Isotretinoin

Abstract

Disseminate and recurrent infundibulofolliculitis (DRIF) is a rarely-reported disorder. Here, the authors describe a case in which isotretinoin was successfully used to treat DRIF.

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Case Report

A 60-year-old white woman presented with a diffuse erythematous follicular rash 2-mm in size. She reported experiencing intense pruritus that had begun seven months previously and was initially located on her trunk. Seasonal association, constitutional symptoms, personal or family history of any other skin or systemic disease was not reported. The physical examination and laboratory tests including full blood count, biochemical profile, and urinary analysis were all normal. The patient reported that the onset of her symptoms was abrupt and occurred immediately after polishing a wooden surface at the fireplace of her house. The skin biopsy taken by 4-mm punch showed foci of necrosis with adjacent collection of polymorphonuclear leukocytes in the infundibulum and few lymphocytes around the blood vessels (Figure 1).

The patient had received corticosteroids locally and hydroxyzine orally in the past, without any response. We put the patient on 10 mg of isotretinoin per day orally for 15 days and then increased the dose to 30 mg for two additional months. During this period, the patient significantly improved, but there were still some lesions and mild pruritus so we advised her to change the lacquer she was using on her furniture. Remission was achieved 45 days after the beginning of therapy. One year after the end of treatment, the individual continues to remain free of symptoms.

[FIGURE 1 OMITTED]

Discussion

Disseminate and recurrent infundibulofolliculitis, described first by Hitch and Lund, is a rare disease affecting mostly black men, usually less than 40 years of age (1). The list of all presently reported cases is rather short; the total number is as high as 24 (1-12).

The case described here was that of a 60-year-old white woman. This case was the second one of DRIF in which we administered isotretinoin (13-cis retinoic acid) successfully. Our previous case was that of a 30-year-old white man that received isotretinoin 0.6 mg/kg/day orally for four months. His response was successful starting one month after the beginning of treatment. This man returned to us three years later with a relapse that occurred after browsing a few times in furniture shops (while three years ago he did not mention a similar event). We believe that some association exists between furniture lacquer and DRIF, possibly the former belonging to a category of precipitating factors. In the present case, a lower dose of isotretinoin was administered and the response started 45 days after the onset of treatment. The case described in this report responded successfully, even with a lower dose of isotretinoin.

References

1. Hitch JM, Lund HZ. Disseminated and recurrent infundibulo-folliculitis, Report of a case. Arch Dermatol 1968; 97:432-435.

2. Thew MA, Wood MG. Disseminated and recurrent infundibulo-folliculitis, Report of a case. Arch Dermatol 1969; 100:728-733.

3. Wolf M. Tolmach J. Disseminated and recurrent infundibulo-folliculitis. Arch Dermatol 1971; 103:552-553.

4. Kaidbey KH, Farah FS, Matta MT. Disseminated and recurrent infundibulo-folliculitis, Report of two cases. Dermatologica 1971; 143:29-35.

5. Hitch JM, Lund HZ. Disseminated and recurrent infundibulo-folliculitis. Arch Dermatol 1972; 105:580-583.

6. Soyinka F. Recurrent disseminated infundibulofolliculitis. Int J Dermatol 1973; 12(5):314-317.

7. Owen WR, Wood C. Disseminate and recurrent infundibulofolliculitis. Arch Dermatol. 1979; 115(2):174-175.

8. Karg E. Kiss A. Schneider I. Recurrent disseminated infundibulofolliculitis. Hautarzt 1986; 37(3):156-158, German.

9. Aroni K. Aivaliotis M. Davaris P. Disseminate and Recurrent Infundibular folliculitis (D.R.I.F): Report of a case succesfully treated with Isotretinoin. J Dermatol 1998; 25:51-53.

10. Ravikumar BC, et al. Disseminate and recurrent infundibulofolliculitis: response to psoralen plus UVA therapy. Int J Dermatol 1999; 38(1):75-76.

11. Calka O. Metin A. Ozen S. A case of disseminated and recurrent infundibulofolliculitis responsive to treatment with systemic isotretinoin. J Dermatol 2002; 29(7):431-434.

12. Heymann WR. Infundibulofolliculitis of the neck. Cutis 2002; 70(3):178-180.

K ARONI MD, A GRAPSA MD, E AGAPITOS MD

ASSOCIATE PROFESSOR IN PATHOLOGY, DEPARTMENT OF PATHOLOGY, MEDICAL SCHOOL

THE NATIONAL AND KAPODISTRIAN UNIVERSITY OF ATHENS, ATHENS, GREECE

ADDRESS FOR CORRESPONDENCE:

K. Aroni MD

Department of Pathology, Medical School

The National and Kapodistrian University of Athens

Mikras Asias 75 Street

GR-115 27 Athens

Greece

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