Vohwinkel Syndrome Medication
- Author: Zoltan Trizna, MD, PhD; Chief Editor: Dirk M Elston, MD more...
Medication Summary
Because of the rarity of this syndrome, all treatment options are based on sporadic experience and are off-label uses. Topical treatment is usually inadequate, although keratolytics (ie, salicylates, urea) and retinoids can alleviate keratoderma. Systemic retinoids can reverse both the keratoderma and pseudoainhum; however, relapse is the rule upon discontinuation of treatment.[9]
Retinoids
Class Summary
Decrease cohesiveness of abnormal hyperproliferative keratinocytes and may reduce potential for malignant degeneration. Modulate keratinocyte differentiation. Have been shown to reduce risk of skin cancer formation in patients who underwent renal transplant.
Isotretinoin (Accutane)
PO agent that treats serious dermatologic conditions. Synthetic 13-cis isomer of 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.
FDA–mandated registry now in place for all individuals prescribing, dispensing, or taking isotretinoin. For more information, see iPLEDGE. Registry aims to further decrease risks of pregnancy and other unwanted and potentially dangerous adverse effects during a course of isotretinoin therapy.
Tretinoin topical (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.
Keratolytics
Class Summary
Cause cornified epithelium to swell, soften, macerate, and then desquamate.
Salicylic acid topical (Sal-Plant, Salactic film)
By dissolving the intercellular cement substance, salicylic acid produces desquamation of the horny layer of skin, while not affecting the structure of viable epidermis (concentrations of 12-17.6%).
Consider benefit-to-risk ratio in off-label use in Vohwinkel syndrome.
Urea (Ureaphil)
Promotes hydration and removal of excess keratin in conditions of hyperkeratosis. Use topical preparations of 10-30%.
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