Comparative study of oral isotretinoin versus oral isotretinoin + 20% salicylic Acid peel in the treatment of active acne.
BACKGROUND
Acne is a self limiting condition that often results in scarring and disfigurement disproportionate to its clinical severity. Isotretinoin is considered the gold standard in the medical management of severe form of acne vulgaris. Salicyclic acid (SA) peels, a β- hydroxy acid peel has got sebosuppressive effect and helps in faster resolution of acne with minimal scarring. It also decreases the post inflammatory hyperpigmentation. Combining both the modalities is usually not advocated because of expected excessive dryness and irritation.


OBJECTIVE
To compare the efficacy of oral isotretinoin and oral isotretinoin with 20% SA peels in patients with moderate to severe acne.


METHODS
60 consecutive patients with moderate to severe facial acne attending the skin department were randomized in to 2 groups. 1(st) group received 20mg oral isotretinoin once daily for 16 weeks and 2nd group received 20mg oral isotretinoin once daily along with 20% SA peels every two weeks for 16 weeks. Baseline grading of acne was done with Michelsons Acne severity index (MASI).Right and left sides of the face were scored separately and total score was taken. Severity score was assessed monthly .Clinical photographs were obtained for evaluation every month. Patients were asked to follow up once every 2 weeks or earlier in case of any adverse events.


RESULTS
Patients in both the groups revealed a reduction in the number of lesions. The 1(st) group showed a reduction of approximately 73.4% after receiving 20mg oral isotretinoin for 16 weeks. The 2(nd) group showed a reduction of approximately 92.5 % after receiving 20mg oral isotretinoin along with 20% SA peel once every 2 weeks for 16 weeks.


CONCLUSIONS
Both oral isotretinoin and combination of oral isotretinoin with 20% SA peels once every 2 weeks are effective in treating moderate to severe acne but the combination showed significantly better clearance of acne than monotherapy with isotretinoin.
Department of Dermatology, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Odisha, India.
Bikash Ranjan
BR
Kar
Department of Dermatology, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Odisha, India.
Sanjita
S
Tripathy
Department of Dermatology, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Odisha, India.
Maitreyee
M
Panda
Acne; isotretinoin; salicylic acid peel