Drug treatment of acne

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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
Ram Nagar
Patiala India

Jo-Ann See, author of the article, comments:

Many thanks for your interest in the article on drug treatment of acne. The aim was to outline a ‘first line’ approach for acne treatment in Australian general practice. Azithromycin is not commonly used for acne in Australia and the intermittent dosing, while effective, may be questioned from an adherence point of view. There have also been recent safety concerns about azithromycin and arrhythmia. The combination of azithromycin with oral isotretinoin was outside the scope of the article. GPs do not prescribe oral isotretinoin, so the discussion of it was aimed at supporting GPs who may have patients they are considering for specialist referral or patients taking isotretinoin who they co-manage with a dermatologist.

As every medicine has potential adverse effects, I have not written about the plethora of potential interactions or concerns that oral isotretinoin may have, including blood donation. It is routine practice for the Australian Red Cross to interview potential blood donors. Donors are also given a questionnaire about medicines taken in the previous 12 months. This would identify any potential risks regarding blood transfusion.Jo-Ann See, author of the article, comments:

Many thanks for your interest in the article on drug treatment of acne. The aim was to outline a ‘first line’ approach for acne treatment in Australian general practice. Azithromycin is not commonly used for acne in Australia and the intermittent dosing, while effective, may be questioned from an adherence point of view. There have also been recent safety concerns about azithromycin and arrhythmia. The combination of azithromycin with oral isotretinoin was outside the scope of the article. GPs do not prescribe oral isotretinoin, so the discussion of it was aimed at supporting GPs who may have patients they are considering for specialist referral or patients taking isotretinoin who they co-manage with a dermatologist.

As every medicine has potential adverse effects, I have not written about the plethora of potential interactions or concerns that oral isotretinoin may have, including blood donation. It is routine practice for the Australian Red Cross to interview potential blood donors. Donors are also given a questionnaire about medicines taken in the previous 12 months. This would identify any potential risks regarding blood transfusion.