Journal of Dermatological Treatment

ISSN: 0954-6634 (Print) 1471-1753 (Online) Journal homepage: https://www.tandfonline.com/loi/ijdt20

The use of isotretinoin in the treatment of chronic

deep dermatophyte infections

Gilles G. Lestringant

To cite this article: Gilles G. Lestringant (1990) The use of isotretinoin in the treatment of
chronic deep dermatophyte infections, Journal of Dermatological Treatment, 1:3, 169-169, DOI:
10.3109/09546639009086724

To link to this article: https://doi.org/10.3109/09546639009086724

Published online: 12 Jul 2009.

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Journal of Dermatological Treatment ( 1990). 1, 169
Letter to the Editor
The use of isotretinoin in the treatment of chronic deep
dermatophyte infections
Sir,
A nine-year-old girl attended the Dermatology Clinic at
Tawam Hospital, A1 Ain, United Arab Emirates, with a
scalp lesion that had progressively enlarged over the
previous three years. She had a 10 x 4 cm patch of
alopecia overlying the sagittal suture. The surface of the
lesion was covered with yellow-brown crusts and pus.
After removal of the crusts, interconnected subcutaneous
abscesses, 5 to 10mm in size, became visible. Some of
them were fistulous and discharging yellow material.
There were also a few boggy, purplish nodules as well as
three non-tender, slightly enlarged, occipital lymph
nodes. The patient was otherwise healthy and weighed
24 kg. She had previously been treated in several other
institutions with systemic antifungals and more recently
with oral antibiotics and topical steroids.
The diagnosis of perifolliculitis abscedens et suffodiens
(PAS) was made, and pus, hair and scales from the
periphery of the lesion were sent for bacteriological and
fungal studies. Treatment was started with griseofulvin
1 g daily and erythromycin 1.2 g daily together with
once-daily povidone iodine shampoo and benzoyl perox-
ide 10% gel topically. We had found the latter to be of
some value previously in the treatment of kerion celsi.
On review after 10 days there was no improvement.
Cultures grew Staphylococcus aureus sensitive to eryth-
romycin and fungal cultures suggested the presence of a
species of Trichophyton. Ten mg isotretinoin per day was
added to the previous treatment. Three weeks later the
lesion was clean. There were no crusts or pus; nodules and
abscesses had regressed and were no longer discharging.
Treatment was continued for another four weeks leading
to complete clearing of the lesion but with marked
residual scarring alopecia. Trichophyton violaceum was
identified from three different specimens.
0 Journal of Dermatological Treatment, 1990
Tinea capitis is common in the United Arab Emirates
and therefore inflammatory fungal lesions are frequently
seen in the Dermatology Clinic. Although the treatment
of kerion is not usually difficult, the few cases of
Majocchi's granulomas and PAS that we have
encountered always need a 6 to 8 month course of
griseofulvin, and sometimes ketoconazole, before total
clearance is obtained. Furthermore it has often been
necessary to use surgery for the abscesses. We decided to
use isotretinoin. in addition to griseofulvin, in this case
because of the similarity of the lesions to those in chronic
granulomatous dermatophytoses and in acne cong-
lobata.' We have used isotretinoin (0.5- 1 mg/kg/day) in
5 other similarly affected patients with the same results,
that is clearing of the chronic fungal lesions in less than 2
months. In no instance did we have to resort to surgery,
and no major and unexpected side-effects have resulted
from using this treatment regimen.
Gilles G. Lestringant. MD,
Department of Dermatology.
Tawam Hospital, PO Box 15258.
A1 Ain. Abu Dhabi.
United Arab Emirates.
Acknowledgements
I am grateful to Benedict Blayney, MD, for reviewing this article
and to Anne Waugh for typing it.
Reference
I . Grigoriu D, Delacretaz J, Borelli D, Chronic deep der-
matophyte infections. Med Mycol Basle: Editiones 'Roche',
(1987): 143-66.