Comparative Study of Oral Isotretinoin versus Oral Isotretinoin +20% Salicylic Acid Peel in the Treatment of Active Acne.

In this paper, authors have compared the efficacy of a combination of oral isotretinoin and salicylic acid peels with isotretinoin monotherapy in the treatment of moderate to severe acne.[1] The study has been conducted in a randomised blinded manner and the total duration of study has been 16 weeks. Some points that need to be commented upon regarding this study are:

Isotretinoin therapy is associated with troublesome xerosis of skin and this adverse effect is likely to exacerbate in combination with salicylic acid peels. This aspect needs to be looked into more closely and assessed more thoroughly if the combination is used. Did the patients on combination require more emollients than those on monotherapy and what should be the choice of emollients in such a setting needs to be elaborated upon

Salicylic acid is available in different concentrations and in different forms to a dermatologist. A number of face washes having 2% of salicylic acid as a component are available and are routinely prescribed to patients with acne. Can the beneficial effect of the combination described in the study be achieved with co-prescription of such face washes with oral isotretinoin therapy? This is also a thought to be pondered over

Daily-use products such as face washes/soaps, creams and moisturizers and even daily dietary habits have play an important role in acne pathogenesis. Hence, all of these factors should be taken into account once a therapeutic study is conducted on patients with acne. A mention should be made of all these factors once a clinical study is conducted on the subject of acne management

Concerns have been expressed in the world literature about combining any cosmetological or laser procedures along with oral isotretinoin therapy.[23] These concerns started after some reports blamed concomitant isotretinoin therapy for some severe adverse reactions to CO2 laser resurfacing. However, a number of clinical studies have been published since then have shown no additional risk of non-ablative laser procedures in patients taking isotretinoin

Salicylic acid peel is a superficial peel and the peeling agent does not penetrate to the level of the dermis.[4] So, a combination of salicylic acid peel with oral isotretinoin can prove to be a good and relatively safe option to circumvent the initial flare-up of acne that is seen with isotretinoin monotherapy.