Title : Comparative study of safety and efficacy of betamethasone oral mini pulse therapy with topical clindamycin and nicotinamide gel versus oral azithromycin pulse therapy with topical clindamycin and nicotinamide gel in treatment of topical corticosteroid induced acne over face
Abstract:
Background: Steroid acne are the acneiform eruptions due to adverse effect of topical or oral corticosteroids due to the degradation of the follicular epithelium, resulting in extrusion of the follicular content. Steroid acne are tiny, firm follicular papules on the cheeks, forehead and chest.
Objectives: To compare the safety and efficacy of oral betamethasone mini pulse therapy in tapering doses with topical clindamycin and nicotinamide gel versus oral azithromycin pulse therapy with topical clindamycin and nicotinamide gel in the treatment of topical corticosteroid induced acne over face.
Methods: A comparative study was done on 50 patients with topical corticosteroid induced acne over face, assigned equally to group 1 and group 2 using simple randomization. Group 1, were given oral betamethasone mini pulse therapy and group 2, were given azithromycin pulse therapy for 6 weeks. Both the groups were advised to apply topical 1% clindamycin gel and 4% nicotinamide gel daily night for 12 weeks. Physician assessment was done using scoring system based on reduction in number of comedones and inflammatory lesions.
Results: Clinical improvement based on improvement of acne lesions assessed by physician,
demonstrated that in group 1, 17 patients (68 %) showed excellent improvement and 6 patients (24%) showed good improvement. Similarly in Group 2, 12 (48%) showed excellent improvement and 10 (40%) showed good improvement (p value = 0.151). Subjective assessment by patients showed that in group 1, 64% were very satisfied whereas in group 2, 12 % were very satisfied. The p value was found to be statistically significant at 0.001.
Conclusion: Steroid acne is a difficult-to-treat disorder with a disfiguring cosmetic impact. Options currently available for managing steroid acne are generally not satisfactory either because of slow response of oral antibiotics or due to issue of resistance and most importantly due to the inflammatory flare-up that occurs after stopping topical corticosteroids. Oral betamethasone mini pulse therapy in tapering doses along with topical anti acne agents is a safe and effective strategy for the treatment of steroid acne in the view of better patient satisfaction, convenience of usage, and higher compliance.
Audience Take Away Notes:
Steroid acne is a difficult-to-treat disorder with a disfiguring cosmetic impact. Although many people claim that treatment of steroid acne is similar to treatment of acne vulgaris, the options currently available for managing steroid acne are generally far from satisfactory either because of slow response of oral antibiotics or due to issue of resistance and most importantly due to the inflammatory flare-up that occurs after stopping topical corticosteroids. With better patient satisfaction, convenience of usage, and higher compliance, oral betamethasone mini pulse therapy in tapering doses along with topical anti-acne medication is a good option for the treatment of steroid acne. This study besides proving that oral betamethasone mini pulse therapy is an effective treatment modality for steroid acne, also allays apprehensions among the medical professionals to use oral steroids in acne due to their potential side effects. However, we recommend further larger trials in this regard to reinforce and revalidate our findings.
