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Lighting the Path: Evaluating Light-Emitting Diode Therapy Versus Salicylic Acid Peel for Inflammatory Acne- A Case Series Analysis
Abstract
Aims: This study aims to assess the efficacy of red, blue, and combined red-blue light therapy versus 20% salicylic acid peel in treating Grades 2 and 3 inflammatory acne. Study Design: Cases studies. Place and Duration of Study: Universidade Nove de Julho, Universidade Adventista de São Paulo, São Paulo Brazil. Between March 2022 from April 2024. Introduction: Acne is an inflammatory disorder that occurs in the pilosebaceous follicles and deeply affects the self-esteem and quality of life of individuals. Conventional treatments usually produce side effects and promote antibiotic resistance. Light therapy has emerged as a promising modality in clinical and scientific realms for acne management. This study aims to evaluate the effectiveness of red, blue and combined red-blue light therapy versus 20% salicylic acid peeling in the treatment of inflammatory acne grade 2 and 3. Methodology: We divided 20 participants into four groups who used a mask of LEDs. Group 1 used a mask with blue light (470nm), group 2 used a mask with red light (660nm), group 3 used a mask with red (660nm) and blue (470nm) lights combined in the same device. The groups that used the LED masks received the treatment 3 times a week for 30 days, totaling 12 sessions. Group 4 was submitted to two sessions of salicylic acid peeling at 20%, every 15 days. Results: Blue light (group 1) showed an improvement of 28.40% in the general skin condition. Group 4 of salicylic acid peeling had an improvement of 28.37%. The combined red and blue light group had an improvement of 26.43%, while the red light showed an improvement of 10.97%. Conclusion: Based on the series of cases presented, all groups showed improvement, but blue light showed higher results than red light and salicylic acid. However, studies with a larger number of participants should be performed and the ideal parameters for Led use in inflammatory acne should be discussed.
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Phototherapy is an important method of dermatological treatments. Ultraviolet (280–400 nm) therapy is of great importance; however, there are concerns of its long-term use, as it can lead to skin aging and carcinogenesis. This review aims to evaluate the role and the mechanism of action of blue light (400–500 nm), a UV-free method. The main mediators of cellular responses to blue light are nitric oxide (NO) and reactive oxygen species (ROS). However, the detailed mechanism is still not fully understood. It was demonstrated that blue light induces an anti-inflammatory and antiproliferative effect; thus, it may be beneficial for hyperproliferative and chronic inflammatory skin diseases such as atopic dermatitis, eczema, and psoriasis. It was also found that blue light might cause the reduction of itching. It may be beneficial on hair growth and may be used in the treatment of acne vulgaris by reducing follicular colonization of Propionibacterium acnes. Further studies are needed to develop accurate protocols, as the clinical effects depend on the light parameters as well as the treatment length. There are no major adverse effects observed yet, but long-term safety should be monitored as there are no studies considering the long-term effects of blue light on the skin.
The relationship between endocrine disrupting chemicals (EDCs) and the pathogenesis of acne vulgaris has yet to be explored in the literature. Acne vulgaris is a chronic inflammatory skin disease of the pilosebaceous unit. The pathogenesis of acne involves several hormonal pathways, including androgens, insulin-like growth factor 1(IGF-1), estrogens, and corticosteroids. EDCs influence these pathways primarily through two mechanisms: altering endogenous hormone levels and interfering with hormone receptor function. This review article describes the mechanistic links between EDCs and the development of acne lesions. Highlighted is the contributory role of androgen receptor ligands, such as bisphenol A (BPA) and mono-2-ethylhexyl Phthalate (MEHP), via upregulation of lipogenic genes and resultant exacerbation of cholesterol synthesis. Additionally discussed is the protective role of phytoestrogen EDCs in counteracting androgen-induced sebocyte maturation through attenuation of PPARy transcriptional activity (i.e., resveratrol) and restoration of estrogen-regulated TGF-B expression in skin cells (i.e., genistein). Examination of the relationship between EDCs and acne vulgaris may inform adjunctive avenues of treatment such as limiting environmental exposures, and increasing low-glycemic, plant-rich foods in the diet. With a better understanding of the cumulative role that EDCs play in acne, clinicians can be better equipped to treat and ultimately improve the lives of their patients.
Salicylic acid has been used to treat various skin disorders for more than 2,000 years. The ability of salicylic acid to exfoliate the stratum corneum makes it a good agent for peeling. In particular, the comedolytic property of salicylic acid makes it a useful peeling agent for patients with acne. Once considered as a keratolytic agent, the role of salicylic acid as a desmolytic agent, because of its ability to disrupt cellular junctions rather than breaking or lysing intercellular keratin filaments, is now recognized and is discussed here. Salicylic acid as a peeling agent has a number of indications, including acne vulgaris, melasma, photodamage, freckles, and lentigines. The efficacy and safety of salicylic acid peeling in Fitzpatrick skin types I–III as well as in skin types V and VI have been well documented in the literature. This paper reviews the available data and literature on salicylic acid as a peeling agent and its possible indications. Its properties, efficacy and safety, the peeling procedure, and possible side effects are discussed in detail. An account of salicylism is also included.
The pathogenesis of acne, a disease of the pilosebaceous follicle and one of the most common chronic skin disorders, is attributed to multiple factors such as increased sebum production, alteration of the quality of sebum lipids, inflammatory processes, dysregulation of the hormone microenvironment, interaction with neuropeptides, follicular hyperkeratinisation and the proliferation of Propionibacterium acnes within the follicle. In particular, the sebaceous gland plays an exquisite role in the initiation of the disease as it possesses all the enzyme machinery for the production of hormones and cytokines. In addition, in response to the altered tissue environment in the pilosebaceous follicle as well as in answer to emotional fret, stress response system mechanisms with induction of central and local expression of neuropeptides, are also initiated. This review summarises the latest advances in understanding the role of sebaceous gland cells in the pathomechanism of acne.
Light-emitting diode photobiomodulation is the newest category of nonthermal light therapies to find its way to the dermatologic armamentarium. In this article, we briefly review the literature on the development of this technology, its evolution within esthetic and medical dermatology, and provide practical and technical considerations for use in various conditions. This article also focuses on the specific cell-signaling pathways involved and how the mechanisms at play can be put to use to treat a variety of cutaneous problems as a stand-alone application and/or complementary treatment modality or as one of the best photodynamic therapy light source.
Available topical treatments are slow and frequently irritating. Oral therapies may be associated with increased bacterial resistance (antibiotics) or possible severe side effects (oral isotretinoin). In vitro and in vivo exposure of acne bacteria to 405-420 nm ultraviolet (UV) free blue light results in the photo-destruction of these bacteria through the effects on the porphyrins produced naturally by Propionibacterium acnes. A novel, high-intensity, narrow band 420 nm UV free blue light has been shown to decrease inflammatory acne lesions after eight bi-weekly treatments.
To examine the effects of high-intensity, narrow band 420 nm UV free blue light (ClearLight) on inflammatory acne lesions.
Three studies were carried out to examine the clinical effects of high-intensity, narrow band blue light on papulo-pustular acne: the split-face dose-response study, the full-face open trial and the split-face, double-blind controlled study. The studies enrolled 10, 13 and 23 patients respectively.
The data show more than an 80% response to 420 nm acne phototherapy with a significant reduction of 59-67% of inflammatory acne lesions after only eight treatments of 8-15 minutes. The reduction in lesions was steady in the follow-ups at 2, 4 and 8 weeks after the end of therapy. Prolonged remission was evident in the 8 weeks after the end of therapy. No adverse effects or patient discomfort were noted in any of the patients.
Acne phototherapy by high intensity, narrow band 405-420 nm light is proven to be an attractive, fast, effective, non-invasive alternative to current topical and parenteral anti-acne remedies.
Introduction:
Acne is a common, complex, multifactorial inflammatory skin disease associated with epidermal barrier dysfunction. Beginning in childhood, acne affects many adolescents and adults. Acne is associated with lower self-esteem, anxiety, and depression and may cause scars and pigmentary sequelae. The review explores the relationships between acne and the skin barrier function and discusses nuances in the prevention, treatment, and maintenance of acne and its impact on the skin barrier.
Methods:
The advisors' previous publications addressed prescription and nonprescription pediatric acne treatment and skincare using cleansers, moisturizers, and a practical algorithm for treatment and maintenance, including skincare recommendations for pediatric acne patients and an algorithm for skin of color patients with acne. Before the meeting, literature was culled on the relationship between the skin barrier and acne and current best practices in acne, addressing prescription and nonprescription acne products and skincare as monotherapy, adjunctive, and maintenance treatment.
Results:
After discussing 13 draft statements, the advisors applied the selected literature and drew from their clinical knowledge and experience, and agreed on five statements. The follicular epithelial barrier is directly involved with changes that occur during both comedogenesis and in stages of inflammation, especially with follicular rupture compromising the barrier's integrity. In acne-affected skin, sebaceous glands are larger, sebum excretion and filaggrin expression higher, and stratum corneum lipids are reduced. Educating patients and clinicians about inflammation's central role in acne and measures to reduce inflammation is essential. Skin irritation and xerosis from acne and treatments lead to poor treatment adherence. A skincare regimen should be included in the acne prevention, treatment, and maintenance care regimen and should be ongoing. Maintenance treatment with topical agents and skincare using gentle ceramide-containing cleansers and moisturizers is a recommended strategy after successfully controlling the disease.
Conclusions:
Epidermal barrier dysfunction contributes to acne exacerbation. Using the appropriate treatment and skincare helps to minimize irritation and inflammation, enhance treatment adherence, and improve patient outcomes.
Acne vulgaris is the most common dermatological disease in the United States, affecting up to 85 percent of teenagers. While the American Academy of Dermatology has established guidelines regarding acne treatment in general, the variability among acne treatments, even within a given class, prevents establishment of a straightforward regimen. For example, moderate to severe acne is generally treated with an oral antibiotic, although several options are available-both across and within antibiotic classes. The aim of this review is to report the efficacy and safety data available for commonly prescribed oral antibiotics. While there are currently no data to support superiority of one drug over another, there are substantial differences in safety profiles and brand-specific features that may make one antibiotic preferable over another.
Acne (syn: acne vulgaris) remains the commonest inflammatory dermatosis treated worldwide as estimated by global skin disease prevalence studies. Latest reports suggest the prevalence may be increasing in adolescents and adults, particularly adult females. The concept of burden of skin disease is multidimensional and can be difficult to quantify in light of different healthcare systems across the globe. In acne, the resulting burden may vary according to the patient demographic, access to treatments and duration of the disease. The visible nature of acne, symptoms and sequelae all contribute physically and psychosocially to the overall burden of disease as do the costs required for management. Acne typically presents in adolescence at a time of significant transition. Profound effects on functional status with strong impact on interpersonal relationships, social functioning as well as on mental health have been demonstrated. The high prevalence of acne also presents an economic burden for society. The widespread and prolonged use of antibiotics introduces a potential added burden through resulting antimicrobial resistance. A James Lind Alliance Acne Priority Setting Partnership has identified numerous areas to inform future research which would help to improve acne management and reduce the burden. Lack of standardized assessments is a major issue in acne trials and challenges the ability to compare treatments and perform meta‐analyses. This paper reviews the current literature on burden of acne, identifies areas of treatment uncertainties, and summarizes the work of Acne Core Outcome Network (ACORN) as a means of supporting a reduction in the burden of disease.
Acne vulgaris is an extraordinarily common skin condition in adolescents. The mainstays of acne treatment have remained largely unchanged over recent years. In the context of increasing antibiotic resistance worldwide, there is a global movement away from antibiotic monotherapy toward their more restrictive use. Classically reserved for nodulocystic acne, isotretinoin has become the drug of choice by dermatologists for moderate to severe acne. Given the virtually ubiquitous nature of acne in teenagers, there remains an appreciable need for novel therapies. In this article, we will cover the currently used acne treatments, evaluate the issues and data supporting their use, explore the issues of compliance and the mental health implications of acne care, and recommend directions for the field of acne management in adolescents in the years ahead.
Background: Antibiotic resistance presents a threat to public health. In dermatology, antibiotics are used extensively for the treatment of acne, sometimes for extended periods. Thus, awareness of antibiotic resistance among dermatology patients is relevant in clinical practice. Methods: An online survey assessed antibiotic resistance awareness in adults with acne (n=809) and the parents of adolescents with acne (n=210).Results: More than 80 percent of subjects said that they were "somewhat familiar" or "very familiar" with antibiotic resistance. Overall, 86 percent of the survey respondents identified the correct definition of antibiotic resistance, with parents more likely than their children to choose the proper definition of resistance, as follows: "When antibiotics and/or antibacterials are used for a period of time, the infectious organism adapts to them and becomes immune, resulting in less effective treatment" (95% confidence interval). Among subjects who might have been prescribed antibiotic treatment for their acne, including individuals that reported antibiotic treatment and individuals that were not sure, 76.9 percent reported that they would be very or extremely likely to use effective antibiotic-free options if given the opportunity. More than 90 percent of people with acne and their parents agreed that healthcare providers should do more to educate patients about antibiotics and antibiotic resistance. Conclusions: This survey indicated that patients with acne and their parents think more should be done to educate the public about about the potential risks associated with antibiotic use and the availability of antibiotic-free treatment options. Discussions with patients about antibiotic therapies, antibiotic resistance, and alternative therapies represent areas of opportunity for healthcare providers in dermatology.
Acne vulgaris is a prevalent cutaneous disease characterized by a multifactorial pathogenic process including hyperseborrhea, inflammation, over‐keratinization of follicular keratinocytes as well as Propionibacterium acnes (P. acnes) overgrowth. Salicylic acid (SA), a beta‐hydroxy acid, is frequently used in the treatment of acne. SA has been found to decrease skin lipids and to possess anti‐inflammatory properties. However, few studies have elucidated the mechanisms and pathways involved in such treatment of acne. In this study, we initially investigated the anti‐acne properties of SA in human SEB‐1 sebocytes. Treatment with SA decreased sebocyte lipogenesis by downregulating the adenosine monophosphate‐activated protein kinase (AMPK)/ sterol response element–binding protein‐1 (SREBP‐1) pathway and reduced inflammation by suppressing the NF‐κB pathway in these cells. Salicylic acid also decreased the cell viability of SEB‐1 by increasing apoptosis via the death signal receptor pathway. Subsequently, histopathological analysis of a rabbit ear acne model after application of SA for three weeks confirmed that SA suppressed the levels of cytokines and major pathogenic proteins around acne lesions, which supports the mechanisms suggested by our in vitro experiments. These results initially clarified that therapeutic activities of SA in acne vulgaris treatment could be associated with the regulation of SREBP‐1 pathway and NF‐κB pathway in human SEB‐1 sebocytes.
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Topical drugs have been used successfully to treat acne for decades. This review discusses the use, efficacy, and safety of options available via prescription. Topical antibiotics, dapsone, benzyl peroxide, azelaic acid, topical retinoids are included. Topical antibiotics should not be used as monotherapy but rather be combined with other agents to avoid resistant Propionebacterium acnes strains. Benzyl peroxide is effective in preventing bacteria resistance. Topical retinoids address primarily the comedonal but also the inflammatory lesions of acne. Azelaic acid is useful in treating acne lesions and for lightening postinflammatory hyperpigmentation that may accompany inflammatory acne lesions. Combinations of agents that address different aspects of acne pathogenesis may offer higher benefit to acne patients.
Background:
Many current guidelines provide detailed evidence-based recommendations for acne treatment.
Objective:
To create consensus-based, simple, easy-to-use algorithms for clinical acne treatment in daily office-based practice and to provide checklists to assist in determining why a patient may not have responded to treatment and what action to take.
Methods:
Existing treatment guidelines and consensus papers were reviewed. The information in them was extracted and simplified according to daily clinical practice needs using a consensus-based approach and based on the authors' clinical expertise.
Results:
As outcomes, separate simple algorithms are presented for the treatment of predominant comedonal, predominant papulopustular and nodular/conglobate acne. Patients with predominant comedonal acne should initially be treated with a topical retinoid, azelaic acid or salicylic acid. Fixed combination topicals are recommended for patients with predominant papulopustular acne with treatment tailored according to the severity of disease. Treatment recommendations for nodular/conglobate acne include oral isotretinoin or fixed combinations plus oral antibiotics in men, and these options may be supplemented with oral anti-androgenic hormonal therapy in women. Further decisions regarding treatment responses should be evaluated 8 weeks after treatment initiation in patients with predominant comedonal or papulopustular acne and 12 weeks after in those with nodular/conglobate acne. Maintenance therapy with a topical retinoid or azelaic acid should be commenced once a patient is clear or almost clear of their acne to prevent the disease from recurring. The principal explanations for lack of treatment response fall into 5 main categories: disease progression, non-drug-related reasons, drug-related reasons, poor adherence, and adverse events.
Conclusion:
This practical guide provides dermatologists with treatment algorithms adapted to different clinical features of acne which are simple and easy to use in daily clinical practice. The checklists to establish the causes for a lack of treatment response and subsequent action to take will facilitate successful acne management.
The Portuguese Acne Advisory Board (PAAB), a group of Portuguese dermatologists with a special interest in acne, develop, as other international groups in this field, consensus recommendations for the treatment of acne. Overall, the goal is to provide a practice guideline to all physicians dealing with this entity. The continuing medical education dossier was divided in two parts: Part I - etiopathogeny and clinical features; Part II - therapy. This Part I reviews acne pathophysiology, clinical aspects, psychological and social impact and several myths surrounding this disease. Some other entities relevant for the differential diagnosis are described. The need of hormonal evaluation is also discussed.
Acne is the most common skin disease in adolescence, with a prevalence of nearly 100%. About 60% of affected adolescents have mild acne for which they use non-prescription preparations without consulting a physician. The remaining 40% constitute the population of acne patients seen in medical practice. The course of acne can be either acute or chronic; its manifestations can appear in waves, sometimes with dramatically severe inflammation leading rapidly to scarring. Acne often has adverse emotional consequences. Its treatment is markedly better than in the past because of new pharmacological and physicochemical approaches and because evidence-based guidelines are now available.
This article is based on a selective review of the literature and also incorporates the authors' own clinical and scientific experience.
Acne vulgaris of grade I or II in an adolescent is generally not hard to treat. In contrast, the more severe grades III and IV and conglobate acne often present a therapeutic challenge, as they are associated with varying constellations of acute lesions, scarring, inflammation, and emotional disturbances. These conditions often require systemic treatment with tetracyclines, which are especially useful because of their para-antibiotic antiinflammatory effect. Severe cases must be treated with isotretinoin. Women can benefit from anti-androgenic contraceptive drugs. Retinoids or azelaic acid are used in maintenance therapy to suppress the formation of microcomedones, the precursor stage of acne lesions.
A variety of effective treatments for acne are available, depending on the severity of the condition.
Monochromatic (laser) and quasimonochromatic (LED) radiation in the red-to-near infrared optical region both in CW and pulsed modes is used to treat in a nondestructive fashion various soft-tissue and neurologic conditions. Cytochrome c oxidase, the terminal enzyme of mitochondrial respiratory chain, is considered as the photoacceptor. The mechanisms of photobiomodulation on cellular level are based on the electronic excitation of CuA and CuB chromophores in cytochrome c oxidase molecule. As the result, the redox status of cytochrome c oxidase molecule as well as its functional activity is modulated. The primary reactions in mitochondria switch on a set of secondary biochemical reactions (light-sensitive retrograde mitochondrial signaling) with endpoint as gene expression in the nucleus. Also, two specific topics are discussed and reviewed: patch-clamp studies in connection with optical stimulation of nerves and differences in CW and pulsed light action mechanisms when biological objects are irradiated.
I am pleased to have the opportunity to serve as guest editor for this special issue of Lasers in Surgery and Medicine that concentrates on low level laser therapy (LLLT) also known as photobiomodulation. I would like to thank Drs. Stuart Nelson and Henry Chan for the invitation to be guest editor and to pay a special tribute to the talented and tireless Ms. Beth Mallen, without whom this would have been an impossible task. LLLT has been known since a few years after the discovery of lasers (incidentally celebrating their 50th anniversary this year). However, it is only in relatively recent times that LLLT has become scientifically and clinically accepted by even a fraction of the medical community. We hope this issue will make a contribution towards increasing the awareness among both physicians and the general scientific public that hard evidence is now available that “sheds light” on the basic mechanisms, pre-clinical applications and clinical benefits of LLLT. It contains a review, basic science and clinical research submissions providing new information concerning cell biology studies after LLLT and highlighting many possible clinical applications of LLLT.
The Global Alliance to Improve Outcomes in Acne published recommendations for the management of acne as a supplement to the Journal of the American Academy of Dermatology in 2003. The recommendations incorporated evidence-based strategies when possible and the collective clinical experience of the group when evidence was lacking. This update reviews new information about acne pathophysiology and treatment-such as lasers and light therapy-and relevant topics where published data were sparse in 2003 but are now available including combination therapy, revision of acne scarring, and maintenance therapy. The update also includes a new way of looking at acne as a chronic disease, a discussion of the changing role of antibiotics in acne management as a result of concerns about microbial resistance, and factors that affect adherence to acne treatments. Summary statements and recommendations are provided throughout the update along with an indication of the level of evidence that currently supports each finding. As in the original supplement, the authors have based recommendations on published evidence as much as possible.
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.
Acne in the first three decades of life: An update of a disorder with profound implications for all decades of life
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