Surgical Management of Acne Combined to Oral Isotretinoin: Case-Series of 1191 Patients

7^th International Congress on Dermatology

March 13-14, 2023 | Frankfurt, Germany

Mohamed Khouazem

Dermatology & Laser Clinic Boumerdes, Algeria

Scientific Tracks Abstracts: J Dermatol Dis

Abstract :

Systemic Isotretinoin is the cornerstone of severe acne treatment, used alone has many disadvantages (inflammatory flares, inefficiency against closed comedones, long improvement time and debatable complete remission rates after reaching the cumulative doses). Cysts and comedones surgical extraction is the key procedure to shortcut these inconveniences. From February 2017 to September 2022, 1191 patients with severe or unresponsive to conventional treatments acne received a protocol based on performing surgical extraction of all closed comedones immediately before launching a 0.5 mg/kg/day Isotretinoin course, assessments based on lesions count were made at the first, second, third, fourth months and after reaching 120-150 mg/kg cumulative doses. Comedones surgical removal was renewed when required throughout the course. Average acne improvement was 88% at one month, 96% at two months, 98% at three months, and 99% at four months. Among the 433 patients who reached the 120- 150 mg/kg cumulative doses, 429 (99%) were in complete remission. Isotretinoin-induced inflammatory flares were inexistent on the surgically cleansed areas and presented only on the non-cleansed ones in patients requiring more than a single surgical session. The procedure didn’t leave scars even when massive mini-incisions were performed on patients under Isotretinoin courses (the average was 100 incisions per session), which seriously questions the recommendation to avoid all physical treatments amid such courses. This is the first documented large scale study of comedones surgical extraction associated with Isotretinoin, the procedure’s main advantages are the immediate and persistent acne clearance even for very severe acne, the avoidance of Isotretinoin-induced worsening flares, and the increased complete remission rates when cumulative doses are reached. Previous literature records about Isotretinoin alone showed acceptable rates but after devastating scars-producing flares during the first treatment weeks, a side effect dramatically avoided by massively extracting comedones. Further RCTs are needed to compare the two procedures.

Biography :

I am an Algerian self-employed dermatologist, I graduated from Algiers university in 2011 (master certificate of dermatology specialized studies) and now I manage my own dermatology clinic in Boumerdes since 2016. I received the prize of the best oral communication in the national congress of dermatology in 2010. My main activity is the surgical treatment of active acne (more than 2000 operations performed so far, 1191 included in a study) with excellent results regarding immediate complete remission and definitive healing. The study was presented in October 2022 during the last Algiers aesthetic medicine congress.