Keloid Formation and Isoretinoin Use: A Case Series

Goals/Purpose: Though scar improvement with use of isotretinoin has been noted in several studies, a handful of reports describe the opposite situation with keloids occurring during or after its use. We present five patients who developed keloids following the use of isotretinoin.

 

Methods/Technique: Patients in this series presented for keloid treatment and reported using isoretinoin.

Results/Complications:

Case 1: 21-year-old Caucasian male who started oral isotretinoin eight days after an abrasive shoulder lesion from a motorcycle accident who subsequently developed keloids managed by cessation of the isotretinoin, Kenalog injections, and laser treatments before eventual excision.

Case 2: 23-year-old Caucasian female who took oral isotretinoin for approximately five months before discontinuing the medication due to spontaneous keloid formation of the back, chest, and shoulders. Treatment included Kenalog injection, laser Vbeam therapy, and topical Imiquimod 5%.

Case 3: 21-year-old Caucasian male who was treated with isotretinoin for seven months, during which he developed spontaneous keloid formation at the angle of the mandible. Treatment included Imiquimod 5% cream, Kenalog injections, and fractional laser therapy.

Case 4: 23-year-old Caucasian male who presented at 16 years old with severe keloids of his chest and back following the use of isotretinoin for refractory acne vulgaris. Treatment included laser and kenalog injections.

Case 5: 24-year-old African-American male with keloids of the cheeks, upper neck, ears and shoulders.  He completed 10 weeks of Aldara, with some response of the facial keloids. Additionally, Vbeam was utilized in an attempt to reduce the keloids.

Conclusion: Our patients' keloid onset varied in relation to the isoretinoin use. Treatment included Imiquimod, Kenalog injections, laser, and excision. Though it appears to be a rare event, the possibility of keloid formation should be taken into account when patients are taking, or have a history of using, isotretinoin as a treatment for acne.