title: Adjuvant Narrow Band UVB Improves the Efficacy of Oral Azithromycin for the Treatment of Moderate to Severe Inflammatory Facial Acne Vulgaris.
abstract: BACKGROUND
  Acne vulgaris (AV) is a common inflammatory disease of the pilosebaceous unit. A variety of treatment modalities are available for the treatment of AV. Among the available options, oral azithromycin is popularly prescribed for its proven anti-inflammatory effects. Narrow band UVB (NBUVB) also has a potent anti-inflammatory action. Concomitant use of both modalities may result in a synergistic therapeutic response; however, the combined efficacy has not yet been evaluated for the treatment of inflammatory AV.
  
  
  OBJECTIVE
  The aim of this study was to compare the efficacy of oral azithromycin plus NBUVB (peak 311 nm) to oral azithromycin alone for the treatment of moderate to severe inflammatory AV.
  
  
  METHODS
  A randomized, open-label, clinical trial was conducted over 4 weeks. Subjects were randomized into two groups. Group 1 received 500 mg of oral azithromycin three times per week. Group 2 received 500 mg of oral azithromycin plus NBUVB three and two times per week, respectively. Concomitant topical or oral AV treatments were not permitted during the treatment period. Response to treatment was measured by photographic records at the primary endpoint (2 weeks) and at the end of treatment.
  
  
  RESULTS
  One hundred and four subjects were enrolled in the trial; 94 subjects completed the treatment period of the study. Group 2 demonstrated significant clinical improvement of the inflammatory papular lesions (88.55%) compared with group 1 (70.34%) at the end of treatment (P = 0.002). The clinical response of pustular (P = 0.562), nodular (P = 0.711) and cystic (P = 0.682) lesions did not significantly differ between the two treatment groups. Interestingly, response to treatment in group 2 had a significant anatomical predilection for the forehead (P = 0.023). There was no side-effect except erythema, which subsided within 1-2 days.
  
  
  CONCLUSIONS
  NBUVB plus oral azithromycin is more effective than oral azithromycin alone for treating papular lesions of inflammatory AV. NBUVB is certainly a viable adjunct in acne therapy.
authors.affiliation: Department of Dermatology, Jundishapur University of Medical Sciences, Ahvaz, Iran.
authors.forename: Sima
authors.initials: S
authors.lastname: Rassai
authors.affiliation: Department of Dermatology, Jundishapur University of Medical Sciences, Ahvaz, Iran.
authors.forename: Esmaeil
authors.initials: E
authors.lastname: Rafeie
authors.affiliation: Department of Dermatology, Tufts Medical Center, Boston, MA, USA.
authors.forename: Marigdalia K
authors.initials: MK
authors.lastname: Ramirez-Fort
authors.affiliation: Department of Dermatology, Jahrom University of Medical Sciences, Jahrom, Iran.
authors.forename: Amir
authors.initials: A
authors.lastname: Feily
keywords: Acne vulgaris; azithromycin; narrow band UVB