Scholarlink

<p>Acne vulgaris is a prevalent inflammatory dermatosis with substantial psychosocial impact. Oral isotretinoin remains the most effective therapy for moderate to severe cases; however, its mucocutaneous adverse effects frequently compromise adherence. H₁-antihistamines, owing to their anti-inflammatory and sebo-suppressive properties, may enhance both efficacy and tolerability of isotretinoin. This systematic review and meta-analysis evaluated the efficacy and safety of combining oral isotretinoin with H₁-antihistamines in patients with acne vulgaris. Following PRISMA guidelines and registering this review in PROSPERO (CRD420251077931), seven databases including PubMed/MEDLINE, Cochrane, Scopus, Web of Science, EMBASE, CINAHL and Google Scholar were searched through June 2025, for randomized controlled trials. Primary outcomes included changes in Global Acne Grading System (GAGS) scores, lesion counts, and treatment efficacy (defined as &gt; 90% GAGS reduction). Secondary outcomes included mucocutaneous adverse effects and acne flare-ups. Random-effects models estimated pooled effects. Risk of bias was assessed with the Cochrane RoB 2.0 tool, evidence quality and robustness were evaluated using GRADE approach and trial sequential analysis (TSA). Eleven trials (n = 741) met inclusion criteria. Combination therapy significantly reduced GAGS scores (MD − 2.35; 95% CI: −3.01 to − 1.65; I² = 0.0%; p &lt; 0.01) and increased the likelihood of achieving &gt; 90% GAGS reduction (RR = 1.49; 95% CI: 1.19 to 1.85; I² = 0.0%; p &lt; 0.01). It also reduced pruritus (RR = 0.33; 95% CI: 0.20 to 0.54; I² = 47.3%; p &lt; 0.01) and modestly decreased the incidence of cheilitis (RR = 0.80; 95% CI: 0.66 to 0.97; I² = 76.7%; p = 0.04). No significant differences were observed in inflammatory or non-inflammatory lesion counts, acne flare-ups, or dryness. GRADE certainty was moderate for GAGS score, efficacy, cheilitis, and pruritus, and low to very low for other outcomes. TSA confirmed benefit only for &gt; 90% GAGS reduction and pruritus; other outcomes remained inconclusive. The addition of H₁-antihistamines to oral isotretinoin improves clinical efficacy by enhancing GAGS score reduction and overall tolerability in acne vulgaris, particularly through mitigation of pruritus and cheilitis. However, current evidence does not support significant improvements in lesion counts. Further high-quality standardized trials are warranted.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Oral isotretinoin combined with antihistaminics for the treatment of acne vulgaris: a systematic review, meta-analysis and trial sequential analysis with GRADE assessment of randomized controlled trials

  • 期刊论文

  • 发表日期：

    2026年3月30日

查看全文
  • Camila Sanchez Cruz,
  • Salma Alejandra Beltran Covarrubias,
  • Alejandro Chen Liang,
  • Montserrat Villa Sanchez,
  • Yeison Cruz Castillo,
  • España De la Rosa Valdez,
  • Frances Marie Mejia,
  • Robin Picavia,
  • Ernesto Calderón-Martinez

摘要

Acne vulgaris is a prevalent inflammatory dermatosis with substantial psychosocial impact. Oral isotretinoin remains the most effective therapy for moderate to severe cases; however, its mucocutaneous adverse effects frequently compromise adherence. H₁-antihistamines, owing to their anti-inflammatory and sebo-suppressive properties, may enhance both efficacy and tolerability of isotretinoin. This systematic review and meta-analysis evaluated the efficacy and safety of combining oral isotretinoin with H₁-antihistamines in patients with acne vulgaris. Following PRISMA guidelines and registering this review in PROSPERO (CRD420251077931), seven databases including PubMed/MEDLINE, Cochrane, Scopus, Web of Science, EMBASE, CINAHL and Google Scholar were searched through June 2025, for randomized controlled trials. Primary outcomes included changes in Global Acne Grading System (GAGS) scores, lesion counts, and treatment efficacy (defined as > 90% GAGS reduction). Secondary outcomes included mucocutaneous adverse effects and acne flare-ups. Random-effects models estimated pooled effects. Risk of bias was assessed with the Cochrane RoB 2.0 tool, evidence quality and robustness were evaluated using GRADE approach and trial sequential analysis (TSA). Eleven trials (n = 741) met inclusion criteria. Combination therapy significantly reduced GAGS scores (MD − 2.35; 95% CI: −3.01 to − 1.65; I² = 0.0%; p < 0.01) and increased the likelihood of achieving > 90% GAGS reduction (RR = 1.49; 95% CI: 1.19 to 1.85; I² = 0.0%; p < 0.01). It also reduced pruritus (RR = 0.33; 95% CI: 0.20 to 0.54; I² = 47.3%; p < 0.01) and modestly decreased the incidence of cheilitis (RR = 0.80; 95% CI: 0.66 to 0.97; I² = 76.7%; p = 0.04). No significant differences were observed in inflammatory or non-inflammatory lesion counts, acne flare-ups, or dryness. GRADE certainty was moderate for GAGS score, efficacy, cheilitis, and pruritus, and low to very low for other outcomes. TSA confirmed benefit only for > 90% GAGS reduction and pruritus; other outcomes remained inconclusive. The addition of H₁-antihistamines to oral isotretinoin improves clinical efficacy by enhancing GAGS score reduction and overall tolerability in acne vulgaris, particularly through mitigation of pruritus and cheilitis. However, current evidence does not support significant improvements in lesion counts. Further high-quality standardized trials are warranted.