Efficacy And Safety Observation Of Isotretinoin Combined With IPL In The Treatment Of Moderate To Severe Acne

Research background:Acne vulgaris is a common chronic inflammatory disease involving sebaceous units of hair follicles in dermatology.The manifestations of the lesions are various,and sequelae such as erythema after inflammation,pigmentation after inflammation and scar may be formed after healing.Although acne is generally considered to be a self-limited disease of adolescence,sequelae can last a lifetime and therefore have a long-term psychosocial impact on the patient’s quality of life.Its pathogenesis has not been fully explained,and how to treat acne more safely and effectively and reduce the formation of acne sequelae is the focus of the current research.Systematic use of isotretinoin is a first-line therapy for severe acne,and it is also the only anti-acne drug that can be used as a single therapy,because it can act on all known factors related to the pathogenesis of acne.The common side effects of isotretinoin are predictable and easy to control,and most of them are dose-dependent.In recent years,photovoltaic therapy is effective and has little side effects.Various guidelines have mentioned that appropriate photovoltaic therapy can be used as a new choice to improve acne and its sequelae.Intense pulsed light is usually a kind of strong light with wavelength of 400～1200nm,which can cover a variety of color groups such as melanin,hemoglobin and other absorption peaks.It is easy to operate and has its unique advantages in the treatment of moderate and severe acne.Its photothermal effect can not only inhibit the secretion of sebaceous glands,but also promote the closure of blood vessels and promote the absorption and regression of inflammation through the principle of photocoagulation.It has been observed that IPL therapy can also induce extracellular protein synthesis in the dermis and increase the content of collagen and elastic fibers in the dermis,which reduces the risk of scar formation.IPL can interfere with the inflammatory process of acne,but the efficacy of IPL is transient and local.In recent years,some scholars have begun to pay attention to the application of oral isotretinoin and intense pulsed light in the treatment of moderate and severe acne.Therefore,in this study,we used both of them to observe the efficacy and safety of 420nm+650nm IPL combined with isotretinoin in the treatment of moderate and severe acne,and to explore whether the combination therapy can improve the efficacy without increasing the occurrence of adverse reactions,in order to provide a new choice for the combined treatment of moderate and severe acne.Research purpose:By comparing the efficacy and adverse reactions of 420nm+650nm IPL combined with oral isotretinoin and 420 nm IPL combined with oral isotretinoin and oral isotretinoin in the treatment of moderate and severe acne,to explore the efficacy and safety of IPL combined with isotretinoin in the treatment of moderate and severe acne.Research subjects and methods:From March 2021 to May 2022,90 patients with II-IV acne who met the modified Pillsbury criteria of dermatology in the first affiliated Hospital of Chengdu Medical College were randomly divided into experimental group(oral isotretinoin combined with 420nm+650nm IPL),control group 1(oral isotretinoin combined with 420 nm IPL)and control group 2(oral isotretinoin),with 30 cases in each group.Intense pulsed light(IPL)treatment: intense pulsed light therapy,once a week,continuous treatment for 8times,isotretinoin treatment: oral isotretinoin soft capsule(0.25-0.5mg/kg.d),continuous treatment for 4 months.Experimental group: oral isotretinoin combined with intense pulsed light therapy(420nm+650nm IPL).Control group 1: oral isotretinoin combined with intense pulsed light therapy(420nm IPL).Control group 2: treated with oral isotretinoin.Before the beginning of treatment(baseline),1 month,2 months,3months and 4 months after treatment,the skin lesions were counted,the disappearance rate of skin lesions was calculated,the curative effect was evaluated,and all adverse reactions during treatment and follow-up were recorded.All patients underwent routine laboratory examination at the end of 1 and 4 months of treatment to monitor transaminase and blood lipids.The patients were followed up for 6 months after the whole treatment.Research result:1.There was no significant difference in age,sex,course of disease,acne severity grade,total lesion count,inflammatory lesion count and non-inflammatory lesion count among the three groups(P > 0.05).The baseline data were comparable.2.At 2 months of treatment,there was significant difference in the total skin lesion disappearance rate between experimental group and control group 1 and control group 2(P < 0.05),and there was significant difference among experimental group,control group 1 and control group 2 at 2 months of treatment(P < 0.05).There was no significant difference in the disappearance rate of non-inflammatory lesions during the treatment period(P > 0.05).3.At 2,3 and 4 months of treatment,the curative effect of the experimental group were 67.86%、78.57%、92.86%,respectively;the curative effect of control group 1 were55.56%、77.78%、92.59%,respectively;the curative effect of control group 1 were44.83%、65.52%、89.66%,respectively.4.There was no significant difference in the incidence of IPL-related adverse reactions and isotretinoin adverse reactions among the three groups during treatment,and there was no photosensitive reaction in isotretinoin combined with IPL group,and there were no rare or rare adverse reactions.5.The three groups were examined for ALT,AST and TG one month after treatment,and the measured values of individual patients exceeded the normal range(ALT,AST did not exceed the upper limit of the normal value,and TG did not exceed the upper limit of the normal value),but did not require special treatment.ALT,AST and TG were examined 4 months after treatment,and basically returned to the normal range.6.During the follow-up,there were significant differences in the treatment of erythema and pigmentation after acne among the three groups(P < 0.05),and the experimental group > control group 1 > control group 2.Research conclusion:1.420nm+650nm IPL combined with oral isotretinoin is effective in the treatment of moderate and severe acne,which is better than 420 nm IPL combined with isotretinoin and oral isotretinoin alone.2.420nm+650nm IPL combined with oral isotretinoin is effective in the treatment of moderate and severe acne.3.420nm+650nm IPL combined with oral isotretinoin in the treatment of moderate and severe acne can improve erythema and pigmentation after acne to some extent.4.The adverse reactions of 420nm+650nm IPL combined with oral isotretinoin in the treatment of moderate and severe acne can be controlled and the safety is guaranteed.5.420nm+650nm IPL combined with oral isotretinoin in the treatment of moderate and severe acne is worthy of clinical application.