IMMUNOMODULATORY EFFECTS OF ADJUNCTIVE LEVAMISOLE IN MODERATE-TO-SEVERE ACNE VULGARIS TREATED WITH SYSTEMIC ANTIBIOTICS: A SYSTEMATIC REVIEW
Keywords:
Acne vulgaris, Levamisole, Systemic antibiotics, Immunomodulation; Inflammatory acneAbstract
Introduction: Moderate-to-severe inflammatory acne vulgaris is a chronic condition with significant physical and psychosocial impact. Systemic antibiotics remain a cornerstone of treatment, yet therapeutic response is often incomplete, and relapse is common. Immunomodulatory agents such as levamisole have been proposed as adjunctive therapies to enhance treatment efficacy.
Objective: To systematically review the clinical evidence on the efficacy and safety of adjunctive levamisole combined with systemic antibiotics in moderate-to-severe acne vulgaris.
Methods: A systematic search of PubMed, Cochrane Library, and ScienceDirect was conducted in accordance with PRISMA guidelines. Randomized controlled trials comparing systemic antibiotics plus oral levamisole versus the same antibiotics alone were included. Outcomes of interest were improvement in acne severity, inflammatory lesion counts, and adverse events. Findings were synthesized narratively.
Results: Four randomized controlled trials were included. Across all studies, adjunctive levamisole consistently resulted in greater reductions in acne severity scores and inflammatory lesion counts compared with antibiotic monotherapy. Higher treatment response rates were observed with combination therapy, particularly in patients with severe or nodulocystic acne. Levamisole was generally well tolerated, with mostly mild and transient adverse events reported.
Discussion: The findings suggest that immunomodulation with levamisole may enhance the efficacy of systemic antibiotics by targeting inflammatory pathways not fully addressed by antimicrobial therapy alone.
Conclusion: Adjunctive levamisole appears to be an effective and tolerable addition to systemic antibiotics for moderate-to-severe inflammatory acne vulgaris, warranting further investigation.
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Copyright (c) 2026 Diandra Erieka Putri, Vinzia Ethiofia Caneabung, Shania Rizky Amalia, Ade Putri, Dita Titis Parameswari (Author)
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