Combined treatment regimen for severe acne vulgaris

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Abstract

BACKGROUND: Treatment of acne vulgaris remains an actual task of practical medicine. Despite the fact that the participation of severe acne in the structure of the morbidity of acne vulgaris is relatively small, precisely they most often leave behind scars, are accompanied by a pronounced cosmetic defect and significantly reduce the patient’s quality of life. Systemic treatment with isotretinoin is the gold standard of management of such patients, but this type of treatment is often accompanied by an exacerbation reaction, which negatively affects the general condition of the patient and reduces the compliance of treatment.

AIM: To determine the effectiveness of the combined use of isotretinoin and a systemic corticosteroid in the treatment of severe forms of acne.

MATERIALS AND METHODS: We observed 27 patients (16 men and 11 women) with severe or very severe grade on the IGA scale. All patients received combination therapy with isotretinoin (Sotret) at a dose of 0.5 mg/kg/day (cumulative dose from 120 to 150 mg/kg) for 8 months and prednisolone 30 mg/day 7 days, followed by dose reduction within a month. The assessment of treatment efficacy was based on the IGA scale, indicators DIA, DLQI and counting the number of inflammatory and non-inflammatory elements.

RESULTS: During the 8 months of the study, 81.4% of patients achieved a 2-point reduction in the degree on the IGA scale (“clear” or “almost clear skin”). The DLQI index showed 74.9% improvement compared to the start of treatment. The average DIA values decreased by 72%. The reduction in the number of inflammatory and non-inflammatory elements showed a marked clinical improvement (91.4% for nodules and 98.3% for pustules). Exacerbations of acne were recorded in 18.5% of patients.

CONCLUSIONS: Combined systemic treatment with isotretinoin and prednisolone for severe acne decreases the number of exacerbations and reduces the duration of treatment.

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About the authors

Larisa S. Kruglova

Central State Medical Academy of Department of Presidential Affairs

Email: kruglovals@mail.ru
ORCID iD: 0000-0002-5044-5265
SPIN-code: 1107-4372

MD, Dr. Sci. (Med.), Professor

Russian Federation, 19/1A Marshala Timoshenko street, 121359, Moscow

Natalia V. Gryazeva

Central State Medical Academy of Department of Presidential Affairs

Author for correspondence.
Email: tynrik@yandex.ru
ORCID iD: 0000-0003-3437-5233
SPIN-code: 1309-4668

MD, Cand. Sci. (Med.), Associate Professor

Russian Federation, 19/1A Marshala Timoshenko street, 121359, Moscow

Anait V. Tamrazova

Central State Medical Academy of Department of Presidential Affairs

Email: anaittamrazova@gmail.com
ORCID iD: 0000-0002-4672-697X
SPIN-code: 1563-1190
Russian Federation, 19/1A Marshala Timoshenko street, 121359, Moscow

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Supplementary files

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2. Fig. 1. Ratio between the severity of acne according to the Investigator’s Global Assessment scale (IGA).

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3. Fig. 2. Dynamics of changes of the Dermatological index of quality of life (DQLI) during therapy.

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4. Fig. 3. Dynamics of changes of the Dermatological index of acne (DIA) during therapy.

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5. Fig. 4. Dynamics of changes in the amount of inflammatory and non-inflammatory elements during therapy.

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СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
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