Isotretinoin Therapy for Progressive Systemic Sclerosis

To the Editor.— The pyogenic granulomalike lesions reported to occur in rare instances during isotretinoin therapy for severe acne 1,2 prompted us to try the substance in patients with progressive systemic sclerosis (PSS). Within the last few months, we have treated three female patients suffering from long-standing advanced PSS. They received 20 to 50 mg of oral isotretinoin (13- cis -retinoic acid) daily. After a few weeks, all three experienced considerable subjective improvement. Furthermore, the movement in the finger joints had improved, and, in one patient, the "rat-bite" necrotic lesions of the finger tips had healed. Vascular changes seem to play an important role in the pathogenesis of PSS. 3 An investigation published only very recently showed a lowered angiogenic capability of peripheral blood lymphocytes in PSS. 4 This finding and the probable angiogenic capability of isotretinoin lends some support to our original idea that the substance might benefit patients