EFFECTIVENESS OF ZINC SUPPLEMENTATION WITH TOPICAL RETINOIDS IN ACNE VULGARIS PATIENTS: A RANDOMIZED, DOUBLE- BLIND, PLACEBO-CONTROLLED TRIAL

Humayra Rumu*, Md Sayedur Rahman, Sarmin Sultana, Sadia Binte Anwar Sonia, Sumayra Jhumu, Rumana Ferdous

ABSTRACT

Background: The investigation of combining zinc supplementation with topical retinoids represents a promising avenue in the pursuit of effective acne vulgaris management. By addressing multiple aspects of acne pathogenesis simultaneously and potentially reducing the adverse effects of retinoid treatment, this approach could offer a well-rounded and enhanced therapeutic strategy for individuals burdened by this dermatological condition. Objective: To evaluate the additional benefit in reducing symptoms by supplementation of oral zinc with topical retinoids treated acne vulgaris patients. Method: This randomized, double-blind, placebo-controlled trial was conducted at Bangabandhu Sheikh Mujib Medical University's Pharmacology and Dermatology and Venereology Department from March 2020 to January 2022 (with enrollment starting in April 2021). The study involved 122 newly diagnosed mild and moderate acne vulgaris (AV) patients treated with 20 mg tablet of zinc sulphate or 20mg of placebo tablet with topical retinoids. Nine patients dropped out due to various reasons, leaving 113 participants for per-protocol (PP) analysis. The study comprised baseline and after 8-week follow-up visits, evaluating GAGS acne severity scores and evaluate the appearance of the adverse effect. Results: Initially, both control and intervention arms had similar GAGS scores (around 16), with no significant difference. After 8 weeks, the control arm's GAGS score decreased to about 15, while the intervention arm showed a significant drop to around 12 (p=0.004). Both groups had notable reductions from their baseline scores (p<0.05). There were no significant differences in side effects (abdominal discomfort, nausea, vomiting, and diarrhea) between the two arms. Conclusion: Incorporating the findings from various studies, it is evident that the effectiveness of combining zinc supplementation with topical retinoids in the treatment of acne vulgaris is influenced by multiple factors, including patient characteristics, formulations used, and treatment duration. While some studies present conflicting results, a general trend towards enhanced clinical outcomes with combination therapy is observed. The synergy between zinc's anti-inflammatory, sebum-regulating, and immunomodulatory properties and retinoids' comedolytic and anti-inflammatory effects offers a promising avenue for improved acne management. This trial was registered in ClinicalTrials.gov with the trial ID number NCT04899843.

Keywords: Zinc Supplementation, Topical Retinoids, Acne Vulgaris Patients, GAGS score.