Paronychia and granulation tissue formation during treatment with isotretinoin

Abstract

This paper describes the association of two unusual side effects of treatment with isotretinoin for severe acne: paronychia and excess granulation tissue in the nails furrows. We report a case of male patient aged 19 years, who in the course of the 36th week of treatment with isotretinoin for acne grade III showed erythema, edema, excess granulation tissue and onychocryptosis in various nail beds of hands and feet, with no history of trauma associated. A literature review revealed few reports of these adverse events, and two clinical patterns of exuberant granulation tissue has been described: one in periungual location and other in lesions of previous acne. The rarity and lack of knowledge on the best treatment for granuloma-like reactions make this theme a considerable challenge.

Figure 1

Paronychia and granulation tissue in feet, secondary to the use of isotretinoin

Figure 2

Pyogenic-like granuloma and paronychia in lateral edge of the first and second right toes

Figure 3

Excess of periungueal granulation tissue and paronychia, located in the first left toe

Figure 4

Two months after the completion of matricectomy: patient presented resolution of onicocriptosis without recurrence of the lesions on toes