Ibrahim Shady M, Farag Assem, Hegazy Rehab, Mongy Mohamed, Shalaby Suzan, Kamel Marwa M
Department of Dermatology, Faculty of Medicine, Al-Azhar University, Cairo, 11651, Egypt.
Department of Dermatology, Faculty of Medicine, Benha University, Cairo, 13518, Egypt.
Lasers Surg Med. 2021 Jul;53(5):603-609. doi: 10.1002/lsm.23356. Epub 2020 Nov 13.
Acne is a widespread disorder of the pilosebaceous unit. Isotretinoin is the background treatment of cases of severe acne. Side effects associated with the standard 0.5-1 mg/kg/day dose decrease patient compliance. Pulsed dye laser (PDL) was proved effective in the management of inflammatory acne. The focus was to evaluate the efficacy of combining low-dose isotretinoin (0.25 mg/kg/day) with PDL in comparison with the standard higher-dose isotretinoin (0.5 mg/kg/day) as monotherapy for the management of acne vulgaris.
STUDY DESIGN/MATERIALS AND METHODS: The current prospective randomized comparative study included 46 acne patients, who were randomly divided into two groups. The first (ISO/PDL group) was treated with oral isotretinoin (0.25 mg/kg/day) and five sessions of PDL. The second (ISO group) was treated with oral isotretinoin (0.5 mg/kg/day). The physician's clinical assessment was done by three blinded dermatologists using quartile scale score and erythema score at baseline, 3 months, and 6 months and global acne grading system (GAGS) at baseline and 6 months. Patient satisfaction was assessed using the Cardiff Acne Disability Index (CADI).
Both groups showed a significant improvement in all assessed parameters compared with baseline at 3 and 6 months. Comparing both groups together, the ISO/PDL group showed a statistically significantly greater improvement regarding all parameters at both assessment times. Regarding adverse events, six patients (26%) suffered from flare in the ISO group versus none in the combined group. Dryness was encountered in 20 patients (86%) in the ISO group versus five patients (21%) in the other group. The ISO/PDL group received significantly less cumulative isotretinoin dosage (48.7 ± 5.7 mg/kg) in comparison to the ISO group (100.4 ± 3.1 mg/kg) (P < 0.05).
The current study offers a new collaboration between two well-studied and established treatment modalities leading to a harmony of therapeutic synergism while minimizing the risk of side effects. Longer periods of follow-up are recommended to diagnose any relapses and modify the proposed protocol. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.
痤疮是一种常见的毛囊皮脂腺疾病。异维A酸是重度痤疮病例的基础治疗药物。标准剂量0.5 - 1mg/kg/天所带来的副作用会降低患者的依从性。脉冲染料激光（PDL）已被证明对炎性痤疮的治疗有效。本研究的重点是评估低剂量异维A酸（0.25mg/kg/天）联合PDL与标准高剂量异维A酸（0.5mg/kg/天）单药治疗寻常痤疮的疗效对比。
研究设计/材料与方法：本前瞻性随机对照研究纳入了46例痤疮患者，随机分为两组。第一组（ISO/PDL组）接受口服异维A酸（0.25mg/kg/天）及5次PDL治疗。第二组（ISO组）接受口服异维A酸（0.5mg/kg/天）治疗。由3名不知情的皮肤科医生在基线、3个月和6个月时使用四分位数量表评分和红斑评分，以及在基线和6个月时使用全球痤疮分级系统（GAGS）进行医生临床评估。使用卡迪夫痤疮残疾指数（CADI）评估患者满意度。
与基线相比，两组在3个月和6个月时所有评估参数均有显著改善。两组对比，ISO/PDL组在两个评估时间点的所有参数改善均具有统计学意义上的显著优势。关于不良事件，ISO组有6例患者（26%）出现病情加重，而联合治疗组无此情况。ISO组有20例患者（86%）出现皮肤干燥，而另一组有5例患者（21%）出现。与ISO组（100.4±3.1mg/kg）相比，ISO/PDL组接受的异维A酸累计剂量显著更少（48.7±5.7mg/kg）（P<0.05）。
本研究提供了两种经过充分研究和确立的治疗方式之间的新联合，在使副作用风险最小化的同时实现了治疗协同作用的协调。建议进行更长时间的随访以诊断任何复发情况并修改所提出的方案。激光外科与医学。©2020威利期刊有限责任公司。
