Low-dose Isotretinoin Research Articles

A comparative study to evaluate the safety and efficacy of low-dose isotretinoin monotherapy versus a combination of low-dose isotretinoin and superficial chemical peels in patients with moderate-to-severe acne vulgaris

Objectives: The aim of the study was to compare the safety and efficacy of low-dose isotretinoin (LDI) monotherapy versus a combination of LDI and superficial chemical peels in treating moderate-to-severe acne in patients attending tertiary care hospital. Material and Methods: Sixty patients in the age group of 15–45 years having moderate-to-severe acne vulgaris were enrolled in the study. The patients were randomly divided into two groups of 30 patients each by random table number method. Group A – patients were put on LDI (0.25 mg/kg body weight [wt]) for 3 months. Group B – LDI (0.25 mg/kg body weight) was started, and these patients were subjected to six sessions of sequential superficial chemical peels every fortnightly for 3 months. Results: Treatment outcome was measured in terms of improvement in global acne grading (GAG) score, pigmentation, scarring, and seborrhea. The mean GAG score at week 0 in Group A was 29.2 ± 5.03, and Group B was 26.7 ± 5.11. The mean GAG score at week 12 in Group A was 15.9 ± 5.09, and in Group B was 9.23 ± 3.24, which showed statistically significant improvement (P < 0.001) in both groups. Post-inflammatory hyperpigmentation and erythema also improved significantly. There was no significant improvement in scarring, yet Group B showed a better response. The patient satisfaction score was high in Group B. Seborrhea improved equally in both groups. Conclusion: LDI gives a good balance between efficacy- and dose-related side effects. Both groups showed statistically significant results in terms of acne severity (global acne grading system (GAGS) W-0 26–29–W12 15– 9). Group B showed faster improvement than Group A.

Management of human epidermal growth factor receptor inhibitors-related acneiform rash: A position paper based on the first Europe/USA Delphi consensus process.

There is a need for unified guidance in the management of acneiform rash induced by epidermal growth factor receptor inhibitors (EGFRi) among dermatologists. To establish unified international guidelines for the management of acneiform rash caused by EGFR inhibitors, based on an experts' Delphi consensus. The initiative was led by five members of the European Academy of Dermatology and Venereology Task Force 'Dermatology for Cancer Patients' who developed a questionnaire that was circulated to a group of 32 supportive oncodermatology experts in Europe, Canada, Argentina, the US States and Asia. The questionnaire consisted of 84 statements in total, regarding diagnosis and treatment of EGFRi-induced acneiform rash. Experts responded to an anonymous 5-point Likert scale survey. The coordinators collected the first-round responses that were checked for consensus (≥75% agreement in positive [agree or strongly agree] or in negative [disagree or strongly disagree] vote). The statements that did not reach strong consensus in the first round were revised, according to experts' feedback, for a second-round survey. Strong consensus was reached in 75/84 (89.3%) of the statements, whilst moderate consensus was achieved in 6/84 elements. Key points include consideration of low-dose isotretinoin for refractory grade II/III acneiform rash, use of topical steroid-sparing agents like topical pimecrolimus in the maintenance phase and use of doxycycline in either 100 or 200 mg per day as prophylactic treatment. Interestingly, experts did not recommend topical antibiotics, neither for prevention, nor for treatment. Consensus failure in 3/84 objects is mostly related to the lack of robust data on these topics. This consensus offers crucial insights often overlooked by radiotherapists, general practitioners, dermatologists and oncologists, and it is expected to improve the management of oncologic patients treated with EGFRi in different settings and continents.

Exploring Epidermodysplasia Verruciformis: A Case Report, Treatment Strategies, and Emerging Therapies

Abstract Introduction/Objective Epidermodysplasia verruciformis (EV) is a rare cutaneous disorder with both inherited and acquired forms. Inherited cases involve mutations in genes such as ERV1 and ERV2, crucial for HPV immunity, while acquired cases affect immunocompromised individuals. EV is linked to cutaneous squamous cell carcinoma (SCC), highlighting the need for prompt diagnosis and treatment. Methods/Case Report A 54-year-old HIV-positive man was referred with a persistent, itchy eruption on his forearms despite given ARV regimen, oral retinoids and topical therapies. Physical examination revealed hypopigmentation and hyperkeratotic plaques on both forearms. Histologic examination revealed large cells with blue-gray cytoplasm and perinuclear halo in the upper epidermis, consistent with EV. Although advised for papilloma virus vaccination and planned for a trial of topical cidofovir, the patient was lost to follow-up. Treatment strategies for EV vary depending on lesion severity. Severe keratinized or precancerous lesions typically require surgical removal as the first-line approach. For early-stage EV with few small lesions, 5-FU, cidofovir, glycolic acid, and imiquimod is recommended. Tazarotene 0.5% cream used twice weekly has shown success in resolving lesions within 14 days. Topical imiquimod’s efficacy appears variable. In HIV-positive patients with EV, topical 1% cidofovir showed success in some cases. Systemic and topical retinoids are advised for diffuse lesions, with electrocautery or cryotherapy as options if initial treatments fail. HPV vaccination combined with oral acitretin, topical tretinoin and imiquimod led to lesion flattening. Continuous low-dose isotretinoin achieved prolonged remission of EV, but its efficacy in acquired EV remains unclear. Topical methyl aminolevulinate followed by photodynamic therapy has also shown promise. Results (if a Case Study enter NA) NA Conclusion Since its discovery in the 1970s, Acquired EV has been observed across diverse demographics, including HIV patients and organ transplant recipients. Advanced HPV typing and sequencing techniques aid in predicting SCC risk. Emerging treatments like topical cidofovir and combination therapies show promise, necessitating larger clinical trials for validation.

Combined low-dose isotretinoin and long-pulsed nd: YAG laser in the treatment of post-acne erythema

Post-acne erythema (PAE) is a bothering skin condition that emerges from inflammatory acne and persists after its resolution. It is characterized by telangiectasia and erythematous macules. the role of 1064-nm Nd: YAG when combined with low-dose isotretinoin in the acne erythema treatment. forty-eight PAE patients were involved in the study. They were divided into two groups; group (A) patients administering a low dose of oral isotretinoin (10 mg/day) and underwent a total of six two-week interval sessions of 1064 ND-YAG laser treatment, group (B) patients administering a low dose of oral isotretinoin (10 mg/day) only. All adverse effects experienced during the course of therapy were documented, and photos were taken before the start of the treatment and following the end of the treatment duration. Following the completion of the therapeutic intervention, a significant improvement in clinical condition was observed in both groups, with more improvement in group (A) compared to group (B) as evidenced by a notable improvement in the score on the Clinician Erythema Assessment Scale (CEAS) and also a significant decrease in the mean value of optical density of the erythema. combined 1064-nm Nd: YAG with low-dose isotretinoin may be an efficient and secure line in the PAE treatment. Also, the combined therapy had superior results when compared to low-dose isotretinoin alone.

Fire needle pretreatment with 5-aminolevulinic acid photodynamic therapy combined with low-dose isotretinoin in the treatment of severe refractory nodulocystic acne

BackgroundNodulocystic acne is a severe form of acne, which is commonly treated with oral isotretinoin, hormones, or antibiotics. However, drug therapy often has some side effects and poor compliance. Fire needle combined with 5-aminolevulinic acid photodynamic therapy (ALA-PDT) is a simple, effective, short-term treatment with few adverse reactions, which is expected to be an effective physiotherapy for nodulocystic acne. Moreover, the combination with isotretinoin can reduce the dosage of the drug, thereby reducing the side effects of isotretinoin. ObjectivesTo evaluate the safety and efficacy of fire-needle pretreated ALA-PDT combined with low-dose isotretinoin in the treatment of severe refractory nodulocystic acne. MethodsThis study reported 10 patients with refractory nodulocystic acne who received combined treatment. During the treatment period, all patients received a low dose of oral isotretinoin capsules daily. The acne lesions were pretreated with fire needle before ALA-PDT treatment. The number of acne lesions, including papules, pustules, and nodular cysts, was documented at weeks 0, 2, 4, 8, and 12 to assess the therapeutic efficacy. Concurrently, adverse reactions such as pain, pruritus, and pigmentation changes were recorded and evaluated throughout the treatment course. ResultsAfter combined treatment, all patients achieved good therapeutic effects, with an overall effective rate of 90 % at week 12. After treatment, skin lesions such as nodules, and cysts subsided significantly. The combination therapy has no serious adverse effects and has a favorable safety profile. ConclusionFire needle pretreatment ALA-PDT combined with low-dose isotretinoin is effective and safe in the treatment of severe refractory nodular cystic acne, which is worthy of clinical promotion and research.

Clinical features and treatment of rosacea

Background: Rosacea is a common facial dermatological disease characterized by central erythema and flushing. It is more common in females than males, with a prevalence of approximately 5.5% in the global population and 2.4% among all dermatological outpatients. In 2002, the National Rosacea Society Expert Committee suggested a subtype-based standardized classification system. The most common subtype of rosacea is erythematotelangiectatic rosacea (ETR), followed by papulopustular rosacea (PPR), phymatous rosacea, and ocular rosacea.Current Concepts: Rosacea is characterized by hyperactive innate and neurovascular immune reactions, which lead to altered adaptive immune reactions and hyperreactive inflammation. In 2017, the National Rosacea Society Expert Committee developed a phenotype-based classification system. The diagnostic features include persistent centrofacial erythema and phymatous changes. ETR is associated with sensitive skin and may have a debilitating psychological impact, often leading to psychological conditions such as depression and anxiety. Doxycycline and minocycline are considered the gold-standard oral treatments for rosacea. Topical ivermectin and metronidazole are commonly used to treat PPR. Low-dose isotretinoin is an alternative to avoid long-term chronic antibiotic use. Carvedilol and propranolol are off-label medications used to reduce persistent facial flushing and erythema in rosacea. Some alpha-adrenergic receptor agonists have also been approved for the treatment of persistent erythema in rosacea.Discussion and Conclusion: Rosacea exhibits multiple phenotypic manifestations. The treatment approach is individualized for each patient through the customization of multimodal treatments, including the avoidance of trigger factors and the assessment of comorbid diseases.

Efficacy of Low-Dose Isotretinoin in the Treatment of Rosacea: A Systematic Review and Meta-Analysis.

Rosacea is a common cutaneous condition caused by persistent, recurring lesions in facial skin vessels. It is a chronic skin condition with a variety of clinical symptoms and an unknown cause. Rosacea begins with the widening of capillaries and a flushed appearance. Following that, telangiectasia appears, and reddened patches persist, particularly on the cheeks and nose. Erythema persists due to repeated vasodilationand telangiectasia. In addition, skin inflammation manifests as papules, pustules, lymphedema, and fibrosis. Despite recent advances in treatment, rosacea, a chronic inflammatory relapsing central facial dermatosis, can be extremely difficult to manage. The purpose of this meta-analysis and systematic review was to evaluate the effectiveness of low-dose isotretinoin in the treatment of rosacea. Following the guidelines set forth by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA), the researcher employed the following search terms in the EMBASE, Web of Science, PubMed, Cochrane Library, and Google Scholar databases to provide a therapeutic update relevant to clinical practice: "low dose isotretinoin," "isotretinoin and rosacea," "isotretinoin treatment of rosacea," and "effectiveness of isotretinoin in treating rosacea". The search was carried out by the researcher for articles published from February 2019 to February 2024. The articles included were all published in the English language. The overall frequency of patients with adverse events differed significantly between the groups treated with low-dose isotretinoin and the comparators(minocycline, pulsed dye laser, evening primrose oil, Lactobacillus plantarum, doxycycline, combined dose or placebo) (0.80, 95% CI 0.73 to 0.88, p = 0.0001). Sub-group analysis indicated that there was a difference between the interventions used in the treatments all in favor of low-dose isotretinoin treatment. The results showed that the moderate group had RR: 0.76, 95% CI: 0.44-1.30, I2 = 0%;the mild group had RR: 0.94, 95% CI: 0.56-1.57, I2 = 0%;and the group with severe rosacea had RR: 0.73, 95% CI: 0.47-1.13, I2 = 0%. According to this study, rosacea can be treated effectively with low-dose isotretinoin even in patients at severe stages of the disease by using the recommended dose once a week. Further, the intervention has also been shown to have fewer side effects on the patients. Therefore, this study recommends randomized controlled trials to be done to fully investigate the best combination options for isotretinoin on mild to severe rosacea based on the fact that some of the treatments combined have shown to be effective on treatment.

Durability of the improvement of collagen I and collagen III with the use of oral isotretinoin in the treatment of photoaging.

Oral isotretinoin (ISO) is the drug of choice for the treatment of severe acne. For photoaging treatment, ISO has been proved to be effective in some controlled and noncontrolled trials and is an alternative to topical retinoic acid (RA) therapy, which causes an expected skin irritation. To evaluate and compare the skin remodeling in patients taking ISO 20 mg 3 times a week for 12 weeks and 12 weeks after the end of the treatment to quantify collagen I and collagen III augmentation. Immunohistochemical studies were performed to evaluate the expression of collagen I and collagen III, metalloproteinases (MMPs) -1, -3, -7, -9, -12, and the tissue inhibitor of MMP type-1 (TIMP-1) of the skin of 20 45 to 50-year-old women through morphometry in a semiquantitative method. The inclusion criteria were facial aging 2 and 3 of Glogau's classification, with phototypes between II and V who had not entered menopause. Biopsies of the skin of the left preauricular region were performed at three different times: pre-treatment (T0), end of 12-week treatment (T1), and 12 weeks posttreatment (T2). Collagen fibers I and III increased with statistical significance in T1 (50.7%; P = 0.012) but not in T2 (49.7%), which in turn was higher than in T0 (47.2%) for collagen I and T1 (33.3%; P = 0.002) but not in T2 (32.7%), and also was higher than T0 (32.0%) for collagen III. MMP-9 presented a decreased activity with statistical significance in T1 (P = 0.047) and T2 (P = 0.058). MMP-1 showed a reduction in T2 only (P = 0.015). MMPs -3, -7, -12, and TIMP-1 did not present significant modification in their expressions during or after the treatment. Low-dose ISO is effective in remodeling the extracellular matrix (ECM). This study found that the increase of collagen occurs through the augmentation of both collagen I and collagen III fibers. With originality, it was possible to verify the durability of these fibers for at least 12 weeks. This may be related to the decrease in MMP-9 expression verified at the end of the treatment and 12 weeks posttreatment.

P20 Job syndrome: hyper IgE syndrome in a young girl with an acneiform rash

Abstract Hyper IgE syndrome (HIES1) is a rare, autosomal dominant, primary immunodeficiency characterized by eczema, recurrent staphylococcal skin infections, pneumonia, increased serum IgE and eosinophilia. It is caused by a heterozygous mutation in the STAT3 gene on chromosome 17q21 with variable expressivity. Nonimmunological findings including characteristic facies, hyperextensibility, long-bone fractures, aneurysms, craniosynostosis and dental abnormalities. We present the case of an 11-year-old girl referred to dermatology with an acneiform facial rash. Examination was consistent with papulo-pustular scarring acne of the face and back. Her history was also significant for recurrent MSSA bacterial lymphadenitis requiring incision and drainage over the proceeding 3 years. Her past medical history was significant for the development of moderate-severity infantile acne at 2 weeks of age, mild childhood eczema, recurrent childhood otitis media Staphylococcus infections resulting in grommet insertion, primary tooth retention requiring extraction and a fractured wrist at age 9 years. Because of the burden of infection the patient was referred to immunology in Crumlin. Investigations revealed mild neutropenia, marginally elevated IgA and IgM, normal eosinophils, marginally elevated IgE, normal lymphocyte subsets, intact complement pathways and normal oxidative burst test. Next-generation sequencing was significant for STAT3 gene mutation consistent with HIES. As there is no family history this likely represents a de novo mutation. The patient is currently on prophylactic azithromycin and low-dose isotretinoin with good effect. This case represents a patient with both immunological and nonimmunological features of HIES1, marginally elevated IgE, absence of eosinophils and negative family history.

Ablative Fractional CO2 Laser with or without Low Dose Isotretinoin in Treatment of Acne Scars: A Comparative Study

Abstract Background Acne scarring is one of the most common sequelae of acne vulgaris. The severity of acne scars correlates with acne duration, severity and delay in treatment of acne as well as positive family history. Patients who have acne scars frequently seek treatment options to improve appearance and quality of life. Aim of the Study The aim of this study was to assess the safety of combining low-dose isotretinoin with ablative fractional CO2 laser in patients with acne scars. Patients and Methods This study included 40 patients with different types of acne scars. There were 27 females and 13 males. The patients have divided into two groups; Group A received low-dose isotretinoin with full face AF Co2 laser session, while Group B was treated with full face AF Co2 laser session. The age of patients ranged from 18 to 45 years old, with the mean age was 27.2± 6.9 yrs in group A and was 27.5± 6.06 yrs in group B. Results Duration of wound healing, PIH and pain were parallel in both groups with no significant difference between them. No other complications were reported as keloid formation, secondary infection, edema, milia or acneform eruption in study groups. Satisfactory results were reported in most of the patients. Conclusion Our study concluded that using low-dose isotretinoin with AF Co2 laser session safe procedure with normal wound healing and no keloid or hypertrophic scars formation.

Retinoids in Lichen Planus Pigmentogenes

Lichen planus pigmentosum (LPP) is an uncommon variant of Lichen plan clinically characterized by lichenoid lesions of photoexposed. Pruritus may be present in the early active phase, and the disease often has a prolonged clinical course [1]. There is no effective treatment for LPP. Various therapeutic modalities such as topical tacrolimus, topical and systemic corticosteroids, high-dose vitamin A and lasers have been tried with no prometting results [2-6]. Isotretinoin is a first generation retinoid discovered in 1952 and was approved by the FDA for the treatment of nodulokystic acne in 1982. Isotretinoin anti-inflammatory properties have allowed it to be used in disorders other than acne. Its adverse effects range from simple xerosis to teratogenicity. There have been a few isolated reports of isotretinoin (topical/systemic) efficiency in the treatment of LPP but its role in LPP has not yet been totally elucidated [7,8]. The objective of this study was to evaluate the efficiency and safety of low-dose isotretinoin in the treatment of LPP

Analyzing the Effects of Low-Dose Isotretinoin on Acne Vulgaris Against the Standard Treatment Protocol

Objective: The study's objective was to evaluate the effectiveness and safety of low-dose isotretinoin vs the standard-dose regimen for the treatment of acne vulgaris. Study Design: Randomized controlled trial Place and Duration: This study was conducted at Department of Dermatology, Bannu Medical College and Federal Government Polyclinic Hospital Islamabad in the period from March, 2022 to August, 2022. Methods: Randomization was used to split the total of 190 patients with acne vulgaris who participated in the study into two groups of 95 sample size each. Patients of both sexes were affected with acne vulgaris. Isotretinoin was administered orally to patients in group I at a dose of 20 milligrammes per day for 12 weeks, whereas patients in group II received conventional dosing regimen 80 milligrammes per day. After a total of 12 weeks of therapy, both groups had a final assessment of their effectiveness. SPSS 23.0 was used to analyze all data. Results: In all 190 cases, majority of the cases 110 (57.9%) were females and 80 (42.1%) were male patients. Mena age of the patients in group I was 24.16±10.52 years and in group II mean age was 25.8±9.87 years. We found that efficacy of conventional dosing regimen was higher in 73 (76.8%) as compared to low doze isotretinoin in 50 (52.6%) with p value <0.005. Post-treatment frequency of complication were higher in group II 46 (48.4%) as compared to group I 28 (29.5%). Dry eyes and headache were the common complications in all cases. Conclusion: As a result of this research, we came to the conclusion that the typical dosing regimen for the treatment of acne vulgaris is more effective but poses a greater risk of side effects than the low dose of isotretinoin. Keywords: Efficacy, Safety, Acne vulgaris, low dose isotretinoin

Acne medication as a potential solution for slowing down the aging process – a systematic review

Introduction One of the major challenges of the 21st century is the fight against aging. There are two main processes that induce skin aging: intrinsic and extrinsic, with sun exposure being the most damaging to the skin. A number of drugs have been used to prevent aging changes. It has been proposed that low dose oral isotretinoin could be administered as a safe and effective treatment for skin that has undergone photoaging changes. Aim of the study The aim of the study was to examine the potential efficacy of low dose oral isotretinoin in the antiaging therapy. Materials and methods A search was conducted using PubMed and Google Scholar databases. Articles were searched in English using the following key words: isotretinoin; low dose isotretinoin; aging; photoaging. Results There was an improvement in the overall appearance of the skin, regarding texture, wrinkles depth and skintone. Skin thickness, suppleness, and pore size improved. Both the number of collagen fibers and the density of elastic fibers increased in the statistically significant manner. Elastosis decreased, the thickness of the epidermis increased, and the stratum corneum diminished. Reduction of pigmented lesions and uneven hyperpigmentation was detected. With low-dose isotretinoin, side effects were absent or negligible, limited to minimal lip dryness. Conclusion The outcome of the literature review leeds to the conclusion that the use of low doses of oral isotretinoin seems to be a safe and effective treatment improving the effects of skin aging. The clinical, histological, and molecular characteristics of photodamaged skin can be alleviated. Isotretinoin is a promising drug in the antiaging therapy.

Perioral dermatitis: Modern methods of therapy

One of the most common causes of perioral dermatitis (PD) is the use of glucocorticosteroids (topically, intranasally, inhaled, systemically). If PD is caused by topical corticosteroids, they must be canceled (according to the authors, without using a sparing reduction technique: a decrease in the frequency of application of corticosteroids and the strength of corticosteroid activity). With a pronounced withdrawal syndrome, it is advisable to start treatment with ‘zero’ therapy: either a complete rejection of the use of external agents, or a lotion with chamomile (5–10 minutes 2 times a day) followed by the use of dermatolichthyol paste (exposure in increasing from 10 minutes to 40 minutes) for 7–10 days, as well as irrigation with hypochlorite thermal water (5–6 times a day). With mild severity of oral dermatitis, monotopic therapy may be prescribed, including cream with activated zinc pyrithione and calcineurin inhibitors. The duration of therapy is determined individually and averages 1.0–1.5 months. In moderate to severe cases, topical therapy should be supplemented with systemic drugs: tetracycline antibiotics (7–10 days) or low-dose isotretinoin (2–4 months). The duration of therapy is determined individually and averages 2 months.

How is oral isotretinoin prescribed for the treatment of acne vulgaris? Results from a UK Dermatology Clinical Trials Network (UKDCTN) and British Dermatological Nursing Group (BDNG) survey of health professionals.

We undertook a survey of UK healthcare professionals through the UK Dermatology Clinical Trials Network and British Dermatological Nursing Group to understand clinicians' routine practice of prescribing oral isotretinoin for treatment of acne vulgaris. We also wanted to understand clinicians' experiences and views on prescribing low daily dose regimens. Overall, the survey showed that clinicians adopted a patient-centred approach when deciding isotretinoin dosing. The rationale for using a low-dose regimen varied, but was focused on patient wellbeing during treatment. Some clinicians were concerned that use of a low-dose regimen could be less effective and lead to longer treatment durations. The survey results will be useful to inform a clinical trial investigating the effectiveness and safety of low daily dose isotretinoin for the treatment of acne.

Dramatic response to colchicine treatment in acne fulminans patients with cytological hemophagocytosis: A case series of 12 patients.

Acne fulminans is a severe form of acne with a sudden onset, rapid ulceration of the lesions, and some systemic symptoms, with or without systemic symptoms. These papulopustular lesions, whose pathogenesis is not fully understood, may exacerbate with systemic isotretinoin or may be a component of some autoinflammatory syndromes. It is recommended to control these sudden pustular attacks with systemic steroids or anti-inflammatory drugs. Here, in 12 patients with acne fulminans who developed exacerbation during systemic isotretinoin treatment and whose cytological examination revealed hemophagocytosis, colchicine treatment was started in addition to low-dose isotretinoin treatment, and a very good response was obtained to this treatment approach that did not contain systemic corticosteroids.

Systemic isotretinoin for acne treatment: Ovarian reserve is safe with the low dose.

Isotretinoin is among the most frequently used medications in the dermatologic daily practice. With a Black box warning, teratogenicity is a major concern. Female fertility may be an issue to be investigated when it comes to its use in females. The aim of this work was to assess the effect of low dose isotretinoin on the ovarian reserve in female patients with moderate to severe acne. Sixty-sex female acne patients candidate for isotretinoin therapy and 66 controls were enrolled in this prospective controlled cohort study. Low dose isotretinoin (0.25-0.4mg/kg/day) was given to the patients group for 6 months. Serum anti-Mullarian hormone (AMH), ovarian volume (OV) and Antral follicle count (AFC) were evaluated at baseline and 6months after the last dose in the patients' group, and 1year after the baseline assessment for the control subjects. There was no significant difference in serum AMH between patients after isotretinoin treatment and control subjects (p=0.898). AMH failed to show any significant change in pre- and post- treatment levels in patients' group (p=0.747). Both OV and AFC showed no significant changes in patient group when comparing pre- post- treatment levels on both sides (p > 0.05) and in control group between baseline and 1-year-interval levels on both sides (p > 0.05). Low-dose isotretinoin in treatment of moderate to severe acne seems to be safer on ovarian reserve as indicated by non-significant change in AMH levels as a sensitive parameter of female fertility.

S2k guideline: Rosacea.

This updated and upgraded S2k guideline deals with the diagnosis and treatment of rosacea, which is a common, chronic inflammatory skin disease mostly affecting the face. Initially, rosacea is characterized by recurrent erythema, telangiectasia and flushing. Later, the inflammatory component predominates, with persistent erythema with follicular papules, papulopustules and pustules. The development of phyma, which usually occurs on the acral localizations, is the most severe manifestation. For the treatment of rosacea, the interdisciplinary guideline committee, with representatives of the German Dermatological Society (DDG), the Professional Association of German Dermatologists (BVDD), the German Opthalmological Society (DOG), the Society for Dermopharmacy (GD), the Swiss Society for Dermatology and Venereology (SGDV) and the German Rosacea Aid e.V., recommends the avoidance of trigger factors and topical applications of metronidazole, azelaic acid or ivermectin. For symptomatic treatment of persistent centrofacial erythema, the topical vasoconstrictors brimonidine or oxymetazoline can also be used. Systemic therapy is recommended for therapy-resistant and severe forms of rosacea papulopustulosa. The drug of choice is low-dose doxycycline. Alternatively, low-dose isotretinoin can be recommended. Ocular rosacea should be treated with lid margin hygiene. For topical treatment, ciclosporin eye drops, azithromycin, ivermectin or metronidazole are suggested.

Combined use of energy-based interventions with low-dose isotretinoin for the treatment of inflammatory acne: An retrospective cohort analysis.

The combined use of oral isotretinoin with energy-based interventions including fractional microneedle radiofrequency, pulsed dye laser, and ablative fractional laser is an effective way to treat moderate-to-severe inflammatory acne lesions. However, studies regarding its efficacy and safety are limited. This study aimed to assess the efficacy and safety of a treatment using low-dose isotretinoin with energy-based interventions for inflammatory acne. This retrospective cohort study included 126 patients who were diagnosed with inflammatory acne and were treated with systemic isotretinoin for at least 3months. Patients were divided into EBD (energy-based intervention) (n=82) and non-EBD groups (n=44). Clinical outcomes of both groups were assessed using medical records and digital photographs. After treatment, the modified Global Acne Grading Score of the EBD and non-EBD groups decreased by 35.1 ± 17.2 and 25.6 ± 10.1, respectively. The improvement in acne severity was significantly greater in the EBD group than in the non-EBD group. Cumulated isotretinoin dose and frequency of drug-related side effects were significantly higher in the non-EBD group than in the EBD group. Combined treatment with low-dose isotretinoin and energy-based intervention is well tolerated and associated with positive responses in patients with inflammatory acne.

Efficacy and safety of low-level light therapy by delicate pulsed light combined with low-dose oral isotretinoin for the treatment of acne vulgaris: a randomized split-face study.

Acne vulgaris (AV) is a common dermatosis that causes psychological problems. Isotretinoin is the first-line treatment for moderate-to-severe AV, but its onset of effect is delayed. Although light-based therapy is widely used in the treatment of AV, there is a lack of reports on delicate pulsed light (DPL) which has a narrow therapeutic spectrum (500-600 nm). Low-level light therapy (LLLT) has shown an emerging role in anti-inflammatory effects and skin repair. This study investigates the efficacy and safety of low-dose oral isotretinoin combined with LLLT using DPL in patients with moderate-to-severe AV. Thirty-six patients with moderate-to-severe AV were enrolled and received low-dose oral isotretinoin (10-20 mg/day). The two sides of the face were randomly assigned to receive DPL (6-9 J/cm2) or not at an interval of 2 weeks for 4 treatment sessions (weeks 0, 2, 4, 6). Photos, GAGS score, counts of papules, pustules, comedones, TEWL, melanin and erythema index, side effects, efficacy, and satisfactory score were recorded at each visit and at 4 weeks after the final treatment (week 10). Thirty-three patients completed the study. DPL and oral isotretinoin combined therapy exhibited significantly improved GAGS score as well as the number of the lesions from week 2 and maintained until week 10. At the end of the observation, the improvement of GAGS was 70.88% on the DPL and isotretinoin combined side versus 62.12% on the side with isotretinoin monotherapy (p = 0.0009). The improvement for papule number was 61.58% on the DPL combined side versus 43.33% on the control side (p < 0.0001), for comedone was 63.15% versus 43.30% (p = 0.0008). TEWL and indexes of melanin and erythema also had better outcomes with DPL combined therapy at week 10. All the side effects were temporary and tolerable; no adverse effects were observed. Oral low-dose isotretinoin combined with LLLT by DPL offers a combination with reduced side effects and better outcomes within a limited treatment duration, which advances the onset of effect of isotretinoin monotherapy and improves lesion clearance.