Metformin-the gospel for patients with moderate to severe acne?

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Dermatologists usually prescribe oral antibiotics combined with isotretinoin to treat acne vulgaris, but the side effects of traditional treatment options have received more and more attention, so it is necessary to find alternative treatment options.Studies have shown that acne production may be related to mTORC1 drive, and the effect of metformin on mTORC1 activity has been confirmed.Therefore, researchers have speculated that metformin may be used as an adjuvant treatment for improving acne, and research has been carried out in this way.Study Design This study was a randomized, open-label, prospective study with the main purpose of assessing the safety and effectiveness of metformin 850 mg per day in combination with topical peroxybenzoyl and tetracycline.The study subjects were adults (18-40 years) with moderate to severe facial acne from the University of Malaysia Medical Centre.Enrollment requirements: Participants’ overall assessment (IGA) score ≥ 3 points (0-5 points), at least 20 inflammatory lesions on the face or ≥ 30 non-inflammatory lesions, and no more than 5 except the outer part of the noseNodular lesions.Exclusion criteria: This study excluded participants with congenital, explosive acne, or secondary acne, as well as those who were pregnant, breastfeeding, were using topical anti-acne preparations, had a chemical peel, and had systemic acne treatment.By.Patients were randomly divided into groups, in which the treatment group received benzoyl peroxide (2.5%, once daily) + tetracycline capsules (250 mg, twice daily) + metformin (850 mg, once daily), and the other group received only the first twoDrugs for 12 weeks.Researchers evaluated participants at baseline, 6 weeks of medication, and 12 weeks of medication.The primary efficacy endpoint was the percentage change in the number of inflammation, non-inflammatory, and total skin lesions from baseline at 12 weeks.The secondary efficacy study endpoint was improvement in the IGA score [Treatment Success Rate: IGA score of 0 (clear) or 1 (nearly clear), or the percentage of participants who improved by 2 levels from the baseline to the 12th week with a CADI score].At each follow-up, the researchers evaluated participants for adverse events and tolerability, and used the insulin resistance homeostasis model (HOMA-IR) to assess participants’ insulin resistance status.The criteria for underweight are BMI <18.5kg / m ^ 2, normal weight BMI18.5-22.9 kg / m ^ 2, overweight BMI 23-25 ​​kg / m ^ 2, and obesity> 25kg / m ^ 2.In addition, the efficacy of metformin in different BMI participants was evaluated in a subgroup analysis.The study results were screened and a total of 84 participants were included. They were randomly divided into the metformin treatment group (n = 42) and the control group (n = 42). The baseline characteristics of the two groups were similar.1. Metformin brings higher treatment success rate In terms of improvement in the amount of non-inflammatory damage, at the 12th week, the metformin group was better than the control group (44.9% vs. 37.4%), but did not reach a significant difference (P= 0.445). In terms of improvement in the number of inflammatory lesions, at the 12th week, the metformin group performed better (83.1% vs. 75.6%), but did not reach a significant difference (P = 0.064).Treatment success rate: At 12 weeks, the treatment success rate of the metformin group was significantly better than that of the control group (66.7% vs. 43.2%, P <0.05).2. The treatment benefit has little to do with obesity. The researchers performed a subgroup analysis of the efficacy of the underweight and overweight / obese people in the metformin group, and found that the treatment success rate, the CADI score improved, and the number of skin lesions improved.No significant difference.3. Metformin has significant effects on body weight and blood glucose: At 12 weeks, BMI in the metformin group was significantly reduced by 0.26 ± 0.72 kg / m ^ 2 (P <0.05), and the control group increased without decreasing.Fasting blood glucose: At 12 weeks, the fasting blood glucose level in the metformin group decreased significantly by 0.15 ± 0.62 mmol / L (P <0.05), while the control group increased without decreasing.4. Safety Among subjects receiving metformin treatment, hypoglycemia did not occur, but 13 people (31.7%) developed gastrointestinal symptoms, including nausea, vomiting, abdominal discomfort and bloating, but within a tolerable rangeWithin two weeks, the duration did not exceed 2 weeks, and no serious adverse events occurred.Limitations of the study The limitations of this study include: 1. The results may be more valuable if metformin is used without other anti-acne drugs; 2. The sample size is small when analyzing the BMI subgroup; 3. Facial acne scarsThe type, size, and severity may have an effect on the CADI score; 4. No confounding factors such as diet, sedentary, stress, and sleep were intervened.This article summarizes for the first time this study evaluated the efficacy of metformin as an adjuvant therapy for acne among participants of different genders, insulin resistance status, and BMI levels.The results showed that in terms of treatment success rate, the metformin group (combined with local peroxybenzoyl + oral tetracycline) was significantly higher than the control group (local peroxybenzoyl + oral tetracycline, 66.7% vs. 43.2%, P = 0.04)And this benefit has little to do with whether the participants are obese.The main adverse reactions (31.7%) in the metformin group were still gastrointestinal symptoms, but they were all tolerable and disappeared within 2 weeks.Researchers believe that this study provides strong data to support metformin as an adjuvant for acne, but further research is needed in the future.I would like to remind you that although this study gives promising results, patients with acne must follow the doctor's advice and do not take medicine on their own.The above content is only authorized by for exclusive use, please do not reprint without authorization of the copyright party..


The author ouyangshaoxia