Isotretinoin versus weekly pulse dose azithromycin in the treatment of acne-a comparative study

Background: Acne is a multifactorial disease and represents a spectrum of disease severityfrom a couple of blackheads and pustules to severe nodulocystic fulminant acne. The severityof the disease differs from patient to patient and treatment must therefore be tailored to theindividual patient with the goal of preventing physical and/or psychological scarring. Objective: To compare the efficacy of isotretinoin vs. weekly pulse dose azithromycin in thetreatment of moderate to severe acne. Patients and methods: An experimental study was done to compare the efficacy ofisotretinoin and pulse dose azithromycin in the treatment of acne (Moderate to severe type).The study was conducted among 60 (sixty) patients of acne aged 15-30 years in theDepartment of Dermatology and Venereology in Bangabandhu Sheikh Medical University,Shahbag, Dhaka and Combined Military Hospital, Dhaka, during a period from January, 2004to May, 2007. Cases having moderate to severe types of acne were included (categorized bythe Global Acne Grading Score, GAGS). Patients were randomly allocated into two equalgroups. Group A was given isotretinoin at a dose of 0.5-1mg/kg body weight according toseverity of the disease for 5 (five) months and group B was given azithromycin 500mg threedays a week for 3 months. Results: Among the 60 cases included in the study, 33 (55%) were male and 27 (45%) werefemale. The mean age of group A was 21.03±4.21 years and in group B was 21.5±4.16 years.Maximum number of patients were having moderate type of acne i.e. 20 (66.7%) in group Aand 25 (83.3%) in group B. The mean duration of the disease was 9.57±5.52 months in groupA and 12.93±6.20 months in group B. In group A, all cases responded and the clinicalresponse was rated as excellent in 24 (80%), good in 5 (16.67%) and fair in 1 (3.33%) case.In group B, 24 (80%) cases responded and the response was categorized as excellent in 6(20%), good in 9 (30%), fair in 3 (10%) and poor in 6 (20%) cases. There was no response in6 (20%) cases. Group A (isotretinoin) responded better than group B (azithromycin)[p 0.05]. Conclusion: Both isotretinoin and azithromycin can be useful for the treatment of moderateand severe acne but isotretinoin appears to be superior to weekly pulse dose of azithromycin.