ISOTRETINOIN THERAPY FOR RECURRENT RESPIRATORY PAPILLOMATOSIS

Retinoic acid has been advocated for use in several premalignant and m alignant epithelial lesions of the head and neck, including benign rec urrent respiratory papillomatosis, with varying results. We describe a 24-year-old man with extensive tracheoesophageal and bronchoalveolar papillomatosis that degenerated into squamous cell carcinoma. Multiple endoscopic carbon dioxide laser excisions, at one point performed on a weekly basis, as well as a prolonged trial of interferon, failed to control the progression of his disease. Isotretinoin (13-cis-retinoic acid) therapy (1 mg/kg per day) was instituted, with dramatic clinical , radiographic, and functional improvement. The patient experienced no significant toxic effects and required no endoscopic procedures over a 6-month period. We propose that isotretinoin may be an effective adj uvant therapy for aggressive respiratory papillomatosis.