Hafif ve orta dereceli aknede intermitant izotretinoin tedavisinin etkinliği

Amaç: İzotretinoin, akne patogenezindeki tüm faktörleri birden etkileyen tek ilaçtır. Son yıllarda, uzun sufceli antibiyotik tedavisine yanıt vermeyen, kronik seyir izleyjkn, skarlaşmaya meyilli ve bu nedenle olumsuz psikolojik etkileri olan orta ve hafif dereceli akne tedavisinde de kullanımı gündeme gelmiştir. Çalışmamızın amacı, orta ve hafif dereceli aknesi olan hastalarda intermitant uygulanan izotretinoinin etkinliğini araştırmaktır. Gereç ve Yöntem: Çalışmamıza yüz bölgesi yerleşimli, orta ve hafif dereceli aknesi olan 42 hasta katıldı. Her hastaya belirlenen akne derecesine ve inflamatuvar lezyon sayısına göre 0,5-0,75 mg/kg/gün dozda izotretinoin, ayda bir hafta kullanılıp, üç hafta kullanmamak üzere toplam altı ay süreyle uygulandı. Bulgular: Çalışmamıza alınan 42 hastadan 26'sı (%61,9), altı aylık tedaviyi tamamladı. Tedavinin sonunda 26 hastadan 21'inde (%80,7) tam düzelme saptandı. Hastalarımızda gözlenen yan etkilerin tümü hafif düzeyde olup, ilacın kesilmesini gerektirmedi. Sonuç: Orta ve hafif dereceli aknesi olan hastalarda, intermitant izotretinoin tedavisinin etkin ve güvenilir bir tedavi seçeneği olduğunu söyleyebiliriz.

Effectiveness of intermittent isotretinoin treatment in mild and moderate acne

Purpose: Isotretinoin is the only drug that affects all factors in the pathogenesis of acne. Recently, its use has become popular in the treatment of mild and moderate acne that is unresponsive to long-term antibiotic therapy and chronic, leading to scarring and negative psychologic effects. The aim of our study was to investigate the effectiveness oj intermittent isotretinoin treatment in mild and moderate acne. Methods: Forty-two patients with mild or moderate acne localized on the face enrolled in the study. Over six months, 0.5-0.75 mg/kg/day isotretinoin was applied for only one week per month to all patients according to the degree oj acne and number of inflammatory lesions. Results: Twenty-six (61.9%) of the 42 patients completed the six-month therapy. At the end of the treatment, complete improvement was observed in 21 (80.7%) of the 26 patients. All adverse effects seen in patients were mild and discontinuation of the treatment was not necessary. Conclusion: Intermittent isotretinoin treatment is a safe and effective choice in patients with mild and moderate acne.

PDF

___

1.Baysal V, Yıldırım M, Alan H. Akne vulgarisli olgularda kullanılan çeşitli tedavi yöntemlerinin karşılaştırılması. T Klin Dermatoloji 1998; 1-6.
2.Dreno B, Poli F. Epidemiology of acne. Dermatology 2003; 1042-1048.
3.Strauss JS, Thibautat DM. Diseases of the sebaceous glands. In. Freedberg I, Eisen AZ, Wolff K, Austen KF, Goldsmith LA, Katz SI, Fitzpatrick JB (eds). Dermatology in general medicine. 5th ed. New York: McGraw-Hill; 1999; 769-784.
4.Cunliffe WJ, van de Kerkhof PCM, Caputo R, Cavicchini S, Cooper A, Fyrand OL, Golhick H, et al. Roaccutane treatment guidelines: Results of an international survey. Dermatology 1997; 351-357.
5.Köse O. Nodüler ve kistik aknede izotretinoin tedavisi. XVI. Ulusal Dermatoloji Kongresi Program ve Özetler 129.
6.Karaoğlu S. Nodülokistik ve klasik tedavilere dirençli aknelerde isotretinoin. T Klin Dermatoloji 1997; 181-186.
7.Sancaoğlu H, Tunalı Ş, Alpakut Ş, Ergus B, Aydoğan K. Akne vulgaris tedavisinde izotretinoin klinik etkisi (18 ay süreli izlem sonuçlan). T Klin Dermatoloji 1998; 8: 24-28.
8.Peck GL, Olsen TG, Batkus D, Pandya M, Arnaud-Battandier J, Cross EG, Windhorst DB, Cheripko. Isotretinoin versus placebo in the treatment of cystic acne. A randomized double-blind study. J Am Acad Dermatol 1982; 735-745.
9.Goulden V, Clark SM, Mcgeown C, Cunliffe WJ. Treatment of acne with intermittent isotretinoin. Br J Dermatol 1997; 106-108.
10.Burke BM, Cunliffe WJ. The assessment of acne vulgaris-the Leeds technique. British Journal of Dermatology, 1984; 83-92.
11.Erdem T, Karakuzu A, Özdemir Ş, Akdeniz N, Sahan F, Atasoy M. Nodüler ve nodülokistik aknede izotretinoin. T Klin Dermatoloji, 1999 ; 75-78.
12.Ellis CN, Krach KJ. Uses and complications of isotretinoin therapy. J Am Acad Dermatol 2001; 150-157.
13.Leyden JJ, McGinley KJ, Foglia AN. Qualitative and quantitative changes in cutaneous bacteria associated with systemic isotretinoin therapy for acne conglobata. J Invest Dermatol 1986; 390-393.
14.Coates P, Adams CA, Cunliffe WJ, McGinley KT, Eady EA, Leyden JJ, Ravenscroft J, Vyakrnam S, Vowels B. Does oral isotretinoin prevent Propionibacterium acnes resistance? Dermatology 1997; 4-9.
15.Eady EA, Jones CE, Tipper JL, Cove JH, Cunliffe WJ, Layton AM. Antibiotic resistant propionibacteria in acne: Need for policies to modify antibiotic usage. Br Med J 1993; 555-556.
16.Layton AM, Knaggs H, Taylor J, Cunliffe WJ. Isotretinoin for acne vulgaris-10 years later: A safe and successful treatment. Br J Dermatol 1993; 292-296.
17.Layton AM, Cunliffe WJ. Guidelines for optimal use of isotretinoin in acne. J Am Acad Dermatol 1992; 27: S2-S7.
18.Goulden V, Layton AM, Cunliffe WJ. Current indications for isotretinoin as a treatment for acne vulgaris. Dermatology 1995; 284-287.
19.Gupta MA, Gupta AK. Depression and suicidal ideation in dermatology patients with acne, alopecia areata, atopic dermatitis and psoriasis. Br J Dermatol, 1998; 846-850.
20.Kellet SC, Gawkodger DJ. The psychological and emotional impact of acne and the effect of treatment with isotretinoin. Br J Dermatol 1999; 273-282.
21.Aktan S, Ozmen E, Sanli B. Anxiety, depression and nature of acne vulgaris in adolescents. Int J Dermatol 2000; 354-357.
22.Mallon E, Newton JN, Klassen A, Ryan TJ, Finlay A. Standard patient-assessed quality of life instruments can be used to measure the benefits of acne treatment. Br J Dermatol 1995; 45-35.
23.Chivot M, Midoun H. Isotretinoin and acne: A study of relapses. Dermatologica 1990; 180: 240-243.
24.Stainforth JM, Layton AM, Taylor JP, Cunliffe WJ. Isotretinoin for the treatment of acne vulgaris: Which factors may predict the need for more than one course? Br J Dermatol 1993; 297-301.
25.Piquero-Martin J, Misticone S, Piquero-Casals V, Piquero-Casals J. Topic therapy-mini isotretinoin doses vs topic therapy-systemic antibiotics in the moderate acne patients. Ann Dermatol Venereol 2002; 129: S382.
26.Palmer RA, Sidhu S, Goodwin PG. 'Microdose' isotretinoin. Br J Dermatol 2000; 205-206.
27.Amichai B. Long-term mini-doses of isotretinoin in the treatment of relapsing acne. J Dermatol. 2003; 30: 572.
28.Zoubolis CC, Piquero-Martin J. Update and future of systemic acne treatment. Dermatology 2003; 37-53.