Systematic review of low‐dose isotretinoin for treatment of acne vulgaris: Focus on indication, dosage, regimen, efficacy, safety, satisfaction, and follow up, based on clinical studies

Sadeghzadeh‐Bazargan, Afsaneh; Ghassemi, Mohammadreza; Goodarzi, Azadeh; Roohaninasab, Masoumeh; Nobari, Niloufar Najar; Behrangi, Elham

doi:10.1111/dth.14438

Cited by 33 publications

(47 citation statements)

References 32 publications

(98 reference statements)

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“…7 Moreover, we have studied the effects of various factors on the treatment of acne vulgaris and related scars and its complications. 5,7,[9][10][11][12][13][14][15] In the present The limited use of trichloroacetic acid on ICE-PICK scars, known as the chemical reconstruction of skin scars (CROSS), was first described by Lee et al 16 They reported better results after the use of 100% TCA compared to 65% TCA, because in the TCA 65% group there was an excellent improvement in scars after six sessions and in the TCA 100% group after three sessions. 16 Brodland et al showed that the use of TCA in high concentrations causes protein precipitation, coagulation necrosis of epidermal cells, and collagen necrosis of papillary and reticular dermis.…”

Section: Discussionmentioning

confidence: 99%

“…Since the use of timolol in accelerating wound healing has received less attention, we, in a review article, reviewed the studies on this topic 7 . Moreover, we have studied the effects of various factors on the treatment of acne vulgaris and related scars and its complications 5,7,9–15 . In the present study, for the first time in a randomized clinical trial, the interaction of TCA‐CROSS, topical timolol, and saline injection in the treatment of atrophic acne scars were evaluated.…”

Section: Discussionmentioning

confidence: 99%

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Efficacy and safety of topical timolol 0.5% plus saline 0.9% versus each one alone in acne scar trichloroacetic acid ‐CROSS therapy: A blinded randomized controlled trial

Ghassemi

Shahverdi

Behrangi

et al. 2022

Dermatologic Therapy

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Trichloroacetic acid‐CROSS (TCA‐CROSS) or chemical reconstruction of scars is an approved method in the treatment of ICE‐PICK scars. Timolol is a blocker of beta‐adrenergic receptors that speeds up the healing of skin wounds. In this study, for the first time, the TCA‐CROSS technique was combined with the use of saline injection and topical timolol to increase the effectiveness of treatment, and reduce the number of treatment sessions and complications, and thus improve the aesthetic result. In this parallel‐group split‐face randomized controlled assessor and analyst‐blinded study, 45 patients with atrophic acne scars were randomly divided into 3 equal groups. TCA‐CROSS treatment was performed on all facial scars of patients. In group 1, before TCA‐CROSS, saline was injected under the scars on one side of the face, in group 2, after TCA‐CROSS, 0.5% timolol eye drops were applied on the scars on one side, and in group 3, saline was injected before TCA‐CROSS. After that, timolol eye drops were applied on the scars of the same side. In all groups, the choice of control side was random. The number of scars and patient and physician satisfaction were the main variables evaluating the effectiveness of the treatment. TCA‐CROSS improved scars in both control and treatment sides of all 3 groups. Although the number of scars decreased on the treatment side of groups 2 and 3, the decrease was not statistically significant. In the saline + TCA group, the number of scars on the treatment side was slightly more than on the control side. In the group of patients who used timolol, the severity and duration of scar hyperpigmentation were significantly lower (group 2 p = 0.016, group 3 p = 0.002). No permanent complication was observed in the patients. Patients' satisfaction in groups 2 and 3 was higher in the treatment side than the control side. The combination of saline injection followed by TCA‐CROSS is not recommended. Application of 0.5% timolol after TCA‐CROSS caused a slight decrease in scar severity and a significant reduction of post‐inflammatory hyperpigmentation (PIH) duration. So, the topical timolol makes a better result of TCA‐CROSS for acne scar treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of topical timolol 0.5% plus saline 0.9% versus each one alone in acne scar trichloroacetic acid ‐CROSS therapy: A blinded randomized controlled trial

Ghassemi

Shahverdi

Behrangi

et al. 2022

Dermatologic Therapy

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“…Various studies have been conducted regarding its efficacy and relapse rate after 4-6 months of treatment with low to high dosages of oral isotretinoin. Systematic reviews and meta-analysis of a large number of studies show that the success rate with this drug ranges from 85% to 90% in reducing resistant acne and preventing its recurrence in the long term [7]. However, this drug hosts a wide range of side effects, a rare one being new-onset myopia.…”

Section: Discussionmentioning

confidence: 99%

Oral Isotretinoin Resulting in Recurrence of LASIK-Treated Myopia: A Rare Side Effect

Qureshi

Tariq

Chaudhry

et al. 2021

Cureus

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Isotretinoin is an analog of vitamin A, used to treat severe, recalcitrant nodular acne, psoriasis and disorders of keratinization. However, its benefits come with a broad range of serious side effects, including ocular adverse effects. We report and describe a rare case of bilateral myopia in a female patient treated with oral isotretinoin for acne vulgaris. A female patient, 29-year old, presented to the office for blurry vision. The patient was treated with oral isotretinoin for four weeks. She had a past medical history of myopia precisely corrected with laser-assisted in situ keratomileusis without any residual refractive error. After a thorough examination and laboratory workup, isotretinoin was thought to be the causative agent of her current complaint, so it was immediately stopped. The follow-up showed no further decrement of visual acuity in the patient. However, the vision loss acquired as an adverse effect of oral isotretinoin persisted.

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“…These pathways also lead to the EMT status by applying Snail and Slug transcription factors, and increasing the expression of E-Cadherin and N-cadherin molecules; by inducing this process in cells, they lead to resistance to chemotherapy in people with malignancy [ 19 ]. Studies show an increase in IL-6 levels in cancer patients with COVID-19, indicating a cytokine storm [ 20 , 21 ]. It is hypothesized that, due to cytokine storms, elevated IL-6 levels in COVID-19 cancer patients and using the mentioned pathways in them, the phenomenon of resistance to chemotherapy drug occurs; it is accompanied by therapeutic effect decrement, increased mortality and survival reduction in patients.…”

Section: Il-6mentioning

confidence: 99%

The effect of COVID-19 derived cytokine storm on cancer cells progression: double-edged sword

et al. 2021

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Objective Severe acute respiratory syndrome coronavirus 2 (SARS-COV2) was first detected in Wuhan, China in December, 2019. The emerging virus causes a respiratory illness, that can trigger a cytokine storm in the body. Method Cytokine storm in patient’s body is associated with severe forms of disease. It is one of the main complications of coronavirus disease-2019 (COVID-19), in which immune cells play a major role. Studies have shown immune cells in the tumor environment can be effective to induce resistance to chemotherapy in cancer patients. Result Therefore, considering the role of immune cells to induce cytokine storm in COVID-19 patients, and their role to cause resistance to chemotherapy, they are effective on disease progression and creation of severe form of disease. Conclusion By examining the signaling pathways and inducing resistance to chemotherapy in tumor cells and the cells affect them, it is possible to prevent the occurrence of severe forms of the disease in cancer patients with COVID-19; it is applicable using target therapy and other subsequent treatment strategies.

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Systematic review of low‐dose isotretinoin for treatment of acne vulgaris: Focus on indication, dosage, regimen, efficacy, safety, satisfaction, and follow up, based on clinical studies

Cited by 33 publications

References 32 publications

Efficacy and safety of topical timolol 0.5% plus saline 0.9% versus each one alone in acne scar trichloroacetic acid ‐CROSS therapy: A blinded randomized controlled trial

Efficacy and safety of topical timolol 0.5% plus saline 0.9% versus each one alone in acne scar trichloroacetic acid ‐CROSS therapy: A blinded randomized controlled trial

Oral Isotretinoin Resulting in Recurrence of LASIK-Treated Myopia: A Rare Side Effect

The effect of COVID-19 derived cytokine storm on cancer cells progression: double-edged sword

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