Isotretinoin versus tetracycline: a comparative study with regard to efficiency in the treatment of acne vulgaris
Abstract number: 1134_02_369
Oprica C., Emtestam L., Nord C.E.
Tetracyclines are most commonly used for treatment of moderate and severe inflammatory acne, and systemically administered isotretinoin has proved to be the most efficient treatment, used in patients with moderate or severe acne that fails to respond to other therapies.
A randomized clinical trial was conducted to compare the clinical efficacy and the antimicrobial susceptibility of Propionibacterium acnes strains isolated before, during and after treatment with either tetracycline or isotretinoin in patients with acne vulgaris.
52 male and female patients, 1535 years of age, with moderate or severe acne, were randomized into two groups of 26 patients each. They received oral tetracycline hydrochloride 1 gram/day together with topical retinoid (differine gel 0.1%) or isotretinoin (Roaccutane) 1 mg/kg/day. The therapy was given for a 6-month period. Clinical evaluation (Leeds acne grading system and lesions counting) and bacterial samples were taken before the treatment started, during the treatment and 2 months after the treatment had stopped. Dermatology Life Quality Index questionnaire was completed by patients before and after treatment, in order to determine impairment of life quality.
Acne severity was significantly reduced by both regimens during therapy, and patients in the isotretinoin group continuously improved the acne scores after the treatment had stopped. After 6 months of treatment, isotretinoin produced greater lesion reductions than tetracycline. The mean per cent reduction in the different lesion counts was as follows: 83% versus 45% for non-inflammatory lesions (p < 0.01) and 80% versus 56% for inflammatory lesions (p < 0.01) in isotretinoin or tetracycline group, respectively. In the drug-free period, the group of patients treated with isotretinoin presented significantly less inflammatory lesions compared to the group treated with tetracycline (p < 0.001). Both treatments had improved the life quality (p < 0.01), independent of acne severity. Resistant P. acnes strains were isolated after treatment in both the tetracycline group (53%) and isotretinoin group (25%).
Both treatments were effective during treatment period. More resistant strains were recovered from the tetracycline group.
|Session name:||XXIst ISTH Congress|
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