Combined Low‐Dose Isotretinoin and Pulsed Dye Laser Versus standard‐Dose Isotretinoin in the Treatment of Inflammatory Acne

Abstract

Background and Objectives: Acne is a widespread disorder of the pilosebaceous unit. Isotretinoin is the background treatment of cases of severe acne. Side effects associated with the standard 0.5-1 mg/kg/day dose decrease patient compliance. Pulsed dye laser (PDL) was proved effective in the management of inflammatory acne. The focus was to evaluate the efficacy of combining low-dose isotretinoin (0.25 mg/kg/day) with PDL in comparison with the standard higher-dose isotretinoin (0.5 mg/kg/day) as monotherapy for the management of acne vulgaris. Study Design/Materials and Methods: The current prospective randomized comparative study included 46 acne patients, who were randomly divided into two groups. The first (ISO/PDL group) was treated with oral isotretinoin (0.25 mg/kg/day) and five sessions of PDL. The second (ISO group) was treated with oral isotretinoin (0.5 mg/kg/day). The physician's clinical assessment was done by three blinded dermatologists using quartile scale score and erythema score at baseline, 3 months, and 6 months and global acne grading system (GAGS) at baseline and 6 months. Patient satisfaction was assessed using the Cardiff Acne Disability Index (CADI). Results: Both groups showed a significant improvement in all assessed parameters compared with baseline at 3 and 6 months. Comparing both groups together, the ISO/PDL group showed a statistically significantly greater improvement regarding all parameters at both assessment times. Regarding adverse events, six patients (26%) suffered from flare in the ISO group versus none in the combined group. Dryness was encountered in 20 patients (86%) in the ISO group versus five patients (21%) in the other group. The ISO/PDL group received significantly less cumulative isotretinoin dosage (48.7 ± 5.7 mg/kg) in comparison to the ISO group (100.4 ± 3.1 mg/kg) (P < 0.05). Conclusion:The current study offers a new collaboration between two well-studied and established treatment modalities leading to a harmony of therapeutic synergism while minimizing the risk of side effects. Longer periods of follow-up are recommended to diagnose any relapses and modify the proposed protocol. Lasers Surg. Med.

Energy‐based devices for the treatment of Acne Scars: 2022 International consensus recommendations

“…Results of a provider survey on procedures in the context of isotretinoin indicated that while a small majority of respondents recommended patients wait at least 6 months or longer after completing isotretinoin therapy before receiving laser and light‐based treatment, 70% reported that primarily medicolegal concerns guided their treatment decisions 40 . Since 2017 multiple studies have found various EBD including vascular lasers, non‐AFL, and 1064‐nm lasers safe and effective for acne and acne scarring either in combination with isotretinoin or starting within 1 month of completing isotretinoin 41–44 …”

“…40 Since 2017 multiple studies have found various EBD including vascular lasers, non-AFL, and 1064-nm lasers safe and effective for acne and acne scarring either in combination with isotretinoin or starting within 1 month of completing isotretinoin. [41][42][43][44] Panel recommendations: EBD for mitigating and treating acne scars in a patient with active acne…”

The Effect of Intense Pulsed Light on the Skin Microbiota and Epidermal Barrier in Patients with Mild to Moderate Acne Vulgaris

“…Acne vulgaris is one of the most common skin diseases with major social and psychological impacts, of which 80%–85% of cases were mild to moderate [18]. Owing to the drawbacks due to the topical use of antibiotics, BPO and isotretinoin, many dermatologists find non‐pharmacological treatments with infrequent adverse effects, such as different kinds of phototherapy, to alleviate inflammatory acne and its sequelae [19–21]. Among them, IPL devices use flashlamps and bandpass filters to emit polychromatic incoherent high‐intensity pulsed light of determined wavelength spectrum, fluence, and pulse duration [19].…”

Treatment protocols and efficacy of light and laser treatments in post‐acne erythema

“…Treatment sessions ranged from 1 to 6 sessions with treatment interval of 2-8 weeks. 6,7,[9][10][11][12] Alster et al demonstrated significant improvement in PAE along with skin texture with one or two sessions of PDL laser in 67.5% and 72.5% of cases compared to untreated side, respectively. 6 Ibrahim et al revealed significant reduction in PAE and acne severity by adding PDL to low-dose of isotretinoin (0.25 mg/kg/day) compared with isotretinoin alone (0.5 mg/kg/day).…”