Kyrle Disease Medication

  • Author: Daniel J Hogan, MD; Chief Editor: William D James, MD   more...
 
Updated: Apr 20, 2012
 

Medication Summary

Assessment of treatments for Kyrle disease is a difficult task since controlled therapeutic studies are not available for this uncommon disorder. Treatments that have been used unsuccessfully in the past include keratolytics, 5-fluorouracil, topical corticosteroids, methotrexate, mercury, chloroquine, and prednisone. A case showed a response to clindamycin therapy.[7] Some improvement has been reported with vitamin A at a dose of 100,000 IU/d, with or without vitamin E at 400 IU/d. This combination has produced improvement after 1 month of therapy. Topical retinoic acid 0.1% cream also can produce improvement, and changes in lesions have been observed as rapidly as within 6-7 days.

Another approach is administration of oral retinoids. In one study, isotretinoin given at a dose of 40 mg bid (1 mg/kg/d) resulted in decreased pruritus, desiccation, and slough of lesions within 4 weeks, with resurfacing of skin approaching normal within 5 weeks. This drug then was decreased to 40 mg/80 mg on alternate days (0.75 mg/kg/d) for 8 more weeks and discontinued, for a total treatment course of 13 weeks.[11] Etretinate in high doses also is effective, but relapse has been reported following discontinuation of therapy.

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Vitamins

Class Summary

Essential for normal DNA synthesis.

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Vitamin A (Aquasol A, Palmitate-A)

 

May improve abnormal keratinization.

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Retinoids

Class Summary

Can influence and alter abnormal keratinization.

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Tretinoin topical (Avita, Retin-A)

 

Inhibits microcomedo formation and eliminates lesions present. Makes keratinocytes in sebaceous follicles less adherent and easier to remove. Available as 0.025, 0.05, and 0.1% creams. Available also as 0.01 and 0.025% gels.

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Isotretinoin (Accutane)

 

Oral agent that treats serious dermatologic conditions. Synthetic 13-cis isomer of the naturally occurring tretinoin (trans -retinoic acid). Both agents are structurally related to vitamin A. Decreases sebaceous gland size and sebum production. May inhibit sebaceous gland differentiation and abnormal keratinization.

Dose used is standard antiacne dose recommended also for treatment of Kyrle disease in one study; doses and duration of therapy have not been subjected to controlled study, but one study recommended a total duration of 13 wk, with a reduction of the dose in mid course.

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Contributor Information and Disclosures
Author

Daniel J Hogan, MD  Clinical Professor of Internal Medicine (Dermatology), Nova Southeastern University College of Osteopathic Medicine; Investigator, Hill Top Research, Florida Research Center

Daniel J Hogan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Contact Dermatitis Society, and Canadian Dermatology Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Marjan Garmyn, MD, PhD  Professor, Faculty of Medicine, Katholieke Universiteit Leuven, Belgium; Chair and Adjunct Head, Department of Dermatology, University of Leuven, Belgium

Disclosure: Nothing to disclose.

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Edward F Chan, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania School of Medicine

Edward F Chan, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD  Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology

Disclosure: Elsevier Royalty Other

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, James W. Patterson, MD, to the development and writing of this article.

References

  1. Carter VH, Constantine VS. Kyrle's disease. I. Clinical findings in five cases and review of literature. Arch Dermatol. Jun 1968;97(6):624-32. [Medline].

  2. Constantine VS, Carter VH. Kyrle's disease. II. Histopathologic findings in five cases and review of the literature. Arch Dermatol. Jun 1968;97(6):633-9. [Medline].

  3. Rapini RP, Herbert AA, Drucker CR. Acquired perforating dermatosis. Evidence for combined transepidermal elimination of both collagen and elastic fibers. Arch Dermatol. Aug 1989;125(8):1074-8. [Medline].

  4. White CR Jr, Heskel NS, Pokorny DJ. Perforating folliculitis of hemodialysis. Am J Dermatopathol. Apr 1982;4(2):109-16. [Medline].

  5. Hurwitz RM, Melton ME, Creech FT 3rd, Weiss J, Handt A. Perforating folliculitis in association with hemodialysis. Am J Dermatopathol. Apr 1982;4(2):101-8. [Medline].

  6. Alyahya GA, Heegaard S, Prause JU. Ocular changes in a case of Kyrle's disease. 20-year follow-up. Acta Ophthalmol Scand. Oct 2000;78(5):585-9. [Medline].

  7. Kasiakou SK, Peppas G, Kapaskelis AM, Falagas ME. Regression of skin lesions of Kyrle's disease with clindamycin: implications for an infectious component in the etiology of the disease. J Infect. Jun 2005;50(5):412-6. [Medline].

  8. Kahana M, Trau H, Dolev E, Schewach-Millet M, Gilon E. Perforating folliculitis in association with primary sclerosing cholangitis. Am J Dermatopathol. Jun 1985;7(3):271-6. [Medline].

  9. Salomon RJ, Baden TJ, Gammon WR. Kyrle's disease and hepatic insufficiency. Arch Dermatol. Jan 1986;122(1):18-9. [Medline].

  10. Khandpur S, Bansal A, Ramam M, et al. Verrucous tuberculid mimicking Kyrle disease. Int J Dermatol. Dec 2007;46(12):1298-301. [Medline].

  11. Saleh HA, Lloyd KM, Fatteh S. Kyrle's disease. Effectively treated with isotretinoin. J Fla Med Assoc. Jun 1993;80(6):395-7. [Medline].

  12. Bolognia JL, Rapini RP, Jorizzo JL, eds. Perforating Diseases. In: Dermatology. Vol 2. 2nd ed. St. Louis, Mo: Mosby; 2008:Chapter 95.

  13. Price ML, Jones EW, MacDonald DM. Flegel's disease, not Kyrle's disease. J Am Acad Dermatol. Jun 1988;18(6):1366-7. [Medline].

 
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A typical lesion of Kyrle disease with central keratotic crater.
 
 
 
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