Combination of isotretinoin and doxycycline as alternate day regimen for the treatment of nodulocystic acne
Keywords:
Isotretinoin, Doxycycline, alternate day regimen, nodulocystic acne, resistant acne, complete and partial clearance, papilledema, intracranial hypertensionAbstract
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.  XMultiCopyPasteTime to upgrade, it’s free!Simply click on the top left of the extension and register to get access to 10 shortcuts. Your email will remain secure, but we might get in touch for your feedback! XMultiCopyPasteTime to upgrade, it’s free!Simply click on the top left of the extension and register to get access to 10 shortcuts. Your email will remain secure, but we might get in touch for your feedback!References
Simpson NB, Cunliffe WJ. Disorders of the sebaceous glands. In: Burns T, Breathnach S, Cox N, Griffiths C, editors. Rook's Text book of Dermatology. 7th ed. Vol. 43. Blackwell Science; 2004. pp. 43.1–43.75.
Gollnick HP, Zouboulis CC, Akamatsu H, Kurokawa I, Schulte A. Pathogenesis and pathognesis-related treatment of acne. J Dermatol 1991; 18: 489–99.
Leyden JJ. New understanding of the pathogenesis of acne. J Am Acad Dermatol. 1995; 32: 515–25.
Plewig G, Kligman AM. Acne and Rosacea. 3rd ed. New York: Springer-Verlag; 2000.
Cunliffe WJ, Gollnick HP. Acne: Diagnosis and management. 1st ed. London: Martin Dunitz Ltd; 2001.
Mernadier J, Alirezai M. Systemic antibiotics for acne. Dermatology 1998; 196: 135-9.
Shapiro LE, Knowles SR, Shear NH. Comparative safety of tetracycline, minocycline, and doxycycline. Arch Dermatol 1997; 133: 1224–30.
Eady EA. Bacterial resistance in acne. Dermatology 1998; 196: 59–66.
Katsamba A, Dessinioti C. New and emerging treatments in dermatology: Acne. Dermatol Ther 2008; 21: 86–95.
Del Rosso JQ. Recently approved systemic therapies for acne vulgaris and rosacea. Cutis 2007; 80: 113–20.
Smith EV, Grindlay DJ, Williams HC. What's new in acne? an analysis of systematic reviews published in 2009-2010. Clin Exp Dermatol 2011; 36(2): 119-122.
Crockett SD, Porter CQ, Martin CF, Sandler RS, Kappelman MD. Isotretinoin use and the risk of inflammatory bowel disease: a case-control study. Am J Gastroenterol 2010; 105(9): 1986-1993.
Titus S, Hodge J. Diagnosis and treatment of acne. Am Fam Physician 2012;86(8): 734-740.
Rigopoulos D, Larios G, Katsambas AD. The role of isotretinoin in acne therapy: why not as first-line therapy? facts and controversies. Clin Dermatol 2010; 28(1): 24-30. 10.1016/j.clindermatol.2009.03.005
Layton AM, Knaggs H, Taylor J, Cunliffe WJ. Isotretinoin for acne vulgaris - 10 years later: A safe and successful treatment. Br J Dermatol 1993; 129: 292-6.
Leyden JJ. The role of isotretinoin in the treatment of acne: personal observations. J Am Acad Dermatol 1998; 39:45–8.
Driscoll MS, Rothe MJ, Abrahamian L, Grant-Kels JM. Long-term oral antibiotics for acne: is laboratory monitoring necessary? J Am Acad Dermatol. 1993; 28: 595–602.
Gilchrist T.C. A bacteriological and microscopical study of over 300 vesicular and pustular lesions of the skin, with a research upon the etiology of acne vulgaris. Johns Hopkins Hospt Rept 1900; 9: 409–430.
Zouboulis CC, Bettoli V. Management of severe acne. Br J Dermatol 2015; 172(1): 27-36. 10.1111/bjd.13639
Dessinioti C, Katsambas AD: The role of Propionibacterium acnes in acne pathogenesis: facts and controversies. Clin Dermatol 2010; 28(1): 2–7.
Mallon E, Newton JN. The quality of life in acne. J Am Acad Dermatol 1999; 140: 672-676.
Dreno B, Poli F. Epidemiology of acne. Dermatology 2003; 206: 7–10.
Browne RH. On the use of a pilot sample for sample size determination. Stat Med 1995; 14: 1933–1940.
