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