Treatment Of Nodulocystic Acne Research Articles

Isotretinoin: In acne and beyond – An overview

Isotretinoin (ISO) has proven to be an extremely valuable drug for all dermatologists. Since its approval in 1982 by the US Food and Drug Administration for nodulocystic acne, it still remains the gold standard drug for the above indication till date, facing no competition from its contemporaries. Along with the treatment of nodulocystic acne, ISO has proved valuable in several other dermatoses as well. Further, even for treating acne, there have been a number of modifications as far as the prescription of ISO is concerned. This review will briefly highlight the various aspects of isotretinoin for acne and other cutaneous disorders.

A prospective observational study on efficacy of black acetic acid combination peel in patients of facial nodulocystic acne

<p class="abstract"><strong>Background:</strong> Nodulocystic acne is a severe form of acne which can result in significant damage to the skin with great impact on quality of life. Oral isotretinoin is considered to be the best treatment for such cases. Although it has a high rate of success and its efficacy is well established in the treatment of nodulocystic acne, it may occasionally fail to meet expected degree of disease control. Known side-effects and long duration to achieve cumulative dose might lead to poor compliance and known contraindications sometimes as well limit its usage.</p><p class="abstract"><strong>Methods:</strong> A prospective observational studies on 20 patients who presented themselves with facial nodulocystic acne on regular OPD basis and were poorly compliant to treatment with isotretinoin owing to its side-effects, the drug failed to meet patients’ expectations or due to any contraindication to isotretenoin usage were included. A peel containing black acetic acid, jasmonic acid, salicylic acid, potassium iodide (“black peel”, Theraderm) was used topically as an alternative treatment, for a course of 3 treatment sittings 2 weeks apart.<strong></strong></p><p class="abstract"><strong>Results:</strong> Significant reduction of nodulocystic lesions was noted after 3 sittings of “black peel” 2 weeks apart. Among 20 patients 55% showed excellent response; 45% showed good response while none of the patients were non responsive. Post treatment ISGA score of 0.45 as opposed to pre-treatment score of 3.70 (p<0.0001) was observed.</p><p class="abstract"><strong>Conclusions:</strong> Black peel can be used as promising and hopeful alternative treatment for difficult to treat nodulocystic acne.</p>

Comprehensive Multiplexed Therapy for Severe Nodulocystic Acne in Puberty

Nodulocystic acne (NCA) usually develops subcutaneous epidermal cyst, granuloma, subcutaneous abscess, hypertrophic scar, keloids, and draining sinus. The pathogenesis of NCA is still unclear. Similar to NCA, acne conglobata (AC) is found in men predominantly with oily skin [1]. Lesions of AC begin in early puberty and culminate in late adolescent [1]. AC is one of the most therapy-resistant diseases which do not respond to usual treatments for acne vulgaris. In Europe and USA, isotretinoin has been used for the treatment for NCA and AC [2]. However, it is unavailable to use in Japan. Therefore, treatment for NCA in Japan is very difficult. Two cases with NCA have been treated with comprehensive therapy with incision, oral and topical antimicrobials, oral tranilast, topical benzoyl peroxide (BPO) and skin care.

The efficacy of oral isotretinoin versus cyproterone compound in female patients with acne and the triad of cutaneous hyperandrogenism: A randomized clinical trial.

Background:SAHA (Seborrhea, Acne, Hirsutism and Androgenetic Alopecia) syndrome is a dermatologic disorder, with variant response to treatment. Triad of cutaneous hyperandrogenism included nodulocystic or severe acne, female pattern hair loss and hirsutism.Aim:The aim of this study is to compare the effectiveness of isotretinoin and cyproterone compound in the treatment of nodulocystic acne, in patients with SAHA syndrome or triad of cutaneous hyperandrogenism.Materials and Methods:30 female patients with SAHA syndrome were divided randomly into two groups. Group A was treated with cyproterone compound from day 5 of menstrual cycle onwards for 3 weeks and a week without it and group B received isotretinoin, with a dose of 0.75 mg/kg per day from the beginning of menses onwards for 4 months. The results were evaluated by a blind dermatologist using Acne Severity Index (ASI) score at baseline and monthly for 4 months.Results:Despite a continuous reduction in ASI score in both the groups, according to both physician (P = 0.63) and patient (P = 0.25) assessment, cyproterone compound was not statistically more effective than conventional treatment of nodulocystic acne at the end of the study. Side-effects were reported in patients in both groups, generally being mild and tolerable except in two subjects.Conclusion:This study indicates that cyproterone compound is not superior to isotretinoin in the treatment of nodulocystic acne in patient with SAHA syndrome or triad of cutaneous hyperandrogenism. Indeed, other studies are needed to evaluate the effect of cyproterone compound (regardless of androgen level) and isotretinoin in subjects with only nodulocystic acne.

Isotretinoin treatment in nodulocystic acne with and without polycystic ovary syndrome: efficacy and determinants of relapse

Isotretinoin is the most efficacious long-lasting treatment for acne; however, some factors, including polycystic ovary syndrome (PCOS), patient age, family history, and type and number of acne lesions, may lead to treatment resistance or relapse following treatment. The aim of this study was to compare the efficacy and permanence of systemic isotretinoin (SI) in nodulocystic acne patients with and without PCOS and to evaluate the factors associated with relapse during the first and second post-treatment years. The study included 96 female patients with nodulocystic acne. SI 0.5-1 mg/kg/dl was given, with a total cumulative dose of 120-150 mg/kg. Response to treatment and relapse during the first and second post-treatment years were evaluated. In all, the 50 non-PCOS and 46 PCOS acne patients were similar. SI was similarly efficacious in both groups. In total, eight patients relapsed during the first post-treatment year, versus 16 during the second. Relapse during the first year was associated with the number of nodules at the start of treatment and the number of papulopustular lesions at the end of treatment, whereas PCOS, patient age, and the number of nodules at the start of treatment were associated relapse during the second year. Regardless of its association with PCOS, SI was effective in the treatment of nodulocystic acne. The factors associated with relapse during the 1(st) and 2(nd) post-treatment years differed, except for the number of nodules at the start of treatment.

Dapsone 5% Gel

Dapsone, a synthetic sulfone that has been available for over 60 years, has been used to treat a myriad of cutaneous disorders. Prior to the general acceptance of isotretinoin, oral dapsone had been reported to be effective in the treatment of nodulocystic acne. However, the potential for systemic toxicity prevented its widespread adoption in the treatment of acne. For many years scientists explored the possibility of developing a topical formulation of dapsone for the treatment of acne in the hope of minimizing the adverse hematologic effects of oral dapsone. Such a formulation had been unavailable until recently. Dapsone 5% gel (Aczone) was recently developed to treat acne vulgaris. This topical formulation was approved in the US based on two randomized, vehicle-controlled studies. A 12-month, open-label study was also conducted to assess the safety and efficacy of topical dapsone over the long term. Finally, two open-label phase I pharmacokinetic studies were conducted to evaluate the systemic absorption of topical dapsone compared with oral dapsone. This article reports the results of these studies, which show a reduction in acne lesion count comparable to those observed in clinical trials of other approved topical acne therapies. With regard to safety, the studies demonstrated that the concentrations of dapsone and N-acetyl dapsone remain low and do not accumulate over time once steady state is reached. Of the total of 50 patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency in all the studies, only two experienced a drop in hemoglobin levels, and those shifts in values were consistent with fluctuations observed for other study participants. A recent study evaluating the risk of hemolysis in patients with G6PD deficiency found topical dapsone 5% gel to be safe to use in this patient population. Based on the observations noted in the above-mentioned studies, we conclude that topical dapsone 5% gel is safe and effective in the treatment of acne vulgaris.

Intralesional Corticosteroids in the Treatment of Nodulocystic Acne

We evaluated the effectiveness of intralesional injections of corticosteroids in the therapy for nodulocystic acne. Triamcinolone acetonide at a concentration of 0.63 mg/mL was as efficacious as a higher concentration of 2.5 mg/mL. Betamethasone phosphate had little, if any, effect on nodulocystic acne lesions at concentrations of 3.0, 1.5, and 0.75 mg/mL, when compared with saline controls.

Intralesional corticosteroids in the treatment of nodulocystic acne

Intralesional corticosteroids in the treatment of nodulocystic acne