The Effectiveness of Autologous Serum and Single-dose Oral Doxycycline in the Treatment of Acne Vulgaris: A Pilot Clinical Trial

Introduction: Acne vulgaris is a chronic inflammatory disease that occurs with various factors, both intrinsic and extrinsic. Treatment of choice can vary from topical, systemic or a combination of both depending on the degree of severity. Recently, treatment using products from human blood has been widely studied, including in the field of dermatology as it has a unique composition. Objective: to assess the effectiveness of autologous serum and single-dose oral doxycycline in the treatment of acne vulgaris Methods: this clinical trial compared two groups which received autologous serum only and autologous serum combined with single dose of oral 200 mg doxycycline, respectively. Photographic pictures and number of lesions (blackheads, papules, pustules) were compared before and after application using Wilcoxon test. Results: A total of 20 participants participated in this study. Both treatment groups showed significant decrease in lesion count (p <0.01). However, the group which received autologous serum and single dose of oral doxycycline showed superior improvement of inflammatory acne lesions. Conclusion: autologous serum and single dose of oral doxycycline was superior to autologous serum only in the treatment acne lesions. Keywords: Acne Vulgaris, Doxycycline, Autologous Serum

Lyme Carditis With Complete Heart Block Successfully Treated With Oral Doxycycline

ABSTRACT Lyme disease is a vector-borne infection that can affect multiple different organ systems. Lyme carditis represents one of these sequelae and is defined by acute onset of high-grade atrioventricular block in the presence of laboratory-confirmed infection. Current guidelines recommend patients with Lyme carditis be admitted for close cardiac monitoring and intravenous antibiotics therapy. Our case illustrates an active duty male who was initially diagnosed with Lyme disease after initially reporting symptoms including headache, fever, eye pain, and rash, with subsequent development of exercise intolerance 6 weeks later. An electrocardiogram (ECG) obtained at that time was misinterpreted as first-degree heart block, and he was initiated on oral doxycycline therapy and referred to cardiology. On follow-up to cardiology clinic, the prior ECG was reviewed and interpreted as complete heart block. A repeat ECG showed resolution of the heart block, and exercise stress testing showed chronotropic competence. This case illustrates the resolution of complete heart block in Lyme carditis with oral doxycycline, suggesting this antibiotic as a possible alternative treatment agent.

Idiopathic Aseptic Facial Granuloma

Pyodermite froide du visage, otherwise known as idiopathic facial aseptic granuloma (IFAG), is a benign lesion exclusively seen in children and presents as a cold abscess on the face.1 We report a case of a 14-year-old male with IFAG who failed initial treatment with oral doxycycline, but responded to treatment with oral 13-cis-retinoic acid, oral trimethoprim-sulfamethoxazole and intralesional triamcinolone injections over a 7 month period.

Cutaneous reaction to sea urchin spines

A 35-year-old male returned from vacation in Hawaii where he went scuba diving and snorkeling. While snorkeling, he stepped on a sea urchin and sustained injuries to the dorsal aspect of his right foot. He began to swim back to shore when he felt significant pain and began removing visible spines when he reached shore. He saw a physician in Hawaii who removed remaining spines and started a treatment regimen of cephalexin 500 mg QID. Patient followed up 2 weeks later with his home dermatologist for persistent granuloma and was given 15-day course of oral doxycycline 50 mg BID with near full recovery within 2 weeks. Even physicians practicing inland need to be aware of coastal injuries and reactions as they can mimic other common skin tumors such as keratoacanthomas.

Adjunctive Corticosteroids for Lyme Neuroborreliosis Peripheral Facial Palsy – a prospective study with historical controls

Background Lyme neuroborreliosis peripheral facial palsy (LNB PFP) and idiopathic peripheral facial palsy, Bell’s palsy (BP), are the most common causes of facial palsy in borrelia-endemic areas and are clinically similar. Early treatment with corticosteroids has been shown to be effective in Bell’s palsy and antibiotics improve outcome in LNB, but there is a lack of knowledge on how the addition of corticosteroids to standard antibiotic treatment affects outcome in LNB PFP. Methods This prospective open trial with historical controls was conducted at two large hospitals in western Sweden between 2011 and 2018. Adults presenting with LNB PFP were included in the study group and were treated with oral doxycycline 200 mg b.i.d. for 10 days and prednisolone 60 mg o.d. for 5 days, then tapered over 5 days. The historical controls were adult patients with LNB PFP included in previous studies and treated with oral doxycycline. Both groups underwent a follow-up lumbar puncture and were followed until complete recovery or for 12 months. Results Fifty-seven patients were included, 27 in the study group and 30 in the control group. Two patients (6%) in the study group and 6 patients (20%) in the control group suffered from sequelae at end follow up. There was no statistically significant difference between the groups, neither in the proportion of patients with sequelae, nor in the decline in CSF mononuclear cell count. Conclusions Adjunctive corticosteroids neither improve nor impair the outcome for patients with Lyme neuroborreliosis peripheral facial palsy treated with doxycycline.

Experience in managing glaucoma filtration surgery complications with oral doxycycline: A case series

Purpose: To report the clinical profile and effectiveness of oral doxycycline as a non-invasive treatment for glaucoma filtering surgery complications. Method: Prospective case series. Results: Doxycycline is widely used in treating corneal melts, ocular surface diseases, meibomian gland disease, recurrent epithelial cell erosion, rosacea, and keratitis sicca. This prospective case series highlights the successful treatment of five patients with leaking blebs and conjunctiva erosion from glaucoma filtration surgery with the use of oral doxycycline. There was no adverse event reported in our cases. Conclusions: This study suggests that oral doxycycline may be a feasible non-surgical treatment modality due to its ability to inhibit collagenolysis, restore the Meibomian gland function, thereby stopping breakdown and promote conjunctival tissue healing.

COMPARISON OF MONTHLY PULSE OF ORAL AZITHROMYCIN WITH DAILY DOXYCYCLINE IN THE TREATMENT OF MODERATE ACNE VULGARIS

Objective: To compare oral Azithromycin with oral Doxycycline in treatment of moderate Acne Vulgaris. Study design: Randomized control trial Place and duration of the study: Dermatology Department , Pak Emirates Military Hospital, Rawalpindi from 1st August 2017 till 31st January 2018. Materials and methods: A total of 92 patients with moderate Acne were selected from Dermatology outpatient department (OPD) Pak Emirates Military Hospital Rawalpindi, after written informed consent. Patients were randomly allocated to one of the two treatment groups: Group A and Group B by lottery method. Patients in group A were given oral Azithromycin 500 mg daily for four consecutive days each month for 03 months and patients in group B were given oral Doxycycline 100 mg daily for 03 months. Patients were reviewed monthly for 03 months and Acne Severity Index (ASI) was recorded at baseline, at one month and three months. The primary outcome measured was more than 50% decrease from baseline in ASI within 3 months of treatment, using Global Acne Grading System (GAGS). Results: Mean age of patients in group A was 21.80 + 4.64 years whereas mean age of patients in group B was 21.61 + 4.48 years. In group A mean pre-treatment ASI was 24.83 + 3.15 and mean post-treatment ASI was 10.15 + 1.7. In group B mean pre-treatment ASI was 25.30 ± 2.96 and mean post-treatment ASI was 9.86 + 1.58. Conclusion: Azithromycin is comparable to Doxycycline in terms of mean change in ASI, in the treatment of moderate Acne Vulgaris.