Combined Low‐Dose Isotretinoin and Pulsed Dye Laser Versus standard‐Dose Isotretinoin in the Treatment of Inflammatory Acne

• Published in: Lasers in surgery and medicine Vol. 53; no. 5; pp. 603 - 609
• Main Authors: Ibrahim, Shady M., Farag, Assem, Hegazy, Rehab, Mongy, Mohamed, Shalaby, Suzan, Kamel, Marwa M.
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc 01.07.2021
• Subjects: Acne; Adverse events; Comparative studies; Dosage; Dye lasers; Dyes; Erythema; Health services; high dose; Inflammation; isotretinoin; Lasers; low dose; Parameters; Patient satisfaction; Patients; pulsed dye laser; Side effects; Synergism
• ISSN: 0196-8092; 1096-9101
• DOI: 10.1002/lsm.23356

Background and Objectives 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). Results 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). Conclusion 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