Thursday, February 09, 2017

Acneiform Drug Reaction

The patient is a 32 yo student from the Central African Republic. On coming to the US he was discovered to have "latent TB" and offered isoniazid,  He elected to take this and started it in September 2016.  Around a month later, he developed deep-seated papules and pustures on his back, chest, neck and to a lesser extent face.  Treatment with a cephalosporin and Bacrim were not successful. He has also had an undiagnosed eye problem during the same period of time.

O/E There are cystic and somewhat purulent lesions in the above-mentioned areas.  This is most pronounced on the chest.

Dx:  Acneiform eruption secondary to INH.
Plan:  1. A biopsy will be done to confirm the clinical impression. 
2. Will need to get advice on whether to treat.
3. He seems to want prophylaxis for TB. Will find out about alternatives.
Does anyone have experience treating this type of acne?

1 comment:

  1. Dear David

    Many thanks for sharing this patient's problem. INH induced acne is indeed very rare and a review of the literature in pubmed showed very few publications and they are quite old publications, some of which are in German. I supposed a chest/ ID physician consult would be useful whether to withhold INH which will resolve within a month or so upon withdrawal. If he is asymptomatic with normal CXR, it is reasonable to withhold INH and treat his cystic acneiform lesions with oral isotretinoin. His latent TB need close monitoring though. In Malaysia, INH prophylaxis for positive PPD is not routinely done. it is too common so is not cost-effective.


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