Section : Articles

Perioral abscess formation with Vitamin A derived oral treatment

Perioral abscess associated with isotretinoin.

Beer K, Oakley H, Waibel J.

J Drugs Dermatol. 2009 Nov;8(11):1034-6.

“Watch out for patients developing infectious abscesses when on systemic isotretinoin treatment”.

Patients on isotretinoin therapy have impaired skin and mucosal barrier function, thus rendering them more susceptible to infections. This case report highlights the need to suspect the diagnosis of lip abscesses in patients presenting with swollen lips while on oral isotretinoin therapy.

Recalcitrant or severe acne vulgaris is often treated with systemic isotretinoin. Numerous dose-dependant and dose-independent adverse effects have been described. Quite often mucocutaneous dose-dependant side-effects can develop. This can result in impairment of the barrier function, thus rendering the lips susceptible to infections.

This case report is of a 16 year-old male who presented for evaluation of a swollen lip. On an initial presumptive diagnosis of angioedema, he was put on 40mg oral prednisone.The following day, pustules also appeared and amoxicillin-clavulanic acid antibiotic therapy was started. After 3 days of unsuccessful treatment, biopsy was performed, and several mls of pus were removed with subsequent relief of discomfort. Pyogenic culture grew methicillin resistant staphylococcus aureus (MRSA). The patient lived with a family member who was colonized with MRSA.

Although Staphylococci have been demonstrated to be present on the lips of patients undergoing treatment with isotretinoin (1), this is the first case report of an infectious perioral abscess developing on isotretinoin. With the spreading in the community of acquired MRSA, it is important to be aware of this diagnostic possibility and to perform bacterial cultures to adapt antibiotic therapy. Imaging can also be performed if clinical diagnosis of an abscess cannot be ascertained.

Future case reports or studies might validate this new side-effect of isotretinoin systemic therapy.