Phototherapy in the treatment of acne vulgaris.(Report)

Abstract

Background: Achieving an effective management of acne vulgaris with minimal complications remains a difficult challenge for physicians. Moreover, the rise in antibiotic-resistant strains reduce the future usefulness of current mainstay therapies, and accordingly, the need for alternative therapies is mandatory. Phototherapy has been shown to be an effective treatment for acne, and there has been a renewed interest in photodynamic therapy as a treatment modality for this condition.

Objectives: To evaluate the effectiveness of pulsed dye laser (PDL), intense pulsed light (IPL) and light-emitting diode (LED) phototherapy for the treatment of moderate to severe acne vulgaris.

Methods: Forty-five patients with moderate to severe acne were randomly divided into 3 equal groups. Group 1 was treated with a PDL, group 2 was treated with IPL, and group 3 was treated with a blue-red combination LED. Treatment was continued until a [greater than or equal to] 90% clearance of patient lesions was achieved. Clinical assessments were conducted before starting treatment, at 1 month as a midpoint evaluation, and after the final treatment session.

Results: Patients treated with the PDL reached a [greater then or equal to]90% clearance of their inflammatory lesions after a mean of 4.1 [+ or -] 1.39 sessions, while patients treated with IPL required a mean of 6 [+ or -] 2.05 sessions. Patients treated with the LED required a mean of 10+3.34 sessions. At the mid-point evaluation, the percent reduction in acne lesions treated with the PDL was 90% or more, in cases of IPL and the LED, the percent reductions were 41.7% and 35.3%, respectively. Laser and light phototherapy sessions were well tolerated with minimal adverse events experienced as being mild and usually self-limiting.

Conclusions: The encouraging results of the present study contributes evidence of phototherapy as useful therapeutic option for treatment of moderate to severe acne, and validates further studies to evaluate treatments with a larger number of patients and for a longer period of follow-up.

Introduction

Acne vulgaris is one of the most prevalent dermatologic diseases. (1) For most people, acne typically decreases or clears with time. Acne lesions are only affected by flares of inflammatory papules, pustules, and nodules with or without concomitant noninflammatory comedones (open and closed). However, acne may leave permanent scars, (2) which are not only a mere cutaneous problem, but scarring can lead to social phobia, lowered self-image, and even depression. (3) With such high prevalence and important social implications, there is always a need for effective, noninvasive, cost-efficient, and convenient therapies. (4)

To date, different treatment modalities have been used to manage this condition. Antibacterials and retinoids are the current mainstay of acne treatment, but success rates are variable. (5) Phototherapy is an emerging tool that can be used as an alternative for treatment of acne vulgaris. Recently, pulsed dye laser (PDL) treatments are proving to be a promising treatment for active acne and acne scarring. (6) Different studies have reported the roles of different wavelengths and the methods of light treatment. These studies have shown that phototherapy with visible light, specifically blue light, has a marked effect on inflammatory acne lesions. In addition, the combination of blue-red light radiation seems to be superior to blue light alone with minimal adverse effects. (5) The presence of small absorption peaks for porphyrin within the intense pulsed light (IPL) emission spectrum and the heterogeneous targets of selective light energy absorption render the IPL a potentially useful light source for photodynamic therapy (PDT) on acne. (7) Accordingly, the present study was designed to evaluate…