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Inflammatory segmental vitiligo during oral isotretinoin use: a casual association?
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Initial bullous detachment at the dermo-epidermal junction (Hematoxylin & eosin, ×40). B, The primary involvement of the skin is on the sebaceous epithelium, as shown by immunohistochemistry specific for varicella zoster virus (Hematoxylin & eosin, ×40).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Gianluca Nazzaro, Stefano Veraldi" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Gianluca" "apellidos" => "Nazzaro" ] 1 => array:2 [ "nombre" => "Stefano" "apellidos" => "Veraldi" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S2666275220301478" "doi" => "10.1016/j.abdp.2019.07.011" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275220301478?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059620300775?idApp=UINPBA00008Z" "url" => "/03650596/0000009500000003/v4_202007210853/S0365059620300775/v4_202007210853/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S0365059620300866" "issn" => "03650596" "doi" => "10.1016/j.abd.2019.07.013" "estado" => "S300" "fechaPublicacion" => "2020-05-01" "aid" => "175" "copyright" => "Sociedade Brasileira de Dermatologia" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by/4.0/" "subdocumento" => "sco" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case Letter</span>" "titulo" => "Terra firma-forme dermatosis: an underdiagnosed condition" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "397" "paginaFinal" => "399" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 602 "Ancho" => 855 "Tamanyo" => 53874 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Area without lesions after rubbing the skin with gauze embedded in 70% alcohol.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Bruna Anjos Badaró, Lucia Martins Diniz, Paulo Sergio Emerich Nogueira" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Bruna Anjos" "apellidos" => "Badaró" ] 1 => array:2 [ "nombre" => "Lucia Martins" "apellidos" => "Diniz" ] 2 => array:2 [ "nombre" => "Paulo Sergio Emerich" "apellidos" => "Nogueira" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S2666275220301570" "doi" => "10.1016/j.abdp.2019.07.013" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275220301570?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059620300866?idApp=UINPBA00008Z" "url" => "/03650596/0000009500000003/v4_202007210853/S0365059620300866/v4_202007210853/en/main.assets" ] "en" => array:17 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case Letter</span>" "titulo" => "Inflammatory segmental vitiligo during oral isotretinoin use: a casual association?" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">Dear Editor</span>," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "399" "paginaFinal" => "400" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Maria Fernanda de Santana Avelar-Caggiano, Caio César Silva de Castro, Gerson Dellatorre" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Maria Fernanda de Santana" "apellidos" => "Avelar-Caggiano" "email" => array:1 [ 0 => "mafe_avelar@yahoo.com.br" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Caio César Silva de" "apellidos" => "Castro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Gerson" "apellidos" => "Dellatorre" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Service of Dermatology, Hospital Santa Casa de Misericórdia de Curitiba, Curitiba, PR, Brazil" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Medical School, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1117 "Ancho" => 1583 "Tamanyo" => 74065 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Wood's light examination revealed fluoresce bright blue-white in malar and perioral right regions.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Segmental vitiligo (SV) accounts for 3–20% of all cases of vitiligo and is usually not associated with autoimmune diseases when compared to non-segmental vitiligo (NSV).<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Among the theories proposed for the path physiology of SV, it is essential to emphasize the presence of an autoimmune attack against a mosaic area.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In the literature, there are few reports on the emergence of vitiligo as a side effect of medications, especially oral isotretinoin. The objective of the present report is to demonstrate a possible new side effect of this medication since there are no descriptions of its association with SV in the literature.</p><p id="par0015" class="elsevierStylePara elsevierViewall">A 17 year-old male patient, previously healthy and without a family history of vitiligo, was diagnosed with resistant acne, previously treated with topical and systemic antibiotic therapy. During the fifth month of treatment with oral isotretinoin (0.4<span class="elsevierStyleHsp" style=""></span>mg/kg/day, cumulative dose of 5.400<span class="elsevierStyleHsp" style=""></span>mg), there were a chromic spots surrounded by an erythematous-scaling halo in malar and perioral areas, not exceeding the mid line on the right side of the face (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Wood's light examination revealed fluorescent chalky white aspect, as well as polios is in beard hair (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>) favoring the SV diagnosis. After the withdrawal of isotretinoin, the patient began treatment with 0.1% tacrolimus ointment twice daily with an improvement of perilesional erythema after two months, although without improvement of achromy. Subsequently, it was submitted to 20 sessions of UVB-NB phototherapy, with little perifollicularre pigmentation.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">In the literature review, only three cases of vitiligo in the context of oral isotretinoin use are described. One report describes the case of a patient who developed vitiligo during the use of oral isotretinoin at a dose of 0.3–0.4<span class="elsevierStyleHsp" style=""></span>mg/kg/day for the treatment of moderate to severe acne.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> In another report, acrofacial vitiligo was developed only two months after the end of treatment with isotretinoin, which reduces the probability of a cause-and-effect relationship.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> There is also a report of worsening of NSV lesions in the lower lip and lower perioral region after chronic cheilitis due to the use of oral isotretinoin; a condition attributed in this case to the Koebner phenomenon.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The mechanism of action of isotretinoin in this presumed association is not yet fully elucidated, but the drug appears to play a role in triggering autoimmunity in genetically susceptible individuals.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> Several reports of autoimmune diseases such as diabetes, autoimmune hepatitis, Guillain–Barré syndrome, and thyroiditis have been reported after the end of the isotretinoin regimen or during the last week of treatment.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> Besides, in vitro studies have also demonstrated that retinoid may have a pro-apoptotic effect on melanocytes.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Although the cause-effect relationship of this association has not yet been proven, the increasing appearance of new cases in the literature is a warning sign for dermatologists to keep vigil on this possible new side effect.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0035" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors' contributions</span><p id="par0040" class="elsevierStylePara elsevierViewall">Maria Fernanda de Santana Avelar-Caggiano: Conception and planning of the study; elaboration and writing of the manuscript; obtaining, analysis, and interpretation of the data; critical review of the literature.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Caio César Silva de Castro: Approval of the final version of the manuscript; effective participation in research orientation; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the manuscript.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Gerson Dellatorre: Approval of the final version of the manuscript; effective participation in research orientation; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the manuscript.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Financial support" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Authors' contributions" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-04-01" "fechaAceptado" => "2019-07-22" "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">How to cite this article: Avelar-Caggiano MFS, Castro CCS, Dellatorre G. Inflammatory segmental vitiligo during oral isotretinoin use: a casual association? An Bras Dermatol. 2020;95:399–400.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Study conducted at the Hospital Santa Casa de Misericórdia de Curitiba, Paraná, PR, Brazil.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 999 "Ancho" => 1500 "Tamanyo" => 123876 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Achromic spots surrounded by halo erythematosus and polios is in beard hairs in the malar and right perioral regions.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1117 "Ancho" => 1583 "Tamanyo" => 74065 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Wood's light examination revealed fluoresce bright blue-white in malar and perioral right regions.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "New insights in segmental vitiligo: case report and review of theories" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N. 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| 2024 Fevereiro | 100 | 71 | 171 |
| 2024 Janeiro | 63 | 51 | 114 |
| 2023 Dezembro | 80 | 59 | 139 |
| 2023 Novembro | 98 | 98 | 196 |
| 2023 Outubro | 92 | 87 | 179 |
| 2023 Setembro | 109 | 95 | 204 |
| 2023 Agosto | 75 | 50 | 125 |
| 2023 Julho | 67 | 42 | 109 |
| 2023 Junho | 58 | 47 | 105 |
| 2023 Maio | 48 | 34 | 82 |
| 2023 Abril | 45 | 25 | 70 |
| 2023 Março | 54 | 57 | 111 |
| 2023 Fevereiro | 52 | 45 | 97 |
| 2023 Janeiro | 48 | 55 | 103 |
| 2022 Dezembro | 57 | 46 | 103 |
| 2022 Novembro | 71 | 68 | 139 |
| 2022 Outubro | 86 | 65 | 151 |
| 2022 Setembro | 44 | 79 | 123 |
| 2022 Agosto | 46 | 62 | 108 |
| 2022 Julho | 40 | 67 | 107 |
| 2022 Junho | 56 | 51 | 107 |
| 2022 Maio | 37 | 57 | 94 |
| 2022 Abril | 37 | 61 | 98 |
| 2022 Março | 44 | 74 | 118 |
| 2022 Fevereiro | 28 | 42 | 70 |
| 2022 Janeiro | 38 | 73 | 111 |
| 2021 Dezembro | 40 | 60 | 100 |
| 2021 Novembro | 51 | 60 | 111 |
| 2021 Outubro | 51 | 86 | 137 |
| 2021 Setembro | 33 | 45 | 78 |
| 2021 Agosto | 47 | 69 | 116 |
| 2021 Julho | 41 | 50 | 91 |
| 2021 Junho | 28 | 59 | 87 |
| 2021 Maio | 44 | 92 | 136 |
| 2021 Abril | 159 | 291 | 450 |
| 2021 Março | 76 | 60 | 136 |
| 2021 Fevereiro | 42 | 23 | 65 |
| 2021 Janeiro | 36 | 21 | 57 |
| 2020 Dezembro | 45 | 22 | 67 |
| 2020 Novembro | 42 | 11 | 53 |
| 2020 Outubro | 25 | 14 | 39 |
| 2020 Setembro | 72 | 16 | 88 |
| 2020 Agosto | 62 | 7 | 69 |
| 2020 Julho | 52 | 10 | 62 |
| 2020 Junho | 12 | 24 | 36 |
| 2020 Maio | 19 | 11 | 30 |
| 2020 Abril | 0 | 2 | 2 |
Mostrar tudo
