Comedone Extraction and Electrodesiccation Added to Topical Adapalene for Comedonal Acne: A Quasi-Experimental Study
Keywords:
acne vulgaris, adapalene, comedone extraction, comedone, electrodesiccation, quasi-experimental studyAbstract
Background: Topical retinoids reduce the formation of microcomedones. The addition of procedural removal may speed up their resolution, but whether this provides an additional benefit in terms of safety and side effects has not been assessed.
Objective: This study compared comedone extraction and electrodesiccation followed by adapalene 0.1% versus topical adapalene 0.1% alone for comedonal acne.
Methodology: We conducted a prospective, single-center, assessor-blinded quasi-experimental study of 80 patients aged 16 to 40 years with comedonal acne using a 2-arm, 8-week regimen. Forty participants were assigned to combined treatment and 40 to adapalene alone by nonrandom alternating allocation. The primary outcome was percentage reduction in total facial comedone density after 8 weeks. Secondary outcomes included Global Acne Grading System improvement, post-inflammatory hyperpigmentation, scarring, tolerability, and adherence.
Results: All 80 participants completed follow-up. Mean Week 8 reduction was 71.94% (SD = 10.62) with combined treatment and 62.67% (SD = 13.86) with adapalene alone, Welch t(73.06) = 3.36, p = .001; mean difference = 9.27 percentage points, 95% CI [3.77, 14.78], Hedges’ g = 0.74. The treatment-by-time interaction favored combined treatment, F(1.15, 89.87) = 10.23, p = .001. Median GAGS improvement was 6.50 versus 4.00 points, p < .001. Week 8 post-inflammatory hyperpigmentation occurred in 17.5% versus 7.5% and scarring in 5.0% versus 0%; both comparisons were imprecise and nonsignificant.
Conclusions: Patients receiving in-office procedures in addition to topical treatment demonstrated greater improvement in comedonal lesions. However, due to the non-randomized design, safety estimates were imprecise and warrant confirmation in future randomized studies.
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