In 1932, Harris, et al., reported that vitamin A had an anti-keratinizing effect on acne vulgaris, and in 1943, Straumf ford, somewhat over-enthusiastically reported that oral use of vitamin A also had a beneficial effect on acne. In spite of studies by Lynch and Cook (1947), and Andrew and Stokoe (1963), which questioned its effectiveness, the original enthusiasm for this regimen has. not been completely dampened.
Kligman (1969) reported that vitamin A acid (VAA), a metabolic end-product of vitamin A metabolism, produced a peeling effect and when applied topically was effective in the treatment of acne.
The mechanism of action of VAA is incompletely understood, however, it is observed to cause, among other things, an increase in the speed of proliferation of the cells of the epidermis ; dissolution of the intracellular lysosomes; increase in the rate of keratin formation and the conversion of hard keratin to soft keratin; and an increase in the secretion of the sebaceous glands.
The effect of VAA in acne treatment is due to the increase in the secretion of the sebaceous glands which prevents the formation of comedones. It is believed that the increased speed of cell division, increased keratinization and softening of the keratin cause a weakening of the intercellular adhesion. These processes cause an acceleration of the flow of cells out of the sebaceous glands which prevents the formation of comedones and forces existing comedones to the surface of the skin.
For this study, thirty eight patients with acne vulgaris were selected from among the outpatients of Severance Hospital. They were divided into two groups. The first group was treated with application of vitamin A acid alone. The second group was treated concurrently with topical vitamin A acid and oral tetracycline.
The results were as follows:
1. The group treated for three weeks with VAA alone showed significant improvement in up to 70 % of the cases.
2. The group treated with VAA and oral tetracycline showed results which-were similar to the group on VAA alone.
3. In both groups. closed comedones and papules gradually disappeared, however, the number of open comedones increased in the first week, but decreased thereafter. In combined therapy, pustules disappeared gradually just like the papules, but in therapy with VAA alone, the number of pustules increased during the first week and decreased thereafter.
4. In the group which was treated with VAA alone, undesirable side effects such as scaling, erythema, tightness, itching and burning sensation were seen, and also occasionally fissures, edema, pain and oozing were noted. In the group treated with combined therapy, similar findings were recorded.
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