Systemic Isotretinoin Treatment Research Articles

Nail changes in patients receiving systemic isotretinoin therapy

In this study, it was aimed to describe isotretinoin-induced nail changes and increase patients’ treatment compliance. A total of 200 patients diagnosed with acne vulgaris were included in the study. 100 of the patients were started systemic isotretinoin treatment and 100 control patients were receiving topical acne treatment. Age and gender of all of the participants, duration of treatment, total doses per month, and type of nail changes were recorded. Patients with persistent nail changes were followed at the 3rd and 6th months after treatment. A total of 34 patients had nail changes in the isotretinoin group. These changes included onychoschizia (55.9%), leukonychia (11.8%), onychorexis (8.8%), median nail dystrophy (5.9%), pyogenic granulomas (5.9%), chronic paronychia and granulation tissue (5.9%), onycholysis (2.9%) and Beau’s line (2.9%). The rate of nail changes in the isotretinoin group was significantly higher than in the topical treatment group (34% vs. 11%, p:0.001). Isotretinoin increases the risk of nail changes, primarily onychoschizia. The risk of developing nail changes is not associated with treatment duration but is associated with the total cumulative dose. Nail findings induced by isotretinoin are completely reversible.

Should Serum Levels of Creatine Kinase be Evaluated in Patients with Acne Vulgaris Treated with Systemic Isotretinoin

The laboratory tests that should be performed and their frequency during isotretinoin treatment are controversial. We wanted to investigate muscle and joint pain and laboratory tests in acne patients who received isotretinoin. Between April 2019 and February 2023, serum CK, AST, ALT, and GGT levels were retrospectively evaluated in acne patients before and three months after systemic isotretinoin treatment. This study included 410 patients. The median serum AST, ALT, and GGT levels significantly increased, whereas serum CK levels were similar in all patients three months after treatment. 23 (5.6%) patients revealed muscle or joint pain after treatment. No significant difference was detected in patients with or without pain in the median serum CK, AST, ALT, and GGT levels after treatment. Isotretinoin treatment at a dose of 10 mg/day was more common in patients with pain than in those without pain, whereas none of the patients who received isotretinoin 40 mg/day developed muscle or joint pain. We suggest that routine evaluation of serum CK levels is unnecessary in acne patients treated with isotretinoin. However, muscle and joint pain may develop even at doses as low as 10 mg/day. Furthermore, monitoring AST, ALT, and GGT levels may be beneficial in acne patients treated with isotretinoin.

Serum Catestatin Levels in Patients with Acne Vulgaris: Single-Center Prospective Study

Introduction: Recent studies showed that antimicrobial peptides have an essential role in the pathogenesis of acne vulgaris. This study aims to investigate serum catestatin levels in acne vulgaris patients and focuses on the change in serum levels after systemic isotretinoin therapy. Methods: This prospective study includes 101 acne vulgaris patients and 28 healthy controls. Serum catestatin levels were measured and compared between acne vulgaris and control group patients. Also, serum catestatin levels were measured again at the 24th week of isotretinoin therapy. Results: The serum catestatin levels in patients with acne vulgaris were statistically higher than in the control group (p < 0.001). In addition, serum catestatin levels were associated with the severity of acne vulgaris. A significant decrease in serum catestatin levels was detected after 24 weeks of systemic isotretinoin treatment. Conclusion: Catestatin was found to be significantly higher in the serum of patients with acne vulgaris compared to the control group. Although, the demonstration that catestatin levels decrease with isotretinoin treatment may indicate that it may have an important role in the pathogenesis of acne and could be used as a biomarker, future studies are needed to establish the role of catestatin in the pathogenesis of acne vulgaris.

Evaluation of recovery time of tear film function and ocular surface after discontinuing oral isotretinoin treatment for acne vulgaris : Correlation between oral isotretinoin and tear film function.

This study aimed to evaluate the recovery time of tear film function and ocular surface after discontinuing systemic isotretinoin treatment. This was a prospective, cross-sectional study. 34 eyes of 17 patients treated with low- dose oral isotretinoin (< 0.5mg/kg/day) were enrolled. The modified OSDI score, tear break-up time, Schirmer test, and corneal staining were performed in all patients at baseline, during the course of treatment and after withdrawing treatment every two weeks until the result returned to baseline. Tear breakup time appeared to be the most sensitive and changed significantly at 2weeks after starting treatment (p < 0.001) and returned to baseline at 4weeks after withdrawal from treatment (p < 0.001). The Schirmer test results significantly decreased at 6weeks and returned to baseline at 4weeks after withdrawal from treatment (p < 0.001). OSDI scores were significantly changed at 6weeks after treatment (81.8%) and returned to baseline at 2weeks (54.5%) after withdrawal from treatment. No significant change was found in the MGD. Corneal staining was significantly positive 90.9% 6weeks after starting treatment and returned to baseline 6weeks after withdrawal from treatment (p < 0.001). Dry eye disease can return to baseline levels after treatment withdrawal. At least 6weeks later, they could wear contact lenses again, and it was useful to prepare all patients requiring further ocular surgery.

Evaluation of the Incidence of Anal Fissures in Patients who Systemic Isotretinoin Therapy for Acne.

Isotretinoin is an effective drug widely used in the treatment of severe acne. In this study, we tried to evaluate the incidence of anal fissures with clinical and laboratory side effects associated with isotretinoin. The study evaluated 210 patients who received systemic isotretinoin treatment. Especially patients with constipation and anal bleeding were evaluated by the General Surgery clinic to arrange appropriate treatments. Of 210 patients included in the study, 138 (65.7%) were female and 72 (34.3%) were male, with a mean age of 23.7 years. The most common adverse event was dry lips in 206 (98.1%) patients. The mucocutaneous side effects were constipation 36 (17.1%), anal bleeding 18 (8.6%), mucosal erosion 10 (4.7%), anal fissure 7 (3.3%). Treatment was discontinued due to elevated liver function tests in 5 patients (2.3%), and because anal bleeding could not be controlled in 1 patient. Isotretinoin is the most effective acne medicine used today. Clarification of the patients about the rarely seen side effects such as dryness, erosion, fissure and bleeding in the anal mucosa in addition to the common mucocutaneous side effects will ensure that patients are more cautious and increase their tolerance to the treatment.

Isotretinoin and timing of procedural interventions: Clinical implications and practical points.

For decades, the notion that elective surgeries and cutaneous procedures should be postponed for 6-12 months in patients on, or recently administered with isotretinoin, has been widely accepted. However, some recent studies showed the need for a change in this regard. Here, we reviewed the existing data in this regard through searching on PubMed, Google Scholar, and Scopus. All of the relevant papers published in English, until October, 2022, which we could access to their full-texts, were included. We found some recommendations made by plastic surgeons, dermatologists, ENT surgeons, ophthalmologists, orthopedic surgeons, and dentists regarding the correct timing of procedural interventions in patients on, or recently administered with isotretinoin and tried to summarize them to provide a practical guide for clinicians. Physicians may discuss with patients regarding the known risk of abnormal wound healing in the setting of systemic isotretinoin treatment and suggest that, when possible, surgical procedures be postponed until the activity of the retinoids has time to subside. It is even more important regarding patients with darker skin phototypes to follow an even more strict guideline.

Skeletal Side Effects of Systemic Isotretinoin Treatment: Do They Depend on Age, Gender, Treatment Duration, Daily Dose and Isotretinoin-Naiveness?

Systemic isotretinoin is the most effective treatment modality in acne vulgaris; however, both patients and physicians hesitate to use it due its side effects. The aim of this study is to determine the prevalence of fatigue, myalgia and low back pain during systemic isotretinoin treatment; and to determine their relationship with age, gender, treatment duration, daily isotretinoin dose and isotretinoin-naiveness of the patient. This is a cross sectional study including the acne vulgaris patients, aged between 13 to 40 years, who have at least received one month of oral isotretinoin treatment. Patients were questioned for side effects during their follow-up visits; a physical therapy and rehabilitation specialist further evaluated patients complaining of low back pain. Fatigue was reported by 4.4% of the patients, myalgia by 2.8% and low back pain by 25% of the patients; 2.2% had inflammatory and 22.8% had mechanical low back pain. None of the patients had sacroiliitis. All the side effects that were examined were found to be independent of age, gender, isotretinoin dosage (mg/kg/day), treatment duration and isotretinoin-naiveness. The side effects are not as common as feared; thus, patients and physicians should not hesitate to use systemic isotretinoin in indicated cases.

Isotretinoin treatment upregulates the expression of p53 in the skin and sebaceous glands of patients with acne vulgaris

The transcriptomic regulation induced by isotretinoin (13-cis retinoic acid) is still a matter of debate as short-term exposures of immortalized sebocytes with isotretinoin produced conflicting results. Based on translational evidence, it has been hypothesized that oral isotretinoin treatment upregulates the expression of the transcription factor p53. Twenty-five patients suffering from acne vulgaris were treated with isotretinoin (0.6 mg/kg body weight) for 6 weeks. Biopsies from back skin were taken before and after isotretinoin treatment for the determination of p53 expression by immunohistochemical staining, quantification of p53 protein concentration by enzyme-linked immunosorbent assay and TP53 gene expression by quantitative reverse transcription real time PCR. Fifteen socio-demographically cross-matched healthy volunteers served as controls. Isotretinoin treatment significantly increased the nuclear expression of p53 in sebaceous glands of treated patients compared to pre-treatment levels and p53 levels of untreated controls. Furthermore, the p53 protein and gene expression significantly increased in the skin after treatment. The magnitude of p53 expression showed an inverse correlation to acne severity score and body mass index. Under clinical conditions, isotretinoin induced the expression of p53, which controls multiple transcription factors involved in the pathogenesis of acne vulgaris including FoxO1, androgen receptor and critical genes involved in the induction of autophagy and apoptosis. Increased p53-FoxO1 signalling enhanced by systemic isotretinoin treatment explains the underlying transcriptomic changes causing sebum suppression but also the adverse effects associated with systemic isotretinoin therapy.

Analysis of corneal topographic and densitometric properties in patients receiving systemic isotretinoin therapy

Purpose To evaluate dry eye parameters, corneal topographic features, corneal densitometric changes, and anterior segment parameters in patients receiving systemic isotretinoin treatment. Methods This prospective cross-sectional study included 66 eyes of 33 patients who were started on oral isotretinoin therapy for severe acne vulgaris. All patients were evaluated in terms of ocular surface tests such as tear break-up time (TBUT) and Schirmer-1 and were asked to fill in the ocular surface disease index (OSDI) questionnaire. Corneal densitometric and topographic measurements were obtained using the Scheimpflug imaging system. Results The mean age of the patients was 19.9 ± 1.6 years, and 21 (63.6%) of the participants were female. The mean OSDI score was significantly higher in the third month than before treatment (20.05 ± 19.38, vs. 26.96 ± 22.94, p = 0.00, respectively). The mean values of the TBUT test were significantly lower in the third month than before treatment (9.06 ± 4.40 sec, vs. 10.71 ± 4.61 sec, p = 0.02, respectively). Mean scores of the Schirmer 1 test showed no statistically significant difference between before treatment and the third month (16.08 ± 8.40 mm, vs. 16.08 ± 8.50 mm, p = 1, respectively). There was no statistically significant difference between before treatment and the third month in the majority of the densitometry measurements in concentric zones. However, the difference tended to be significant between the groups concerning posterior zone 0–2 mm (11.01 ± 0.85 GSU vs. 10.62 ± 0.89 GSU, p = 0.006). The RMS LOAs (front), RMS Total (Total), RMS LOAs Total (Total), RMS HOAs Total (Total), K max, CCT, and CoV values were significantly higher in the third month than before treatment (p < 0.05 for all). Conclusions The dermatology specialists should be aware of the ocular complications of systemic isotretinoin therapy. Therefore, a complete ophthalmologic examination for the prompt apprehension and management of ocular involvement is essential in patients under isotretinoin therapy to increase ocular comfort and adherence to the therapy.

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.

Evaluation of peripheral lymphocyte subsets in acne vulgaris patients before and after systemic isotretinoin treatment.

Isotretinoin (ISO) is a retinoic acid-derived molecule which is very efficient in the treatment of acne vulgaris (AV). Little is known regarding alterating affects of systemic ISO on immune system. Thirty-two patients with moderate and severe AV with indications for systemic ISO treatment were recruited. The evaluation of peripheral blood lymphocyte subsets was made on treatment initiation and at the end of the therapy by flow cytometry. CD16/56+ natural killer (NK) cell levels were higher in patients with severe acne compared to moderate acne (P = 0.009). CD45RA+ (naive) cell levels decreased significantly after systemic ISO treatment; the mean percentage was 66.9 ± 6.5 which decreased to 63.9 ± 7.5 after treatment (P = 0.013). CD19+ cell levels were also significantly increased; mean percentage (%) and absolute cell counts were 8.0 ± 3.1 and 161.3 ± 7.36 cells/μl which increased to 10 ± 2.7 and 227.7 ± 108.7 cells/μl, at the end of treatment, respectively (P = 0.007, P = 0.011). NK cell count may be a parameter related to acne severity. Systemic ISO may have an inhibitory effect on naïve T cells. Finally, systemic ISO seems to stimulate mature B-cell proliferation.

The effects of the systemic isotretinoin treatment on ocular surface and meibomian glands: a prospective longitudinal study

Purpose To assess the effects of systemic isotretinoin therapy (SIT) on the ocular surface, meibomian glands (MG) and cornea microstructure in acne vulgaris (AV) patients. Methods Patients with AV (n = 20) and healthy controls (n = 20) were enrolled in the study. All participants underwent ocular surface tests in the order of ocular surface disease index (OSDI) questionnaire, corneal sensitivity, tear break-up time (BUT), fluorescein and lissamine green (LG) staining and Schirmer II test with anaesthesia. MG alterations were evaluated with meibography for upper (UE) and lower eyelids (LE) separately. Corneal basal epithelium and subbasal nerve plexus (SNP) were evaluated using In Vivo Confocal Microscopy (IVCM). Results Schirmer II test with anaesthesia, BUT, corneal sensitivity, fluorescein and LG staining grades and OSDI score results showed no difference between the control group and the baseline of the patient group. Whereas the meibomian gland dysfunction (MGD) grades, UE and LE meiboscores were higher in the patient group at the baseline (p = 0.013, p = 0.004, p = 0.008 respectively). The Control group possessed higher numbers of total and long nerve fibres compared with patients at the baseline (p ≤ 0.001 for both two values). Compared to the baseline and the third month, BUT decreased and fluorescein staining grades increased (p = 0.017 and p = 0.043, respectively). MGD grades, UE and LE meiboscores increased in the third month compared to the baseline (p < 0.001, p < 0.001, p = 0.008 respectively). Basal epithelial cell density (BECD) decreased in the third month of SIT (p = 0.043). Conclusions This prospective study showed that systemic Isotretinoin treatment effects not only ocular surface parameters but also corneal and Meibomian glands structure. Considering early alterations in the course of treatment, ophthalmological assessment and follow-up during SIT are mandatory.

Ocular manifestations of systemic isotretinoin in patients with acne: a systemic review and meta-analysis

Purpose To examine the effects of systemic isotretinoin treatment on the eye using several ocular examination parameters. Methods We conducted a systemic review for literature published up to June 2021 in both PubMed and Web of Science databases. We included prospective observational or interventional studies evaluating ocular manifestations of isotretinoin in acne patients. The primary outcome measures were anaesthetized and non-anaesthetized Schirmer test, tear break-up time (TBUT), central corneal thickness (CCT), average retinal nerve fibre layer (RNFL) thickness, ganglion cell-inner plexiform layer (GC-IP) thickness, subfoveal choroidal thickness, axial length, ocular surface disease index (OSDI), meibomian gland expression (MGE) and conjunctival stain. The National Institute of Health (NIH) quality assessment tools were used to assess the data quality. The effect size used to analyse the included studies was the weighted mean difference (WMD) and its related confidence intervals (95%CIs). Results Twenty-one publications involving 1105 eyes of 842 participants met the inclusion criteria. Isotretinoin use was significantly associated with reduction in the scores of anaesthetized Schirmer (WMD = –2.23, 95%CI: −3.28 to −1.18), non-anaesthetized Schirmer (WMD = –3.74, 95%CI: −4.23 to −3.25), TBUT (WMD = –3.47, 95%CI: −5.09 to −1.86), and CCT (WMD= −7.39, 95%CI: −13.91 to −0.88). Isotretinoin use was significantly associated with increase of OSDI (WMD = 18.29, 95%CI: 7.54–29.03), MGE (WMD = 1.02, 95%CI: 0.70–1.33) and conjunctival stain scores (WMD = 0.61, 95%CI: 0.47–0.76). No significant change was noted in RNFL thickness (WMD = −0.64, 95%CI: −1.80 to 0.51); GC-IP thickness (WMD = 0.42, 95%CI: −1.08 to 1.92); subfoveal choroidal thickness (WMD = –1.80, 95%CI: −6.69 to 3.09), and axial length (WMD = 0.08, 95%CI: −0.19 to 0.35). A significant heterogeneity was found between the study estimates in each of anaesthetized Schirmer, TBUT, MGE, OSDI, and conjunctival stain tests. Conclusion Isotretinoin use results in a statistically significant reduction of the central corneal thickness, TBUT, and Schirmer test scores. A statistically significant increase in MGE, OSDI and conjunctival stain scores was found. No statistically significant change of average RNFL, GC-IP thickness, subfoveal choroidal thickness, or axial length was observed. Further well-designed studies should evaluate the long-term effect of isotretinoin on the eye and reach a firmer conclusion.

Akne Vulgaris Hastalarında Tedavinin Hematolojik Parametreler Üzerine Etkisi

Acne vulgaris is a multifactorial disease of the pilosebaceous unit. Various immunological and inflammatory factors play a role with different pathophysiological mechanisms in the development of acne vulgaris by increasing sebum production. The aim of this study was to reveal the changes in CBC sub-parameters and calculated parameters before and after acne vulgaris treatment and to enable these parameters to be used as non-invasive, low-cost, effective new laboratory tests in the evaluation of treatment efficacy. A total of 162 patients (109 females, 67.3%; 53 males, 32.7%) were included in this study. In this study, it was found that NEU, MPV, P-LCR, and PDW levels decreased significantly after treatment (p&amp;lt;0.001). There was a significant decrease in NLR and PLR values (p&amp;lt;0.001). LYM and PLT count increased significantly after the treatment (p&amp;lt;0.001). CBC parameters such as NLR, PLR, and P-LCR can be used to evaluate the efficacy of systemic isotretinoin treatment in patients with acne vulgaris.

Evaluation of musculoskeletal adverse effects in patients on systemic isotretinoin treatment: A cross-sectional study.

Objectives This study aims to investigate the frequency of musculoskeletal adverse effects in acne vulgaris patients receiving systemic isotretinoin treatment.Patients and methods Between January 2016 and December 2017, a total of 200 severe acne patients (22 males, 178 females; mean age: 21.8±0.4 years; range, 15 to 53 years) who were on isotretinoin treatment were retrospectively analyzed. Data including age, sex, body mass index (BMI), duration of disease, diagnosis, and comorbidities were recorded. Back pain severity was evaluated with the Visual Analog Scale (VAS).Results The treatment period was mean 8.5±0.1 (range, 6 to 12) months. The dose of isotretinoin was mean 0.6±0.1 (range, 0.5 and 1) mg/kg. Musculoskeletal side effects were seen in 99 (49.5%) patients. Back pain was reported during the treatment period in 78 (78.7%) patients. The diagnosis was mechanical back pain in 31 (39.7%) and inflammatory back pain in 47 (60.3%) patients. The moderate-severe back pain group received higher cumulative isotretinoin doses than the mild back pain group (p=0.003). The BMI values did not show a significant difference between the patients with and without back pain (p=0.55). There was no significant correlation between the BMI and VAS scores (p=0.06). The VAS scores were found to be correlated with age (p=0.04). Sacroiliitis was diagnosed in four (4%) patients. One (1%) patient was diagnosed with enthesitis. Creatine kinase elevation was reported in 18 (18.1%) patients, while three (3%) patients described myalgia of mild severity.Conclusion Low back pain is one of the most common musculoskeletal side effects of isotretinoin treatment that usually resolves with dose reduction. The cumulative dose of isotretinoin does not seem to play a role in the development of back pain, but can determine pain severity. Pain severity is directly correlated with the increasing age. Evaluation of the patients for musculoskeletal side effects during isotretinoin use is important in clinical practice, as it is a common occurrence.

Sistemik İsotretinoin Tedavisi Alan Akne Vulgaris Hastalarında Nötrofil- Lenfosit Oranı ve C-Reaktif Protein Düzeyleri

Introduction and Aim: Inflammatory mediators have importance in acne vulgaris pathogenesis. Which mediators cause lesions or increase with which variants is not clear. Neutrophil-lymphocyte ratio and C-reactive protein are the inflammatory indicators that used for follow up of inflammatory diseases. There are various studies state that neutrophil-lymphocyte ratio and C-reactive protein levels are important for systemic isotretinoin treatment or not. Evaluation of changes in neutrophil-lymphocyte ratio and C-reactive protein levels with systemic isotretinoin treatment is the aim of this study. Material and Method: Acne vulgaris patients who are treated with systemic isotretinoin and healthy control subjects between January 2006 and December 2016 in Konya Training and Research Hospital Dermatology outpatient clinic are included to study. Neutrophil-lymphocyte ratio and C-reactive protein levels compared in each group at the beginning of treatment and at the 3rd month. Results: 50 patients (28 of women and 22 of men) who are treated with systemic isotretinoin for acne vulgaris and 50 healthy control patients (21 of women and 29 of men) included to study. Mean age of treatment group was 21 (19-23) and control group was 29,5. Neutrophil-lymphocyte ratio are not found statistically significiant in patients and control group at the begining and middle of the treatment (1,84,[3,36-0,51] – 1,62,[4,07-0,68], p:0,107), C-reactive protein levels show a statistically significiant decrease in patient group with treatment (p&amp;lt;0,028). Conclusion: Systemic isotretinoin treatment may affect neutrophil-lymphocyte ratio and C-reactive protein levels in patients. Further studies are needed to clarify this relation.

Safety of Laser Hair Removal in Patients Receiving Systemic Isotretinoin for Acne Vulgaris.

A few reports on scar and keloid formation in patients receiving systemic isotretinoin have encouraged a conservative approach in which laser procedures are delayed during and 6 to 12 months after the completion of treatment. To assess the safety of laser hair removal with alexandrite, diode, and Nd:YAG lasers in patients receiving systemic isotretinoin treatment. Fifty-two patients who underwent laser hair removal during isotretinoin treatment were retrospectively analyzed and compared with a control group for side effects. There were 48 female and 4 male patients. The average isotretinoin dose was 33.7 mg/d. The average interval between the start of isotretinoin treatment and the first laser hair removal was 39.3 days. The mean number of sessions under treatment was 4.1. Three patients had temporary crusting, and 1 patient had a small area of temporary hypopigmentation. Five (9.6%) patients in the control group had crusting. The incidence of side effects was not significantly different between the 2 groups (p > .05). Neither patients in the isotretinoin group nor those in the control group experienced blistering, pigmentation, ulceration, and scar or keloid formation. Laser hair removal is a safe procedure with alexandrite, diode, and Nd:YAG lasers in patients receiving systemic isotretinoin.

Longitudinal assessment of meibomian glands and tear film layer in systemic isotretinoin treatment.

This study aimed to analyze the changes in meibomian glands (MGs) and tear film layer over time in patients taking systemic isotretinoin treatment. Patients who received systemic isotretinoin treatment between 4 and 8 months were prospectively followed up. In addition to full ophthalmologic examination, MG dysfunction (MGD), noncontact meibography, noninvasive and invasive tear break-up time (TBUT), ocular surface disease index (OSDI), corneal staining, and eyelid margin abnormality scores were recorded before, during, and after treatment. A total of 88 eyes of 88 patients were included in the study. The right eyes of all the patients were included. The mean age of the patients was 21 ± 2.9 years. Of the 88 patients, 70 (79.6%) were females and 18 (20.4%) were males. Before the treatment, MGD, noncontact meibography, first noninvasive TBUT, mean noninvasive TBUT, invasive TBUT, OSDI, corneal staining, and eyelid margin abnormality scores were 0.29 ± 0.45, 4.93 ± 3.50, 13.78 ± 3.89 s, 14.47 ± 3.09 s, 12.96 ± 3.61 s, 0.54 ± 1.00, 0.04 ± 0.20, and 0.09 ± 0.28, respectively. Twelve months after the end of treatment, the scores were 0.97 ± 0.87 (p < 0.001), 9.62 ± 3.89 (p < 0.001), 11.24 ± 3.52 s (p < 0.001), 12.34 ± 3.02 s (p < 0.001), 11.31 ± 2.90 s (p < 0.001), 1.90 ± 2.44 (p < 0.001), 0.20 ± 0.40 (p < 0.001), and 0.56 ± 0.49 (p < 0.001), respectively. Systemic isotretinoin treatment causes morphological changes in the MGs. However, this treatment may negatively affect the tear film layer of patients. Some of these changes may persist for a long time even if the treatment is discontinued.

Evaluation of the changes in sebum, moisturization and elasticity in acne vulgaris patients receiving systemic isotretinoin treatment

Aim The aim of this study was to determine the change in facial skin sebum, hydration and elasticity of acne vulgaris patients after being treated with systemic isotretinoin. Method Patients who were diagnosed with acne vulgaris and who received systemic isotretinoin treatment for 6 months in Cerrahpaşa Medical Faculty Department of Dermatology between June 2012 and May 2017 were included in this study. The sebum, hydration and elasticity of the skin were measured non-invasively with a device called “Soft Plus Skin Analyses System” before treatment and 6 months after treatment. The relationship between the pre-treatment and post-treatment values were evaluated statistically. 35 adult patients (20 female, 15 male) who were diagnosed with acne vulgaris and who received systemic isotretinoin treatment for 6 months. Results The pre-treatment sebum value for both sexes ranged between 5 and 100 and the mean value was calculated as 75.8 28.0. The post-treatment sebum values ranged between 1 and 98 and the mean value was calculated as 48.4 31.8. The difference between the pre-treatment and post-treatment values was statistically significant, p < 0.001. The decline in sebum value after treatment was 36%. The pre-treatment hydration values ranged between 9 and 77.5 and the mean was 34.6 14.6. The post treatment hydration values ranged between 4.8 and 100 and the mean was calculated as 62.4 28.6. The difference between the pre-treatment and post-treatment hydration values were statistically significant, p < 0.001. The post-treatment increase in hydration was 79%. The pre-treatment skin elasticity ranged between 28 and 50; the mean was 40.4 5.5. The post-treatment elasticity values ranged between 20 and 50; and the mean was 37.5 8.2. However, the difference was not statistically significant (p = 0.1). Conclusion With this study, it was concluded that, systemic isotretion leads to a 36% decline in skin sebum values and a 79% increase in the skin hydration. However, the change in skin elasticity was not statistically significant. Furthermore, the changes in sebum and skin hydration did not lead to a change in skin elasticity.

An evaluation of the efficacy of a single-session 577 nm pro-yellow laser treatment in patients with postacne erythema and scarring.

Erythema and scarring are among the most common complications of severe inflammatory acne. In this study, we aimed to share our experience with pro-yellow laser and document the efficacy and safety of this treatment in postacne erythema and scarring. The study included 40 patients, 24 (60%) females, and 16 (40%) males with a mean age of 29.5 ± 8.16 (min. 18 years, max. 57 years). The pro-yellow laser was applied to all patients as a single session with irradiation of 22 J/cm2 . Improvement in postacne erythema and scars were evaluated after the treatment. The study included 40 patients, 24 patients (60%) were females and 16 patients (40%) were males with the mean age of 29.5 ± 8.16 (ranged between 18 and 57 years old). A total of 21 patients (52.5%) had good improvement (51%-75% regression), 10 patients (25%) had excellent improvement (76%-100% regression), and a moderate improvement (26%-50%) was detected in 9 patients (22.5%). Also, there were mild improvement (1%-25%) in 20 patients (76.9%) and a moderate improvement (26%-50%) in 6 patients (23.1%). We found that pro-yellow laser is highly effective in the treatment of postacne erythema, while its effectiveness was mild to moderate in atrophic acne scars. Also, it has been observed that the pro-yellow laser system can be used safely immediately after cessation of systemic isotretinoin treatment.