Inflammatory Neovascular Nodules Associated With Oral Isotretinoin Treatment of Severe Acne

Isotretinoin is extremely effective in the treatment of severe cystic acne.1,2We have recently noted the occurrence of inflammatory neovascular nodules See also p 808. (INNs), or exuberant nodular granulation tissue, in two of 12 patients with severe acne who were treated with oral isotretinoin. Report of Cases Case 1.— A 17-year-old boy with severe acne was entered into the Hoffmann-La Roche Isotretinoin Study. His acne had progressed while he was receiving conventional topical, intralesional, and oral therapy all of which were discontinued several weeks prior to entry into the study. Physical examination of the patient revealed numerous, crusted, draining, inflammatory nodulocystic lesions associated with sinus tracts, pustules, comedones, and mild scarring involving the face, neck, upper aspect of the trunk, and proximal, upper part of the arms. According to the study protocol, the patient began receiving a moderately low dose (1 mg/kg/day) of oral isotretinoin, which was increased