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Derma Update : Effectiveness of isotretinoin and antihistamine compared with isotretinoin alone in moderate to severe acne

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eMediNexus    16 May 2020

Acne vulgaris is most commonly seen in young adolescents. It has a significant effect on physical and psychological health of these young boys and girls. Isotretinoin has been considered the most effective drug available for acne treatment but with limited approval due to its adverse effects.

Antihistamine causes inhibition of inflammatory mediators, Propionibacterium acnes induced itching, reduction of sebum, reduces anxiety and also lowers hormonal derangement and prevents mast cell induced fibrosis and scars. Clinical importance is deficient regarding the use of antihistamine in the treatment of acne and its efficacy.

A study was done to evaluate the efficacy and safety of combining isotretinoin and antihistamine with comparison to isotretinoin alone in patients with moderate to severe acne after 12 weeks. One hundred patients with moderate to severe acne were included in this randomized, controlled study. Fifty patients were treated with isotretinoin and 50 patients were treated with added antihistamine, levocetirizine. The evaluation was done at baseline, 4, 8 and 12 weeks of treatment.

At the end of 12 weeks, combination of isotretinoin and levocetirizine group showed more significant reduction in score of global acne grading system (51.0 vs. 38.5%) and acne lesion counts (non-inflammatory lesion: 63.2 vs. 44.5%; inflammatory lesions: 75.9 vs. 62.7%; total lesions: 66.07 vs. 48.7%; all p< 0.05), as compared to isotretinoin only group.

Acne flare-ups occurred less frequently and adverse effects were more tolerable in levocetirizine and isotretinoin group. Thus, the study concluded that the use of antihistamine with isotretinoin provides synergic effect. It also reduces the side effects of isotretinoin and has a better clearance of the lesion and scars.

Source: Pandey D, Agrawal S. Efficacy of Isotretinoin and Antihistamine versus Isotretinoin Alone in the Treatment of Moderate to Severe Acne: A Randomised Control Trial. Kathmandu Univ Med J (KUMJ). 2019 Jan.-Mar; 17(65):14-19.

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