Cyclosporine Plus Isotretinoin for Darier Disease: A Preliminary Observation in Three Patients

Darier disease (DD) is a chronic disorder of keratinization characterized by pruritic keratotic papules and plaques in seborrheic areas, for which effective treatment options remain limited. To describe the preliminary outcomes of combination therapy with cyclosporine and isotretinoin, we retrospectively reviewed the medical records of three patients with clinically and histopathologically confirmed DD. Outcomes included changes in cutaneous lesions, pruritus visual analog scale (VAS) scores, and Dermatology Life Quality Index (DLQI) scores, as well as adverse events, laboratory findings, and the post-treatment clinical course. All three patients showed clinical improvement in cutaneous lesions and pruritus, with reductions of 6-7 points in pruritus VAS scores and 10-14 points in DLQI scores from baseline to treatment completion. After treatment discontinuation, no clinically apparent relapse occurred during follow-up periods of 9, 4, and 3 months in Cases 1, 2, and 3, respectively. Mild adverse events included cheilitis, alopecia, and xerosis; transient mild laboratory abnormalities were also observed, and no serious adverse events occurred. In this small retrospective case series, cyclosporine plus isotretinoin was associated with clinical improvement and acceptable short-term tolerability. Larger studies with longer follow-up are needed to evaluate the efficacy and safety of this combination.