COMPARISON OF ISOTRETINOIN PLUS AZITHROMYCIN COMBINATION VERSUS ISOTRETINOIN PLUS CLARITHROMYCIN IN THE MANAGEMENT OF SEVERE ACNE VULGARIS

Abstract

Objective: to compare the efficacy of combination of isotretinoin and azithromycin versus isotretinoin and clarithromycin.

Method: controlled comparative clinical trial. 70 severe acne vulgaris patients were randomly divided into 2 groups: group A was managed with isotretinoin 0.3 – 0.5 mg/kg/day in 12 weeks combined with azithromycin 500mg in 3 consecutive days per week in 8 weeks; group B was managed with isotretinoin 0.3 – 0.5 mg/kg/day in 12 weeks combined with clarithromycin 500mg twice per day, 1 week per month in 2 months. Assessment was made at week 4, 8 and 12.

Result: at week 12, both groups showed good improvement: in group A, mean number of inflammatory lesions reduced from 44.5 to 7.5, mean number of noninflammatory lesions reduced from 22.2 to 4.3; in group B mean number of inflammatory lesions reduced from 44.7 to 8.8, mean number of noninflammatory lesions reduced from 22.5 to 10.8. The total lesion number after 12 weeks in group A was significantly lower than in group B (11.8 and 19.6, respectively) with p < 0.05. 62.9% patients in group A had good outcome, higher than group B (40.0%) but the difference was not significant, p > 0.05.

Conclusion: In this clinical trial, combination of isotretinoin and azithromycin or clarithromycin in the treatment of severe acne vulgaris had improved both inflammatory and noninflammatory lesions. In clinical practice, we consider to combine isotretinoin plus azithromycin is firts choice and clarithromycin is the second choice.