10.5826/dpc.1401a12
text/xml
2160-9381
3346
en
Alexander Katoulis
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
pyogenic granuloma
Penile Granulomas Induced by Isotretinoin
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Research Letter
2024-01-31
2023-03-17
2024-01-31
2024-02-21
e2024012
Dermatol Pract Concept
Alexander Katoulis
2024/01/31
10.5826/dpc.1401a12
e2024012
2nd Department of Dermatology and Venereology, National and Kapodistrian University of Athens, Medical School, "Attikon" General University Hospital, Athens, Greece
2160-9381
pyogenic granuloma
en
e2024012
Cuenca-Barrales C, Ródenas-Herranz T, Linares-Gonzalez L, Ruiz-Villaverde R. Pyogenic Granuloma in an Atypical Location Following Isotretinoin Treatment. Sultan Qaboos Univ Med J. 2018 Aug;18(3):e409-e410. doi: 10.18295/squmj.2018.18.03.028. PubMed PMID: 30607291; PubMed Central PMCID: PMC6307634.
Penile Granulomas Induced by Isotretinoin
https://dpcj.org/index.php/dpc/article/download/3346/2444
            Penile Granulomas Induced by Isotretinoin
  Antonios Kanelleas1,2, Georgia Pappa1, Eleni Routsi1, Vassilis Milionis1,3, Evangelia Bozi1,
                                   Alexandros Katoulis1


1 2nd Department of Dermatology and Venereology, National and Kapodistrian University of Athens, Medical School, “Attikon” General
   University Hospital, Athens, Greece
2 Dermathens Private Practice, Athens, Greece
3 Istomedica Private Anatomic Pathology Lab, Athens, Greece



Key words: isotretinoin, acne, adverse event, pyogenic granuloma
Citation: Kanelleas A, Pappa G, Routsi E, Milionis V, Bozi E, Katoulis A. Penile Granulomas Induced by Isotretinoin. Dermatol Pract
Concept. 2024;14(1):e2024012. DOI: https://doi.org/10.5826/dpc.1401a12
Accepted: May 15, 2023; Published: January 2024
Copyright: ©2024 Kanelleas et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing Interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding Author: Prof. Alexandros Katoulis, “Attikon” General University Hospital, 2nd Dept. of Dermatology-Venereology, Athens,
Greece. E-mail: alexanderkatoulis@yahoo.co.uk




Introduction                                                             denied trauma or prior contact with chemicals or allergens
                                                                         before the lesion development. The patient had a history of
Pyogenic granuloma (PG) is a common, acquired, benign                    moderate to severe acne and had completed a 6-month course
vascular tumor arising on skin and mucous membranes [1].                 of oral isotretinoin treatment approximately 3 months prior
Isotretinoin, a retinoid used in the treatment of moderate to            to the lesions onset. During treatment with isotretinoin, he
severe acne, is associated with several adverse events, includ-          noticed the abrupt onset of a hemorrhagic nodule on the lat-
ing PG development [2]. We report a case who developed                   eral nail fold of the right big toe, initially considered to be an
two penile PGs following treatment with oral isotretinoin                ingrown nail. However, after surgical excision of the lesion,
for acne.                                                                it was histologically confirmed to be a PG.
                                                                              Clinical examination of total skin and mucous membranes
Case Presentation                                                        was otherwise unremarkable. Serologic testing for hepatitis
                                                                         B, C, HIV and VDRL/TPHA were negative. Swab cultures
A 29-year-old male patient presented to our outpatient                   from lesional skin for aerobic and anaerobic bacteria were
dermatology clinic with a 3-month history of two smooth,                 also negative. Shave biopsies of both lesions were obtained.
­erythematous, exophytic lesions on the penis; the first on the          Differential diagnoses included genital warts, amelanotic
glans (Figure 1A), and the second near the frenulum of the               melanoma, and squamous cell carcinoma. Histopathological
penis (Figure 1B). The patient reported that the lesions were            examination revealed a lobular proliferation of congested
asymptomatic, except for some occasional bleeding, and had               capillary vessels. There was a superficial mucosal erosion,
gradually increased in size over the past few months. He                 while the underlying stroma was edematous with a mixed




Research Letter | Dermatol Pract Concept. 2024;14(1):e2024012                                                                            1
          Figure 1. A. Erythematous, glistening, well-demarcated, infiltrated plaque on the glans of the penis in a 29-year-old pa-
          tient previously treated with oral isotretinoin. B. A second red, fleshy nodule with a broad base near the frenulum of the
          penis in the same patient.




Figure 2. A, B. Shave biopsy showing lobular configuration of proliferating congested capillary vessels (H&E, x40 and x100 respective​​​​​​​ly).



perivascular inflammatory infiltrate (Figure 2, A and B).
                                                                          Conclusions
These findings were consistent with PG. The lesions were
surgically excised, and histologic examination confirmed the              One plausible explanation for the occurrence of post-
original diagnosis of PG. No recurrence was observed on                   isotretinoin PG in our case could be the epidermal barrier
6-month follow-up.                                                        impairment caused by isotretinoin, further potentiated by




2                                                                              Research Letter | Dermatol Pract Concept. 2024;14(1):e2024012
localized trauma and infection, predisposed by sexual prac-                2. Benedetto C, Crasto D, Ettefagh L, Nami N. Development of
tices or poor hygiene of the area, leading to granulation tis-                periungual pyogenic granuloma with associated paronychia fol-
                                                                              lowing isotretinoin therapy: a case report and a review of the
sue production [3,4].
                                                                              literature. J Clin Aesthet Dermatol. 2019;12(4):32-36. PMID:
    In the literature, there are very few cases of isotretinoin-
                                                                              31119008. PMCID: PMC6508482.
induced PGs. Most of them were periungual (lateral and distal              3. Puig L, Moreno A, Llistosella E, Noguera X, de Moragas JM.
nail folds), but there were also cases arising on the head, trunk,            Granulation tissue proliferation during isotretinoin treatment.
or upon prior acneic lesions [2,3]. There is only one report                  Int J Dermatol. 1986;25(3):191-193. DOI: 10.1111/j.1365
of multiple anogenital PGs in a young female that appeared                    -4362.1986.tb02218.x. PMID: 2939033.
                                                                           4. Del Rosso JQ. Clinical relevance of skin barrier changes asso-
during isotretinoin treatment, requiring dose modification [5].
                                                                              ciated with the use of oral isotretinoin: the importance of bar-
However, in our case, the development of PGs occurred three
                                                                              rier repair therapy in patient management. J Drugs Dermatol.
months after the completion of isotretinoin treatment.                        2013;12(6):626-631. PMID: 23839177.
    The present case highlights the need to consider PG in                 5. Cuenca-Barrales C, Ródenas-Herranz T, Linares-Gonzalez L,
our differential diagnostic approach of vascular lesions of                   Ruiz-Villaverde R. Pyogenic Granuloma in an Atypical Location
the skin and mucous membranes, including the genitals, in                     Following Isotretinoin Treatment. Sultan Qaboos Univ Med J.
                                                                              2018;18(3):e409-e410. DOI: 10.18295/squmj.2018.18.03.028.
patients treated with isotretinoin. More studies are needed
                                                                              PMID: 30607291. PMCID: PMC6307634.
for a better understanding of the pathophysiology of PG oc-
currence after treatment with isotretinoin.


References
 1. Sarwal P, Lapumnuaypol K. Pyogenic Granuloma. 2022 Oct 23.
    In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publish-
    ing; 2023 Jan–. PMID: 32310537.




Research Letter | Dermatol Pract Concept. 2024;14(1):e2024012                                                                               3
