Imran Majid
Department of Dermatology, Government Medical College, Srinagar, Jammu and Kashmir, India

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1. Isotretinoin therapy is associated with troublesome xerosis of skin and this adverse effect is likely to exacerbate in combination with salicylic acid peels. This aspect needs to be looked into more closely and assessed more thoroughly if the combination is used. Did the patients on combination require more emollients than those on monotherapy and what should be the choice of emollients in such a setting needs to be elaborated upon
2. Salicylic acid is available in different concentrations and in different forms to a dermatologist. A number of face washes having 2% of salicylic acid as a component are available and are routinely prescribed to patients with acne. Can the beneficial effect of the combination described in the study be achieved with co-prescription of such face washes with oral isotretinoin therapy? This is also a thought to be pondered over
3. Daily-use products such as face washes/soaps, creams and moisturizers and even daily dietary habits have play an important role in acne pathogenesis. Hence, all of these factors should be taken into account once a therapeutic study is conducted on patients with acne. A mention should be made of all these factors once a clinical study is conducted on the subject of acne management
4. Concerns have been expressed in the world literature about combining any cosmetological or laser procedures along with oral isotretinoin therapy. ^[2],[3] These concerns started after some reports blamed concomitant isotretinoin therapy for some severe adverse reactions to CO ₂ laser resurfacing. However, a number of clinical studies have been published since then have shown no additional risk of non-ablative laser procedures in patients taking isotretinoin
5. Salicylic acid peel is a superficial peel and the peeling agent does not penetrate to the level of the dermis. ^[4] So, a combination of salicylic acid peel with oral isotretinoin can prove to be a good and relatively safe option to circumvent the initial flare-up of acne that is seen with isotretinoin monotherapy.

References

1.	Kar BR, Tripathy S, Panda M. Comparative study of oral isotretinoin versus oral isotretinoin + 20% salicylic acid peel in the treatment of active acne. J Cutan Aesth Surg 2013;6:204-8.
2.	Bernestein LJ, Geronemus RG. Keloid formation with the 585-nm pulsed dye laser during isotretinoin treatment. Arch Dermatol 1997;133:111-2.
3.	Zachariae H. Delayed wound healing and keloid formation following argon laser treatment or dermabrasion during isotretinoin treatment. Br J Dermatol 1988;118:703-6.
4.	Bari AU, Iqbal Z, Rahman SB. Tolerance and safety of superficial chemical peeling with salicylic acid in various facial dermatoses. Indian J Dermatol Venereol Leprol 2005;71:87-90.   [PUBMED]

Correspondence Address:
Imran Majid
Government Medical College, Srinagar, Jammu and Kashmir
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/0974-2077.123405