Drug treatment of acne
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Letter to the Editor
Editor, – In the article on drug treatment of acne (Aust Prescr 2012;35:180-2), Dr Jo-Ann See has omitted the important role of azithromycin in treatment of acne. In cases of severe inflammatory and papulopustular acne, azithromycin pulses (for example three days every week for up to 8–12 weeks) with or without systemic isotretinoin have been found to be safe, well tolerated, effective and promote patient compliance.1,2 In fact, in a randomised study, pulsed azithromycin treatment for acne vulgaris was as effective and safe as daily doxycycline for two weeks.3 Tetracyclines (including doxycycline and minocyclin) cannot be combined with isotretinoin because of the risk of the shared adverse effect of raised intracranial tension. This is not the case with macrolides, and early in therapy, when isotretinoin may cause an initial flare in some patients, concomitant azithromycin can be safely used.
Secondly, it should be emphasised that a patient who is taking oral isotretinoin should not donate blood during and for up to one month after completion of therapy, as the blood may be transfused to a female of child-bearing age.
Naveen Kumar Kansal
Department of Dermatology and Venereology
Gian Sagar Medical College and Hospital
- Antonio JR, Pegas JR, Cestari TF, Do Nascimento LV. Azithromycin pulses in the treatment of inflammatory and pustular acne: efficacy, tolerability and safety. J Dermatolog Treat 2008;19:210-5.
- De D, Kanwar AJ. Combination of low-dose isotretinoin and pulsed oral azithromycin in the management of moderate to severe acne: a preliminary open-label, prospective, non-comparative, single-centre study. Clin Drug Investig 2011;31:599-604.
- Maleszka R, Turek-Urasinska K, Oremus M, Vukovic J, Barsic B. Pulsed azithromycin treatment is as effective and safe as 2-week-longer daily doxycycline treatment of acne vulgaris: a randomized, double-blind, noninferiority study. Skinmed 2011;9:86-94.