Alopecic Scalp Cysts Following Isotretinoin

Isotretinoin is often used for acne treatment. Common side effects include dry eyes and mouth, muscle aches, and hypertriglyceridemia. Scalp cysts have not yet been reported in conjunction with isotretinoin. In this report, we describe a case of alopecic scalp cysts developing following 3 weeks of isotretinoin use by a young female for facial nodulocystic acne. On dermoscopy, hair follicular openings were patent, with few scattered black dots and open comedones. A diagnosis of pseudo-acne fulminans was made, and she was treated with a tapering course of oral prednisolone, oral erythromycin, and topical minoxidil, with the resolution of the cysts and good hair regrowth. As isotretinoin is commonly used by dermatologists, it is important for clinicians to be aware of the presentation and treatment of this unintended outcome, particularly in acne patients with scalp comedones.