Combination of isotretinoin and doxycycline as alternate day regimen for the treatment of nodulocystic acne

Dr. Irfan Ullah, Mohammad Majid Paracha, Mehran khan, Aysha Saliha, Dawood Khan


Background  Oral isotretinoin is used in the treatment of nodulocystic acne with standard dose of 0.5-1mg/kg/day. It is used mostly in mild to moderate papulopustular acne, but the combination of isotretinoin and doxycycline has never been tried before due to the adverse effect on the same day. In this study we administered the combination of isotretinoin and doxycycline on alternate days for the treatment of severe nodulocystic acne.


Objective To determine the efficacy of isotretinoin plus doxycycline, an alternate day regimen, for the treatment of nodulocystic acne and to assess its possible side effects.


Methods A prospective observational study was conducted in Dermatology department MTI Khyber Teaching Hospital; Peshawar, Pakistan. Study was conducted from September 2019 till February 2020. All the patients who came to the outpatient department of dermatology unit for treatment of their severe nodulocystic acne were included in the study. A total of thirty patients were included in the study. The administered dose on alternative days of isotretinoin was 20mg and doxycycline was 200mg in two divided doses. Each patient was advised to do baseline complete blood counts, lipid profile, liver function tests and fundoscopy. These investigations were then repeated on followup. Data was analyzed through SPSS version 20.


Results At the end of the first 6 months of this study, two female patients were missing. The results were divided into complete clearance and partial clearance, based on complete resolution of acne with non visible acne lesions and some isolated lesions, respectively. At the end of initial 03 months therapy, 24 patients (85.71%) were found with complete clearance of lesions. At the end of 5th month of therapy remaining 3 patients (10.71%) showed complete clearance from acne lesions. 01 patient (3.51%) did not give complete response to the therapy at the end of the 6th month, as poor compliance to the recommended medications was an obvious reason.  No significant side effects were noted. P value of <0.05 was considered significant.


Conclusion Isotretinoin combined with doxycycline on alternate day is considered a much efficacious as well as safe treatment modality in treatment of severe and resistant nodulocystic acne and also is very cost effective.


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Isotretinoin, Doxycycline, alternate day regimen, nodulocystic acne, resistant acne, complete and partial clearance, papilledema, intracranial hypertension

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