Nasim Niknezhad; Behnaz Hamedani; Abbas Zamanian; Reza Mahmoud Robati; Elnaz Hamedani
Abstract
Introduction: Acne vulgaris affects individuals of all ages, and isotretinoin is the most effective treatment available for this disease. However, serious adverse effects, including the possibility of depression and suicide, could limit its use. This study aimed to investigate the ...
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Introduction: Acne vulgaris affects individuals of all ages, and isotretinoin is the most effective treatment available for this disease. However, serious adverse effects, including the possibility of depression and suicide, could limit its use. This study aimed to investigate the frequency of depression in patients with acne vulgaris treated with oral isotretinoin.Materials and Methods: Forty acne vulgaris patients treated with oral isotretinoin and 40 age- and sex-matched controls treated with a systemic antibiotic (doxycycline 100-200 mg/day) and atopical retinoid were enrolled in this study. The depression score was measured based on Beck’s Depression Inventory (BDI) in both groups before and after two months of treatment.Result: The BDI score and the rate of depression were not significantly different between the two groups after the twomonth treatment period. Moreover, we did not find any significant change in BDI score in each group after treatment (P > 0.05).Conclusion: Our study showed that short-course oral isotretinoin therapy does not increase the depression rate among acne vulgaris patients. It should be noted that oral isotretinoin causesa significant clinical improvement in patients with moderate to severe acne vulgaris, which could be associated with a decrease in depression scores.
Behrangi Elham; Sadeghi Somayeh; Sadeghzadeh-Bazargan Afsaneh; Goodarzi Azadeh; Ghassemi Mohammadreza; Sepasgozar Saba; Rohaninasab Masoomeh
Abstract
Background: Insulin resistance and increased insulin-like growth factor (IGF)-1 with consequent mammalian target of rapamycin complex (mTORC) 1 overexpression is responsible for acne pathogenesis, especially in women with polycystic ovary syndrome (PCOS). Metformin is shown to improve acne as an adjunct ...
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Background: Insulin resistance and increased insulin-like growth factor (IGF)-1 with consequent mammalian target of rapamycin complex (mTORC) 1 overexpression is responsible for acne pathogenesis, especially in women with polycystic ovary syndrome (PCOS). Metformin is shown to improve acne as an adjunct therapy in females with PCOS and males with altered metabolic profile. We evaluated the use of metformin in the treatment of resistant and late-onset acne in females, and compared it with isotretinoin.
Methods: Females with late-onset acne or acne resistant to common therapies (n=70) were randomized to receive metformin (n=35) or isotretinoin (n=35) for 6 months. Changes in acne severity were scored by global acne grading system (GAGS) which was the primary outcome. Other endpoints were changes in the components of metabolic profile.
Results: Six-month treatment with metformin and isotretinoin significantly reduced the GAGS from 31.9 to 24.6 and from 34.1 to 13.3, respectively, indicating the superior impact of isotretinoin. Metfromin was more effective in decreasing the GAGS score in those with PCOS (13.5±7.1 vs. 24.2±19.4, P<0.05). Furthermore, patients with hirsutism had a higher reduction score with metformin compared to patients without hirsutism (21.1±9.1 vs. 30.2±6.4) (P<0.05). Lipid profile and fasting blood sugar were improved following the 6-month treatment with metformin, and isotretinoin increased the levels of liver enzymes and bilirubin (P<0.05).
Conclusion: Metformin is effective in treating late-onset or resistant acne and improving metabolic status, without serious side effects. In patients with altered metabolic profiles such as PCOS, metformin seems to be superior to isotretinoin regarding acne treatment.
Ghiasi Maryam; Lajevardi Vahide; Mortazavi Hossein; Damavandi Maedeh Raiyati
Volume 16, Issue 4 , 2013, , Pages 137-140
Abstract
Background: Systemic isotretinoin is a very effective medication for the treatment of acne, but it has some side effects. One of its side effects is musculoskeletal problems such as increased levels of creatine phosphokinase (CPK), myalgia, and serious muscle damage such as rhabdomyolysis. The aim of ...
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Background: Systemic isotretinoin is a very effective medication for the treatment of acne, but it has some side effects. One of its side effects is musculoskeletal problems such as increased levels of creatine phosphokinase (CPK), myalgia, and serious muscle damage such as rhabdomyolysis. The aim of this study was to evaluate the incidence of myalgia and its relationship with the elevation of serum CPK levels in patients treated with isotretinoin.Method: This study was done on forty acne patients in Razi Hospital. Isotretinoin was administered at a dose of 0.25 mg/kg in all patients. Serum CPK levels were measured before the treatment and every 2 months during treatment. On each visit, the patients were asked about muscular symptoms such as myalgia.Result: Twenty-eight (70%) patients were female. The mean age of the patients was 22.6±5.4 years. The mean serum CPK level did not increase during treatment with isotretinoin. However, 2.5%, 36.8% and 31.5% of the patients had myalgia 2, 4, and 6 months after the initiation of isotretinoin, respectively. There was no significant difference in the mean CPK level of those who had myalgia after treatment with isotretinoin and those who were asymptomatic.Conclusion: It seems that low dose isotretinoin does not induce the elevation of CPK, but can cause myalgia in some patients irrespective of the CPK level. Myalgia in patients under treatment with low dose isotretinoin is a benign phenomenon and is not an alarm for serious muscle damage. Therefore, routine measurement of the CPK level in patients receiving low dose isotretinoin is not recommended.
Mortazavi Hossein; Aghazadeh Nessa; Ghiasi Maryam; Lajevardi Vahideh
Volume 16, Issue 4 , 2013, , Pages 144-158
Abstract
Retinoids are synthetic and natural analogues of vitamin A that have various effects on cellular differentiation, cellular proliferation, immune system, and embryonic development. The present study reviews the history of systemic retinoids in medicine, the structure of syn
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Retinoids are synthetic and natural analogues of vitamin A that have various effects on cellular differentiation, cellular proliferation, immune system, and embryonic development. The present study reviews the history of systemic retinoids in medicine, the structure of syn
Hamideh Moravvej; Maryam Yousefi; Nahid Mohtasham; Nelda Saadat; Hamid Reza Haghighatkhah
Volume 11, Issue 3 , 2008, , Pages 108-112
Abstract
Background: Few studies have investigated on vitamin D metabolites Serum levels, and calcium homeostasis in humans receiving retinoids, despite a substantial amount of literature concerning retinoid-induced osteoporosis in animals. We prospectively measured vitamin D metabolites serum levels and calcium ...
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Background: Few studies have investigated on vitamin D metabolites Serum levels, and calcium homeostasis in humans receiving retinoids, despite a substantial amount of literature concerning retinoid-induced osteoporosis in animals. We prospectively measured vitamin D metabolites serum levels and calcium homeostasis and radiographic bone changes in short course treatment with oral isotretinoin in severe acne.Methods: 1,25-dihydroxy vitamin D and 25-hydroxy vitamin D, calcium, phosphate, Parathyroid hormone and axial spine , femoral neck radiographies were measured in 30 nodulocystic acne patients ( 17 -28 years ) before and after twenty weeks of treatment with oral isotretinoin at the recommended dose (0.75 -1 mg/kg/day) .Results: vitamin D metabolites, calcium, phosphate, Parathyroid-hormone did not change significantly and hyperostosis and other sclerotic change were not observed in any patients.Conclusion: Short course treatment with oral isotretinoin at the recommended dose did not lead to any significant changes in serum vitamin D metabolites, calcium, phosphate and Parathyroid hormone and has no effects on bone radiography in acne patients.
F Ghalamkar Pour; H Morravej Farshi; S Zolghadr
Volume 8, Issue 6 , 2006, , Pages 448-456
Abstract
Background and aim: Side effects of long-term systemic isotretinion use with high accumulative doses on skeletal system have been known, but there are few studies about the effects of short term isotretinoin therapy for acne patients. This study was aimed to recognize the effects of systemic isotretinion ...
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Background and aim: Side effects of long-term systemic isotretinion use with high accumulative doses on skeletal system have been known, but there are few studies about the effects of short term isotretinoin therapy for acne patients. This study was aimed to recognize the effects of systemic isotretinion on calcium homeostasis and bone density in acne patients referring to clinics affiliated to the Skin Research Center of Shahid Beheshti University of Medical Sciences.Materials and Methods: In this before and after clinical trial, 20 patients with severe acne vulgaris in whom systemic treatment with isotretinoin was indicated were assessed. They included 13 female and 7 male patients with a mean age of 24.3±4.7 years. Serum levels of calcium, phosphorus and alkaline phosphatase as well as lumbar and hip bone mineral density (BMD) of the patients were evaluted before and after treatment with 120 mg/kg total dose of isotretinion. Results were analysed using Wilcoxon signed ranked test before and after treatment and P values less than 0.05 were considered statistically significant.Results: The mean levels of serum calcium and alkaline phosphatase were decreased after treatment course while the mean level of serum phosphorus was increased in comparison to their mean levels before the treatment but the changes were statistically non-significant. BMD of neck and total femur showed no significant difference, but trivial increase (0.0151 gr/cm2) was detected in lumbar BMD after treatment (P<0.05).Conclusion: Considering no significant change in neck and total femur BMD and trivial and clinically unimportant increase in lumbar BMD (L<sub>2</sub>-L<sub>4</sub>), it seems that 120 mg/kg total dose of isotretinion that is used for acne has no significant effect on skeletal system.
P Toosi; A Sadiqha; H Monshi Zadeh; R Toosi
Volume 8, Issue 4 , 2005, , Pages 256-259
Abstract
Background and objective: Oral isotretinoin is the only treatment that has an effect on all the major etiological factors involved in acne (Increased sebum production, alterations in microbial flora, hyperkeratinization of pilosebaceous duct, and inflammation). Considering complications and relative ...
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Background and objective: Oral isotretinoin is the only treatment that has an effect on all the major etiological factors involved in acne (Increased sebum production, alterations in microbial flora, hyperkeratinization of pilosebaceous duct, and inflammation). Considering complications and relative expense, several treatment regimens have been suggested. The objective of this study was to evaluate the efficacy of intermittent doses of isotretinoin in acne patients. Materials ad Methods: We made a quasi-experimental clinical trial in the acne patients without nodular and cystic lesions that were recalcitrant to conventional therapy. Therapeutic regimen included 0.5 mg/kg isotretinoin per day for a week every month; So we use 21 mg/kg as total dosage. Results: Acne severity decreased in entire patients at the end of treatment course. After six months follow up, recurrence rate was 19.3% and partially recurrence rate was 44%. Conclusion: It seems that intermittent isotretinoin treatment with a total dose of 21 mg/kg has led to good therapeutic results in patients without nodulocystic lesions.