A randomised study to evaluate the efficacy of isotretinoin, electrodessication and comedone extraction in the treatment of comedonal acne

Kuraganty Ramya; Bakuru Gayatri Devi; K. V. T. Gopal; T. Narayana Rao

doi:10.18203/issn.2455-4529.IntJResDermatol20193080

Authors

Kuraganty Ramya Department of DVL, Maharaja's Institute of Medical Sciences, Vizianagaram, Andhra Pradesh, India
Bakuru Gayatri Devi Department of DVL, Maharaja's Institute of Medical Sciences, Vizianagaram, Andhra Pradesh, India
K. V. T. Gopal Department of DVL, Maharaja's Institute of Medical Sciences, Vizianagaram, Andhra Pradesh, India
T. Narayana Rao Department of DVL, Maharaja's Institute of Medical Sciences, Vizianagaram, Andhra Pradesh, India

DOI:

https://doi.org/10.18203/issn.2455-4529.IntJResDermatol20193080

Keywords:

Comedonal acne, Isotretinoin, Electrodessication

Abstract

Background: Comedonal acne commonly seen in adolescents and young patients which is refractory to standard treatments. This study is being undertaken to determine the efficacy and adverse effects of oral isotretinoin, electrodessication and comedone extraction in patients of comedonalacne.

Methods: A total of 120 patients of comedonal acne were enrolled and randomly divided into 4 groups of 30 patients each. Group A, B, C and D patients were treated with isotretinoin (20 mg daily), electrodessication, comedone extraction (4 weeks interval) and topical antibiotic daily for 12 weeks. The response in each group was assessed based on decrease in total comedonal count after 12 weeks of treatment. Statistical analysis was done using chi square test.

Results: Eighty seven (72%) cases had predominantly closed comedones and 33 (27%) cases showed open comedones. After 12 weeks of treatment, more than 75% decrease in comedonal count was seen in 60% of patients in electrodessication group followed by 30% (isotretinoin), 13.3% (comedone extraction). The decrease in total number of comedone was significantly higher with electrodessication (84.4%) followed by isotretinoin (73%), comedone extraction (43.2%) and topical antibiotic (5.7%). After follow up of 3 months, recurrence of comedones was least with isotretinoin followed by comedone extraction and electrodessication.

Conclusions: For comedonal acne, initial electrodessication followed by isotretinoin over 12 weeks gives the best outcome of quick remission and least recurrence. Electrodessication and comedone extraction are the preferred modalities in patients with predominantly closed and open comedones respectively.

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Author Biography

Kuraganty Ramya, Department of DVL, Maharaja's Institute of Medical Sciences, Vizianagaram, Andhra Pradesh, India

assistant proffessor

department of DVL

References

Layton AM, E. Eady A, Zouboulis CC. Acne. In: Griffiths C, Barker J, Bleiker T, Chalmers R, Creamer D (eds). Rook’s Textbook of Dermatology. 9th edition. Oxford: Wiley Blackwell; 2016; 90.1-90.65.

Zaenglein AL, Graber EM, Thiboutot DM. Acne vulgaris and acneiform eruptions. In: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K (eds). Fitzpatrick’s Dermatology in General medicine. 8th edition. McGraw Hill Medical; 2013: 897-917.

Vaishampayan S, Baveja S, Garg S. Acne, Rosacea and Perioral dermatitis. In: Sacchidanand S (ed). IADVL Text Book of Dermatology. 4th edition. Mumbai: Bhalani Publishing House; 2015: 1365-1412.

Wolverton SE. Systemic retinoids. In: Wolverton S (ed). Comprehensive dermatologic drug therapy. 3rd edition. Elsevier Saunders; 2013: 252-268.

Savant SS, Gore D. Electrosurgery and Surgery for active acne. In: Savant SS. Text book of Dermatosurgery and Cosmetology. 2nd edition. Mumbai, India: ASCAD; 2005: 81-91, 626-635.

Lucky AW, Barber BL, Girman CJ, Williams J, Ratterman J, Waldstreicher J. A multirater variation study to assess the reliability of acne lesion counting. J Am Acad Dermatol. 1996;35:559-65.

Lucchina LC, Kollias N, Phillips SB. Quantitative evaluation of non inflammatory acne with flourescence photography. J Invest Dermatol. 1994;102:560.

Adityan B, Tappa DM. Profile of acne vulgaris– A hospital based study. Indian J Dermatol Venereol Leprol. 2009;75:272-8.

Vallerand IA, Lewinson RT, Forris MS, Sibley CD, Ramien ML, Bulloch AGM, et al. The efficacy and adverse events of oral isotretinoin for acne a systematic review. Br J Dermatol. 2018;178:76-85.

Bottomley WW, Yip J, Knaggs H, Cunliffe WJ. Treatment of closed comedones – fulguration with topicalretinoid and electrocautery with fulguration. Dermatology. 1993;186:253-7.

Dhir R, Gehi NP, Agarwal R, More YE. Oral isotretinoin is as effective as a combination of oral isotretinoin and topical antiacne agents in nodulocystic acne. Ind J Dermatol Venereol Leprol. 2008;74:187.

Fox L, Csongradi C, Aucamp M, du Plessis J, Gerber M. Treatment modalities for acne. Molecules. 2016:21(8).

Gollnick HPM, Krautheim A. Topical treatment of acne: Current status and future aspects. Dermatology. 2003;206:29-36 .

Wise EM, Graber EM. Comedone extraction for persistent macro comedones and while on isotretinoin. J Clin Aesthet Dermatol. 2011;4:20-1.

Kaya TI, Tursen U, Kokturk A, Ikizoglu G. An effective extraction technique for treatment of closed macro comedones. Dermatol Surg. 2003;29:741-4.

Prasad S, Mukhopadhyay A, Kubavat A, Kelkar A, Modi A, Swarnkar B. Efficacy and safety of nano-emulsion gel formulation of adapalene 0.1% and clindamycin 1% combination in acne vulgaris: A randomised, open label, active-controlled, multicentric, phase 4 clinical trial. Indian J Dermatol Venereol Leprol. 2012;78:459-67.

Dogra A, Sood VK, Minocha YC. Comparative evaluation of retinoic acid, benzoyl peroxide and erythromycin lotion in acne vulgaris. Indian J Dermatol Venereol Leprol. 1993;59:243-6.

Murray J, Potts A. The phototoxic and photoallergy potential of clindamycin phosphate 1.2%, tretinoin 0.025% gel for facial acne: results of two single center, evaluator- blinded, randomised, vehicle – controlled phase 1 studies in healthy volunteers. J Drugs Dermatol. 2014;13:16-22.

Biswas S, Mondal KK, Dutta RN, Sarkar DK. Comparative evaluation of efficacy of four topical medications individually or combination in treatment of grade 1 acne vulgaris. J Indian Med Association. 2009;107:219-22.

Shalitha A. Integral role of topical and oral retinoids in early treatment of acne vulgaris. J Eur Acad Dermatol Venereol. 2001;15:43-9.