Treatment Of Severe Acne Vulgaris Research Articles

EVALUATION OF THE THERAPEUTIC SUPPORT EFFECTS OF LIGHT THERAPY FOR PATIENTS WITH SEVERE ACNE VULGARIS

Objective: To evaluate the treatment results of combined blue light (415 nm wavelength) and red light (633 nm wavelength) therapy for patients with severe acne vulgaris. Subjects and methods: A pre-post comparative interventional study on 30 patients with severe acne vulgaris, examined and treated at the Central Dermatology Hospital from July 2022 to June, 2023. Results: The female-to-male patient ratio was approximately 2.3/1. Patients aged 16-25 accounted for 70.8%, and 46.7% had family members with acne. Clinically, 100% of patients had facial lesions (with 97.8% of lesions in the cheek area). The number of inflammatory and non-inflammatory lesions gradually decreased from week four to week 12 of treatment. The differences between treatment weeks and pre-treatment were statistically significant, with p < 0.05. Good and very good treatment results increased for both genders after four, eight, and 12 weeks of the treatment, with statistically significant changes (p1-2 < 0.05 and p3-1 < 0.05). Dry lips remained a common unwanted effect at the end of treatment (60.0%). Conclusions: Treatment of severe acne vulgaris with isotretinoin combined with blue light and red light had a good treatment effect after 12 weeks of treatment.

ACNE AND INSULIN RESISTANCE: A SYSTEMATIC REVIEW

Acne is a skin disorder that is characterized by persistent inflammation and involves the folliculopilosebaceous unit. It has an impact on a sizeable portion of the general population. Acne affects a disproportionate number of females and teenagers, especially those between the ages of 15 and 24, who are most susceptible to the condition. In recent times, there has been seen to be a growing interest in the possible connection between acne and insulin resistance (IR). This attention has been seen, and it is appreciated. It would appear that IR has a strong connection to acne, which is a persistent skin condition that can lead to inflammation. Research has been conducted on a wide variety of etiopathological factors that have been associated with the progression of IR. It would appear that obesity is one of the most common. Additionally, it would appear that factors such as chronic inflammation, hypertriglyceridemia, low HDL serum concentration, mitochondrial dysfunction, gut microbiota, and the excess activity of antagonistic hormones such as cortisol, glucagon, and thyroid hormones all play a significant role in the development of this condition. We identified a linkage between insulin resistance and severe acne vulgaris, which was reported to have a positive link with insulin resistance. On the basis of these findings, it is a legitimate assumption to hypothesize that medications that are now utilized for the treatment of insulin resistance would also be helpful for the treatment of severe acne vulgaris.

PA06 Impact of clinical pharmacist-led isotretinoin management and acne care education at a multispecialty clinic

Abstract Isotretinoin, an oral retinoid derived from vitamin A, is one of the most effective medications in the treatment of severe acne vulgaris. However, it carries serious risks due to the teratogenic nature of the drug. The iPledge national programme in the USA has been founded to reduce and prevent adverse isotretinoin reactions and complications by ensuring its safe use by patients. Owing to the strict monitoring parameters of isotretinoin, an increased workload is placed on prescribing physicians for accurate and timely iPledge authorization, comprehensive counselling, laboratory testing and many patient follow-up visits. The most commonly reported reasons for delay were iPledge-related, including issues navigating the iPledge website, missed pick-up windows, and missed or delayed doctor appointments or laboratory tests. To remedy the difficulties with isotretinoin monitoring, physicians can look to clinical pharmacists as a valuable asset to their practice. Because clinical pharmacists are well trained in isotretinoin dispensing and iPledge regulation and consultation, they can play a crucial role in the management and education of patients with severe acne vulgaris. This retrospective, longitudinal case study takes place at a multispeciality clinic with internal medicine, rheumatology and dermatology. At this multispecialty clinic, a clinical pharmacist will be integrated into the practice with complete patient appointments and isotretinoin follow-ups under the training and direction of a dermatological specialist. The initial evaluation, diagnosis and prescribing of isotretinoin will be completed by the physician. The clinical pharmacist will follow-up the patients in subsequent visits in conjunction with the physician. The study population is approximately 50 patients with existing diagnoses of severe acne vulgaris. The inclusion criteria will include patients with acne who complete a clinical pharmacist visit for isotretinoin acne treatment from September 2022 to March 2023. At each follow-up clinical pharmacist visit, patients receive management and counselling on medications, a review of laboratory values, iPledge verification, and monitoring of symptoms and quality of life. Primary outcomes are patient symptoms and quality of life, acne grade and severity and side-effects; secondary outcomes are navigation of the iPledge website, number of misses in pick-up windows and doctor appointment adherence. The preliminary results showed significant improvement in primary and secondary outcomes. Patient acne grade decreased, while satisfaction increased; there was also a decreased risk of missed pick-up windows and improved doctor appointment adherence compared with the national standard. In addition, a clinical pharmacist-led iPledge programme can substantially reduce the time required for administrative work on managing isotretinoin while maintaining the same quality of care for patients with severe acne.

A Young Patient Presenting with Dilated Cardiomyopathy and Renal Infarction during Treatment with Isotretinoin: Mere Coincidence or Serious Side Effect of a Drug Commonly Used in Adolescence?

Isotretinoin or 13-cis-retinoic acid (RA) is one of the most effective and widely used drugs for the treatment of severe acne vulgaris. Despite being deemed safe, no definite consensus has been reached on the cardiovascular risk of RA derivatives. We report a case of heart failure due to dilated cardiomyopathy (DCM) and concomitant renal infarction occurring after 5 months of isotretinoin use in a previously healthy 18-year-old male. The patient, with a history of acne vulgaris, presented to our emergency department with left iliac fossa pain and effort dyspnea. A trans-thoracic echocardiogram showed DCM and severely reduced left ventricle ejection fraction (LVEF: 29%). During hospitalization, a total body computed tomography (CT) showed an ischemic lesion in the left kidney. Ischemic, autoimmune, infective, and heritable causes of DCM were ruled out. Cardiac magnetic resonance (CMR) evidenced LV circumferential mid-wall late gadolinium enhancement. Heart failure therapy was promptly started and up-titrated, but only poor LVEF improvement was detected overtime. Our case aims to raise awareness on rare life-threatening cardiovascular events possibly associated with isotretinoin use. To the best of our knowledge, this is the first described case of renal thromboembolism and severe DCM leading to implantable cardioverter-defibrillator (ICD) implantation occurring during isotretinoin treatment.

Abstract 15052: A Young Patient Who Presented With Dilated Cardiomyopathy and Renal Infarction During Treatment With Isotretinoin

Background: Isotretinoin or 13-cis-retinoic acid (RA) is one of the most effective and widely used drug for the treatment of severe acne vulgaris. Despite deemed safe, no definite consensus has been reached on the cardiovascular risk of RA derivatives. We describe the first case of concomitant dilated cardiomyopathy (DCM) and renal infarction after 5 months of isotretinoin use in a previously healthy 18-years old man. Case Summary: An18-years-old man, with history of acne vulgaris, presented in August 2021 to our emergency department because of left iliac fossa pain and effort dyspnea. Computed tomography scan revealed left renal infarction and echocardiogram demonstrated global left ventricular (LV) dilatation with severely reduced LV-ejection fraction (LVEF: 29%). Coronary artery disease, autoimmune, infective, or heritable causes of DCM were ruled out. Cardiac magnetic resonance evidenced LV circumferential mid-wall late gadolinium enhancement and ECG monitoring revealed several non-sustained ventricular tachycardia episodes. Thus, Bisoprolol, Sacubitril/Valsartan, and Eplerenone were started and up titrated until maximum tolerated doses, with only poor LVEF improvement. Conclusion: Our case aims to raise awareness on rare life-threatening cardiovascular events associated with isotretinoin use for the treatment of severe acne in young patients. To the best of our knowledge, this is the first described case of renal thromboembolism and DCM requiring S-ICD implantation and cardiac transplant program listing occurring in the course of isotretinoin treatment.

A feasibility study for a triple-blind randomized controlled trial investigating the effects of oral isotretinoin on mood and quality of life in patients with acne vulgaris.

Isotretinoin is used in the treatment of severe acne vulgaris (AV), but has controversially been associated with depression and suicide. Large prospective studies have failed to translate this clinically. We undertook a feasibility study to investigate the parameters of a triple-blind, randomized controlled trial (RCT) assessing the effect of oral isotretinoin on quality of life (QoL) and mood in patients with AV. Patients meeting the inclusion criteria were randomized for 2weeks to isotretinoin or doxycycline. Participants completed verified depression and QoL screening questionnaires at baseline and week 2. In total, 194 patients with AV were screened, with 48 meeting the inclusion criteria and 13 of these being willing to participate. The follow-up rate was 92% and questionnaire response rate was 96%. To our knowledge, this is the first study to demonstrate a successful design for a triple-blind RCT investigating the effects of isotretinoin on mood in patients with AV.

Combination of adapalene-benzoyl peroxide and oral doxycycline is efficacious in short-term therapy: Maintenance with adapalene-benzoyl peroxide prevents relapse in treatment of severe acne vulgaris

Combination of adapalene-benzoyl peroxide and oral doxycycline is efficacious in short-term therapy: Maintenance with adapalene-benzoyl peroxide prevents relapse in treatment of severe acne vulgaris

Adapalene 0.1%/benzoyl peroxide 2.5% gel with doxycycline hyclate 100 mg tablets compared to vehicle gel with doxycycline hyclate 100 mg tablets in the treatment of severe acne vulgaris

Adapalene 0.1%/benzoyl peroxide 2.5% gel with doxycycline hyclate 100 mg tablets compared to vehicle gel with doxycycline hyclate 100 mg tablets in the treatment of severe acne vulgaris

Topical ALA PDT for the treatment of severe acne vulgaris

To evaluate the effectiveness of topical 5-aminolevulinic acid (ALA)-medicated photodynamic therapy (PDT) for the treatment of severe acne vulgaris. A total of 78 Chinese patients with Grade 4 severe facial acne were treated with 1-3 courses of ALA PDT. ALA cream (10%) was applied topically to acne lesions for 3 h. The lesions were irradiated by a LED light of 633 nm at dose levels of 50-70 J/cm(2) at 66 mW/cm(2). Clinical assessment was conducted before and after treatment up to 6 months. 22% of patients showed excellent improvement after one-course treatment and another 34% showed excellent improvement after two-course. The rest (44%) required three-course treatment to further reduce the number and size of residual lesions. Adverse effects were minimal. The symptoms and signs in recurrent cases (14%) were much milder and responded well to conventional topical medication. ALA PDT is a simple, safe and effective therapeutic option for the treatment of severe acne. Further studies to fully understand its mechanisms and optimize its effectiveness are needed.

Type I collagen N-telopeptide variation in adolescents receiving oral isotretinoin for severe acne.

The prolonged use of retinoids has been reported to be associated with changes of bone biochemical markers and toxic skeletal effects. Among collagen markers, type I collagen N-telopeptide (NTx) is present in all tissues that contain type I collagen, mostly in bone and in cutaneous tissue. It is a reliable indicator of bone resorption in metabolic bone disease, but has not previously been investigated in dermatological diseases during retinoid therapy. Isotretinoin, a synthetic 13-cis-retinoic acid, is highly effective in the treatment of severe acne vulgaris. We evaluated the effect of low-dose short-term oral isotretinoin treatment on bone remodeling markers in 10 adolescents (mean age 17.8 years) affected by severe acne. We measured urinary NTx as a marker of bone resorption, alkaline phosphatase (ALP) and osteocalcin (OC) as markers of bone formation, parathyroid hormone (PTH) and metabolites of vitamin D (25OH-D3 and 1,25(OH)2D3). Clinical and laboratory tests were performed before and after three months of isotretinoin treatment at the dosage of 0.5 mg/kg/day. All patients showed a good clinical response to the treatment (7/10 marked improvement, 3/10 mild improvement). No changes were detected in serum PTH, 25OH-D3, 1,25(OH)2D3, OC and ALP, while urinary NTx concentrations were significantly reduced (p < 0.05). In conclusion, the lack of change in PTH, OC, ALP and vitamin D metabolites and the absence of increase of NTx suggest no bone effect of the isotretinoin treatment. The decrease of urinary NTx could be due to the effect of isotretinoin on the cutaneous component of type I collagen. Severe acne in the active inflammatory phase could change the levels of this marker. Thus, short-term low-dose oral isotretinoin is an effective and safe treatment for severe acne.

Failure of Colchicine in the Treatment of Severe Acne Vulgaris

Failure of Colchicine in the Treatment of Severe Acne Vulgaris

Effects of Isotretinoin on Bone Mineralization During Routine Therapy With Isotretinoin for Acne Vulgaris

To examine the effects of isotretinoin on bone mineralization and other markers of calcium homeostasis in individuals receiving isotretinoin for routine therapy for severe acne vulgaris. Cohort study. An academic medical center. Twenty individuals receiving isotretinoin for severe acne vulgaris. None. The primary outcome was the change in bone mineralization as measured by dual-energy x-ray absorptiometry of the lumbar spine and hip before and after isotretinoin therapy. Additional measurements included serum osteocalcin, calcium, 25-dihydroxyvitamin D, 1,25-dihydroxyvitamin D, and intact parathyroid hormone and urine hydroxyproline or calcium. No changes were noted in bone mineralization of the lumbar spine or hip. Furthermore, no alterations were noted in serum measurements of osteocalcin, calcium, 25-dihydroxyvitamin D, intact parathyroid hormone, or urine measurements of hydroxyproline or calcium. A statistically significant change was noted in 1,25-dihydroxyvitamin D when serum from before and after isotretinoin therapy was compared. The use of isotretinoin for 20 weeks for the treatment of severe acne vulgaris does not appear to have any substantial adverse effect on bone mineralization.