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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:
    7
    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 colloquially referred to by its former brand name Accutane or Roaccutane), is a medication primarily used to treat severe acne. Rarely, 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.

    Isotretinoin is primarily used as a treatment for severe acne. The most common adverse effects are a transient worsening of acne (lasting 1–4 months), 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 which 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, have been reported to be persistent.

    In the United States, a special procedure is required to obtain the pharmaceutical. In most other countries, a consent form is required which explains these risks. Women taking isotretinoin must not get pregnant during and for one month after the discontinuation of isotretinoin therapy. Sexual abstinence or effective contraception is mandatory during this period. Barrier methods by themselves (e.g., condoms) are not considered adequate due to the unacceptable failure rates of approximately 3%. Women who become pregnant while taking isotretinoin therapy are generally counseled to have an abortion.

    It was patented in 1969 and approved for medical use in 1982.[2] It sold well for many years, but in 2009, Roche decided to discontinue manufacturing due to diminishing market share due to the availability of the many generic versions of the drug and in the setting of multiple lawsuits over side effects. It continues to be manufactured worldwide in 2019 as Absorica, Amnesteem, Claravis, Myorisan, Sotret, and Zenatane.[3]

    1. ^ Cite error: The named reference brands was invoked but never defined (see the help page).
    2. ^ Fischer, Jnos; Ganellin, C. Robin (2006). Analogue-based Drug Discovery. John Wiley & Sons. p. 476. ISBN 9783527607495.
    3. ^ https://www.mayoclinic.org/drugs-supplements/isotretinoin-oral-route/description/drg-20068178
     
  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:
    7
    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:
    7
    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 (trade name Kerydin) is a topical antifungal medication for the treatment of onychomycosis, a fungal infection of the nail and nail bed. Tavaborole began its Phase 3 trials in December 2010[1] and was approved by the US FDA in July 2014.[2] Tavaborole 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. ^ Clinical trial number NCT01270971 at ClinicalTrials.gov
    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%)
     
  10. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
  11. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    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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