Acne vulgaris is a common dermatological disorder affecting pilosebaceous units and accounts for a significant proportion of dermatology consultations worldwide. Nodulocystic acne represents a severe form requiring systemic therapy. Oral isotretinoin is considered the gold standard, while azithromycin is used as an alternative due to better tolerability. To compare the efficacy, safety, and patient satisfaction of oral isotretinoin versus weekly pulse azithromycin in the treatment of nodulocystic acne. This experimental study was conducted at the Department of Dermatology, Combined Military Hospital (CMH), Dhaka, from April 2023 to September 2023. A total of 108 patients with nodulocystic acne were enrolled and divided into two groups (54 patients each). The isotretinoin group received oral isotretinoin (0.51 mg/kg/day) for 12 weeks. The azithromycin group received azithromycin 500 mg daily for 3 consecutive days per week for 12 weeks. Patients were evaluated at baseline and at 4, 8, and 12 weeks using the Investigator’s Global Assessment (IGA) scale. Treatment response, patient satisfaction, safety, and compliance were recorded. A total of 101 patients completed the study (3 from the isotretinoin group and 4 from the azithromycin group were lost to follow-up). Most participants were aged 16–20 years. Female predominance was observed in both groups. Both treatments showed statistically significant improvement (p < 0.05); however, isotretinoin demonstrated superior efficacy. Reduction in acne severity at 12 weeks was higher in the isotretinoin group (58.33%) compared to the azithromycin group (49.49%). Patient satisfaction was significantly higher in the isotretinoin group, with 20%reporting high satisfaction compared to 6.1% in the azithromycin group (p = 0.01). A greater proportion of patients achieved excellent response with isotretinoin (9.62%) compared to azithromycin (6.1%). Oral isotretinoin is more effective than weekly pulse azithromycin in the treatment of nodulocystic acne, with better clinical response and patient satisfaction. Azithromycin may be considered as an alternative in patients who cannot tolerate isotretinoin.

Rashna Sharmin Jessy is a board-certified dermatologist specializing in medical, surgical, and cosmetic dermatology. She works as a clinical and aesthetic dermatologist in BNS Haji Mohsin Sick Bay, Bangladesh Navy Hospital. She has completed her MBBS from Armed Forces Medical College, Dhaka, Bangladesh, and holds DDV and MCPS qualifications in Dermatology and Venereology, and has clinical experience in military and civilian hospitals, including the Combined Military Hospital, Dhaka, the Institute of Women and Child Health, Ashulia, Dhaka, and Bangladesh Navy Hospital (Sick Bay). Her expertise includes skin biopsy, cryotherapy, PRP, laser hair removal, fractional CO2 laser, and acne management. She is committed to evidence-based patient care and advancing dermatologic practice through research and professional development.