Comparative efficacy and safety and efficacy of systemic 13-cis retinoic acid 20mg/day vs. 40mg/day in acne vulgaris
Keywords:
13-cis retinoic acid, acne vulgarisAbstract
Background Early and effective treatment in acne vulgaris is essential to prevent facial scarring and psychological distress.Objective To evaluate the safety and efficacy of two different doses of 13-cisretinoic acid in the treatment of acne vulgaris.Patients and methods Sixty patients of moderate to severe acne vulgaris were selected from the dermatology out patient clinics of Abbassi Shaheed hospital, Aga Khan Hospital, Burhani Hospital and Taj Medical Complex, Karachi. They were randomly divided into two groups. Group I was given 20mg systemic 13-cis retinoic acid daily and group II, 40mg daily for 24 weeks. Assessment of the severity of acne was done using Global Acne Grading System (GAGS). Clinical improvement was measured on physician acceptance scale, every two months till 24 weeks. Safety was evaluated on the basis of side effects and lab abnormalities at the baseline and end of therapy.Results Marked dose related decrease in acne lesions was noted within 8 weeks of the onset of therapy in all patients. In group I, out of 30 patients 24 showed 70% clearance in 8 weeks, 90% clearance in 16 weeks and 100% in 24 weeks, with residual pits in four patients. Six female patients were prescribed Diane 35® at 24 weeks, who still had premenstrual flare of acne. In group II, 26 patients out of 30 showed 90% clearance in 8 weeks and 100% clearance from 16-24 weeks. Mild scarring was noted in six patients at 24 weeks of treatment. Three female patients still had new eruption and were given Diane 35® after 24 weeks and in one male patient the dosage was increased to 60mg/day, which cleared the acne in 32 weeks. The results of two groups were insignificant (p>0.5). Side effects noted were chelitis, dryness pruritus and desqumation of skin, more in group II. A mild mood change with irritability was noted in 3 female patients.Conclusion 13-cis retinoic acid is safe and efficacious in the treatment of acne vulgaris. A dose-dependent faster response is seen, although 20 mg/day works equally well than 40mg/day till 24 weeks.References
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