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Isotretinoin - Ingrowing toe nails

Discussion in 'General Issues and Discussion Forum' started by toughspiders, Jul 4, 2009.

  1. toughspiders

    toughspiders Active Member


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    I attended to a patient who was receiving acne treatment.

    His complaint, an area of inflammation to the medial sulci of the hallux with hypergranulation tissue. Obviously initial thought ingrowing toe nail. His mother then goes on to tell me. That his consultant asked him if he was suffering with ingrowing toe nails. He proceded to tell her that they are a side effect of the drug.

    This is a new one on me. I read that it can have a drying effect on the skin and the nails. I can see how it could make the edges of the nail flaky and split and therefore irritate or grow in....however his nail seemed to be of good texture.

    Anyone know anything of this???
     
  2. Craig Payne

    Craig Payne Moderator

    Articles:
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    Re: Roaccutane - Ingrowing toe nails

    Its a known side affect. I recall hearing a couple of conference presentations on this. See this.
     
  3. admin

    admin Administrator Staff Member

    Isotretinoin

    Isotretinoin, also known as 13-cis-retinoic acid and sold under the brand name Accutane among others, is a medication primarily used to treat severe acne. It is also used to prevent certain skin cancers (squamous-cell carcinoma), and in the treatment of other cancers. It is used to treat harlequin-type ichthyosis, a usually lethal skin disease, and lamellar ichthyosis. It is a retinoid, meaning it is related to vitamin A, and is found in small quantities naturally in the body. Its isomer, tretinoin, is also an acne drug.

    The most common adverse effects are dry lips (cheilitis), dry and fragile skin, and an increased susceptibility to sunburn. Uncommon and rare side effects include muscle aches and pains (myalgias), and headaches. Isotretinoin is known to cause birth defects due to in-utero exposure because of the molecule's close resemblance to retinoic acid, a natural vitamin A derivative that controls normal embryonic development. It is also associated with psychiatric side effects, most commonly depression but also, more rarely, psychosis and unusual behaviours. Other rare side effects include hyperostosis and premature epiphyseal closure, which have been reported to be persistent.

    Isotretinoin was patented in 1969 and approved for medical use in 1982.[6] In 2021, it was the 264th most commonly prescribed medication in the United States, with more than 1 million prescriptions.[7][8]

    1. ^ Cite error: The named reference brands was invoked but never defined (see the help page).
    2. ^ "FDA-sourced list of all drugs with black box warnings (Use Download Full Results and View Query links.)". nctr-crs.fda.gov. FDA. Retrieved 22 October 2023.
    3. ^ Product. Roaccutane PI guildlink.com.au
    4. ^ Anvisa (31 March 2023). "RDC Nº 784 - Listas de Substâncias Entorpecentes, Psicotrópicas, Precursoras e Outras sob Controle Especial" [Collegiate Board Resolution No. 784 - Lists of Narcotic, Psychotropic, Precursor, and Other Substances under Special Control] (in Brazilian Portuguese). Diário Oficial da União (published 4 April 2023). Archived from the original on 3 August 2023. Retrieved 15 August 2023.
    5. ^ List of nationally authorised medicinal products European Medicines Agency. 1 December 2022. Retrieved 25 December 2022
    6. ^ Fischer J, Ganellin CR (2006). Analogue-based Drug Discovery. John Wiley & Sons. p. 476. ISBN 978-3-527-60749-5.
    7. ^ "The Top 300 of 2021". ClinCalc. Archived from the original on 15 January 2024. Retrieved 14 January 2024.
    8. ^ "Isotretinoin - Drug Usage Statistics". ClinCalc. Retrieved 14 January 2024.
     
  4. toughspiders

    toughspiders Active Member

    Is it noted in the literature that comes with the drug Craig?

    The aritcle states it can cause paronychia, unless i misinterpreting it. How does it cause an ingrowing nail? It is a true o/c or is it inflammation caused by the drying effect on the skin, or does it cause the nail to grow differently?

    My patient asked if he came off the drug would it go away?

    Sorry for the barrage of q's???
     
  5. Craig Payne

    Craig Payne Moderator

    Articles:
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    Hopefully someone who knows more about this than me will respond, but there is the link I posted above (this - scroll down to picture) and this Google search
     
  6. toughspiders

    toughspiders Active Member

    Yeah thanks Craig, I read it.

    Im guessing now that what we see if the clinic may be paranycia and not an ingrowing nail????

    Begs the question of whether nail surgery would be a fruitless exercise

    B
    X
     
  7. SicaL

    SicaL Welcome New Poster

    Isotretinoin does make your skin very fragile, delicate and prone to infection. I would proabably try to manage the ingrown nail before doing a PNA as you take longer to heal when taking the meds. I think the ingrown nail is a result of the changes to the skin being more delicate. If you were to do surgery the area may not heal as quickly and be more prone to infection. Once the client completes the course of medication the skin will return to normal and the ingrown nail may not be a problem as the skin will not be so delicate. This is my first post and is not a very scientific explanation but i hope it helps.
     
  8. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    Here is another drug that has ingrown nails as a side affect:
    Kerydin™ (tavaborole)
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4123802/

    Tavaborole

    Tavaborole, sold under the brand name Kerydin, is a topical antifungal medication for the treatment of onychomycosis, a fungal infection of the nail and nail bed with a complete clearance rate of 6-7% and partial clearance rate of 23-24% in individuals whose “infection border does not reach the cuticle at the base of the large toenail.”[1] Tavaborole was approved by the US FDA in July 2014.[2] The medication inhibits an essential fungal enzyme, leucyl-tRNA synthetase, that is required for protein synthesis. The inhibition of protein synthesis leads to termination of cell growth and then cell death, eliminating the fungal infection.

    1. ^ Cite error: The named reference :0 was invoked but never defined (see the help page).
    2. ^ "FDA Approves Anacor Pharmaceuticals' KERYDIN™ (Tavaborole) Topical Solution, 5% for the Treatment of Onychomycosis of the Toenails". Market Watch. July 8, 2014.
     
  9. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Adverse effects of isotretinoin: A large, retrospective review
    Piotr Brzezinski et al
    Dermatologic Therapy
    In full text, it said: Paronychia 14 (0.39%)
     
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    NewsBot The Admin that posts the news.

    Articles:
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  11. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
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    Onychocryptosis and asymptomatic external urethritis as complications of oral isotretinoin therapy
    Krishan Sivaraj et al.
    BMJ Case Reports
     
  12. Natalie Morgan

    Natalie Morgan Welcome New Poster

    Anecdotally I have seen quite a few patients who have experienced infected Ingrowing toenails whilst on Isotretoin therapy.
    It is a known side effect.
    Worth noting that all those patients I saw were active teenagers who are also a cohort who frequently present with this issue.
     
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    NewsBot The Admin that posts the news.

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