Randomized prospective study of low-dose isotretinoin alone and combination with salicylic acid and mandelic peel against acne tarda.

BACKGROUND: Acne tarda (AT) is typically known as adult acne and most preferably affected 25-45 age groups. Used isotretinoid monotherapy is not effective and also produces side effects from long treatment. AIM: The present study assesses the effectiveness of combined treatment of oral isotretinoid with topical chemical peeling (20% salicylic and 10% mandelic acid known as SM peeling) by a comparative double-blind randomized single-center interventional open-label study. MATERIALS AND METHODS: A total fifty-eight participants AT outpatients (25-45 age groups) attending for diagnosis in two groups and effectiveness of proposed combined treatments were determined at baseline and follow-up within 4-week interval. Briefly group A (n = 28) received 0.5 mg/kg of oral isotretinoin once daily for 16 weeks and group B (n = 30) received the same oral dose, addition with SM peeling every 4 weeks interval for 16 weeks. After 4 weeks, treatment efficacy was assessed based on Michelson's acne severity index (MASI) and visual analog scale (VAS), further validated using statistical tools. RESULTS: Based on MASI and VAS scores, combined treatment was significantly effective than the monotherapy. The pre- and post-treatment analyses of response to scarring, inflammatory components at baseline and at the end of treatment were also statistically significant with p > 0.008. CONCLUSION: The above investigation revealed that the combination of oral isotretinoin with SM peeling was highly effective and could be used as newer therapy against AT without any serious side effects.

A prospective randomized controlled trial of Q-switched Nd:YAG laser with topical 3% tranexamic acid (TA) versus microneedling with topical 3% tranexamic acid (TA) in treatment of melasma.

INTRODUCTION: Treatment of melasma is challenging. Topical TA has shown promising results as an adjuvant, when combined with microneedling or QS Nd:YAG laser. The efficacy of both combinations has been demonstrated but the efficacy between these two combinations has never been compared. AIM AND OBJECTIVES: To compare the efficacy and side effects of microneedling and QS Nd:YAG laser when combined with topical 3% TA gel. MATERIALS AND METHODS: 60 patients were randomized into 2 groups. Group A received Nd:YAG laser sessions monthly with daily 3% TA gel while Group B underwent microneedling monthly with daily 3% TA gel. A total of 5 sessions were given with follow-up after 2 months. Evaluation using modified Melasma Area and Severity Index (mMASI), Patient satisfaction score, and photography was done at baseline, 3rd session, 5th session, and final follow-up. RESULTS: Mean fall in mMASI at follow-up in Group A was 5.12 ± 2.66 to 2.33 ± 1.33 and Group B was 4.60 ± 2.38 to 1.88 ± 1.08 (p < 0.001). Patient satisfaction score was not significantly different. Side effects of both interventions included erythema, pain, and burning sensation. CONCLUSION: Our study shows equal efficacy of microneedling and QS Nd:YAG laser when combined with topical 3% TA gel in treating melasma without serious side effects. Microneedling has more downtime and maybe less preferable as a lunchtime procedure.