Beneficial effect of 15% azelaic acid cream on acne vulgaris

Patients treated with azelaic acid (15%) cream for chloasma reported simultaneous improvement of acne lesions within the treated areas. This prompted an open study of its effect in cases of acne without chloasma. One hundred patients with acne vulgaris were treated for 3–9 months by twice-daily application of the cream with significant improvement in every case.     

异维A酸联合水杨酸治疗中重度痤疮的疗效观察

目的:探讨口服异维A酸胶囊联合30％超分子水杨酸治疗中重度痤疮的临床疗效.方法:将80例中重度痤疮患者随机分为对照组(40例)和观察组(40例),对照组给予异维A酸胶囊10 mg口服,一天2次,连续8周;观察组给予异维A酸胶囊的同时联合30％超分子水杨酸治疗,每隔4周治疗一次,共3次.比较两组患者总积分、临床疗效、不良...     

Treatment of an infantile acne with oral isotretinoin

We report the case of a little girl who presented with a nodulocystic acne which had its onset at the age of 20 months. She had no clinical or biological features of endocrinopathy. The lesions did not respond to conventional antibiotics so she was started on oral isotretinoin. A seven-month treatment period was necessary to achieve remission. The onset of infantile acne is usually around 6 to 16 months and there is a male predominance. The onset is later in females. Oral erythromycin is the first line treatment when topical therapies are inefficacious. Some cystic lesions do not respond to oral antibiotics. In these cases, oral isotretinoin may be effective and the treatment is similar to that of an adult. Clinical and biological tolerance is good with no growth retardation. Lesions may relapse after the withdrawal of isotretinoin but they are less important and easily controlled with topical treatments. Isotretinoin can be used for nodulocystic acne to reduce the risk of scarring.     

夫西地酸联合他扎罗汀治疗中度寻常痤疮的疗效观察

目的 探讨夫西地酸联合他扎罗汀外用治疗痤疮的临床疗效和安全性.方法 采用随机数字法,将79例中度痤疮患者随机分为2组:治疗组39例,给予夫西地酸乳膏外用,每天2次,他扎罗汀乳膏点涂,每晚1次,4周为1个疗程,共用2个疗程;对照组40例,给予甲硝唑凝胶外用,每天2次,他扎罗汀乳膏点涂,每晚1次,疗程同治疗组.治疗结束时,通过计算症状积分下降指数(SSRI)、痊愈率及有效率评价临床疗效.全程记录不良反应.结果 结果:治疗结束时,治疗组36例、对照组33例全程完成了试验.治疗组36例中痊愈19例(52.78％),SSRI为0.87±0.12,对照组痊愈12例(36.37％),SSRI为0.61±0.09,治疗组显著高于(均P＜0.01),治疗组有效13例(36.11％),也较对照组(10例,30.30％)为高,但差异无统计学意义(P＞0.05).部分患者发生不良反应但可耐受,未发现系统不良反应.结论 夫西地酸与他扎罗汀外用治疗痤疮疗效确切、不良反应轻微.     

The effect of azelaic acid on acne

A patient with urticaria caused specifically by alcohol is described. The reaction could be blocked by indomethacin and naloxone, indicating that the eruption was mediated by endogenous opiates and prostaglandins. Sodium cromoglycate blocked the reaction completely and consistently.     

Comparison of guidelines and consensus articles on the management of patients with acne with oral isotretinoin

Guidelines and consensus on the management of patients with acne aim to give evidence-based, expert-group recommendations. This review compares current guidelines and consensus articles to provide a compilation of recommendations on the treatment of acne with oral isotretinoin. Ten common, relevant, clinical questions are addressed, based on published recommendations, including the indications of isotretinoin, the proposed daily dose, the cumulative isotretinoin dose and the laboratory monitoring needed. Recommendations on special considerations are also addressed, including the timing of procedures and the question of an association of depression or inflammatory bowel disease with isotretinoin. A major limitation is the use of different classification systems for acne across guidelines. The recommended daily dose ranges from 0.3 to 0.5 mg/kg in the European guidelines to up to 1 mg/kg in the US guidelines. A specific duration of treatment of at least 6 months is only recommended in the European guidelines. All guidelines report the need of strict pregnancy prevention measures. The European, French and US guidelines recommend to monitor for symptoms of depression. Important clinical questions that are inconsistently addressed in guidelines include the age indication, the recommendation for a cumulative dose, the timing of procedures, the association of isotretinoin with IBD, the recommendation for preventing acne flares and for appropriate laboratory monitoring. These topics should be clearly included in the recommendations of guidelines as they are often raised in everyday clinical practice.     

口服异维A酸痤疮患者的血脂特点：附89例分析

 目的: 了解口服异维A酸治疗痤疮患者的血脂特点。方法：对2018年8月至2019年2月于中山大学附属第三医院皮肤科门诊确诊的有口服异维A酸适应症的资料完整的痤疮患者进行回顾性分析。结果：共纳入89例患者,均接受每日口服20~30 mg异维A酸的治疗。患者初诊时血脂均在正常范围内,服药后出现血脂异常35例（39.32%）,其中TC合并LDL-C异常者共6例（17.14%）,仅LDL-C异常者共29例（82.85%）,血脂明显异常升高者共5例（14.28%）;未发现TG或HDL异常者;34例（97.14%）在服药第8周出现血脂异常,仅1例（2.86%）在第16周出现血脂异常。服药第8周、第16周TC、TG、LDL-C相比第0周水平均升高,差异有统计学意义（均P＜0.01）,而HDL-C相比第0周水平均降低,差异有统计学意义（P＜0.01）。第16周时TG水平较第8周升高,差异有统计学意义（P＜0.01）,而TC、LDL-C、HDL-C水平较第8周降低,差异有统计学意义（均P＜0.05）。TC和LDL-C均呈先升高后降低的变化趋势。结论：痤疮患者服用异维A酸后TC、TG、LDL-C有升高趋势,HDL-C有降低趋势;出现血脂异常的患者绝大部分仅表现为LDL-C轻微异常,在服药第8周出现,以后趋于稳定甚至下降。     

Treatment outcome of acne vulgaris with oral isotretinoin in 89 patients

This is a retrospective study of 114 patients who received oral isotretinoin for acne vulgaris for a minimum of 6 weeks between January 1994 and March 1995. Relapse was defined as deterioration in acne sufficient to merit systemic therapy, either with antibiotics or with another course of isotretinoin. Patients were considered nonrelapsers after a minimum period of 1 year post-treatment with isotretinoin.
Case notes were traced and the following data were retrieved: age, sex, duration of acne, site of acne, previous treatment with either antibiotics or isotretinoin, indications for treatment, total cumulative dose of oral isotretinoin, average daily dose of isotretinoin,
response, relapse, time taken to relapse, and subsequent treatment. Those with either complete or partial (>80%) clearance were considered as responders because of the difficulty in categorizing them accurately due to the retrospective nature of the study. A telephone interview was conducted as far as possible with all patients who had an inadequate follow-up period to ascertain if they had relapsed, i.e. if they had been prescribed systemic therapy for further flares of acne. Analyses of laboratory abnormalities were performed only in patients who had serial alanine aminotransferase (ALT), total cholesterol, and triglyceride readings.
Data were analyzed using the chi-squared test, Student's t -test, Mann–Whitney U -test, and Fisher's exact test.
Of the 114 cases studied, 21 were excluded because of the following reasons: no weight was documented, 12; antibiotics were started immediately after completion of treatment making it impossible to document relapse, 2; patients were not seen at all after completing treatment and were uncontactable, 7. A further four cases with a break of 4 weeks or more during treatment were excluded as the accuracy of the calculated total cumulative dose of isotretinoin may be affected, given the half-life of 10–20 h.     

Treatment of severe acne with isotretinoin in patients with inflammatory bowel disease

Four patients with inflammatory bowel disease and severe cystic acne were treated with isotretinoin. Two patients had a successful course of treatment without any gastrointestinal side-effects. One patient had two episodes of profuse rectal bleeding that were probably related to pre-existing haemorrhoids. The fourth patient had a flare-up of his Crohn's disease after starting isotretinoin.     

Topical azelaic acid and the treatment of acne: a clinical and laboratory comparison with oral tetracycline

Topical azelaic acid and oral tetracycline were compared in a 6-month double-blind study for treatment of acne vulgaris in 45 male subjects with clinical acne. Their acne was graded, inflamed or non-inflamed, lesions were counted and the density of their skin microflora was measured. Both treatments were of benefit and produced only a few minor side-effects. Although oral tetracycline was more effective than azelaic acid, the differences were only just significant. The average reduction in numbers of cutaneous micrococcaceae and Propionibacterium sp. with azelaic acid treatment was 224 and 30-fold, respectively. In a separate group of 11 male subjects with physiological acne the effect of azelaic acid on sebum excretion rate was assessed, and little change was detected.     

Safety of a new micronized formulation of isotretinoin in patients with severe recalcitrant nodular acne: A randomized trial comparing micronized isotretinoin with standard isotretinoin.

BACKGROUND: Isotretinoin is a very effective drug for treating severe recalcitrant nodular acne. A new micronized formulation of isotretinoin has been shown to be clinically equivalent to standard isotretinoin with improved bioavailability and minimal food effect. The safety profile of the micronized formulation has not been described previously. OBJECTIVE: The objective of this article is to report the incidence and intensity of adverse events found in a comparative, double-blind efficacy study that showed clinical equivalence of the new micronized formulation of isotretinoin and the standard isotretinoin formulation (Accutane). METHODS: Six hundred patients with severe recalcitrant nodular acne were treated with micronized isotretinoin (n = 300) under fasted conditions or standard isotretinoin (n = 300) under fed conditions. One cohort received single daily doses of 0.4 mg/kg of micronized isotretinoin without food and the other cohort received 1.0 mg/kg per day of standard isotretinoin in two divided doses with food. Adverse events were monitored during 20 weeks of drug therapy. RESULTS: The proportion of adverse events in most body systems was generally lower in patients receiving micronized isotretinoin than in those receiving standard isotretinoin. CONCLUSION: Micronized isotretinoin appears to have a safety profile similar to that of standard isotretinoin and to carry a lower risk of mucocutaneous events and hypertriglyceridemia.     

Terminal hematuria associated with oral isotretinoin treatment in a patient with acne vulgaris

Hematuria is defined as the abnormal presence of red blood cells in the urine and is commonly divided into gross and microscopic hematuria. Terminal hematuria occurs at the end of the urine stream and may have a prostatic, bladder, or trigonal cause. Here, we present a 16-year-old boy who developed terminal hematuria after 1 month of treatment with isotretinoin for acne vulgaris. This side effect of isotretinoin is not reported in the literature. This is the first case report.