Abstract

Background: A combination of azithromycin & isotretinoin has been used for treatment of Severe nodulocystic acne before, however, an optimal scheduled doses regimen of such combination remained to be elucidated.
Objectives: To evaluate the effectiveness, safety and tolerability of using a new combination of fixed low doses of isotretinoin and azithromycin in an alternative days regimen in treatment of severe nodulocystic acne in Iraqi patients.
Patients and Methods: A prospective open-labeled clinical study in which 54 young adult and adolescent patients with severe nodulocystic acne were recruited for the study at the Department of Dermatology in Basra General Hospital during from May-October 2015. The patients were received a combination of fixed dose of isotretinoin 20 mg thrice weekly and 500 mg azithromycin given orally thrice weekly on alternating days and one day off for 12 weeks. The participants was assessed before, during and after treatment. The calculation of percentage and scoring of reduction of acne lesions was also carried out.
Results: There was a marked reduction in the inflammatory lesions at the first 4 weeks of the treatment, with a significant clearance of 38.4% of the papular lesions, 63.5% of pustular and 43% of the nodular lesions. At the end of the study, there was a significant reduction in the number of the inflammatory lesions, with the clearance of 76% of the papules, 96% of the pustules and 86% of the nodules. The most frequent adverse effects reported was dryness of face and lips.
Conclusion: Fixed dose of azithromycin 500 mg combined with isotretinoin 20 mg on alternating day regimen proved to be effective, safe & well tolerated regimen for treatment of severe nodulocystic acne with high score of patient satisfaction.