| Objective:To study the efficacy and safety of doxycycline combined with low dose isotretinoin in the sequential treatment of moderate and severe acne vulgaris.It provides a useful reference for clinical work.Methods:Collecting 61 patients with moderate and severe acne vulgaris in the First Hospital of Shanxi Medical University from June 2018 to June 2019,moderate grade ? patiens were given oral doxycycline 100mg/d and oral isotretinoin 10mg/d,moderate grade ? patiens and severe grade ? patiens were treated with oral doxycycline 200mg/d.Subsequent visit in the second and fourth week,and every two weeks thereafter,the dose of doxycycline and isotretinoin was adjusted according to the improvement of skin lesions and the dryness of lips during the follow-up(if the acne skin lesions of moderate grade III and severe grade IV are reduced to moderate grade II in the second week,the above-mentioned moderate grade II medication plan shall be carried out,otherwise,doxycycline will continue to be administered at the original dose of 200mg/d until the 4th week,and the above-mentioned moderate grade II drug regimen will be carried out;if the lips are obviously dry,the isotretinoin shall be continued to be treated with 10mg/d;if the lips are not obviously dry,the isotretinoin shall be added to 20mg/d).After acne skin lesions were reduced to mild grate ?,stop using doxycycline;after the total score of acne skin lesions was 1 point,continue taking isotretinoin 10 mg every other day for one month until it is stopped.Results:1.After treatment with doxycycline alone(3.32 ± 0.92)weeks in moderate grade III and severe grade IV patients,the inflammation was basically controlled,then treatment with doxycycline in combination with isotretinoin(7.76 ± 3.00)weeks,the acne skin lesions were significantly improved,at the end of treatment,the total course of doxycycline was(10.87 ± 2.60)weeks,the total course of isotretinoin was(27.05 ± 6.77)weeks,and the cumulative dose of isotretinoin was(40.49±19.05)mg/kg.After treatment with doxycycline and isotretinoin for(8.47 ± 2.56)weeks in moderate grade II patients,the acne skin lesions improved significantly,at the end of the treatment,the total course of doxycycline was(8.47 ± 2.56)weeks,the total course of isotretinoin was(23.32 ± 7.06)weeks,and the cumulative dose was(28.77 ± 9.28)mg/kg.In 57 patients,the longest course of isotretinoin was 36 weeks,the shortest 16 weeks.2.The effective rates of moderate grade II,moderate grade III and severe grade IV patients were 57.9%,57.7% and 16.7% respectively at the 8th week,100%,92.3% and 75% respectively at the 12 th week,and 100% at the end of treatment.3.The adverse reactions:4 cases were discontinued due to adverse reactions(1 case for headache,1 case for backache,1 case for ALT increased continually and 1case for DBIL increased continually);Side-effects of 57 cases who completed the study:57 cases of xerocheilia(100%),5 cases of xerosis of face(8.8%),1 case of ALT increased(1.8%),1 case of AST increased(1.8%),2 cases of TG increased(3.5%),1 cases of TBIL increased(1.8%)and 1 cases of DBIL increased(1.8%).4.After 6 months follow-up,the recurrence rate was 12.3%,of which 7% was mild recurrence and 5.3% was moderate recurrence.Conclusion:1.Doxycycline combined with low dose isotretinoin in the sequential treatment of moderate and severe acne has good efficacy,small side effects and high compliance,which is worth of clinical promotion.2.The inflammation of moderate grade III and severe grade IV patients can be basically controlled for about 3 weeks,and the acne skin lesions can be significantly improved for about 11 weeks;the acne skin lesions of moderate grade II patients can be significantly improved for about 8 week.3.Although doxycycline combined with low-dose isotretinoin sequential treatment of moderate and severe acne has significant effect,it still has a certain recurrence rate,suggesting that the treatment of moderate and severe acne needs a better comprehensive plan. |
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