key: cord-0733299-n9kuy8um
authors: Moreno-Ramírez, D.; Duarte-Ferreras, M. A.; Ojeda-Vila, T.; García-Morales, I.; Conejo-Mir, M. D.; Fernández-Orland, A.; Sánchez-del-Campo, A. I.; Eiris, N.; Carrizosa, A. M.; Ruiz-de-Casas, A.; de-la-Torre, J. M.; Herrerías-Esteban, J. M.; Ferrándiz, L.
title: Telemedicine Management of Systemic Therapy with Isotretinoin of Patients with Moderate-to-Severe Acne During the COVID-19 Pandemic. a Longitudinal Prospective Feasibility Study
date: 2022-03-07
journal: J Am Acad Dermatol
DOI: 10.1016/j.jaad.2022.03.004
sha: d833040844067f465dc8514ce89b2631baffb772
doc_id: 733299
cord_uid: n9kuy8um

nan

Moreno-Ramírez D 1 , Duarte-Ferreras MA 1 , Ojeda-Vila T 1 , García-Morales I 1 , 6

Conejo-Mir MD 1 , Fernández-Orland A 1 , Sánchez-del-Campo AI 1 , Eiris N 1 , 7

Carrizosa AM 1 , Ruiz-de-Casas A 1 , de-la-Torre JM 1 , Herrerías-Esteban JM 2 , In the intention-to-treat analysis, 79.25% of the patients achieved an 80% 89 reduction in the basal GAGS score (n=42), with 58.49% (n=31) of the patients 90 achieving a 100% reduction in the basal GAGS score (IGA 0). At the end of the 91 study, the GAGS score showed an 87.94% reduction (table I). The per-protocol 92 J o u r n a l P r e -p r o o f analysis yielded GAGS80 and GAGS100 rates of 91.30% (n=42), and 67.39% 93 (n=31), respectively (table I) . 94

After exclusion of mucocutaneous effects, the most common adverse effects 95 were hyperlipidemia (13.04%), myalgia (10.87%) and hypertransaminasemia 96 (6.52%) followed by creatin-phosphokinase increase (6.52%), headaches 97 (4.30%), arthralgia (4.30%), effluvium (4.30%), keloids (2.17%), and hands 98 eczema (2.17%). All these toxic events were mild and led to isotretinoin 99 discontinuation in only 1 patient, who showed a 3-fold increase in liver enzyme 100

This study was conducted during the second wave of the COVID-19 pandemic 102

in Spain. Primary care services had still not been restored to normal, and 103 hospital services were avoiding in-person care as much as possible. In this 104 settings, teledermatology-based acne management has yielded remarkable 105 therapeutic response, with a refusal rate (9.38%) similar to the rate reported in 106 face-to-face visits (13.3%) 3 , and with an early termination percentage (13.21%) 107 much lower than reported by the iPLEDGE Program (36.8%) 4 . 108

Limitations of this study are related to the sample size, consequence of the 109 innovative approach, and GAGS score underestimation due to the lack of 110 pictures from some anatomic areas in 15.43% of teleconsultations, and the 111 more difficult assessment of nodules (score 4). 112

Store-and-forward teledermatology is feasible for the management of moderate- IGA, Investigator´s Global Assessment: 0 "Clear skin", residual hyperpigmentation and erythema may be present. 1 "Almost clear", a few scattered comedones and a few small papules. 2 "Mild", easily recognizable, less than half the face is involved, some comedones and some papules and pustules. 3 "Moderate", more than half the face is involved, many comedones, papules and pustules, one nodule may be present. 4 "Severe", entire face is involved, covered with comedones, numerous papules and pustules, and few nodules and cysts. GAGS, Global Acne Grading System.

J o u r n a l P r e -p r o o f

Feasibility and 143 cost of a telemedicine-based short-term plan for initial access in general 144 dermatology in Andalusia

Severity of Acne 147 Vulgaris: Comparison of Two Assessment Methods

150 Perceptions about oral isotretinoin treatment

Differences in 153 isotretinoin start, interruption, and early termination across race and sex in the 154 iPLEDGE era