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Safe Use of Therapeutic-Dose Oral Isotretinoin in Patients With a History of Pseudotumor Cerebri

Suzanne J. Tintle, MD, MPH1; Julie C. Harper, MD2; Guy F. Webster, MD, PhD3; Grace K. Kim, DO4; Diane M. Thiboutot, MD1
[+] Author Affiliations
1Department of Dermatology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
2Department of Dermatology, University of Alabama, Birmingham
3Department of Dermatology, Jefferson Medical College, Philadelphia, Pennsylvania
4Couture Dermatology and Plastic Surgery, Las Vegas, Nevada
JAMA Dermatol. 2016;152(5):582-584. doi:10.1001/jamadermatol.2015.3447.
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This report of cases describes the safe and successful use of therapeutic-dose oral isotretinoin in 3 patients with a history of pseudotumor cerebri.

Drugs common in the treatment of acne vulgaris, such as minocycline and isotretinoin, have been reported in association with pseudotumor cerebri (PTC), which can lead to severe, irreversible symptoms, including vision loss. There is a paucity of data on isotretinoin use in patients with prior PTC.

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Figure 1.
Patient 1 Before and After Isotretinoin Treatment

A, Prior to isotretinoin treatment, severe nodular cystic acne, and a large linear scar on the cheek from prior cyst excision are visible. B, After 9 months of isotretinoin treatment (cumulative dose, 120 mg/kg), despite a thin layer of makeup, marked improvement of acne can be appreciated.

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Figure 2.
Patient 2 Before and After Isotretinoin Treatment

A, Before isotretinoin treatment, severe inflammatory and nodular acne are apparent. B, Following a 7-month course of isotretinoin therapy (cumulative dose, 140 mg/kg), dramatic improvement in acne is seen, with minimal residual scarring.

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