scholarly journals ISOTRETINOIN FOR TREATING ACNE VULGARIS

2021 ◽  
pp. 20-25
Author(s):  
IRMA BERNADETTE S. SITOHANG
Keyword(s):  
Side Effects ◽  
Literature Review ◽  
Cellular Proliferation ◽  
Acne Vulgaris ◽  
Treatment Modalities ◽  
Extensive Literature ◽  
Essential Information ◽  
Therapeutic Modalities ◽  
Oral Isotretinoin ◽  
Systemic Antibiotics

Acne vulgaris (AV) occurs in more than 80% of dermatological cases in adolescents and young adults and affects the quality of life. Oral isotretinoin, a metabolite product of vitamin A, is well-known to be the most effective treatment for severe nodulocystic AV and moderate AV that does not respond to other therapeutic modalities. Thus, this literature review was conducted to explain the mechanism of action, effectiveness, contraindications, side effects, and safety of oral isotretinoin in AV, which provided essential information for dermatologists. Furthermore, isotretinoin is the only treatment modality that has implications for the entire pathogenesis of acne. It contributes to decreasing corneocytes’ adhesion, supporting cellular proliferation and follicular renewal, induction of cell apoptosis, and immune regulation. The effectiveness of AV therapy with isotretinoin has expanded as it is also indicated for moderate to severe AV that does not respond well to topical combination therapy or systemic antibiotics. However, isotretinoin is included in Category X drugs and may induce many side effects from mucocutaneous effects to teratogenicity. From this extensive literature review, it can be concluded that isotretinoin is one of the treatment modalities for acne with good effectivity due to its mechanism of actions that affect the entire acne pathogenesis. Considering the various side effects of isotretinoin, its use requires adequate clinical assessment and monitoring by a dermatologist.

scholarly journals Standard daily dosage versus pulse dosage of Isotretinoin in acne vulgaris: A hospital based comparative study

2018 ◽  
Vol 7 (2) ◽  
pp. 68-74
Author(s):  
Eliz Aryal ◽  
SB Shrestha ◽  
G Pokhrel ◽  
S Bhattarrai
Keyword(s):  
Side Effects ◽  
Comparative Study ◽  
Acne Vulgaris ◽  
College Teaching ◽  
Poor Response ◽  
Lumbosacral Spine ◽  
Daily Regimen ◽  
Severe Acne ◽  
Pulse Dose ◽  
Oral Isotretinoin

Background: Acne is a multi factorial disease ranging from a couple of comedones and pustules to severe nodulocystic fulminantacne. Isotretinoin (13-cis-retinoic-acid) drug affect all the factors involved in pathogenesis of acne and approved by Food and Drug Administration in 1982. It causes several dose-dependent mucocutaneous and systemic side effects and cost effectObjective: To assess and compare the efficacy and tolerability of two regimens (daily conventional and pulse dose) in moderate to severe acne vulgaris.Methodology: This is a prospective randomized comparative study in moderate to severe acne vulgaris in Kathmandu Medical College Teaching Hospital. The patients were randomly divided into two groups (A and B). In group A conventional dose of 20 mg of oral isotretinoin was given daily and in group B 20 mg of oral isotretinoin was given thrice (Pulse Dosage in alternate day) in a week for six months. The baseline haematological, biochemical and radiological (lumbosacral spine) was compare on first, third and six month.Results: Seventy-four patients were enrolled with mean age of 21.73 years. Patients with daily regimen show good response throughout the therapy for six months (1st, 3rd 6th months), where as those in pulse therapy show moderate to poor response during early month and gradually improve by end of sixth month. At end of sixth month, both the regimen show good response and was statistically significant.Conclusion: However, the pulse dose regimen makes the treatment more acceptable, for patients with acne than the classical standard daily regimen, in term of side effects and cost effectiveness and patient compliance. Journal of Kathmandu Medical CollegeVol. 7, No. 2, Issue 24, Apr.-Jun., 2018, Page: 68-74

scholarly journals Azithromycin Pulse Therapy with Oral Doxycycline in the Treatment of Acne Vulgaris, a Randomized Group Study

2021 ◽  
pp. 1-9
Author(s):  
C. Sadhana ◽  
N. S. Muthiah
Keyword(s):  
Adverse Event ◽  
Side Effects ◽  
Acne Vulgaris ◽  
Pulse Therapy ◽  
Response To Treatment ◽  
Antibiotics Resistance ◽  
Once Daily ◽  
Severe Acne ◽  
Group I ◽  
Systemic Antibiotics

Acne vulgaris is a common dermatological problem. The choice of proper treatment is determined by the severity and extent of acne. Moderate to severe acne vulgaris cases respond well to systemic antibiotics. Antibiotics execute their anti-propionic bacterium effect by inhibiting the bacterial growth and colonization of pilosebaceous glands and thus further inflammation is prevented. The efficacy and possible side effects of various oral antibiotics has been the subject of numerous studies for at least the last twenty years in an effort to understand, which products are likely to produce better efficacy with least possible side effects. The new emerging problem is antibiotics resistance to propionic bacterium. There has been a constant increase in search of safe medications to overcome the side effects and resistance of existing formulations for the treatment of acne vulgaris. The study duration was 8 weeks. A total of 200 study participants of both sexes with complaints of acne vulgaris were included in the study and randomized into two groups. Group I (100 study subjects) – 500 mg Azithromycin once daily for three consecutive days in a week for 2 months and Group II (100 study subjects) –100 mg Doxycycline once daily for 2 months. After doing initial laboratory tests treatment was initiated. Three scheduled visits – Baseline, at the end 4th week and at the end of study were done and the response to treatment was evaluated. The efficacy of the drugs was assessed by the change in grading of acne from baseline and at follow up visits. Doxycycline was found to be better than azithromycin pulse therapy in reducing acne severity. During the visits gastrointestinal, dermatological and other side effects were also noted and recorded. Adverse event profile of both the drugs showed that there was no non- compliance incidence due to adverse event. But the number of adverse events was higher in doxycycline group.

scholarly journals Efficacy of Oral Isotretinoin in Combination with Desloratadine in the Treatment of Common Vulgaris Acne in Vietnamese Patients

2019 ◽  
Vol 7 (2) ◽  
pp. 217-220
Author(s):  
Thuong Nguyen Van ◽  
Lan Duong Thi ◽  
Hao Nguyen Trong ◽  
Tro Chau Van ◽  
Trang Trinh Minh ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Side Effects ◽  
Treatment Time ◽  
Acne Vulgaris ◽  
Control Group ◽  
Inflammatory Lesions ◽  
Comparative Clinical Trial ◽  
Oral Isotretinoin ◽  
The Mean

AIM: To evaluate the efficacy of oral isotretinoin used alone and in combination with desloratadine in the treatment of moderate acne vulgaris. METHODS: A comparative clinical trial was undertaken to evaluate the efficacy of oral isotretinoin alone and in combination with desloratadine in the treatment of 62 moderate acne vulgaris patients. Patients were randomised into two groups with 31 patients in each group. Each studied group's patient took 20 mg isotretinoin and 5 mg desloratadine per day. In the control group, patients took only 20 mg isotretinoin per day. The treatment time was 16 weeks. The evaluation and follow-up were done at week 2, 4, 8, 12 and 16 of the treatment. RESULTS: The studied group had a better curative rate than the control group (45.2% versus 22.6%). The average number of inflammatory lesions in the studied group was significantly lower than the control group (0.19 versus 0.94). The mean GAGS score of the studied group was significantly lower than the control group (3.71 versus 6.52). Acne outbreaks rate of the studied group was lower than the control group (in week 2: 22.6% versus 45.2% and in week 4: 16.1% versus 38.7%, respectively). The rate of itchy was lower in the studied group. CONCLUSION: In the treatment of moderate acne vulgaris, oral isotretinoin in combination with desloratadine is more effective and has fewer side effects than using isotretinoin alone.

scholarly journals Analysis of the effects of isotretinoin on the premature epiphyseal closure in pediatric populations: a literature review

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Sama Alazawi ◽  
Tami Hendriksz
Keyword(s):  
Side Effects ◽  
Literature Review ◽  
Growth Plate ◽  
Growth Arrest ◽  
Primary Care Providers ◽  
Care Providers ◽  
Elevated Liver Enzymes ◽  
Pediatric Populations ◽  
Oral Isotretinoin ◽  
Epiphyseal Closure

Abstract Context Oral isotretinoin, a systemic retinoid and a vitamin A derivative, has been widely utilized to treat acne in both adult and pediatric populations. Additionally, systemic retinoids have also been utilized to treat neuroblastoma in pediatric patients. Common side effects associated with oral isotretinoin include dry eyes, dry mouth, elevated liver enzymes, depression, and arthralgia. Less common side effects of isotretinoin include hearing loss, pseudotumor cerebri, anaphylaxis, and skeletal abnormalities including growth arrest. The U.S. Food and Drug Administration (FDA) has received reports of premature epiphyseal closure in patients treated with isotretinoin retinoids, which are commonly prescribed by primary care providers as a treatment for acne. It is important to raise awareness of the potential side effects of isotretinoin to enable informed treatment decisions before beginning an isotretinoin regimen. Objectives This chapter aims to elucidate that isotretinoin, given at various doses and durations, has been associated with growth plate abnormalities, which can lead to premature epiphyseal closure. Methods Two databases were utilized for the literature review and were conducted at different time periods. Our literature review was conducted between December 2020 and June 2021, utilizing PubMed with the following search terms: “isotretinoin” and “isotretinoin and premature epiphyseal closure.” In April 2021, we searched the FDA’s “Drug Data and Adverse Event Report System” utilizing the terms “isotretinoin” and “epiphysis premature fusion.” We included in our query reports of patients worldwide under 18 years of age with premature epiphyseal closure or growth plate damage secondary to isotretinoin. Studies published in English between 1980 and 2020 were also included, as well as background sources relating to an isotretinoin profile with side effects and dosing. We narrowed our search to exclude patients with a history of growth plate disorders due to trauma, malignancy, or other pathological processes, as well as patients with growth arrest due to endocrine factors. Growth plate abnormalities associated with retinoid derivatives other than isotretinoin were also excluded. Results A total of 28 items were selected for our literature review including: one FDA drug label, one FDA website of adverse reactions, 19 supplemental articles, six case reports, and one case series of premature epiphyseal closure secondary to isotretinoin. The FDA received 41 reports worldwide of premature epiphyseal closure related to isotretinoin in patients under 18 years of age. Additionally, premature epiphyseal closure and growth plate abnormalities occurred in nine patients with various durations and doses of isotretinoin ranging from the lowest dose of 0.5 mg/kg/day for a few months to 3.5 mg/kg/day for years. Conclusions Isotretinoin-induced premature epiphyseal closure and growth plate deformities seem to be linked to higher doses of isotretinoin for the duration of months to years. There have been reported cases of premature epiphyseal closure in individuals receiving therapeutic doses of isotretinoin for acne treatment, which are much lower compared to the high doses utilized for neuroblastoma. Based on this study, isotretinoin appears to impact the growth plates of proximal tibia and distal femur. A cause-and-effect relationship between isotretinoin and premature epiphyseal closure cannot be concluded.

scholarly journals Ayurvedic Literature Review of Pratishyaya w.s.r. Rhinitis

2020 ◽  
Keyword(s):  
Global Warming ◽  
Side Effects ◽  
Literature Review ◽  
Life Style ◽  
Clinical Condition ◽  
Treatment Modalities ◽  
Common Disease ◽  
Nasal Discharge ◽  
Modern System ◽  
Prevention And Cure

Ayurveda is the ancient most medicine science with equal emphasis upon prevention and cure. Due to environmental pollution, global warming, and life style disorders, a very common disease, Pratishyaya/Rhinitis occurs much more frequently than before. Pratishyaya has been considered as a separate clinical condition in Uttar Tantra of Sushruta Samhita. Improper management or negligence can lead to lots of complications like Badhirya, Andhata, Gandhanasha, Kasa etc. Rhinitis is an inflammation of the nasal membranes, characterized by watery nasal discharge, nasal obstruction, sneezing and nasal itching. This may also be associated with symptoms of itching in the eyes, palate and pharynx. Many treatment modalities are explained in modern system of medicine like corticosteroids, antiallergics, inhalers, antihistamines etc., but none of them are totally effective in curing the disease as well as preventing its recurrence, more over they have their own side effects.

Prospective, Randomized, Open-Label Trial Comparing the Safety, Efficacy, and Tolerability of an Acne Treatment Regimen with and without a Probiotic Supplement and Minocycline in Subjects with Mild to Moderate Acne

2013 ◽  
Vol 17 (2) ◽  
pp. 114-122 ◽  
Author(s):  
Gordon W. Jung ◽  
Jennifer E. Tse ◽  
Isabella Guiha ◽  
Jaggi Rao
Keyword(s):  
Side Effects ◽  
Therapeutic Option ◽  
Acne Vulgaris ◽  
Antibiotic Use ◽  
Vaginal Candidiasis ◽  
Lesion Count ◽  
Open Label ◽  
Group B ◽  
Systemic Antibiotics

Background: Systemic antibiotics are an effective treatment for acne vulgaris. However, intolerable side effects may invariably occur. Objective: To determine whether probiotics reduce the side effects imparted by systemic antibiotics while working synergistically with the latter in treating inflammatory acne. Methods: Forty-five 18- to 35-year-old females were randomly assigned to one of three arms in this prospective, open-label study. Group A received probiotic supplementation, whereas group B received only minocycline. Group C was treated with both probiotic and minocycline. Clinical and subjective assessments were completed at baseline and during the 2-, 4-, 8-, and 12-week follow-up visits. Results: All patients demonstrated a significant improvement in total lesion count 4 weeks after treatment initiation ( p < .001), with continued improvement seen with each subsequent follow-up visit ( p < .01). At the 8- and 12-week follow-up visits, group C had a significant decrease in total lesion count versus groups A ( p < .001) and B ( p < .01). Two patients (13%) from group B failed to complete the study secondary to vaginal candidiasis. Conclusion: Probiotics may be considered a therapeutic option or adjunct for acne vulgaris by providing a synergistic antiinflammatory effect with systemic antibiotics while also reducing potential adverse events secondary to chronic antibiotic use.

scholarly journals Comparative Efficacy and Safety of Low Dose versus High Dose Isotretinoin in Severe Acne Vulgaris Patients

2019 ◽  
Vol 8 (1) ◽  
pp. 18-22
Author(s):  
Maria Syed ◽  
Syed Afaq Ahmed
Keyword(s):  
Side Effects ◽  
Low Dose ◽  
Acne Vulgaris ◽  
High Dose ◽  
High Dose Regimen ◽  
Severe Acne ◽  
Dose Oral ◽  
Group A ◽  
Oral Isotretinoin ◽  
Group B

Background: Oral isotretinoin is the recommended treatment for acne vulgaris, a skin disease especially common in teenagers and adolescents. This study was designed to compare the efficacy and safety of low dose with high dose isotretinoin in severe acne vulgaris patients.Material and Methods: This randomized controlled trial included 110 patients with a clinical diagnosis of acne vulgaris. They were divided into two groups. Both groups were matched for age (mean 18.2±3.7 vs 17.6±3.2 years), weight (mean 58±10.2 vs 60.7±9.3 Kg), gender and disease duration (3±1.1 vs 3±1.0 years). Group A received low dose oral isotretinoin (20 mg/day) while group B received standard high dose regimen (1mg/kg/day). All patients were followed up for 16 weeks to assess efficacy (assessment of complete remission) and safety (mucocutaneous side effects). All calculations were performed using SPSS v. 16 with p value <0.05 considered as statistically significant.Results: There was no statistically significant difference in efficacy. However, significantly fewer mucocutaneous side effects were reported in group A (80%) as compared to group B (100%). This safety profile spectrum was observed across all pre-defined subsets i.e chielitis (78.1% vs 98.2%), dry skin (69.1% vs 92.7%), dry mouth (47.2% vs 72.7%) and facial rash (12.7% vs 30.9%).Conclusion: In patients with severe acne vulgaris, efficacy (complete remission) of low dose oral isotretinoin is almost equal to conventional high dose regimen but it is statistically superior in terms of safety (mucocutaneous side effects).

scholarly journals A randomized open label comparative study to determine the various side effects and patient satisfaction of low dose continuous versus low dose intermittent oral isotretinoin therapy in moderate to severe acne vulgaris

2018 ◽  
Vol 7 (6) ◽  
pp. 1169
Author(s):  
Santhosh A. Shetti ◽  
Nagesh H. N. ◽  
Nagabushan Hanumanthaiah
Keyword(s):  
Patient Satisfaction ◽  
Side Effects ◽  
Low Dose ◽  
Acne Vulgaris ◽  
Once Daily ◽  
Severe Acne ◽  
Treatment Regimens ◽  
Group A ◽  
Oral Isotretinoin ◽  
Group B

Background: Acne Vulgaris is chronic inflammatory disease of pilosebaceous units. Oral isotretinoin is recommended for moderate to severe acne vulgaris who are not responding satisfactorily to conventional therapies. Recent reports indicate that acne patients have been benefiting from the low dose treatment protocols. However, long term daily use of this drug results in frequent side effects such mucocutaneous and systemic side effects. Our aim was to assess and compare the various side effects and patient satisfaction of oral isotretinoin in low dose continuous and intermittent treatment of moderate to severe acne vulgaris.Methods: This was a prospective randomized open labeled comparative study carried out at outpatient department in the Department of Dermatology in Mandya Institute of Medical sciences, Mandya. Patients with moderate to severe acne were assigned equally (50 subjects each) to one of the two treatment regimens by using block randomization technique, Group A was given low dose continuous regimen-20 mg oral isotretinoin once daily for 4 months and Group B was given low dose intermittent regimen-20 mg oral isotretinoin once daily for 1 week out of every 4 weeks. The patients were followed up every 4th week during the treatment period. The patients were examined and side effects were noted in each visit. A six month follow-up evaluation was done to analyze patient satisfaction.Results: Muco-cutaneous dryness was most common adverse effect noted in both the groups A and B. Itching (42%), Alopecia (44%), Myalgia (36%) were seen most commonly in group A and Acne flaring (47%) was most common with group B. With regard to patient satisfaction, in group A 42% were satisfied and 20% were very satisfied, in group B 36% were satisfied and 14% were very satisfied.Conclusions: Study suggests that, Muco-cutaneous dryness was most common side effect in both treatment regimens. Side effects were more frequent with low dose continuous than low dose intermittent isotretinoin regimen. Patient satisfaction was better in continuous regimen.

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