Effects of isotretinoin on serum vitamin E levels in patients with acne (original) (raw)
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Vitamin E does not reduce the side-effects of isotretinoin in the treatment of acne vulgaris
International journal of dermatology, 2005
Isotretinoin is widely used in the treatment of severe, recalcitrant, nodular acne. Mucocutaneous side-effects are seen in the great majority of patients and some of them have elevations in their serum lipid and liver enzyme profiles. Recently, it has been shown that addition of vitamin E decreased the toxicity of high-dose retinoids. The purpose of this investigator-blinded, randomized study was to assess whether vitamin E would reduce the side-effects of isotretinoin in the treatment of acne vulgaris. Eighty two patients were randomly assigned to one of two treatment groups with isotretinoin (1 mg/kg/day) alone or combined with vitamin E (800 IU/day). The treatment duration was 16 weeks. Mucocutaneous side-effects such as facial erythema, facial dryness, cheilitis and serum lipid and liver enzyme profiles were assessed. There was no difference in the incidence and severity of side-effects related to isotretinoin between the two treatment groups. Eight hundred IU/day vitamin E did ...
Oral Vitamin A for Acne Management: A Possible Substitute for Isotretinoin
Journal of Drugs in Dermatology
for acne underwent clinical trials until isotretinoin was approved in 1982. We examined the published literature on the use of vitamin A from 1934-2021 using the databases PubMed and Google Scholar to assess its ability to serve as an alternative to isotretinoin for patients with acne. Nine studies (8 clinical trials and one case study) were included after evaluation for relevancy to the topic of interest. Of the 9 trials reviewed, 8 had improvement in patients' acne using vitamin A (Table 1). Treatment doses ranged from 36,000 IU daily to 500,000 IU daily. 4-12 Forty-four percent of trials used 100,000 IU daily with success. Treatment lengths ranged from one month to seven months. Mean duration until clinical improvement ranged from 7 weeks to 4 months after initiation of therapy. Relapse was noted in 33% of the trials included, however, this is comparable to the relapse rates (13-42%) noted for isotretinoin. In the clinical trials reviewed for both vitamin A and isotretinoin, the most frequent side effects were mucocutaneous, such as cheilitis and xerosis. At doses of 500,000 IU daily, mucocutaneous side effects were more severe, however, no serious side effects were noted. Benign elevations
Low-dose isotretinoin in acne vulgaris
International Journal of Medical Science and Public Health, 2016
Oral isotretinoin (13-cis-retinoic acid) is the only drug that counteracts all the pathogenetic mechanisms that contribute to the development of acne through its broad effects on cellular differentiation, apoptosis, inflammation, and sebaceous gland activity. It results in a significant reduction in sebum production, influences comedogenesis, lowers surface and ductal P. acnes, and exhibits anti-inflammatory properties. [2] Proper use of isotretinoin in acne can minimize the scarring and postacne hyperpigmentation and induce long-term remission. [3] In 1982, US FDA-approved isotretinoin for use in severe recalcitrant nodular acne. [4] In recent days, isotretinoin is recommended in a dose of 1 mg/kg/day with a total cumulative dose of 120-150 mg/kg. The use of such a high dose (1-2 mg/kg/day) leads to a number of dose-dependent mucocutaneous, systemic, and biochemical side effects, which require regular monitoring and lead to a poor compliance. [3] One of the ways of reducing the dose-dependent adverse events and Background: Oral isotretinoin is the only drug counteracting all the pathogenetic mechanisms causing acne. Its proper use can minimize scarring and induce long-term remission. Objective: To assess the efficacy and safety of low-dose (0.5 mg/kg/day) isotretinoin in cases of acne vulgaris with the help of this prospective, single-arm, interventional study. Materials and Methods: Cases with grades II (resistant cases), III, and IV acne vulgaris were enrolled. They were given oral isotretinoin for 4 months. After the completion of 4 months, those with complete clearance of lesions were switched to pulse therapy (1 week on, 3 weeks off), while those with new lesions were continued on isotretinoin for another 2 months. The total duration of therapy was for 6 months, and posttherapy cases were followed up for 6 months to check for relapse. Result: A total of 96 patients were enrolled in the study. At 2-, 4-, and 6-months therapy, complete clearance was seen in 26.7%, 46.7%, and 93.3% in acne grade II (n = 15); 7.9%, 26.3%, and 60.5% in grade III (n = 38); 0%, 26.3%, and 52.6% in grade IV (n = 38) patients, respectively, and 7.4% and 14.1% cases on pulse and continuous therapies, respectively, showed recurrence 6 months after stoppage of therapy. The most common adverse drug reaction was cheilitis (89%). All mucocutaneous adverse events subsided with time, none warranting discontinuation of therapy. Conclusion: Low-dose isotretinoin (0.5 mg/kg/day) therapy has a good efficacy and is associated with minimal side effects, improving patients' compliance and acceptability.
The effectiveness of intermittent isotretinoin treatment in mild or moderate acne
Journal of the European Academy of Dermatology and Venereology, 2006
Background Isotretinoin is the only drug that affects almost all factors in acne pathogenesis. Recently, its use for the treatment of chronic mild or moderate acne unresponsive to long-term antibiotic therapy, and with a tendency to cause scarring and leading to negative psychological effects, has became popular. The aim of the study was to investigate the effectiveness of intermittent isotretinoin treatment in mild or moderate acne. Methods Sixty patients with mild or moderate acne localized to the face were enrolled in the study. The treatment regimen consisted of isotretinoin, 0.5-0.75 mg/kg per day, applied for 1 week every 4 weeks for a total period of 6 months, according to the degree of acne and number of inflammatory lesions. Results Forty-one (68.3%) of the 60 patients completed the 6-month therapy. At the end of the treatment complete improvement was observed in 34 patients (82.9%) out of 41. All adverse effects were mild and discontinuation of the treatment was not necessary. Conclusion Intermittent isotretinoin treatment was found to be a safe and effective choice for patients with mild or moderate acne.
Systemic isotretinoin in the management of acne - a patient questionnaire survey : original research
South African Family Practice, 2009
The acne medication history revealed that commercial brands of beauty products were used by 57.9% of respondents, topical benzoyl peroxide by 22.8%, and systemic cotrimoxazole by 19.3%. Only nine females used an oral contraceptive as acne treatment prior to isotretinoin. The average daily dose of isotretinoin was 44.2 (SD=16.9) mg. Half of the respondents received a suboptimal cumulative dosage of isotretinoin. The average prescribed duration of isotretinoin therapy was 6.2 months. Adequate counselling was received by only 57.9% of patients. A third of the patients who were able to fall pregnant received recommendations for contraception. Pregnancy tests were conducted in only two females. Just over 40% of patients reported a complete clearance of acne lesions.
Ibnosina Journal of Medicine and Biomedical Sciences, 2013
Background: Oral isotretinoin, a vitamin A acid derivative, is the most effective treatment of severe acne. As its use is associated with many side effects, low-dose and intermittent application protocols for patients with mild or moderate acne have been reported. Aim: Our purpose was to compare the outcome of two different regimens of low dose isotretinoin; daily versus monthly doses in patients with moderate acne vulgaris. Patients and methods: A randomized controlled trial was conducted on 75 patients with moderate acne vulgaris attending outpatient clinic in the dermatology department at El-Jumhuriya hospital in Benghazi city during the period of June 2009 to June 2011. The patients were randomly assigned to two groups. Group 1 consisted of 45 patients, treated with a daily fixed dose of 20 mg of isotretinoin and group 2 consisted of 30 patients, treated with 20 mg of isotretinoin twice daily for seven days every month. Both groups were treated for a total period of four months. No topical treatments were permitted for
Қазақстанның клиникалық медицинасы, 2018
Objectives: Acne is a chronic inflammatory disease that affects the pilosebaceous units of the skin. Isotretinoin is a derivative of the synthetic 13-cis-retinoic acid and is an efficient drug for acne treatment. In clinical studies, the negative effects of long-term and short-term isotretinoin use on vitamin D levels and bone metabolism restrict its use. In this study, the effect of isotretinoin treatment on vitamin D levels was examined in patients with acne vulgaris. Material and Methods: Ninety patients with clinically diagnosed acne vulgaris who came to the Malatya Research and Training Hospital Dermatology Clinic participated in this study. Patients who had been using any systemic drug for the previous month or who had any systemic disease were not included in the study. Patients with abnormalities in calcium (Ca), alkaline phosphatase (ALP), and parathyroid hormone (PTH) levels, which affect vitamin D metabolism, also were not included in the study. Patients were treated first with 0.5 to 1.0 mg/kg (per kilogram of body weight) doses of isotretinoin, with the aim of total dosage of 120 mg/kg. The patients' 25-hydroxy vitamin D3 [25'(OH) vit D3] levels were measured before treatment and at the sixth month of treatment. Results: Among the 90 patients who participated in the study, 51 (56.7%) were female, and 39 (43.3%) were male, with an age range of 16 to 50 years (mean ±standard deviation) age, 23.55±5.58 years. Eight patients dropped out of the study. The patients' (mean ± standard deviation) 25'(OH) vit D3 level was 18.28±9.92 before treatment and 13.28±7.78 at the sixth month of treatment (p=0.000). Conclusion: The negative effect of isotretinoin on vitamin D levels and bone metabolism has been shown in previous studies. In this study, 25'(OH) vit D3 levels decreased significantly in patients treated with isotretinoin in the long term (p>0.000).
JAMA Dermatology, 2013
IMPORTANCE Isotretinoin is the most effective treatment for acne. The ideal dosing regimen is unknown. OBJECTIVE To determine the rates of relapse of acne vulgaris and retrial of isotretinoin after high cumulative-dose treatment and the changes to the adverse effect profile. DESIGN, SETTING, AND PARTICIPANTS A prospective, observational, intervention study was conducted from August 1, 2008, to August 31, 2010, in a single academic tertiary care center with multiple providers. A total of 180 patients with acne resistant to other treatments were enrolled. Of these, 116 participated in the 12-month follow-up survey, for a response rate of 64.4%. EXPOSURE Patients received isotretinoin, with dosing based on the providers' judgment. Patients were divided into 2 groups on the basis of cumulative dosing (<220 mg/kg and Ն220 mg/kg). MAIN OUTCOMES AND MEASURES Relapse (treatment with a prescription topical or oral acne medication after a course of isotretinoin) or retrial (retreatment with isotretinoin) at 12-month follow-up and adverse effects experienced during and after 12 months of treatment. RESULTS The mean age of the participants was 19.3 years, 51.9% were female, and 74.1% were white. At 12 months' follow-up, 97.4% of the patients reported that their acne was improved. Overall, acne in 32.7% of patients in the study relapsed at 12 months, and 1.72% of the patients required a retrial. In the lower-dose treatment group (<220 mg/kg), the relapse rate was 47.4% (95% CI, 32.3%-63.0%) compared with 26.9% (95% CI, 18.3%-37.8%) in the high-dose group (P = .03). Almost 100% of the patients in both treatment groups developed cheilitis and xerosis during treatment. Retinoid dermatitis was significantly more common in the high-dose treatment group (53.8% vs 31.6%; P = .02). None of the other adverse effects was significantly different between the 2 groups. CONCLUSIONS AND RELEVANCE The dosing regimen used in the present study is considerably higher than that used in previous studies of isotretinoin. At 1 year after completion of isotretinoin treatment, we found that patients receiving 220 mg/kg or more had a significantly decreased risk of relapse. Rash was the only adverse effect that was significantly more common in the high-dose group during treatment. This study suggests that significantly higher doses of isotretinoin are effective for treating acne and decreasing relapse rates without increasing adverse effects.
2018
Background. Acne vulgaris is an inflammatory disease of pilosebaceous units whichmay cause permanent dyspigmentation and/or scars if not treated. Isotretinoin is recommended in the treatment of recalcitrant or severe acne, but it is associated with common adverse effects that frequently result in patients incompliance and discontinuation of the drug. The present study was designed to assess the efficacy of oral omega-3 in decreasing the adverse effects of isotretinoin. Materials and Methods. In this randomized double-blind clinical trial, a total of 118 patients with moderate or severe acne were randomly divided into two (case and control) groups.The control groupwas treatedwith isotretinoin 0.5mg/kg, and the case group was treatedwith the same dose of isotretinoin combined with oral omega-3 (1 g/day). The treatment was lasted for 16 weeks and mucocutaneous side effects of isotretinoin were recorded and compared between the two groups in weeks 4, 8, 12, and 16. Results. Cheilitis (a...
Dermatology Research and Practice
Background. Acne vulgaris is an inflammatory disease of pilosebaceous units which may cause permanent dyspigmentation and/or scars if not treated. Isotretinoin is recommended in the treatment of recalcitrant or severe acne, but it is associated with common adverse effects that frequently result in patients incompliance and discontinuation of the drug. The present study was designed to assess the efficacy of oral omega-3 in decreasing the adverse effects of isotretinoin. Materials and Methods. In this randomized double-blind clinical trial, a total of 118 patients with moderate or severe acne were randomly divided into two (case and control) groups. The control group was treated with isotretinoin 0.5 mg/kg, and the case group was treated with the same dose of isotretinoin combined with oral omega-3 (1 g/day). The treatment was lasted for 16 weeks and mucocutaneous side effects of isotretinoin were recorded and compared between the two groups in weeks 4, 8, 12, and 16. Results. Cheili...