To compare the clinical effectiveness of azithromycin vs doxycycline on the first follow-up visit of acne vulgaris patients

Abstract

Acne Vulgaris is a chronic inflammatory disorder of pilosebaceous unit which frequently affects the cosmetically important areas of the body like face, back, chest, neck, and upper arms. It is a multifactorial disease and its pathophysiology centres on the interplay of increased sebum production, follicular hyperkeratinisation, colonization with Propionibacterium Acnes and inflammation. There are many systemic modalities for the treatment of acne among which Azithromycin and Doxycycline are the commonly prescribed ones. With an aim to manage patients effectively a case-control study was conducted on 70 patients to compare the clinical effectiveness of both the drugs for the early symptomatic relief of moderate to severe inflammatory acne. Method This study was conducted at the outdoor of dermatology department at Punjab Rangers Teaching Hospital over a period of three months starting from August 2019 till the end of October. A total of 70 acne patients compatible with the inclusion criteria were enrolled and divided into two equal groups of cases and controls. The cases were prescribed Azithromycin 500mg once a day for first two weeks followed by 250mg once a day for the next two weeks, while the controls were prescribed Doxycycline 100 mg once a day. Both groups were treated for a period of four weeks and were assessed based on new lesion count and the settlement of older lesions to compare the clinical effectiveness of each drug. Results Based on the clinical assessment at the first follow-up after 4 weeks, it was observed that in the Azithromycin group 21 patients (60%) showed a good response with (more than 50%) clearance of the inflammatory pustules and nodules, 9 (26%) patients showed a moderate response between 30-50% and 5 (14%) patients showed a mild response between 20-30%. In Group B, 12 (34%) patients showed moderate response between 30- 50%, 12 (34%) patients showed mild response between 20-30%, while the remaining 11 (32%) patients were placed in the no response category with less than 20% improvement. Overall Azithromycin showed significantly better response, p-value < 0.001 than other group, p-value=0.014. Conclusion It was observed that Azithromycin has an earlier onset of action in the treatment of inflammatory acne as compared to Doxycycline. So, for patients where prompt results are desired Azithromycin has proven to be more effective as compared to Doxycycline.