Lip Mesotherapy With Dexpanthenol As A Novel Approach To Prevent Isotretinoin-Associated Cheilitis
Keywords:
cheilitis, dexpanthenol, isotretinoin, mesotherapy, mucocutaneous side effectAbstract
Introduction: Isotretinoin (ISO)-associated cheilitis is the most common side effect and the most common reason for discontinuation of ongoing therapy. So, various lip balms are also routinely recommended for all patients.
Objectives: We aimed to investigate the effectiveness of local intradermal injections (mesotherapy) of dexpanthenol into the lips to prevent ISO-associated cheilitis.
Methods: This pilot study was conducted on patients over the age of 18 using ISO (about 0.5 mg/kg/day). All patients were prescribed only hamamelis virginiana distillate in ointment form as a lip balm. In the mesotherapy group (n=28), 0.1 ml of dexpanthenol was injected into each lip tubercle (4 points total) to the submucosal level. The patients in the control group (n=26) used only the ointment. “ISO cheilitis grading scale (ICGS)” was used in the evaluation of ISO-associated cheilitis. The patients were followed for 2 months.
Results: Although there was an increase in ICGS scores in the mesotherapy group compared to the baseline, no statistically significant change was observed after treatment (p=0.545). However, in the control group, there was a statistically significant increase in ICGS scores in the 1st and 2nd months compared to the baseline (p<0.001). Lip balms were needed significantly less frequently in the mesotherapy group compared to the control, both in the 1st and 2nd months (p=0.006, p=0.045; respectively).
Conclusions: Lip mesotherapy with dexpanthenol will be a useful option for preventing ISO-associated cheilitis because of its easy application, cost-effectiveness, low complication risk, and high patient satisfaction.
References
Brelsford M, Beute TC. Preventing and managing the side effects of isotretinoin. Semin Cutan Med Surg. 2008; 27: 197-206. doi: 10.1016/j.sder.2008.07.002.
Rademaker M. Adverse effects of isotretinoin: A retrospective review of 1743 patients started on isotretinoin. Australas J Dermatol. 2010;5 1: 248-253. doi: 10.1111/j.1440-0960.2010.00657.x.
Brito MF, Sant'Anna I, Galindo J, Rosendo L, Santos J. Evaluation of clinical adverse effects and laboratory alterations in patients with acne vulgaris treated with oral isotretinoin. An Bras Dermatol. 2010; 85: 331-337. doi: 10.1590/s0365-05962010000300006.
McLane J. Analysis of common side effects of isotretinoin. J Am Acad Dermatol. 2001; 45: S188-194. doi: 10.1067/mjd.2001.113719.
Ornelas J, Rosamilia L, Larsen L, et al. Objective assessment of isotretinoin-associated cheilitis: Isotretinoin Cheilitis Grading Scale. J Dermatolog Treat. 2016; 27: 153-155. doi: 10.3109/09546634.2015.1086477
Goforoushan F, Azimi H, Goldust M. Efficacy of vitamin E to prevent dermal complications of isotretinoin. Pak J Biol Sci. 2013; 16: 548-550. doi: 10.3923/pjbs.2013.548.550.
Proksch E, de Bony R, Trapp S, Boudon S. Topical use of dexpanthenol: a 70th anniversary article. J Dermatolog Treat. 2017; 28: 766-773. doi: 10.1080/09546634.2017.1325310.
Gorski J, Proksch E, Baron JM, Schmid D, Zhang L. Dexpanthenol in wound healing after medical and cosmetic interventions (Postprocedure wound healing). Pharmaceuticals (Basel). 2020; 13: 138. doi: 10.3390/ph13070138.
Proksch E and Nissen H. Dexapanthenol enhances skin barrier repair and reduces inflammation after sodium lauryl sulphate-induced irritation. J Dermatolog Treat. 2002; 13: 173-178. doi: 10.1080/09546630212345674.
Ebner F, Heller A, Rippke F, Tausch I. Topical use of dexpanthenol in skin disorders. Am J Clin Dermatol. 2002; 3: 427-433. doi: 10.2165/00128071-200203060-00005.
Park KY, Ko EJ, Kim IS, et al. The effect of evening primrose oil for the prevention of xerotic cheilitis in acne patients being treated with isotretinoin: a pilot study. Ann Dermatol. 2014;26:706-712. doi: 10.5021/ad.2014.26.6.706
Mirnezami M, Rahimi H. Is oral omega-3 effective in reducing mucocutaneous side effects of isotretinoin in patients with acne vulgaris? Dermatol Res Pract. 2018; 2018: 6974045. doi: 10.1155/2018/6974045.
Strauss JS, Gottlieb AB, Jones T, et al. Concomitant administration of vitamin E does not change the side effects of isotretinoin as used in acne vulgaris: A randomized trial. J Am Acad Dermatol. 2000; 43: 777-784. doi: 10.1067/mjd.2000.110391.
Kus S, Gün D, Demirçay Z, Sur H. Vitamin E does not reduce the side effects of isotretinoin in the treatment of acne vulgaris. Int J Dermatol. 2005; 44: 248-251. doi: 10.1111/j.1365-4632.2004.02072.x.
Markiewicz A, Zasada M, Erkiert-Polguj A, Wieckowska-Szakiel M, Budzisz E. An evaluation of the antiaging properties of strawberry hydrolysate treatment enriched with L-ascorbic acid applied with microneedle mesotherapy. J Cosmet Dermatol. 2019; 18: 129-135. doi: 10.1111/jocd.12545.
Lee JC, Daniels MA, Roth MZ. Mesotherapy, microneedling, and chemical peels. Clin Plast Surg. 2016;43:583-595. doi: 10.1016/j.cps.2016.03.004.
Bergler-Czop B and Brzezińska-Wcisło L. The new therapy schema of the various kinds of acne based on the mucosa-skin side effects of the retinoids. Cutan Ocul Toxicol. 2012;31:188-194. doi: 10.3109/15569527.2011.633949.
Björklund S, Pham QD, Jensen LB, et al. The effects of polar excipients transcutol and dexpanthenol on molecular mobility, permeability, and electrical impedance of the skin barrier. J Colloid Interface Sci. 2016; 479: 207-220. doi: 10.1016/j.jcis.2016.06.054.
Heise R, Skazik C, Marquardt Y, et al. Dexpanthenol modulates gene expression in skin wound healing in vivo. Skin Pharmacol Physiol. 2012; 25: 241-248. doi: 10.1159/000341144.
Wiederholt T, Heise R, Skazik C, et al. Calcium pantothenate modulates gene expression in proliferating human dermal fibroblasts. Exp Dermatol. 2009;18:969-978. doi: 10.1111/j.1600-0625.2009.00884.x.
El-Mofty M, Elkot S, Ghoneim A, Yossri D, Ezzatt OM. Vitamin C mesotherapy versus topical application for gingival hyperpigmentation: a clinical and histopathological study. Clin Oral Investig. 2021; 25(12): 6881-6889. doi: 10.1007/s00784-021-03978-6.
Wolf H, Kieser M. Hamamelis in children with skin disorders and skin injuries: results of an observational study. Eur J Pediatr. 2007; 166: 943-948. doi: 10.1007/s00431-006-0363-1.
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