ABSTRACT
Background: Acne vulgaris is a chronic inflammatory disease of the pilosebaceous unit with considerable psychosocial impact. Oral azithromycin or oral doxycycline can be used for the management of moderate and severe acne vulgaris. However, there is no consensus on which antibiotic is superior and the optimal dose for management.Methods: A prospective randomized interventional study was carried out among 120 patients of moderate to severe acne vulgaris. The patients were randomized into group A and B. While group A was prescribed oral azithromycin 500 mg three times a week, group B was given oral doxycycline 100 mg daily for 12 weeks. Topical clindamycin twice daily application was also given. Global Acne Grading Scale (GAGS) score was recorded at baseline and at 2nd, 4th, 8th and 12th weeks.Results: GAGS score at baseline in azithromycin (n = 53) and doxycycline (n = 55) group was 31.98±4.49 and 30.63±3.78 respectively (p value >0.05). 83.91±6.83% (p <0.001) and 81.87±6.75% (p <0.001) improvement was seen in azithromycin group and doxycycline group after 12 weeks of treatment. However, there was no difference in the GAGS score between the groups at any follow-up (p value >0.05). 15.09% patients in azithromycin group and 20% patients in doxycycline group reported adverse effects. The most commonly reported adverse effect was diarrhoea. All adverse effects were of ‘mild’ category and causality assessment was ‘possible’.Conclusions: Oral azithromycin is equally efficacious but safer alternative to oral doxycycline for the management of acne vulgaris.
ABSTRACT
Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis and manifested by formation of tubercles and caseous necrosis in tissues. In the musculoskeletal system, tuberculous spondylitis is the most typical form of the disease; however, joint changes in extraspinal sites, such as the hip, knee, wrist and elbow, also may occur. Other abnormalities commonly encountered are tuberculous dactylitis and involvement of the tendon sheath. Characteristically, the tissues respond to the mycobacterial infection by forming tubercles. Clusters of epithelial cells surround a central zone of caseating necrosis, with the central part of the tubercle being composed of multinucleated giant cells and the periphery consisting of a mantle of lymphocytes. Special types of tuberculous osteomyelitis include cystic tuberculosis and tuberculous dactylitis. The radiographic characteristics of cystic tuberculosis resemble those of eosinophilic granuloma, sarcoidosis, cystic angiomatosis, plasma cell myeloma, fungal infections, metastases and other conditions. Tuberculous dactylitis involving the short tubular bones of the hands and feet occurs especially frequently in children. In addition to soft tissue swelling, periostitis of phalanges, metacarpals or metatarsals may be evident. Expansion of the bone with cystic quality is termed spina ventosa.Tuberculosis of the metacarpals ,metatarsals and phalanges is uncommon after the age of five years.