Oral Isotretinoin in HIV-Positive Women with Acne: Report of Three Cases

The document reports on three HIV-positive women with severe facial acneiform eruptions who were treated with oral isotretinoin. The first patient, a 32-year-old woman with a CD4 count of 10/mm3, experienced a dramatic improvement in her skin lesions after a 5-month isotretinoin treatment with a total dose of 90 mg/kg body weight, and her CD4 count improved to 80/mm3 over 6 months with no relapse after 24 months. The second patient, a 43-year-old woman with a CD4 count of 4/mm3, had a dramatic response to isotretinoin but discontinued treatment after 21 days due to severe xerosis, with no relapse after 9 months and an improvement in HIV viremia and CD4 count following HIV tritherapy. The third patient, a 30-year-old woman with less than 200 CD4/mm3, completed a 15-week isotretinoin treatment with a total dose of 83 mg/kg body weight, resulting in complete acne regression but also diffuse hair loss. The study suggests that lower total doses of isotretinoin may be sufficient for treating acneiform eruptions in HIV-positive women, with the treatment being well-tolerated overall, though one patient experienced severe skin dryness and another had hair loss. No adverse interactions with HIV disease were noted.