosmeceuticals.

          Olivier Sorg, Christophe Antille, Gurkan Kaya … (2015)
          Retinoids are natural and synthetic vitamin A derivatives. They are lipophilic molecules and easily penetrate the epidermis. Their biologically active forms can modulate the expression of genes involved in cellular differentiation and proliferation. Retinoic acid (tretinoin), its 13-cis isomer isotretinoin, as well as various synthetic retinoids are used for therapeutic purposes, whereas retinaldehyde, retinol, and retinyl esters, because of their controlled conversion to retinoic acid or their direct receptor-independent biologic action, can be used as cosmeceuticals. These natural retinoic acid precursors are thus expected to be helpful in (i) renewing epidermal cells, (ii) acting as UV filters, (iii) preventing oxidative stress, (iv) controlling cutaneous bacterial flora, and (v) improving skin aging and photoaging. Retinol and retinyl esters are not irritant, whereas demonstrating only a modest clinical efficiency. On the other hand, retinaldehyde, which is fairly well tolerated, seems to be the most efficient cosmeceutical retinoid; it has significant efficiency toward oxidative stress, cutaneous bacterial flora, epidermis renewing, and photoaging.
          Article 0 comments Cited 25 times – based on 0 reviews     Review now
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            Uses and complications of isotretinoin therapy.

            K Krach, N. Ellis (2001)
            Isotretinoin (13-cis-retinoic acid) is a retinoid that has been used over the past 2 decades to treat a wide variety of dermatologic conditions, some with great success. Although it is beneficial in many skin conditions, the side effects and toxicities of oral retinoids require careful monitoring by experienced physicians. The clinical applications of oral retinoids continue to expand both within and beyond the field of dermatology.
            Article 0 comments Cited 22 times – based on 0 reviews     Review now
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              Preventing and managing the side effects of isotretinoin.

              Megan Brelsford, Trisha Clarke Beute (2008)
              Isotretinoin (13-cis-retinoic acid) is widely used for the treatment of severe acne as well as for disorders of conification, for psoriasis, and for skin cancer prevention. As a member of the retinoid family, it has a wide spectrum of side effects, including reproductive, cutaneous, ocular, neurological, musculoskeletal, and hepatic. As long as patients are able to tolerate these side effects, it can be a very effective treatment option. This article examines both the most common and the most concerning side effects as well as ways in which providers and patients may best manage them to be able to benefit from isotretinoin treatment.
              Article 0 comments Cited 20 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Peter Arne Gerber: peterarne.gerber@med.uni-duesseldorf.de
                Gabriela Kukova: gabrielakukova@med.uni-duesseldorf.de
                Edwin Bölke: boelke@med.uni-duesseldorf.de
                Bernhard Homey: homey@uni-duesseldorf.de
                Evelyn Diedrichson: Diedrichson@med.uni-duesseldorf.de
                Journal
                Journal ID (nlm-ta): Eur J Med Res
                Journal ID (iso-abbrev): Eur. J. Med. Res
                Title: European Journal of Medical Research
                Publisher: BioMed Central (London )
                ISSN (Print): 0949-2321
                ISSN (Electronic): 2047-783X
                Publication date (Electronic): 7 November 2014
                Publication date PMC-release: 7 November 2014
                Publication date Collection: 2014
                Volume: 19
                Issue: 1
                Electronic Location Identifier: 60
                Affiliations
                [ ]Department of Dermatology, Medical Faculty, Heinrich Heine University Dusseldorf, Moorenstrasse 5, 40225 Duesseldorf, Germany
                [ ]Department of Radiation Oncology, Medical Faculty, Heinrich Heine University Dusseldorf, Moorenstrasse 5, 40225 Duesseldorf, Germany
                Article
                Publisher ID: 60
                DOI: 10.1186/s40001-014-0060-x
                PMC ID: 4230351
                PubMed ID: 25376482
                SO-VID: cc5b6a09-bb22-4633-8b45-6eb174fab2c5
                Copyright © © Gerber et al.; licensee BioMed Central Ltd. 2014
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 12 February 2014
                Date accepted : 21 October 2014
                Categories
                Subject: Case Report
                Custom metadata
                issue-copyright-statement © The Author(s) 2014

                ScienceOpen disciplines: Medicine
                Keywords: hyperpigmentation,low-dose isotretinoin,peel treatment,scarring
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: hyperpigmentation, low-dose isotretinoin, peel treatment, scarring

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