Isotretinoin 0.05% / Erythromycin 2% gel

Doxycycline is commonly used to manage acne vulgaris (AV), but comprehensive comparisons of its efficacy and safety against alternative treatments remain limited. This study aimed to systematically evaluate and compare the efficacy and safety of oral doxycycline with other therapeutic options for AV treatment. A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted following PRISMA guidelines. Literature searches were performed in PubMed/MEDLINE, Embase, Cochrane CENTRAL, Scopus, Web of Science, and Google Scholar up to March 2024, using Medical Subject Headings (MeSH) and relevant free-text terms (e.g., "doxycycline AND acne vulgaris"). The primary outcomes were treatment success, change in inflammatory lesion count, and Global Acne Grading System (GAGS) scores, while safety outcomes focused on the incidence of reported adverse events. The risk of bias across studies was evaluated using the Cochrane ROB-2 tool, and meta-analyses were conducted using random-effects models to account for expected heterogeneity. A total of 23 RCTs comprising 2,672 patients were included. Doxycycline showed similar efficacy to azithromycin in achieving treatment success (OR 1.28; 95% CI [0.54, 3.04], p = 0.57; I2 = 60%), with no significant difference in inflammatory lesion reduction (MD -0.71; 95% CI [-8.61, 7.19], p = 0.86; I2 = 97%). However, other treatments (e.g., isotretinoin, silymarin) demonstrated greater improvements in GAGS scores (MD 1.76; 95% CI [1.53, 2.00], p < 0.00001; I2 = 53%). More adverse events, particularly gastrointestinal and dermatological, were reported with doxycycline. While effective, its safety profile and comparative performance warrant further investigation through high-quality RCTs.

Abstract licence: CC BY-NC-ND

BackgroundAcne vulgaris is a common skin condition that may cause psychosocial distress. There is evidence that topical treatment combinations, chemical peels and photochemical therapy (combined blue/red light) are effective for mild-to-moderate acne, while topical treatment combinations, oral antibiotics combined with topical treatments, oral isotretinoin and photodynamic therapy are most effective for moderate-to-severe acne. Effective treatments have varying costs. The National Institute for Health and Care Excellence (NICE) in England considers cost-effectiveness when producing national clinical, public health and social care guidance.AimTo assess the cost-effectiveness of treatments for mild-to-moderate and moderate-to-severe acne to inform relevant NICE guidance.MethodsA decision-analytical model compared costs and quality-adjusted life-years (QALYs) of effective topical pharmacological, oral pharmacological, physical and combined treatments for mild-to-moderate and moderate-to-severe acne, from the perspective of the National Health Service in England. Effectiveness data were derived from a network meta-analysis. Other model input parameters were based on published sources, supplemented by expert opinion.ResultsAll of the assessed treatments were more cost-effective than treatment with placebo (general practitioner visits without active treatment). For mild-to-moderate acne, topical treatment combinations and photochemical therapy (combined blue/red light) were most cost-effective. For moderate-to-severe acne, topical treatment combinations, oral antibiotics combined with topical treatments, and oral isotretinoin were the most cost-effective. Results showed uncertainty, as reflected in the wide confidence intervals around mean treatment rankings.ConclusionA range of treatments are cost-effective for the management of acne. Well-conducted studies are needed to examine the long-term clinical efficacy and cost-effectiveness of the full range of acne treatments.

Abstract licence: CC BY-NC

Acne vulgaris frequently affects women during pregnancy and lactation. Hormonal and physiologic changes in pregnancy contribute to the pathogenesis of acne during the various phases of pregnancy. Several effective acne treatments commonly prescribed in the general population are contraindicated during pregnancy or lactation. There is a lack of guidelines and updated resources on acne management in these populations. In this narrative review, we summarize existing evidence on the safety and efficacy of acne treatments during pregnancy and breastfeeding. Acne management in pregnancy and lactation should follow a stepwise approach based on severity to minimize risk. Topical therapies, such as benzoyl peroxide, azelaic acid, or keratolytics, can be used to treat mild-to-moderate disease. Moderate-to-severe acne may require systemic treatments, including penicillin, amoxicillin, cephalexin, and erythromycin, with special consideration for trimester-specific teratogenicity of medications and relevant medical history of the mother and infant. For refractory cases, oral or intralesional corticosteroids as well as laser and light therapies may be considered. This review provides an updated reference to aid patient-physician decision-making on acne management in these special populations.

Abstract licence: CC BY-NC

Key clinical messagePulsed dye laser (PDL) has proven effective in resolving lupus miliaris disseminatus faciei (LMDF) where drug therapies have failed with a lack of treatment consensus for LMDF, considering early PDL intervention is crucial to achieve resolution without scarring, prevent relapse, and enhance overall treatment outcomes.AbstractLupus miliaris disseminatus faciei (LMDF) is a rare inflammatory and granulomatous dermatologic disease that primarily affects the face. The optimal treatment for LMDF remains controversial, and there is a lack of consensus on the most effective therapy. This case report highlights the successful use of a 595 nm pulsed dye laser (PDL) in the treatment of LMDF following unsuccessful drug therapy. A 28-year-old male presented with reddish-brown eruptions on his face that had persisted for several months. Clinical examination revealed discrete dome-shaped eruptions in clusters on the central area of the face. Histopathological examination confirmed the diagnosis of LMDF, based on the presence of epithelioid granulomas with central caseous necrosis. Previous treatment with an oral isotretinoin and methotrexate combination also failed to yield satisfactory results. After discontinuing drug therapy, the patient underwent five sessions of PDL treatment. Ten days after the first session, the eruptions began to regress without scarring. Subsequent PDL sessions led to the complete resolution of the eruptions. The patient experienced no relapse during the follow-up period. This case report suggests that PDL treatment may be an effective option for LMDF, particularly in cases where drug therapy has failed. Early initiation of laser treatment may prevent scarring, minimize the adverse effects associated with drug therapy, and reduce the risk of disease relapse. Further research and controlled trials are needed to establish the efficacy of laser therapy in the treatment of LMDF.

Abstract licence: CC BY