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A Comparative Study Between Once-Weekly and Alternating Twice-Weekly Regimen Using Blue (470 nm) and Red (640 nm) Light Combination LED Phototherapy for Moderate-to-Severe Acne Vulgaris
Abstract
Background and objective:
Phototherapy for acne with a combination of blue and red light-emitting diodes (LEDs) appears to have excellent potential in treating inflammatory acne. However, a standard twice-weekly protocol administered 3 days apart may not be practical for patients. This study aims to seek the efficacy of LED treatment in moderate to severe acne, comparing between once and alternating twice-weekly regimens.
Study design/materials and methods:
Thirty subjects with moderate to severe acne, as defined by Burton's grading score, were recruited in the study. The subjects were randomly divided into two groups- one group received alternating blue (470 nm) and red (640 nm) light in two visits per week for 4 consecutive weeks, while the other group got blue and red light treatments consecutively on the same visit for 4 consecutive weeks. During the study period, conventional treatments were prohibited. Clinical assessments were performed by lesion counts and blinded comparative photographs before treatment and at 1, 4, and 8 weeks after the final treatment.
Results:
There was no statistically significant difference between once- and alternating twice-weekly regimens. Both regimens provided marked improvement only for inflammatory lesions. The median percentage of acne reduction was significantly demonstrated for 1 week after finishing the course of treatment and was sustained until the end of the study. There were no side effects noted throughout the study period.
Conclusion:
LED therapy is safe and effective for treatment of inflammatory acne. The treatment outcomes of once and alternating twice-weekly regimens were comparable, hence, once-weekly treatment could be considered as an alternative choice for patient's convenience. Lasers Surg. Med. © 2021 Wiley Periodicals LLC.
... A much more significant improvement was found with narrowband ultraviolet B. However, the use UVB treatments must be restricted and strictly controlled by dermatologists due to UVB potential to induce carcinogenesis. Another study demonstrated that there were no differences between alternating RL and BL or applying them in the same session, and that one session per week is sufficient in inflammatory acne with LED BL-RL [90]. When photodynamic therapy (PDT) was compared with intense pulsed light (IPL) and the combination of RL-BL, PDT demonstrated higher effectiveness. ...
Photobiomodulation (PBM) is a procedure that uses light to modulate cellular functions and bio-logical processes. Over the past decades, PBM has gained considerable attention for its potential in various medical applications due to its non-invasive nature and minimal side effects. This narrative review article examines the existing literature on PBM, encompassing research studies, clinical trials, and technological developments. This review highlights the mechanisms of action underlying PBM, including the interaction with cellular chromophores and the activation of in-tracellular signaling pathways. The evidence from clinical trials and experimental studies to evaluate the efficacy of PBM in clinical practice is summarized with a special emphasis on der-matology. Furthermore, advancements in PBM technology, such as novel light sources and treat-ment protocols, are discussed in the context of optimizing therapeutic outcomes and improving patient care. This narrative review underscores the promising role of PBM as a non-invasive therapeutic approach with broad clinical applicability. Despite the need for further research to develop standard protocols, PBM holds great potential for addressing a wide range of medical conditions and enhancing patient outcomes in modern healthcare practice.
... A much more significant improvement was found with narrow-band ultraviolet B. However, the use of UVB treatments must be restricted and strictly controlled by dermatologists due to UVB's potential to induce carcinogenesis. Another study demonstrated that there were no differences between alternating RL and BL or applying them in the same session and that one session per week is sufficient in inflammatory acne with LED BL-RL [116]. When photodynamic therapy (PDT) was compared with intense pulsed light (IPL) and the combination of RL-BL, PDT demonstrated higher effectiveness. ...
Photobiomodulation (PBM) is a procedure that uses light to modulate cellular functions and biological processes. Over the past decades, PBM has gained considerable attention for its potential in various medical applications due to its non-invasive nature and minimal side effects. We conducted a narrative review including articles about photobiomodulation, LED light therapy or low-level laser therapy and their applications on dermatology published over the last 6 years, encompassing research studies, clinical trials, and technological developments. This review highlights the mechanisms of action underlying PBM, including the interaction with cellular chromophores and the activation of intracellular signaling pathways. The evidence from clinical trials and experimental studies to evaluate the efficacy of PBM in clinical practice is summarized with a special emphasis on dermatology. Furthermore, advancements in PBM technology, such as novel light sources and treatment protocols, are discussed in the context of optimizing therapeutic outcomes and improving patient care. This narrative review underscores the promising role of PBM as a non-invasive therapeutic approach with broad clinical applicability. Despite the need for further research to develop standard protocols, PBM holds great potential for addressing a wide range of medical conditions and enhancing patient outcomes in modern healthcare practice.
... In particular, blue light, which forms a large percentage of ultraviolet A light (380-400 nm) and frequently has a wide variety of wavelengths, has been used in light treatment more frequently in recent years. Furthermore, many blue light-emitting lamps are advertised as improving well-being, emitting blue light at a maximum of 400-440 nm [14]. We conducted a thorough investigation using LED arrays to assess the impact of various wavelengths (412-940 nm) on skin cells. ...
... What's more, studies have also found that collagen dressings could promote cell differentiation, movement, chemotaxis and repair of connective tissue; it was convenient for leukocyte mediators to mediate the role of phagocytes, increase local bacterial power, and improve the speed of epidermal regeneration [18,19]. In the study of Nitayavardhana et al. [20], it was found that alternating red and blue light evidently ameliorated the inflammation in patients with moderate and severe acne vulgaris. Another one by Kharazi et al. [21] also claimed that patients' conditions was obviously improved after the therapy. ...
Objective:
To explore the therapeutic effect of alternating red and blue light irradiation combined with collagen in patients with acne vulgaris and the risk factors of short-term recurrence.
Method:
A retrospective analysis was conducted on 105 patients with acne vulgaris treated in Baoji Hospital of Traditional Chinese Medicine from January 2019 to February 2020. 50 patients received conventional treatment (Pumen red and blue light) were taken as the control group, and the other 55 patients treated with collagen dressing on the basis of control group were taken as the research group. Clinical efficacy, changes of serum interleukin-1β (IL-1β) and interleukin-6 (IL-6) before and after treatment, and the occurrence of adverse reactions were compared between the two groups of patients. The scores of inflammatory skin lesions, facial seborrhea scores, stratum corneum water content and transepidermal water loss (TEWL) were compared before and after the treatment. The 1-year review records of patients were queried, and they were divided into a relapse group and a non-relapse group according to the recurrence situation. Logistic regression was used to analyze the risk factors affecting the recurrence of the patients.
Results:
The clinical efficacy of the patients in research group after treatment was significantly higher than that in the control group (P<0.05). IL-1β and IL-6 in the serum of patients after treatment were markedly decreased, and such decline in the research group was more evident after treatment (P<0.05). The incidence of adverse reactions, the scores of inflammatory skin lesions, and facial seborrhea and TEWL in the research group after treatment were all lower than those in the control group (all P<0.05), while the water content of the stratum corneum was higher comparatively (P<0.05). 17 patients were confirmed with recurrence within 1 year after treatment. Logistic regression analysis found that age, monthly income, pre-treatment IL-1β and pre-treatment IL-6 were risk factors for recurrence.
Conclusion:
Alternating red and blue light irradiation combined with collagen can improve the treatment efficacy in patients with acne vulgaris. And indexes like age, monthly income, pre-treatment IL-1β and pre-treatment IL-6 are risk factors affecting the recurrence of patients.
... Acne vulgaris is one of the most common skin diseases with major social and psychological impacts, of which 80%-85% of cases were mild to moderate [18]. Owing to the drawbacks due to the topical use of antibiotics, BPO and isotretinoin, many dermatologists find non-pharmacological treatments with infrequent adverse effects, such as different kinds of phototherapy, to alleviate inflammatory acne and its sequelae [19][20][21]. Among them, IPL devices use flashlamps and bandpass filters to emit polychromatic incoherent highintensity pulsed light of determined wavelength spectrum, fluence, and pulse duration [19]. ...
Background and Objectives
The skin microbiota partly determined by epidermal barrier plays an important role in acne vulgaris and intense pulsed light (IPL) has been verified as a safe and effective therapeutic option for this disease. Nevertheless, the exact role of the IPL treatment on the skin microbiota and epidermal barrier for patients with acne vulgaris remains unclear. This article was designed to solve this problem.
Study Design/Materials and Methods
Nineteen healthy controls and 20 patients with mild to moderate acne were enrolled in this study, who received IPL treatment for 12 weeks. The epidermal barrier and skin samples were collected at baseline and after treatment. The microbial diversity was analyzed based on a high-throughput sequencing approach, which targets the V3–V4 region of the bacteria 16S ribosomal RNA genes.
Results
After treatment of IPL, the Global Acne Grading System (GAGS) scores, sebum, sclererythrin, and red area of patients were significantly improved by IPL treatment (P < 0.05). Although there was no difference in microbiota diversity before and after IPL treatment, the Nonmetric Multidimension Scaling (NMDS) analysis showed that the samples of the acne patients before and after treatment could be divided into two different sets by skin microbiota (P = 0.011), which could be verified by heatmap analysis. Moreover, we found that the relative abundance of Staphylococcus epidermidis (S. epidermidis) significantly increased, but Cutibacterium acnes (C. acnes) decreased after IPL treatment. The sebum concentration was positively correlated with PH value (R = 0.525, P = 0.017), and the GAGS was positively associated with both sclererythrin (R = 0.477, P = 0.002) and red area (R = −0.503, P = 0.001).
Conclusions
IPL could successfully improve the GAGS scores of acne vulgaris, as well as regulate the equilibrium between C. acnes and S. epidermidis, and inhibit the sebum secretion. Lasers Surg. Med. © 2021 The Authors. Lasers in Surgery and Medicine published by Wiley Periodicals LLC.
Cutibacterium acnes (C. acnes) is a Gram-positive anaerobic facultative bacterium that is part of the human skin commensal microbiome. It colonizes various regions of the body, including the face, back, and chest. While typically a harmless commensal, under certain conditions, C. acnes can become pathogenic, leading to or promoting conditions such as acne vulgaris (AV), post-surgical infections, prostate cancer, and sarcoidosis. Current treatments for C. acnes infections often involve antibiotics, but the rise of antibiotic resistance has raised concerns. This review presents the virulence factors, clinical relevance, and current treatments of C. acnes, highlighting its association with AV, post-surgical infections, and other diseases. It also explores alternative innovative therapies such as phage therapy in development/research that are gaining prominence, with a growing focus on personalized medical approaches. To enhance C. acnes treatment while minimizing side effects and antibiotic prescription concerns, numerous clinical studies have been undertaken. These investigations span various pathological profiles and employ diverse strategies, such as utilizing bacterial extracts and compounds to restore healthy skin flora. The limitations and challenges of current and innovative treatments are also addressed, emphasizing the need for multidisciplinary strategies to combat C. acnes infections effectively.
Benefit deriving from the use of light is known since ancient time, but, only in the last decades of twentieth century, we witnessed the rapid expansion of knowledge and techniques. Light-emitted diode (LED)-based devices represent the emerging and safest tool for the treatment of many conditions such as skin inflammatory conditions, aging, and disorders linked to hair growth. The present work reviews the current knowledge about LED-based therapeutic approaches in different skin and hair disorders. LED therapy represents the emerging and safest tool for the treatment of many conditions such as skin inflammatory conditions, aging, and disorders linked to hair growth. The use of LED in the treatment of such conditions has now entered common practice among dermatologists. Additional controlled studies are still needed to corroborate the efficacy of such kind of treatment.
Background:
Acne vulgaris is a multifaceted skin disorder, affecting more than 85% of young individuals worldwide. Pharmacological therapy is not always desirable because of the development of antibiotic resistance or the potential risk of adverse effects. Non-pharmacological therapies can be viable alternatives for conventional therapies. However, sufficient evidence based support in the efficacy and safety of non-pharmacological therapies is lacking.
Objective:
To assess the efficacy and safety of several non-pharmacological therapies in the treatment of acne vulgaris.
Methods:
A systematic literature review, including a best-evidence synthesis was performed to identify literature. Three electronic databases were accessed and searched for studies published between January 2000 and May 2017.
Results:
Thirty three eligible studies were included in our systematic review. Three main types of non-pharmacological therapies were identified: laser and light-based therapies, chemical peels and fractional microneedling radiofrequency. The majority of the included studies demonstrated a significant reduction on acne lesions. However, only 7 studies had a high methodologic quality. Based on these 7 trials, a best-evidence synthesis was conducted. Strong evidence was found for glycolic acid (10-40%). Moderate evidence was found for amino fruit acid (20-60%), IPL (400-700nm and 870 - 1200nm) and the diode laser (1450nm). Initially, conflicting evidence was found for pulsed dye laser (585-595nm). The most frequently reported side-effects for non-pharmacological therapies included erythema, tolerable pain, purpura, oedema and a few cases of hyperpigmentation, which were in most cases mild and transient.
Conclusion:
Circumstantial evidence was found for non-pharmacological therapies in the treatment of acne vulgaris. However, the lack of high methodological quality among included studies prevented us to draw clear conclusions, regarding a stepwise approach. Nevertheless, our systematic review including a best-evidence synthesis did create order and structure in resulting outcomes in which a first step towards future research is generated. This article is protected by copyright. All rights reserved.
In the early 1990s, the biological significance of light-emitting diodes was realized. Since this discovery, various light sources have been investigated for their cutaneous effects.
A Medline search was performed on light-emitting diode lights and their therapeutic effects between 1996 and 2010. Additionally, an open-label, investigator-blinded study was performed using a yellow light-emitting diode device to treat acne, rosacea, photoaging, alopecia areata, and androgenetic alopecia.
The authors identified several case-based reports, small case series, and a few randomized controlled trials evaluating the use of four different wavelengths of light-emitting diodes. These devices were classified as red, blue, yellow, or infrared, and covered a wide range of clinical applications. The 21 patients the authors treated had mixed results regarding patient satisfaction and pre- and post-treatment evaluation of improvement in clinical appearance.
Review of the literature revealed that differing wavelengths of light-emitting diode devices have many beneficial effects, including wound healing, acne treatment, sunburn prevention, phototherapy for facial rhytides, and skin rejuvenation. The authors' clinical experience with a specific yellow light-emitting diode device was mixed, depending on the condition being treated, and was likely influenced by the device parameters.
The combinations of topical keratolytics with anti-microbials and topical retinoids with antimicrobials are commonly prescribed in the treatment of acne.
The present study was undertaken with the aim of comparing the efficacy and safety of topical benzoyl peroxide and clindamycin versus topical benzoyl peroxide and nadifloxacin versus topical tretinoin and clindamycin in patients of acne vulgaris.
100 patients between 15 and 35 years having ≥2 and ≤30 inflammatory and/or noninflammatory lesions with Investigator's Global Assessment (IGA) score 2/3 were randomly divided into 3 groups. Group A was prescribed benzoyl peroxide 2.5% gel and clindamycin 1% gel, Group B was prescribed benzoyl peroxide 2.5% gel and nadifloxacin 1% cream and Group C was prescribed tretinoin 0.025% and clindamycin 1% gel. Total number of lesions and adverse effects during the treatment were assessed at 0, 4, 8, 12 weeks with IGA score.
There was statistically significant reduction in total number of lesions with better improvement in Group A. Adverse drug reactions during the study showed a better safety profile of Group B which is found to be statistically significant also.
These findings confirm that Group A is more efficacious and Group B is safest among the other two groups.
Background:
Acne vulgaris, a chronic inflammatory disease of the pilosebaceous unit associated with socialisation and mental health problems, may affect more than 80% of teenagers. Isotretinoin is the only drug that targets all primary causal factors of acne; however, it may cause adverse effects.
Objectives:
To assess efficacy and safety of oral isotretinoin for acne vulgaris.
Search methods:
We searched the following databases up to July 2017: the Cochrane Skin Group Specialised Register, CENTRAL, MEDLINE, Embase, PsycINFO and LILACS. We updated this search in March 2018, but these results have not yet been incorporated in the review. We also searched five trial registries, checked the reference lists of retrieved studies for further references to relevant trials, and handsearched dermatology conference proceedings. A separate search for adverse effects of oral isotretinoin was undertaken in MEDLINE and Embase up to September 2013.
Selection criteria:
Randomised clinical trials (RCTs) of oral isotretinoin in participants with clinically diagnosed acne compared against placebo, any other systemic or topical active therapy, and itself in different formulation, doses, regimens, or course duration.
Data collection and analysis:
We used standard methodological procedures expected by Cochrane.
Main results:
We included 31 RCTs, involving 3836 participants (12 to 55 years) with mild to severe acne. There were twice as many male participants as females.Most studies were undertaken in Asia, Europe, and North America. Outcomes were generally measured between eight to 32 weeks (mean 19.7 weeks) of therapy.Assessed comparisons included oral isotretinoin versus placebo or other treatments such as antibiotics. In addition, different doses, regimens, or formulations of oral isotretinoin were assessed, as well as oral isotretinoin with the addition of topical agents.Pharmaceutical companies funded 12 included trials. All, except three studies, had high risk of bias in at least one domain.Oral isotretinoin compared with oral antibiotics plus topical agentsThese studies included participants with moderate or severe acne and assessed outcomes immediately after 20 to 24 weeks of treatment (short-term). Three studies (400 participants) showed isotretinoin makes no difference in terms of decreasing trial investigator-assessed inflammatory lesion count (RR 1.01 95% CI 0.96 to 1.06), with only one serious adverse effect found, which was Stevens-Johnson syndrome in the isotretinoin group (RR 3.00, 95% CI 0.12 to 72.98). However, we are uncertain about these results as they were based on very low-quality evidence.Isotretinoin may slightly improve (by 15%) acne severity, assessed by physician's global evaluation (RR 1.15, 95% CI 1.00 to 1.32; 351 participants; 2 studies), but resulted in more less serious adverse effects (67% higher risk) (RR 1.67, 95% CI 1.42 to 1.98; 351 participants; 2 studies), such as dry lips/skin, cheilitis, vomiting, nausea (both outcomes, low-quality evidence).Different doses/therapeutic regimens of oral isotretinoinFor our primary efficacy outcome, we found three RCTs, but heterogeneity precluded meta-analysis. One study (154 participants) reported 79%, 80% and 84% decrease in total inflammatory lesion count after 20 weeks of 0.05, 0.1, or 0.2 mg/kg/d of oral isotretinoin for severe acne (low-quality evidence). Another trial (150 participants, severe acne) compared 0.1, 0.5, and 1 mg/kg/d oral isotretinoin for 20 weeks and, respectively, 58%, 80% and 90% of participants achieved 95% decrease in total inflammatory lesion count. One RCT, of participants with moderate acne, compared isotretinoin for 24 weeks at (a) continuous low dose (0.25 to 0.4 mg/kg/day), (b) continuous conventional dose (0.5 to 0.7 mg/kg/day), and (c) intermittent regimen (0.5 to 0.7 mg/kg/day, for one week in a month). Continuous low dose (MD 3.72 lesions; 95% CI 2.13 to 5.31; 40 participants; one study) and conventional dose (MD 3.87 lesions; 95% CI 2.31 to 5.43; 40 participants; one study) had a greater decrease in inflammatory lesion counts compared to intermittent treatment (all outcomes, low-quality evidence).Fourteen RCTs (906 participants, severe and moderate acne) reported that no serious adverse events were observed when comparing different doses/therapeutic regimens of oral isotretinoin during treatment (from 12 to 32 weeks) or follow-up after end of treatment (up to 48 weeks). Thirteen RCTs (858 participants) analysed frequency of less serious adverse effects, which included skin dryness, hair loss, and itching, but heterogeneity regarding the assessment of the outcome precluded data pooling; hence, there is uncertainty about the results (low- to very-low quality evidence, where assessed).Improvement in acne severity, assessed by physician's global evaluation, was not measured for this comparison.None of the included RCTs reported birth defects.
Authors' conclusions:
Evidence was low-quality for most assessed outcomes.We are unsure if isotretinoin improves acne severity compared with standard oral antibiotic and topical treatment when assessed by a decrease in total inflammatory lesion count, but it may slightly improve physician-assessed acne severity. Only one serious adverse event was reported in the isotretinoin group, which means we are uncertain of the risk of serious adverse effects; however, isotretinoin may result in more minor adverse effects.Heterogeneity in the studies comparing different regimens, doses, or formulations of oral isotretinoin meant we were unable to undertake meta-analysis. Daily treatment may be more effective than treatment for one week each month. None of the studies in this comparison reported serious adverse effects, or measured improvement in acne severity assessed by physician's global evaluation. We are uncertain if there is a difference in number of minor adverse effects, such as skin dryness, between doses/regimens.Evidence quality was lessened due to imprecision and attrition bias. Further studies should ensure clearly reported long- and short-term standardised assessment of improvement in total inflammatory lesion counts, participant-reported outcomes, and full safety accounts. Oral isotretinoin for acne that has not responded to oral antibiotics plus topical agents needs further assessment, as well as different dose/regimens of oral isotretinoin in acne of all severities.
Topical treatment is the mainstay of acne therapy. The most commonly prescribed topical medications for acne include benzoyl peroxide, clindamycin, and retinoids. Despite their effectiveness in treating mild to moderate acne vulgaris, these topical medications are found to be irritating, and are historically associated with poor tolerability and diminished patient adherence. Thus, choosing the right formulation that will be effective and well tolerated is essential. Novel formulations that optimize drug concentration and utilize improved delivery vehicles have helped to enhance the tolerability and efficacy, and allow for less frequent application or co-application of drugs that were previously considered incompatible. This article will review the goals of topical therapy for the treatment of acne, in addition to common therapies and their challenges. Advanced formulations and combination formulations of benzoyl peroxide, clindamycin, and tretinoin will also be discussed. J Drugs Dermatol. 2018;17(6 Suppl):s6-10.
We undertook a Cochrane review of randomized controlled trials (RCTs) evaluating the effects of light-based interventions for acne vulgaris. We searched the Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase, LILACS, ISI Web of Science, and grey literature sources (September 2015). We used the Grading of Recommendations Assessment, Development and Evaluation Working Group approach to assess the quality of evidence (QE). We included 71 RCTs (4211 participants, median sample size 31). Results from a single study (n = 266, low QE) showed little or no difference in effectiveness on participants’ assessment of improvement between 20% aminolevulinic acid (ALA) photodynamic therapy (PDT), activated by blue light, versus vehicle plus blue light, whereas another study (n = 180) of a comparison of ALA-PDT (red light) concentrations showed 20% ALA-PDT was no more effective than 15%, but better than 10% and 5% ALA-PDT. Pooled data from three studies, (n = 360, moderate QE) showed that methyl aminolevulinate (MAL)-PDT, activated by red light, had a similar effect on changes in lesion counts, compared with placebo cream with red light. Several studies compared yellow light to placebo or no treatment, infrared light to no treatment, gold-microparticle suspension to vehicle, and clindamycin/benzoyl peroxide (C/BPO) combined with pulsed dye laser to C/BPO alone. None of these showed any clinically significant effects. Most studies reported adverse effects, but inadequately, with scarring reported as absent, and blistering only in studies on intense pulsed light, infrared light and PDT (very low QE). Carefully planned studies, using standardised outcome measures, and common acne treatments as comparators are needed. This article is protected by copyright. All rights reserved.
Background:
The American Society of Dermatologic Surgery (ASDS) periodically develops consensus documents for its members concerning various aspects of dermatologic surgery. Advances in photodynamic therapy (PDT) have been many and PDT use has been established in a variety of skin conditions.
Objective:
The ASDS board of directors proposed a committee of experts in the field to develop consensus documents on different treatments. An expert panel reviewed the literature on PDT and discussed the findings. The consensus was reached with evidence-based recommendations on different clinical applications for PDT.
Patients and methods:
This consensus document includes discussions regarding PDT, including different photosensitizers and various light source activators, historical perspective, mechanism of action, various therapeutic indications and expected outcomes, pre- and post-care, and management of adverse outcomes.
Results:
Photodynamic therapy is highly effective for pre-cancerous lesions, superficial nonmelanoma skin cancers, inflammatory acne vulgaris and other conditions. New protocols including laser mediated PDT significantly improve results for several indications.
Conclusion:
The ASDS consensus document on PDT will be helpful for educating members on safe and effective PDT for a variety of indications.
Background:
Photodynamic therapy (PDT) has been used for acne, however, the efficacy and safety need to be determined.
Objective:
To assess the effects and safety of PDT for acne using an evidence-based approach.
Methods:
Randomized controlled trials (RCTs) on the treatment of acne with PDT were identified by searching PubMed, CNKI and the Cochrane Library.
Results:
A total of 14 RCTs involving 492 patients were included. Photosensitizers included aminolevulinic acid (ALA), methylaminolevulinate (MAL), and indole-3-acetic acid (IAA). Light sources included red light, pulsed dye laser (PDL), intense pulsed light (IPL), long-pulsed dye laser (LPDL) and green light. The PDT protocols, including ALA + red light, ALA + PDL, ALA + IPL, MAL + red light, and MAL + LPDL, all showed great efficacy on inflammatory lesions. ALA + red light also had effects on non-inflammatory lesions and sebum secretion. ALA + IPL and IAA + green light significantly decreased sebum secretion. Triple treatment protocols showed great improvement on inflammatory and non-inflammatory lesions. Increasing ALA concentration, ALA incubation time, PDT sessions, dose of light source or using occlusion for photosensitizers, or a combination of other treatments with PDT may achieve greater efficacy. The common side effects of PDT were tolerable and transient.
Conclusion:
Limited evidence indicates that PDT shows good efficacy in the treatment of acne with acceptable side effects. ALA + red light was shown to be the optimal choice. However, more RCTs are needed to determine the types and concentrations of photosensitizers and light sources, and the duration of light activation and incubation.
Nicotinamide and clindamycin gels are two popular topical medications for acne vulgaris. This study aimed to compare efficacy of the topical 4% nicotinamide and 1% clindamycin gels in these patients. In this randomized, double-blind clinical trial, patients with moderate inflammatory facial acne vulgaris were randomly allocated to receive either topical 4% nicotinamide (n = 40) or 1% clindamycin gels (n = 40) twice daily. In each group, they were further categorized in two subgroups with oily and non-oily types of facial skin. The Cook's acne grade was determined at baseline and at weeks 4 and 8 post treatment. Acne grade decreased from an average of 5.93 ± 0.83 at baseline to 4.03 ± 1.33 at week 4 and 2.08 ± 1.59 at week 8 in nicotinamide receivers, and from an average of 5.70 ± 0.94 at baseline to 3.85 ± 1.66 at week 4 and 2.03 ± 1.53 at week 8 in the clindamycin group (within-group P < 0.001, between-group P > 0.05). Comparing with each other, nicotinamide and clindamycin gels were significantly more efficacious in oily and non-oily skin types, respectively. No major side effect was encountered by any patient. Skin type is a significant factor in choosing between topical nicotinamide and clindamycin in patients with acne vulgaris.
Background Blue and red light have been reported to have beneficial effects on acne. However, there has been no double-blind, randomized study of acne treatment for combined blue and red light-emitting diode (LED) devices, and the associated molecular mechanisms have rarely been investigated.
Objectives To evaluate the efficacy, safety and histological changes of combined blue and red LED phototherapy for acne vulgaris.
Methods Thirty-five patients with mild-to-moderate acne were randomly assigned to either a home-use irradiation group using an LED device, or a control group using a sham device. The treatment group was instructed to serially irradiate their forehead and cheeks with 420-nm blue light and 660-nm red light for 2·5 min twice daily for 4 weeks.
Results At the final visit at 12 weeks, both inflammatory and noninflammatory acne lesions had decreased significantly, by 77% and 54%, respectively, in the treatment group. No significant difference was observed in the control group. In the treatment group, sebum output reduction, attenuated inflammatory cell infiltrations and a decreased size of the sebaceous gland were found. The immunostaining intensities for interleukin (IL)-8, IL-1α, matrix metalloproteinase-9, toll-like receptor-2, nuclear factor-κB, insulin-like growth factor-1 receptor and sterol response element binding protein (SREBP)-1 were reduced concomitantly. Messenger RNA expression of SREBP-1c was also decreased. No severe adverse reactions were reported.
Conclusions This LED phototherapy was safe and effective for treating not only inflammatory but also noninflammatory acne lesions, with good compliance. The experimental results correlated well with clinical results, partly elucidating the related molecular mechanisms.
Acne may be common, but it causes considerable distress and doctors should treat it effectively, not trivialise it
Acne vulgaris is common and affects nearly all adolescents and adults at some time in their lives. Although overall health is not impaired, acne is not a trivial disease; it can produce cutaneous and emotional scars that last a lifetime. 1 2 Numerous psychological problems stem from acne, even resulting in decreased employability in adulthood.3 Fortunately, acne is eminently treatable, and this review provides an outline of current treatments.
Summary points
Acne is a multifactorial disease which, although not life threatening, has profound effects on patientsThe microcomedo is the primary lesion in acneReduction of comedones and Propionibacterium acnes is the main aim of treatmentMost effective acne regimens treat inflammatory and comedonal acne lesions with a combination of antibacterial and retinoid drugs
Sources and selection criteria
A literature review augmented my extensive experience of the topic. I used
Entrez PubMed for all literature searches.
Pathogenesis
Acne has a complex aetiology, involving abnormal keratinisation, hormonal function, bacterial growth, and immune hypersensitivity. 1 2 The disease is limited to pilosebaceous follicles of the head and upper trunk because the sebaceous glands in these regions are particularly active. The primary acne lesion is the “blackhead” (microcomedo), an impaction and distension of the follicle with improperly desquamated keratinocytes and sebum. The stimulus for comedogenesis is uncertain.
At puberty, when androgens stimulate the production of sebum, pre-existing comedones become filled with lipid and may enlarge to become visible. Subsequently, some patients also begin to show signs of inflammation. Comedones that become inflamed are nearly always clinically invisible before the pimple develops.
Inflammatory acne is the result of the host response to the follicular inhabitant Propionibacterium acnes, 1 4 which is a member of the normal flora and is a harmless …
Topical treatment for mild acne
Benzoyl peroxide 2.5-10% once daily Azaleic acid 20% twice dailyTretinoin 0.1-0.25% once dailyIsotretinoin 0.05% once or twice dailyClindamycin 1% twice dailyErythromycin 2% and 4% with zinc acetate 1.2% twice dailyTetracycline 4% twice daily
Summary points
Summary pointsAcne is as common as it was 20 years ago but is now less severe in teenagers and affects more people in their 20s and 30s, who have high expectation of treatmentTopical treatments are effective for mild to moderate acne, and oral antibiotics (and anti-androgens for women) are helpful for moderate acneFor severe acne high dose oral antibiotics can be used, but oral isotretinoin has a rapid effect and a high rate of long term remissionIsotretinoin is only available through hospital dermatologists because of its side effectsEarly treatment and regular review are necessary to prevent scarring
Acne severity
Severity of acne can be graded for therapeutic studies according to the Leeds grading scale,6 but in the general treatment of acne vulgaris most doctors would divide the condition into mild, moderate, and severe. Mild disease consists of open and closed comedones and some papules and pustules, while moderate acne encompasses more frequent papules and pustules with mild scarring. Severe disease contains all of the above plus nodular abscesses and leads to more extensive scarring which may be keloidal in some cases.
Treatment of mild acne
Topical preparations are the mainstay of treatment for mild acne vulgaris (see box). These are popular with patients, but their slow benefit needs careful explanation to encourage good compliance.
Benzoyl peroxide is a potent oxidising agent with antibacterial and keratolytic properties. It does not induce any change in the resistance pattern of aerobic bacteria to antibiotics; it also prevents such resistance when used concomitantly with topical erythromycin.7 Benzoyl peroxide is applied daily in lotions or creams …
Studies have shown that low-level laser irradiation increases the proliferation of fibroblasts in cell culture. The mechanism of action is unknown. Basic fibroblast growth factor (bFGF) is a multifunctional polypeptide that has been detected in most tissues and which supports cell proliferation and differentiation. The purpose of this study was to determine whether laser irradiation (660 nm) can stimulate production of bFGF from fibroblast cells in cell culture. Our study showed that fibroblasts irradiated with laser energy at 2.16 J/cm2 demonstrated increased cell proliferation and enhanced production of bFGF, whereas fibroblasts irradiated with laser energy at 3.24 J/cm2 neither demonstrated increased cell proliferation or an enhanced release of bFGF as compared to the control group. These results provide direct evidence that the proliferation of fibroblasts as a result of stimulation by low level laser irradiation may be associated with the autocrine production of bFGF from fibroblasts.
Acne vulgaris, or acne, as it is generally called, is the most common skin disease, affecting nearly 80 percent of persons at some time between the ages of 11 and 30 years.1 It can persist for years and result in disfigurement and permanent scarring, and it can have serious adverse effects on psychosocial development, resulting in emotional problems, withdrawal from society, and depression.2 The pathogenesis of acne is multifactorial, and therapy can now be directed at many of these factors. This review summarizes current concepts of the rational treatment of acne vulgaris. Pathophysiology of Acne Acne vulgaris is the result . . .
In this study we have evaluated the use of blue light (peak at 415 nm) and a mixed blue and red light (peaks at 415 and 660 nm) in the treatment of acne vulgaris. One hundred and seven patients with mild to moderate acne vulgaris were randomized into four treatment groups: blue light, mixed blue and red light, cool white light and 5% benzoyl peroxide cream. Subjects in the phototherapy groups used portable light sources and irradiation was carried out daily for 15 min. Comparative assessment between the three light sources was made in an observer-blinded fashion, but this could not be achieved for the use of benzoyl peroxide. Assessments were performed every 4 weeks. After 12 weeks of active treatment a mean improvement of 76% (95% confidence interval 66-87) in inflammatory lesions was achieved by the combined blue-red light phototherapy; this was significantly superior to that achieved by blue light (at weeks 4 and 8 but not week 12), benzoyl peroxide (at weeks 8 and 12) or white light (at each assessment). The final mean improvement in comedones by using blue-red light was 58% (95% confidence interval 45-71), again better than that achieved by the other active treatments used, although the differences did not reach significant levels. We have found that phototherapy with mixed blue-red light, probably by combining antibacterial and anti-inflammatory action, is an effective means of treating acne vulgaris of mild to moderate severity, with no significant short-term adverse effects.
Blue light irradiation is known to be effective against acne. However, the profile of a good candidate is still unclear.
Thirty-one Taiwanese with symmetrical facial acne were irradiated with blue light on one side of the face selected randomly twice weekly for 4 consecutive weeks. The other half of the face was left untreated as control. Parameters, including scar type, pore size, and facial follicular porphyrin fluorescence intensity, were documented. The severity of acne was assessed before the treatment, after two, four, and eight sessions of treatment, and 1 month after the treatment was completed.
Compared with the non-irradiation side, eight sessions of blue light irradiation were effective in acne treatment (P<0.001). Gender (P=0.471), scar type (P-values of pitted, atrophic, and hypertrophic type were 0.688, 0.572, and 0.802, respectively), pore size (P=0.755), and pretreatment fluorescence intensity (P=0.656) could not be used as predictive factors of therapeutic effectiveness. Compared with pretreatment, nodulocystic lesions tended to worsen despite treatment. In addition, the therapeutic effectiveness was not related to the fluorescence intensity change (P=0.812).
Blue light irradiation is effective in acne treatment. Patients without nodulocystic lesions are better candidates for blue light irradiation.
Blue light sources have been shown to be effective in the treatment of mild to moderate inflammatory acne vulgaris lesions.
We evaluated the safety and efficacy of a new blue light source in the treatment of mild to moderate inflammatory acne vulgaris in comparison to topical 1% clindamycin solution.
Blue light therapy reduced inflammatory acne vulgaris lesions by an average of 34%, as compared to 14% for topical 1% clindamycin solution.
The blue light source presented in this report is a safe and effective treatment option available to our patients with mild to moderate inflammatory acne lesions.
This article discusses the psychological effect of acne vulgaris. It is shown that acne has significant effect on self-image and impacts quality of life. The impact of acne may be equivalent to that of asthma or epilepsy. Anxiety and depression and a reduction in social functioning are a consequence of this condition. Effective treatment results in improvement of quality-of-life measurement. Most of the data is gathered from case control studies. Further work, particularly prospective longitudinal cohort studies, needs to be performed to validate the impact of acne on quality of life. Acne severity grading should incorporate life quality scores to better establish the true impact of this condition on our patients in order to optimize therapy.
The effective management of acne remains a challenge; achieving an optimal response whilst minimizing adverse events is often difficult. The rise in antibiotic resistance threatens to reduce the future usefulness of the current mainstay of therapy. The need for alternative therapies remains important. Phototherapy has previously been shown to be effective in acne, with renewed interest as both endogenous and exogenous photodynamic therapies are demonstrated for this condition.
To determine the effect of narrowband blue light in the reduction of inflammatory and non-inflammatory lesions in patients with mild to moderate acne and to evaluate patient tolerance of the therapy.
We performed an open study utilizing a blue LED light source in 30 subjects with mild to moderate facial acne. Two weeks after screening, lesions were counted and recorded by lesion type. Over 4 weeks, patients received eight 10- or 20-minute light treatments, peak wavelength 409-419 nm at 40 mW/cm2. Assessments were taken at weeks 5, 8 and 12 and lesion counts were recorded. Repeated measures-ANOVA and Dunnett's tests, respectively, allowed assessment of the different scores over time and permitted comparison of mean counts.
An overall effect on inflammatory counts was observed at week 5, and a statistically significant decrease in inflamed counts was detected at the week 8 assessments, which continued to week 12. There was little effect on non-inflamed lesions. The treatment was well tolerated with adverse events experienced generally rated as being mild and usually self-limiting.
Eight 10- or 20-minute treatments over 4 weeks with a narrowband blue light was found to be effective in reducing the number of inflamed lesions in subjects with mild to moderate acne. The treatment had little effect on the number of comedones. The onset of the effect was observable at the first assessment, at week 5, and maximal between weeks 8 and 12. Blue light phototherapy using a narrowband LED light source appears to be a safe and effective additional therapy for mild to moderate acne.
Inflammatory acne vulgaris is a very common condition, particularly in adolescents and young adults, and new effective and well-tolerated treatments are needed.
To evaluate the efficacy and tolerability of methyl aminolaevulinate-based photodynamic therapy (MAL-PDT) in patients with moderate to severe facial acne vulgaris in a randomized, controlled and investigator-blinded trial.
Twenty-one patients were assigned to the treatment group and 15 patients to the control group. The treatment group received two MAL-PDT treatments, 2 weeks apart. Both groups were evaluated 4, 8 and 12 weeks after treatment. Efficacy evaluation included changes from baseline in numbers of noninflammatory and inflammatory lesions, changes from baseline in global acne severity grade and clinical assessments of clinical improvement by patient and evaluating dermatologist. Pain scores during treatment and local adverse effects were also evaluated.
Twelve weeks after treatment the treatment group showed a 68% reduction from baseline in inflammatory lesions vs. no change in the control group (P=0.0023). We found no reduction in number of noninflammatory lesions after treatment. All patients experienced moderate to severe pain during treatment and developed severe erythema, pustular eruptions and epithelial exfoliation. Seven patients did not receive the second treatment due to adverse effects.
MAL-PDT proved to be an efficient treatment for inflammatory acne. The treatment was associated with severe pain during treatment and severe adverse effects after treatments. Efforts must be made to optimize the treatment regimen and to avoid adverse effects.
Acne vulgaris represents both a challenge to the treating dermatologist and a major concern for the patient. Conventional treatments have proved inconsistent with often unacceptable side effects and high rates of recurrence. Non-thermal, non-laser, phototherapy for acne with a combination of blue and red light has recently attracted attention. The present study was designed to assess the efficacy of this combination phototherapy.
Twenty-four subjects, Fitzpatrick skin types II-V, with mild to severe symmetric facial acne vulgaris were recruited for the study. Subjects were well matched at baseline in terms of both age and duration of acne. Subjects were treated over eight sessions, two per week 3 days apart, alternating between 415 nm blue light (20 minutes/session, 48 J/cm2) and 633 nm red light (20 minutes/session, 96 J/cm2) from a light-emitting diode (LED)-based therapy system. Patients received a mild microdermabrasion before each session. Acne was assessed at baseline and at weeks 2, 4, 8 and 12.
Twenty-two patients completed the trial. A mean reduction in lesion count was observed at all follow-up points. At the 4-week follow-up, the mean lesion count reduction was significant at 46% (p=0.001). At the 12-week follow-up, the mean lesion count reduction was also significant at 81% (p=0.001). Patient and dermatologist assessments were similar. Severe acne showed a marginally better response than mild acne. Side effects were minimal and transitory. Comedones did not respond as well as inflammatory lesions.
Combination blue and red LED therapy appears to have excellent potential in the treatment of mild to severe acne. Treatment appears to be both pain- and side effect-free.
Narrow-band blue light (420 nm) has demonstrated safety and efficacy in the treatment of acne vulgaris. It works by exhibiting a phototoxic effect on the heme metabolism of Propionibacterium acnes. Previous studies using blue light showed more improvement in inflammatory lesions than in comedones, as well as some improvement on the untreated side. Cytokines have demonstrated a critical role in the development of inflammation. The expression of pro-inflammatory cytokines such as IL-1alpha have been shown to result in the expression of vascular and dermal adhesion molecules, the chemoattraction of inflammatory cells, and the stimulation of other inflammatory mediators. In addition, UVB radiation serves as a potent modulator of cell-mediated immune responses.
This study investigated the effect of narrow-band blue light on the inflammatory process in the presence and absence of cytokines and UVB using IL-1alpha and ICAM-1 as markers for inflammation.
Two immortalized keratinocyte cell lines were compared: HaCaT, produced by spontaneous immortalization of a genetically altered cell line, and hTERT, obtained by stable transfection of primary cell culture with human telomerase reverse transcriptase. Cells were treated with INF-y and TNF-alpha and exposed to UVB (312 nm at 50 mJ/cm2) and/or blue light (420 nm at 54 mJ/cm2 and 134 mJ/cm2). The expression of IL-1alpha and ICAM-1 was measured by quantitative ELISA.
The results showed that blue light and low-dose UVB treatment of HaCaT and hTERT cells resulted in inhibition of cytokine-induced production of IL-1alpha. The level of IL-1alpha decreased by 82% in HaCaT and by 75% in hTERT cells when exposed to blue light. It decreased by 95% in HaCaT and by 91% in hTERT cells when blue light was used in combination with UVB. ICAM-1 expression was similarly reduced in HaCaT, but not in hTERT cells.
This study showed that narrow-band blue light has anti-inflammatory effects on keratinocytes by decreasing the cytokine-induced production of IL-1alpha and ICAM-1. In addition, blue light demonstrated synergistic effects with low-dose UVB light. These results expand the properties of narrow-band blue light in modulating the inflammatory process and will facilitate testing of its phototherapeutic applications in different inflammatory skin conditions.
Blue light is effective for acne treatment, inducing photodynamic destruction of Propionibacterium acnes (P. acnes). This study was designed to investigate the efficacy of combined blue and red light-emitting diode (LED) phototherapy for acne vulgaris.
Twenty-four patients with mild to moderately severe facial acne were treated with quasimonochromatic LED devices, alternating blue (415 nm) and red (633 nm) light. The treatment was performed twice a week for 4 weeks. Objective assays of the skin condition were carried out before and after treatment at each treatment session. Clinical assessments were conducted before treatment, after the 2nd, 4th, and 6th treatment sessions and at 2, 4, and 8 weeks after the final treatment by grading and lesion counting.
The final mean percentage improvements in non-inflammatory and inflammatory lesions were 34.28% and 77.93%, respectively. Instrumental measurements indicated that the melanin levels significantly decreased after treatment. Brightened skin tone and improved skin texture were spontaneously reported by 14 patients.
Blue and red light combination LED phototherapy is an effective, safe and non-painful treatment for mild to moderately severe acne vulgaris, particularly for papulopustular acne lesions.
Low-level laser irradiation (LLLI) was found to promote the proliferation of various types of cells in vitro. Stem cells in general are of significance for implantation in regenerative medicine. The aim of the present study was to investigate the effect of LLLI on the proliferation of mesenchymal stem cells (MSCs) and cardiac stem cells (CSCs).
Isolation of MSCs and CSCs was performed. The cells were cultured and laser irradiation was applied at energy densities of 1 and 3 J/cm2.
The number of MSCs and CSCs up to 2 and 4 weeks respectively, post-LLLI demonstrated a significant increase in the laser-treated cultures as compared to the control.
The present study clearly demonstrates the ability of LLLI to promote proliferation of MSCs and CSCs in vitro. These results may have an important impact on regenerative medicine.
Recently, a demand for safe and effective treatment of acne has been increasing. Although visible light has attracted attention as a new option, the effect of red light alone has not yet been evaluated.
The objective was to assess the efficacy of red light phototherapy with a portable device in acne vulgaris.
Twenty-eight volunteers with mild to moderate acne were treated with portable red light-emitting devices in this split-face randomized trial. The right or left side of the face was randomized to treatment side and phototherapy was performed for 15 minutes twice a day for 8 weeks. Clinical photographs, lesion counts, and a visual analog scale (VAS) were used to assess each side of the face at baseline and Weeks 1, 2, 4, and 8, and a split-face comparison was performed.
The percent improvement in noninflammatory and inflammatory lesion counts of the treated side was significant compared to the control side (p<.005). VAS decreased from 3.9 to 1.9 on the treatment side and the difference between the treatment and control sides was significant at Week 8 (p<.005).
This study shows that red light phototherapy alone can be a new therapeutic option for acne vulgaris.
Due to the late introduction of oral isotretinoin, there is only a single report of the use of this drug from India.
To evaluate the efficacy, acceptability and side effects of oral isotretinoin in Indian conditions and to compare the efficacy of oral isotretinoin monotherapy with that of a combination of oral isotretinoin and topical anti-acne agents.
Sixty clinically diagnosed patients of nodulocystic acne were divided into two groups of 30 each. Patients in group A were administered oral isotretinoin 20 mg twice a day along with topical clindamycin (1%) and adapalene (0.1%) for 24 weeks. Patients in group B were given only oral isotretinoin. An objective clinical scoring was repeated every four weeks and patients were followed up for six months on completion of treatment.
Out of the 60 patients, 50 completed the treatment and 35 completed the follow-up at six months. The mean pretreatment score in group A came down from 12.8 to 1.24 and in group B from 12.4 to 1.48, thus showing a 90.55% and 88% reduction in pretreatment scores respectively. There was no statistical difference in the results obtained from the two groups. Side effects were common but minor in nature.
Isotretinoin produces gratifying results in patients of nodulocystic acne in Indian conditions. Addition of topical antiacne agents does not alter the final outcome. This addition is well tolerated but requires careful monitoring.
An overview of acne therapy, part 1: Topical therapy, oral antibiotics, laser and light therapy, and dietary interventions
- JW Marson
- HE Baldwin