• Muhammad Waqas Pak-Emirates Military Hospital Rawalpindi
  • Ayesha Anwar Pak-Emirates Military Hospital Rawalpindi
  • Amer Ejaz Pak-Emirates Military Hospital Rawalpindi
  • Anum Malik


Background:  Acne vulgaris (AV) is an inflammatory disorder of pilosebaceous unit and it affects over 85% of teenagers (peak age 17 years) during some point in their lives. Of these 30% have acne severe enough to require medical treatment. The overall incidence is comparable in both genders. Objective was to compare the efficacy of azithromycin plus levamisole with azithromycin alone in the treatment of moderate to severe acne. It was a single centre randomized controlled trial, conducted at the Department of Dermatology at Military Hospital Rawalpindi. Methods: We selected 118 patients of acne who fulfilled the inclusion criteria from the dermatology outpatient department. Diagnosis was based on clinical features of acne and severity defined using Acne Global Severity Score. The patients were randomly assigned two treatment groups; Patients in group A received Azithromycin 500 mg per day given for 3 days a week plus oral levamisole 150 mg per day was given for 2 days a week for a total of 08 weeks. Group B patients (N= 59) received Azithromycin 500 mg per day given for 3 days a week for a total of 08 weeks. Patients were followed up fortnightly till they completed their treatment. Response to treatment was graded according to the Acne Global Severity Score. Scoring was done at first visit before therapy and after 08 weeks of therapy in both groups. Therapy was considered efficacious if the patients achieved post-therapy reduction of global score below 19 at the end of 8th week of initiation of therapy.Results:  Among our 118 study cases, we had 38 male patients while 80 were female patients. The study cases had mean age of 20.10±2.65 years. Mean global severity was 31.25±3.41 while 56 (47.5%) had moderate acne and 62 (52.5%) had severe acne. Efficacy was found to be higher in patients receiving Azithromycin plus levamisole combination. Conclusion: Azithromycin plus levamisole was observed as a more effective therapy for the treatment of acne as compared to Azithromycin alone. The study supports the administration of combination therapy for the treatment of Acne to achieve desired outcomes in patients.

Author Biographies

Muhammad Waqas, Pak-Emirates Military Hospital Rawalpindi

General MedicineDermatology

Ayesha Anwar, Pak-Emirates Military Hospital Rawalpindi


Amer Ejaz, Pak-Emirates Military Hospital Rawalpindi

Consultant Dermatologist

Anum Malik

General Practitioner


Cinna P, Durai T, Nair DG. Acne Vulgaris and Quality of Life Among Young Adults in South India. Indian J Dermatol 2015;60(1):33–40.

Bhate K, Williams HC. Epidemiology of acne. Br J Dermatol 2013;168(3):474–85.

Asai Y, Baibergenova A, Dutil M, Humphrey S, Hull P, Lynde C, et al. Management of acne: Canadian clinical practice guideline. CMAJ 2016;188(2):118–26.

Beylot C, Auffret N, Poli F, Claudel JP, Leccia MT, Del Giudice P, et al. Propionibacterium acnes: an update on its role in the pathogenesis of acne. J Eur Acad Dermatol Venereol 2014;28(3):271–8.

Koo EB, Petersen TD, Kimball AB. Meta-analysis comparing efficacy of antibiotics versus oral contraceptives in acne vulgaris. J Am Acad Dermatol 2014;71(3):450–9.

Bardazzi F, Savoia F, Parente G, Tabaneli M, Balestri R, Spadola G, et al. Azithromycin: a new therapeutic strategy for acne in adolescents. Dermatol Online J 2007;13(4):4.

Pradhan S, Madke B, Kabra P, Singh AL. Anti-inflammatory and Immunomodulatory Effects of Antibiotics and Their Use in Dermatology. Indian J Dermatol 2016;61(5):469–81.

Rassai S, Mehri M, Yaghoobi R, Sina N, Mohebbipour A, Feily A. Superior efficacy of azithromycin and levamisole vs. azithromycin in the treatment of inflammatory acne vulgaris: an investigator blind randomized clinical trial on 169 patients. Int J Clin Pharmacol Ther 2013;51(6):490–4. Ref no 8&10 are same

Ansarin H, Savabynasab S, Behzadi AH, Sadigh N, Hasanloo J. Doxycycline plus levamisole: Combination treatment for severe nodulocystic acne. J Drugs Dermatol 2008;7(8):737–40.

Haneke E. Levamisole treatment of acne fulminans (author's transl). Z Hautkr 1981;56(17):1160–6.

Westphal HJ, Schütt C, Kaben U, Mattheus A. Acne conglobata with immunodeficiency and its Levamisole treatment (autho’s transl). Dermatol Monatsschr 1981;167(7):410–7.

Batool S, Mustafa G, Hanif M, Mahmood N, Sadia F, Hassan M. Perception of acne patients regarding its pathogenesis and treatment. J Sheikh Zayed Med Coll 2010;1(2):60–4.

Ullah G, Noor SM, Bhatti Z, Ahmad M, Bangash AR. Comparison of oral azithromycin with oral doxycycline in the treatment of acne vulgaris. J Ayub Med Coll Abottabad 2014;26(1):64–7.

Shaukat S, Aman S, Hussain I, Kazmi AH. The effect of oral doxycycline and topical 5% benzoyl peroxide on quality of life in patients with mild to moderate acne vulgaris. J Pak Assoc Dermatol 2013;23(2):173–9.

Gupta A, Sharma YK, Dash KN, Chaudhari ND, Jethani S. Quality of life in acne vulgaris: Relationship to clinical severity and demographic data. Indian J Dermatol Venereol Leprol 2016;82(3):292–7.

Hazarika N, Archana M. The Psychosocial impact of acne vulgaris. Indian J Dermatol 2016;61(5):515–20.

Naeem, Akram B, Luqman L. Acne vulgaris; psychosocial stressors in patients. Prof Med J 2013;20(3):403–8.



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