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Oral isotretinoin (13-cis-retinoinc acid) is a derivative of vitamin A and belongs to the first generation of retinoids, which act as synthetic isomers of retinoic acid (RA). It is a very effective agent in a treatment of acne vulgaris; however, multiple side effects related to therapy with retinoids preclude the use of isotretinoin in less severe acne vulgaris. A significant limitation for the administration of isotretinoin appears in case of concomitant kidney disease with a special attention regarding the safety of the agent in patients with lupus nephritis (LN). The aim of this review is an assessment of the safety of isotretinoin for the treatment of acne vulgaris in patients with LN. We searched both MEDLINE and SCOPUS databases, as well as several dermatological textbooks, to present all limitations and benefits of therapy with isotretinoin or its isomer (ATRA) for patients with kidney diseases. Several mouse models of SLE revealed a significant modulatory influence of retinoids on autoimmune injury of the glomerular unit. Retinoids were demonstrated to affect mononuclear cell infiltrations of renal tissue allowing for a reduction in the overall glomerular damage. Presumptively, they can affect a synthesis of autoantibodies significantly limiting their deposition in the glomerular unit. Moreover, retinoids were also shown to affect the synthesis of different cytokines specific both for lymphocytes Th1 (IL-2, IL-12, INFγ) ant Th2 (IL-4, IL-10). The influence of retinoids on the course of LN seems to be more multidimensional than only restricted to immune aspects and these synthetic RA isomers manifest also antiproteinuric activity in comparable extent to steroidal agents. The agents were demonstrated to counteract a loss of podocytes after the injury of the glomerular unit. They can promote a differentiation of renal progenitor cells (RPCs) within the Bowman capsule into mature podocytes leading to regeneration of podocyte number. Additionally, retinoids can probably protect podocytes from injury limiting their apoptosis, as well as reducing foot process effacement. Although, an endogenous production of RA isomers increases after the injury of the glomerular unit aiming to the restoration of podocyte number, it can be significantly impaired by a loss of albumins into urine. RA isomers are progressively sequestered by albumin within the Bowman's space and therefore, they are quickly eliminated with urine. It was demonstrated that the administration of exogenous RA isomers (retinoids) can bypass the activity of albumins enhancing the regeneration of podocytes. Finally, retinoids can regulate the production of vasoactive substances influencing on different vascular functions in the kidney. They can beneficially change a balance of angiotensin metabolites through by down-regulation of angiotensin-converting enzyme type 1 and the enhancement of an expression of angiotensin-converting enzyme type 2. Another studies revealed that retinoids could also alter the activity of renal endothelin pathway; however, the significance of this effect requires further elucidation. Taken all these presented effects of retinoids in the kidney into consideration, we can conclude that isotretinoin can be the safe treatment option of acne vulgaris in patients with LN.

Retinoids are compounds chemically related to vitamin A, which are frequently used in dermatological practice (1). They are characterized by numerous mechanisms of action leading to normalization of keratinocyte proliferation and maturation. They have anti-seborrhoeic, immunomodulatory and anti-inflammatory effects (1, 2). A number of side effects to retinoid treatment have been recorded; one group of such side effects relates to eyes and vision. Dry eye syndrome and blepharoconjunctivitis are the most common side effects, appearing in 20-50 % of patients treated with retinoids. They often contribute to the occurrence of other side-effects such as eye discomfort and contact lens intolerance. Due to the widespread use in clinical practice, the adverse effects, including ocular side effects, should be studied. To confirm the variety of adverse effects of retinoids, several case reports of rare side-effects are presented.

Common acne is the most frequently diagnosed dermatosis at the age of adolescence. It may lead to psychic disturbances and/or even depression as a result of its distinctly visible localization, very long-lasting symptoms, in sequela numerous deforming scars or vicious cicatrices. The objective of the present paper is to assess recurrences after the treatment of severe acne forms in patients treated in the Department of Dermatology in the years 1991-2000, with administration of various medications applied locally and/or generally. The evaluation of treatment results determined the highest, statistically significant difference between the patients subjected to isotretinoin-supported treatment process and the locally cured patients. In the group of locally treated patients the rate of the acne symptoms recurrence could be observed more often. In the remaining groups of patients, no statistically significant differences were reported. A little higher acne symptoms recurrence rate is apparent in the group of patients locally treated, as compared with that subjected to antibiotics-supported therapy. A statistically significant relationship between the therapy duration with the application of individual methods and the recurrence of illness has not been proven as yet. The value of p = 0,5245 proved that there existed no relationship between the diagnosis and a period of time elapsed--at the end of therapy--since the recurrence of acne disorders has been observed. The longest period of remission lasted when inversed acne had been recognized. Recurrence of the disease was observed the most rapidly in patients affected with acne conglobata. When examining the relationship between the duration of acne symptoms recurrence vs. treatment process, statistically significant differences amongst the individual applied methods were recorded. In the group A, recurrence of illness occurred at a higher rate. A statistically significant relationship between the recurrence of signs and symptoms and the initial diagnosis was excluded. A higher percentage of recurrence in the groups I, II and III has been reported as compared with group V. There is a certain relationship between the patient's age and the recurrence of the disease. It mainly referred to the elderly. Statistical analysis has proved that there existed significant relationship between the recurrence of the disease analysed and the patients' sex. A little higher rate of illness occurrence can be observed in a female group. The study revealed that recurrences in group of patients treated by locally active preparations were observed usually 6 months after the end of therapy.

Aim: The objective of the present paper is to assess side effects linked to the treatment of severe acne forms with administration of isotretinoin systemic and various drugs applied locally and/or systemic., Materials and Methods: All the examinations were carried out on patients suffering from severe acne (n=206; 126 F and 80 M) hospitalized in Department of Dermatology, Silesian Medical School, in the years of 1991-2000, as well as amongst patients who continued their therapy in the outpatient clinic of the Dermatology Department during this period., Results: When assessing the individual groups, the following conclusions have been drawn: lack of the relationship between the diagnosis and the therapeutical process in the group of patients locally treated and in the groups of sick persons cured by other methods; there exists a very significant relationship between the diagnosis and the therapeutical process in the group of patients to whom the isotretinoin preparation was administered and in the group of patients locally cured. The obtained results showed that the most frequently encountered diagnoses, i.e. acne conglobata and acne papulous-pustular were treated by the isotretinoin preparation and via local therapy, respectively. In the period of hospitalization, the value p=0.5570 testifies to lack of relationship between the number of side effects and the treatment period. All side effects occurred almost exclusively in patients cured by the isotretinoin preparation. The test value, p=0.0418 computed for all the periods, has revealed statistically significant relationships between the female/male sex and the side effects, most frequently reported in male patients. For the purpose of analysis the two (2) more often groups of symptoms were taken into consideration: dermal changes and biochemical disturbances and/or dysfunctions. The value p=0.5312 (p>0.05) excludes the existence of statistically significant relationship between the kind of a specific symptom and the therapy period., Conclusions: The performed medical examinations permitted to find out that side effects could be often recorded in a group of patients subjected to generally applied isotretinoin but it is never caused to stop therapy.

Retinoids--new agents derived from vitamin A have initiated a new era in therapy of many skin diseases. They are highly effective medicines used in the treatment of severe forms of psoriasis. Also they are administered in many forms of acne, as alternative drugs do not exist. Moreover, retinoids show antineoplastic activity. They are also effective in the symptomatic treatment of the congenital keratinization disorder syndromes. The recent development of retinoids combined with the growth of expertise with regard to the biological function and mechanisms of retinoid receptors, are likely to improve the present therapeutic methods and to reveal new potentials regarding the use of retinoids in the therapy of many skin disorders.