Kyrle Disease Medication
- Author: Daniel J Hogan, MD; Chief Editor: William D James, MD more...
Kyrle disease is relatively rare, so controlled therapeutic studies do not exist. Many treatments have been used, but most have been unsuccessful, including keratolytics, 5-fluorouracil, topical corticosteroids, methotrexate, mercury, chloroquine, and prednisone. One case showed a response to clindamycin therapy. In addition, improvement has been reported with oral vitamin A at a dose of 100,000 IU/day, with or without vitamin E at 400 IU/d, 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.
Oral isotretinoin at 40 mg bid (1 mg/kg/day) 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/day) for 8 more weeks and discontinued, for a total treatment course of 13 weeks. Etretinate in high doses may also be effective, but relapse has been reported following discontinuation of therapy.
Fat-soluble vitamins are essential for normal DNA synthesis.
Vitamin A may improve abnormal keratinization.
Can influence and alter abnormal keratinization.
Topical tretinoin inhibits microcomedo formation and eliminates lesions present. It makes keratinocytes in sebaceous follicles less adherent and easier to remove. It is available as 0.025, 0.05, and 0.1% creams and as 0.01 and 0.025% gels.
Isotretinoin is an oral agent that treats serious dermatologic conditions. It is a synthetic 13-cis isomer of the naturally occurring tretinoin (trans -retinoic acid). Both agents are structurally related to vitamin A. Isotretinoin decreases sebaceous gland size and sebum production. It may inhibit sebaceous gland differentiation and abnormal keratinization.
The dose used is the 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 weeks, with a reduction of the dose in mid course.
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