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Lee SD, Kim SW, Cho YH, Han YM, Jeong KH. Microchanneling and ultrasonic delivery of gold and platinum nanoparticles for selective photothermolysis of sebaceous follicles in the treatment of acne: a pilot study using porcine skin. Lasers Med Sci 2024; 39:168. [PMID: 38954141 DOI: 10.1007/s10103-024-04124-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 06/24/2024] [Indexed: 07/04/2024]
Abstract
PURPOSE Several treatment options for acne vulgaris are limited by their associated adverse effects. An innovative approach involves introducing light-absorbing nanoparticles into sebaceous follicles before destroying the follicles using selective photothermolysis. We aimed to investigate efficient methods for introducing gold and platinum nanoparticles into sebaceous follicles and to identify suitable laser equipment and parameters for the effective destruction of these follicles. METHODS We used porcine skin as the experimental model. We compared the efficacies of a thulium laser, ultrasound, and manual massage and evaluated the optimal method for delivering nanoparticles in close proximity to sebaceous follicles. Subsequently, a 1064-nm-wavelength neodymium-doped yttrium aluminum garnet (Nd: YAG) laser was employed to induce selective photothermolysis. We compared different parameters to identify the optimal pulse duration and fluence of the Nd: YAG laser. The extent of penetration and destruction of sebaceous follicles was assessed using hematoxylin and eosin (H&E) staining, and a numerical evaluation was conducted. RESULTS H&E staining showed that irradiation with a long-pulsed Nd: YAG laser following a combination of thulium laser and sonophoresis effectively destroyed sebaceous follicles, with destruction rates exceeding 50%. These results were valid with a long pulse duration and a high fluence of the Nd: YAG laser. CONCLUSION This study demonstrated that sebaceous follicles can be effectively destroyed through a mixture of gold and platinum nanoparticle delivery by a combination of microchanneling and sonophoresis, followed by selective thermal damage induced by a 1064-nm long-pulsed high-fluence Nd: YAG laser.
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Affiliation(s)
- Sang-Doo Lee
- Department of Dermatology, Kyung Hee University College of Medicine, Kyung Hee University Hospital, #23, Kyung Hee Dae-ro, Dongdaemun-gu, Seoul, 02447, Korea
| | - So-Woon Kim
- Department of Pathology, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul, Korea
| | - Yang-Hoon Cho
- Mimont Skin and Laser Clinic, Guri, Gyonggi-do, Korea
| | - Young-Min Han
- Department of Dermatology, Kyung Hee University College of Medicine, Kyung Hee University Hospital, #23, Kyung Hee Dae-ro, Dongdaemun-gu, Seoul, 02447, Korea
| | - Ki-Heng Jeong
- Department of Dermatology, Kyung Hee University College of Medicine, Kyung Hee University Hospital, #23, Kyung Hee Dae-ro, Dongdaemun-gu, Seoul, 02447, Korea.
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Hammoda TM, Ahmed NA, Hamdino M. Fractional CO 2 laser versus 1064-nm long-pulsed Nd:YAG laser for inflammatory acne vulgaris treatment: a randomized clinical trial. Lasers Med Sci 2023; 38:187. [PMID: 37592125 PMCID: PMC10435603 DOI: 10.1007/s10103-023-03855-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 08/08/2023] [Indexed: 08/19/2023]
Abstract
Acne vulgaris is challenging to treat for several individuals. Laser therapy may be a desirable alternative to traditional therapies with limited success. This study aimed to assess efficacy of fractional CO2 laser versus Nd:YAG laser for acne vulgaris therapy. Thirty cases with acne vulgaris underwent both fractional CO2 laser and Nd: YAG laser treatments in a randomized split face design at a 14-day interval for four sessions. The clinical efficacy was evaluated by counting acne lesions and utilizing the Global Acne Severity Scale (GEA Scale). GEAs decreased significantly after both fractional CO2 and Nd:YAG modalities after treatment and at a 3-month follow-up; fractional CO2 demonstrated significant more decrease in GEAs with (P = 0.006, 0.00 (respectively. Moreover, fractional CO2 showed a significantly higher satisfaction level (P = 0.004) and a better clinical improvement percentage regarding inflammatory and noninflammatory acne lesions (P = 0.007 and 0.000, respectively) after 3 months of follow-up. Apart from transient erythema, there were insignificant adverse effects concerning both treated sides. Fractional CO2 and Nd:YAG lasers are efficient physical modalities of acne treatment. However, fractional CO2 laser was more effective and more satisfying to the patients.
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Affiliation(s)
- Tasneem Muhammad Hammoda
- Dermatology and Venereology Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Naglaa Abdallah Ahmed
- Dermatology and Venereology Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Mervat Hamdino
- Dermatology and Venereology Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt.
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3
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Cho YH, Oh SM, Choi JY, Jeong KH. Acne treatment based on selective photothermolysis with topically delivered light-absorbing platinum nanoparticles. Lasers Med Sci 2023; 38:125. [PMID: 37209256 DOI: 10.1007/s10103-023-03787-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 05/12/2023] [Indexed: 05/22/2023]
Affiliation(s)
| | - Seung-Min Oh
- Department of Dermatology, Kyung Hee University College of Medicine, Kyung Hee University Medical Center, 23 Kyung Hee Dae-ro, Dongdaemun-gu, Seoul, 02447, Korea
| | | | - Ki-Heon Jeong
- Department of Dermatology, Kyung Hee University College of Medicine, Kyung Hee University Medical Center, 23 Kyung Hee Dae-ro, Dongdaemun-gu, Seoul, 02447, Korea.
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Long XX, Xie AD, Yang P, Xie J, Chen XL, Huang YD, Zhang LP, Peng XB. Effect of various types of photodynamic therapy on inflammatory and non-inflammatory lesions in patients with acne: A network meta-analysis of randomized controlled trials. Photodiagnosis Photodyn Ther 2023; 42:103365. [PMID: 36842473 DOI: 10.1016/j.pdpdt.2023.103365] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 02/17/2023] [Accepted: 02/21/2023] [Indexed: 02/28/2023]
Abstract
BACKGROUND Recent studies have demonstrated that photodynamic therapy (PDT) is safe and effective in treating acne vulgaris. The present study aimed to evaluate various PDTs on inflammatory and non-inflammatory lesions in patients with acne by a network meta-analysis (NMA) of randomized controlled trials (RCTs). METHODS The researchers of this paper searched PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL) databases from inception to March 2022 to identify suitable RCTs. The included studies were evaluated for methodological quality using the Cochrane bias risk assessment tool. Twenty-one RCTs were included, with a total sample size of 898 participants. RESULTS Network meta-analysis (NMA) revealed that indocyanine green (ICG) + near-infrared (NIR) diode laser, ICG+830 nm light-emitting diode (LED), indole-3-acetic acid (IAA) + 520 nm LED, and 5-aminolevulinic acid (ALA) + sunlight demonstrated obvious curative effects in patients with acne vulgaris. Importantly, ICG+NIR diode laser provided the greatest improvement in both inflammatory and non-inflammatory acne lesions (surface under the cumulative ranking curve [SUCRA]: 84.4% and 93.5%, respectively). CONCLUSIONS Based on the NWM and SUCRA ranking, ICG + NIR diode laser can be considered more effective in treating acne than the other PDTs of the RCTs. However, this conclusion should be interpreted with caution due to the limitations of the present study.
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Affiliation(s)
- Xin-Xin Long
- Department of Dermatology, Zengcheng Branch, Nanfang Hospital, Southern Medical University, No.28, Innovation Avenue, Yongning Street, Zengcheng District, Guangzhou, Guangdong 511356, China
| | - Ai-Di Xie
- Department of Dermatology, Zengcheng Branch, Nanfang Hospital, Southern Medical University, No.28, Innovation Avenue, Yongning Street, Zengcheng District, Guangzhou, Guangdong 511356, China
| | - Peng Yang
- Department of Dermatology, Zengcheng Branch, Nanfang Hospital, Southern Medical University, No.28, Innovation Avenue, Yongning Street, Zengcheng District, Guangzhou, Guangdong 511356, China
| | - Jie Xie
- Department of Dermatology, Zengcheng Branch, Nanfang Hospital, Southern Medical University, No.28, Innovation Avenue, Yongning Street, Zengcheng District, Guangzhou, Guangdong 511356, China
| | - Xiao-Li Chen
- Department of Dermatology, Zengcheng Branch, Nanfang Hospital, Southern Medical University, No.28, Innovation Avenue, Yongning Street, Zengcheng District, Guangzhou, Guangdong 511356, China
| | - Yun-Di Huang
- Department of Dermatology, Zengcheng Branch, Nanfang Hospital, Southern Medical University, No.28, Innovation Avenue, Yongning Street, Zengcheng District, Guangzhou, Guangdong 511356, China
| | - Li-Ping Zhang
- Department of Dermatology, Zengcheng Branch, Nanfang Hospital, Southern Medical University, No.28, Innovation Avenue, Yongning Street, Zengcheng District, Guangzhou, Guangdong 511356, China
| | - Xue-Biao Peng
- Department of Dermatology, Nanfang Hospital, Southern Medical University, No.1838, North Guangzhou Avenue, Baiyun District, Guangzhou, Guangdong 510515, China; Department of Dermatology, Zengcheng Branch, Nanfang Hospital, Southern Medical University, No.28, Innovation Avenue, Yongning Street, Zengcheng District, Guangzhou, Guangdong 511356, China.
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5
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Wu X, Yang Y, Wang Y, Wang H, Zheng Y, Chen J, Xu H. Treatment of refractory acne using selective sebaceous gland electro-thermolysis combined with non-thermal plasma. J COSMET LASER THER 2022; 23:188-194. [PMID: 35388729 DOI: 10.1080/14764172.2022.2050760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Acne is one of the most common skin diseases whose disfiguring results may cause psychological problems. Despite of the various choices in the treatment of acne, new therapy with fewer complications and lower relapse rate is still in need. In this study, we aim to evaluate the clinical efficacy of a new therapy using selective sebaceous gland electro-thermolysis and non-thermal plasma (NTP) in refractory acne patients. Treatments were given at a monthly interval for three times. The last visit was set at 3 months after the third treatment. Thirty-six moderate to very severe acne patients were enrolled. All the patients got more than 50% clearance after the third treatment. The excellent response rate was 44% at 1 month after the third treatment and 50% at 3 months after the third treatment. Porphyrin and erythema values were significantly reduced after the third treatment. No irreversible complication was reported. Selective sebaceous gland electro-thermolysis combined with NTP can be a safe and effective new option in the treatment of acne.
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Affiliation(s)
- Xiaojin Wu
- Department of Dermatology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yali Yang
- Department of Dermatology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Department of Laser and Aesthetic Medicine, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yutong Wang
- Department of Dermatology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Haoyu Wang
- Department of Dermatology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ying Zheng
- Department of Dermatology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jun Chen
- Department of Dermatology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Department of Laser and Aesthetic Medicine, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hui Xu
- Department of Dermatology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Department of Laser and Aesthetic Medicine, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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6
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Histology changes of in vivo human skin after treatment with fractional 1064 nm Nd:YAG picosecond laser in different energy settings. Lasers Med Sci 2021; 37:2087-2092. [PMID: 34657214 DOI: 10.1007/s10103-021-03396-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/03/2021] [Indexed: 10/20/2022]
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7
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Eid MM, Saleh MS, Allam NM, Elsherbini DM, Abdelbasset WK, Eladl HM. Narrow Band Ultraviolet B Versus Red Light-Emitting Diodes in the Treatment of Facial Acne Vulgaris: A Randomized Controlled Trial. PHOTOBIOMODULATION PHOTOMEDICINE AND LASER SURGERY 2021; 39:418-424. [PMID: 34015228 DOI: 10.1089/photob.2020.4988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: One of the most common dermatological conditions affecting most teenagers is acne. Phototherapy was described as a therapeutic modality with low-side effects of acne vulgaris (AV). Hence, we examined the effects of narrow band ultraviolet B (NBUVB) versus red light-emitting diodes (LEDs) on facial AV. Methods: Forty-five subjects suffering from facial AV mild to a moderate degree were randomly assigned into three groups, 15 subjects within every group. Group A was equipped to NBUVB with 311-313 nm and an initial dose of 250 mJ/cm2, thrice a week for 8 weeks, Group B was equipped red LED with wavelengths 633 ± 6 nm and power density of 80 mW/cm2, thrice a week for 8 weeks, whereas group C had received the only erythromycin as a control group. Outcome measures included measurement of acne lesion count and degree of severity. Measures at three-time intervals were assessed: baseline, 4 weeks (post I), and 8 weeks (post II). Results: Acne numeral findings revealed a significant variance among groups A, B, and C in favor of group A (p < 0.001). Notable improvements were observed across all three groups (p < 0.001). The degree of adjustment effects indicated a greater increase in group A in comparison with group B (p < 0.01), whereas no statistical variance was detected between group B and group C (p > 0.05). Conclusions: Both NBUVB and red LED were effective in acne treatment; NBUVB, however, revealed a highly efficient treatment than red LED in decreasing the acne lesions count and the improved degree of AV severity as measured by the global investigator's assessment scale. Clinical Trial Registration No. NCT04254601.
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Affiliation(s)
- Marwa M Eid
- Department of Physical Therapy for Surgery and Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Marwa S Saleh
- Department of Basic Science for Physical Therapy, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Nesma M Allam
- Department of Physical Therapy for Surgery and Faculty of Physical Therapy, Cairo University, Giza, Egypt.,Department of Physical Therapy and Health Rehabilitation and College of Applied Medical Sciences, Jouf University, Sakaka, Saudi Arabia
| | - Dalia M Elsherbini
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Jouf University, Sakaka, Saudi Arabia.,Department of Anatomy, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Walid Kamal Abdelbasset
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia.,Department of Physical Therapy, Kasr Al-Aini Hospital, Cairo University, Giza, Egypt
| | - Hadaya Mosaad Eladl
- Department of Physical Therapy for Surgery and Faculty of Physical Therapy, Cairo University, Giza, Egypt.,Department of Physical Therapy and Health Rehabilitation and College of Applied Medical Sciences, Jouf University, Sakaka, Saudi Arabia
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8
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Park KY, Han HS, Hong JY, Seo SJ, Lee SJ. Gold nanoshell-mediated photothermal therapy for acne vulgaris. Dermatol Ther 2019; 33:e13189. [PMID: 31837243 DOI: 10.1111/dth.13189] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 12/11/2019] [Indexed: 12/30/2022]
Abstract
Acne vulgaris, a common and chronic disorder of the pilosebaceous unit, affects up to 85% of adolescent and young adults. Although the current treatment options are effective, they are associated with unwanted side effects, chronicity, relapses, and recurrences. Recently, the Food and Drug Administration approved topical application of gold microparticles for selective photothermolysis to treat acne vulgaris. Here, we report two cases showing the efficacy of gold nanoshell-mediated photothermal therapy for recurrent acne that were refractory to previous treatments. In both cases, three sessions of photothermal therapy prevented the development of new lesions during a follow-up period of 3-4 months without causing any adverse effects. The two cases reported here demonstrate the possibility of gold nanoshell-mediated photothermal therapy as a safe and effective treatment for recurrent acne vulgaris in Asian patients.
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Affiliation(s)
- Kui Young Park
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Hye Sung Han
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Ji Yeon Hong
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Seong Jun Seo
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Sang Ju Lee
- Department of Dermatology, Yonsei Star Skin & Laser Clinic, Seoul, South Korea
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9
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Fuchs CSK, Bay C, Adatto M, Lomholt H, Haedersdal M. Acne Treatment With Light Absorbing Gold Microparticles and Optical Pulses: An Open-Label European Multi-Centered Study in Moderate to Moderately Severe Acne Vulgaris Patients. Lasers Surg Med 2019; 51:686-693. [PMID: 31090089 DOI: 10.1002/lsm.23099] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 04/11/2019] [Accepted: 04/18/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND OBJECTIVE Recently, a novel acne treatment based on selective photothermolysis of pilosebaceous units with follicular delivery of inert gold microparticles as an exogenous chromophore and diode laser pulses has been developed. To evaluate the efficacy and safety of a single monotherapy treatment regimen with gold microparticles and diode laser exposure in patients with moderate and moderately severe acne. Further, to evaluate the added benefit of a second treatment regimen combined with pharmaceutical acne treatment in patients with inadequate initial response. MATERIALS AND METHODS Patients with moderate and moderately severe facial acne were recruited in this open-label, pilot study. A single treatment regimen consisted of three weekly facial treatments with topically applied gold microparticles and diode laser pulses. Outcome measures were the proportion of patients with ≥40% improvement in number of acne lesions (weighted lesion count [WLC]) at 12 weeks (single treatment regimen, primary outcome measure), 24, and 36 weeks from baseline (two treatment regimens), safety, and patient satisfaction. RESULTS A total of 28 patients were enrolled in the study (18 males, 10 females, 19 patients with moderate acne severity, 9 with moderately severe, mean age: 19.8 years). Twenty-five patients underwent analysis for outcome measures. After a single monotherapy treatment regimen, 76% patients (19/25) achieved ≥40% reduction in WLC (mean WLC reduction: 63%; SD: 13%). Of the patients undergoing two treatment regimens (n = 9 patients), 56% experienced a reduction in acne lesion burden (WLC) ≥40% at 24 weeks and 89% 36 weeks post-baseline. Mean pain score was 4.0 (SD: 1.3), and transient erythema and perifollicular edema were commonly noted after treatment. Most patients (81%) were either "satisfied" or "very satisfied" with the treatment. CONCLUSION Acne therapy based on selective photothermolysis with gold microparticles shows promise and may be used in treatment of moderate to moderately severe acne. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
| | - Christiane Bay
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, DK-2400, Denmark
| | - Maurice Adatto
- Skinpulse Dermatology & Laser Centre, Geneva, 1205, Switzerland
| | - Hans Lomholt
- Skincenter North and University of Aalborg, Aalborg, DK-9220, Denmark
| | - Merete Haedersdal
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, DK-2400, Denmark
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10
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Pestoni Porvén C, Vieira dos Santos V, del Pozo Losada J. Fractional carbon dioxide (CO2) laser combined with topical tretinoin for the treatment of different forms of cystic acne. J COSMET LASER THER 2017; 19:465-468. [DOI: 10.1080/14764172.2017.1349323] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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11
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Barbaric J, Abbott R, Posadzki P, Car M, Gunn LH, Layton AM, Majeed A, Car J. Light therapies for acne. Cochrane Database Syst Rev 2016; 9:CD007917. [PMID: 27670126 PMCID: PMC6457763 DOI: 10.1002/14651858.cd007917.pub2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Acne vulgaris is a very common skin problem that presents with blackheads, whiteheads, and inflamed spots. It frequently results in physical scarring and may cause psychological distress. The use of oral and topical treatments can be limited in some people due to ineffectiveness, inconvenience, poor tolerability or side-effects. Some studies have suggested promising results for light therapies. OBJECTIVES To explore the effects of light treatment of different wavelengths for acne. SEARCH METHODS We searched the following databases up to September 2015: the Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase and LILACS. We searched ISI Web of Science and Dissertation Abstracts International (from inception). We also searched five trials registers, and grey literature sources. We checked the reference lists of studies and reviews and consulted study authors and other experts in the field to identify further references to relevant randomised controlled trials (RCTs). We updated these searches in July 2016 but these results have not yet been incorporated into the review. SELECTION CRITERIA We included RCTs of light for treatment of acne vulgaris, regardless of language or publication status. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS We included 71 studies, randomising a total of 4211 participants.Most studies were small (median 31 participants) and included participants with mild to moderate acne of both sexes and with a mean age of 20 to 30 years. Light interventions differed greatly in wavelength, dose, active substances used in photodynamic therapy (PDT), and comparator interventions (most commonly no treatment, placebo, another light intervention, or various topical treatments). Numbers of light sessions varied from one to 112 (most commonly two to four). Frequency of application varied from twice daily to once monthly.Selection and performance bias were unclear in the majority of studies. Detection bias was unclear for participant-assessed outcomes and low for investigator-assessed outcomes in the majority of studies. Attrition and reporting bias were low in over half of the studies and unclear or high in the rest. Two thirds of studies were industry-sponsored; study authors either reported conflict of interest, or such information was not declared, so we judged the risk of bias as unclear.Comparisons of most interventions for our first primary outcome 'Participant's global assessment of improvement' were not possible due to the variation in the interventions and the way the studies' outcomes were measured. We did not combine the effect estimates but rated the quality of the evidence as very low for the comparison of light therapies, including PDT to placebo, no treatment, topical treatment or other comparators for this outcome. One study which included 266 participants with moderate to severe acne showed little or no difference in effectiveness for this outcome between 20% aminolevulinic acid (ALA)-PDT (activated by blue light) versus vehicle plus blue light (risk ratio (RR) 0.87, 95% confidence interval (CI) 0.72 to 1.04, low-quality evidence). A study (n = 180) of a comparison of ALA-PDT (activated by red light) concentrations showed 20% ALA was no more effective than 15% (RR 1.05, 95% CI 0.96 to 1.15) but better than 10% ALA (RR 1.22, 95% CI 1.05 to 1.42) and 5% ALA (RR 1.47, 95% CI 1.19 to 1.81). The number needed to treat for an additional beneficial outcome (NNTB) was 6 (95% CI 3 to 19) and 4 (95% CI 2 to 6) for the comparison of 20% ALA with 10% and 5% ALA, respectively.For our second primary outcome 'Investigator-assessed changes in lesion counts', we combined three RCTs, with 360 participants with moderate to severe acne and found methyl aminolevulinate (MAL) PDT (activated by red light) was no different to placebo cream plus red light with regard to change in inflamed lesions (ILs) (mean difference (MD) -2.85, 95% CI -7.51 to 1.81), percentage change in ILs (MD -10.09, 95% CI -20.25 to 0.06), change in non-inflamed lesions (NILs) (MD -2.01, 95% CI -7.07 to 3.05), or in percentage change in NILs (MD -8.09, 95% CI -21.51 to 5.32). We assessed the evidence as moderate quality for these outcomes meaning that there is little or no clinical difference between these two interventions for lesion counts.Studies comparing the effects of other interventions were inconsistent or had small samples and high risk of bias. We performed only narrative synthesis for the results of the remaining trials, due to great variation in many aspects of the studies, poor reporting, and failure to obtain necessary data. Several studies compared yellow light to placebo or no treatment, infrared light to no treatment, gold microparticle suspension to vehicle, and clindamycin/benzoyl peroxide combined with pulsed dye laser to clindamycin/benzoyl peroxide alone. There were also several other studies comparing MAL-PDT to light-only treatment, to adapalene and in combination with long-pulsed dye laser to long-pulsed dye laser alone. None of these showed any clinically significant effects.Our third primary outcome was 'Investigator-assessed severe adverse effects'. Most studies reported adverse effects, but not adequately with scarring reported as absent, and blistering reported only in studies on intense pulsed light, infrared light and photodynamic therapies. We rated the quality of the evidence as very low, meaning we were uncertain of the adverse effects of the light therapies.Although our primary endpoint was long-term outcomes, less than half of the studies performed assessments later than eight weeks after final treatment. Only a few studies assessed outcomes at more than three months after final treatment, and longer-term assessments are mostly not covered in this review. AUTHORS' CONCLUSIONS High-quality evidence on the use of light therapies for people with acne is lacking. There is low certainty of the usefulness of MAL-PDT (red light) or ALA-PDT (blue light) as standard therapies for people with moderate to severe acne.Carefully planned studies, using standardised outcome measures, comparing the effectiveness of common acne treatments with light therapies would be welcomed, together with adherence to the Consolidated Standards of Reporting Trials (CONSORT) guidelines.
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Affiliation(s)
- Jelena Barbaric
- School of Medicine, University of ZagrebAndrija Stampar School of Public HealthRockefellerova 4ZagrebCroatia10000
| | - Rachel Abbott
- University Hospital of WalesWelsh Institute of DermatologyHeath ParkCardiffUKCF14 4XW
| | - Pawel Posadzki
- Lee Kong Chian School of Medicine, Nanyang Technological UniversityCentre for Population Health Sciences3 Fusionopolis Link, #06‐13Nexus@one‐northSingaporeSingapore138543
| | - Mate Car
- Imperial College LondonDepartment of Primary Care and Public HealthSt Dunstan's RoadLondonUKW6 8RP
| | - Laura H Gunn
- Stetson UniversityPublic Health Program421 N Woodland BlvdDeLandFloridaUSA32723
| | - Alison M Layton
- Harrogate and District NHS Foundation TrustDepartment of DermatologyHarrogateUK
| | - Azeem Majeed
- Imperial College LondonDepartment of Primary Care and Public HealthSt Dunstan's RoadLondonUKW6 8RP
| | - Josip Car
- Lee Kong Chian School of Medicine, Nanyang Technological UniversityCentre for Population Health Sciences3 Fusionopolis Link, #06‐13Nexus@one‐northSingaporeSingapore138543
- University of LjubljanaDepartment of Family Medicine, Faculty of MedicineLjubljanaSlovenia
- Imperial College LondonGlobal eHealth Unit, Department of Primary Care and Public Health, School of Public HealthReynolds BuildingSt Dunstans RoadLondonUKW6 8RP
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A Comparative Split-Face Study Using Different Mild Purpuric and Subpurpuric Fluence Level of 595-nm Pulsed-Dye Laser for Treatment of Moderate to Severe Acne Vulgaris. Dermatol Surg 2016; 42:403-9. [PMID: 26890802 DOI: 10.1097/dss.0000000000000658] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Various forms of laser therapy including the pulsed-dye laser (PDL) have been reported to reduce acne lesion counts. OBJECTIVE In this study, the benefits and complications when using a 595-nm PDL for the treatment of acne vulgaris were evaluated when comparing a subpurpuric (low) fluence level with a purpuric (high) fluence level. MATERIALS AND METHODS This study was a prospective, single-blinded split-face clinical trial. Inclusion criteria included subjects with moderate to severe facial acne. All participants were treated with PDL, with each half of the face receiving either high or low fluence at 3-week intervals for a total of 4 treatments. Standardized facial photographs were obtained and blindly evaluated. RESULTS Sixty-two subjects were enrolled with a mean age of 22.3 years. Fifty-five patients completed the study. The results showed a significant decrease in lesion counts compared with baseline after all treatments. However, the study did not demonstrate a statistically significant difference between the fluence parameters. The only treatment-related adverse event was temporary hyperpigmentation. CONCLUSION This study demonstrates that PDL is effective in reducing acne lesions using purpuric and subpurpuric fluences. However, there was no statistically significant difference in acne lesion count between the higher and lower fluences.
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Seo HM, Min HG, Kim HJ, Shin JH, Nam SH, Han KS, Ryu JH, Oh JJ, Kim JY, Lee KJ, Lee SJ, Kim HS, Kim JI, Song MK, Kim WS. Effects of repetitive photodynamic therapy using indocyanine green for acne vulgaris. Int J Dermatol 2016; 55:1157-63. [DOI: 10.1111/ijd.13258] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 09/30/2015] [Accepted: 11/17/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Hyun-Min Seo
- Department of Dermatology; Kangbuk Samsung Hospital; Sungkyunkwan University School of Medicine; Seoul Korea
| | | | | | | | | | | | | | | | | | | | | | - Han-Saem Kim
- Department of Dermatology; Kangbuk Samsung Hospital; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Jung-In Kim
- Department of Dermatology; Kangbuk Samsung Hospital; Sungkyunkwan University School of Medicine; Seoul Korea
| | | | - Won-Serk Kim
- Department of Dermatology; Kangbuk Samsung Hospital; Sungkyunkwan University School of Medicine; Seoul Korea
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Choi JW, Kim TI, Jeong KH, Shin MK. A case of successfully treated recalcitrant EGFR inhibitor-induced acneiform eruption following non-ablative fractional laser. Dermatol Ther 2016; 29:252-4. [PMID: 27146102 DOI: 10.1111/dth.12361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Epidermal growth factor receptor (EGFR) inhibitor, a targeted therapy in the field of oncology, is a new drugs suggested for the cause of acneiform eruptions. The unresponsiveness to conventional acne therapy is a pivotal reason of seeking alternatives to treat drug-induced acneiform eruptions. A 30-year-old female treated with cetuximab, EGFR inhibitor presented with numerous sized erythematous papules and pustules on her face. All responses of oral medications and topical application were poor. She was treated with two passes of non-ablative 1550 nm fractional erbium glass laser with topical clindamycin. After three laser sessions, the skin lesions improved dramatically without any side effects. There is currently no single effective treatment for acneiform eruption. This report shed light on the possibility that non-ablative fractional laser can be an alternative for recalcitrant drug-induced acneiform eruptions.
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Affiliation(s)
- Joong Woon Choi
- Department of Dermatology, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Tae In Kim
- Department of Dermatology, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Ki-Heon Jeong
- Department of Dermatology, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Min Kyung Shin
- Department of Dermatology, School of Medicine, Kyung Hee University, Seoul, Korea
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1,213 Cases of Treatment of Facial Acne Using Indocyanine Green and Intense Pulsed Light in Asian Skin. BIOMED RESEARCH INTERNATIONAL 2015; 2015:596161. [PMID: 26558274 PMCID: PMC4628978 DOI: 10.1155/2015/596161] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 08/03/2015] [Accepted: 08/05/2015] [Indexed: 11/26/2022]
Abstract
Background. Photodynamic therapy (PDT) has been used for acne, with various combinations of photosensitizers and light sources. Objective. We evaluated the effectiveness and safety of indocyanine green (ICG) and intense pulsed light (IPL) in the treatment of acne. Materials and Methods. A total of 1,213 patients with facial acne were retrospectively reviewed. Patients received three or five treatments of ICG and IPL at two-week intervals. Clinical response to treatment was assessed by comparing pre- and posttreatment clinical photographs and patient satisfaction scores. Results. Marked to excellent improvement was noted in 483 of 1,213 (39.8%) patients, while minimal to moderate improvement was achieved in the remaining 730 (60.2%) patients. Patient satisfaction scores revealed that 197 (16.3%) of 1,213 patients were highly satisfied, 887 (73.1%) were somewhat satisfied, and 129 (10.6%) were unsatisfied. There were no significant side effects. Conclusion. These results suggest that PDT with ICG and IPL can be effectively and safely used in the treatment of acne.
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Paithankar DY, Sakamoto FH, Farinelli WA, Kositratna G, Blomgren RD, Meyer TJ, Faupel LJ, Kauvar ANB, Lloyd JR, Cheung WL, Owczarek WD, Suwalska AM, Kochanska KB, Nawrocka AK, Paluchowska EB, Podolec KM, Pirowska MM, Wojas-Pelc AB, Anderson RR. Acne Treatment Based on Selective Photothermolysis of Sebaceous Follicles with Topically Delivered Light-Absorbing Gold Microparticles. J Invest Dermatol 2015; 135:1727-1734. [PMID: 25748556 PMCID: PMC4580730 DOI: 10.1038/jid.2015.89] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 12/15/2014] [Accepted: 01/11/2015] [Indexed: 11/09/2022]
Abstract
The pathophysiology of acne vulgaris depends on active sebaceous glands, implying that selective destruction of sebaceous glands could be an effective treatment. We hypothesized that light-absorbing microparticles could be delivered into sebaceous glands, enabling local injury by optical pulses. A suspension of topically applied gold-coated silica microparticles exhibiting plasmon resonance with strong absorption at 800 nm was delivered into human pre-auricular and swine sebaceous glands in vivo, using mechanical vibration. After exposure to 10-50 J cm(-2), 30 milliseconds, 800 nm diode laser pulses, microscopy revealed preferential thermal injury to sebaceous follicles and glands, consistent with predictions from a computational model. Inflammation was mild; gold particles were not retained in swine skin 1 month after treatment, and uptake in other organs was negligible. Two independent prospective randomized controlled clinical trials were performed for treatment of moderate-to-severe facial acne, using unblinded and blinded assessments of disease severity. Each trial showed clinically and statistically significant improvement of inflammatory acne following three treatments given 1-2 weeks apart. In Trial 2, inflammatory lesions were significantly reduced at 12 weeks (P=0.015) and 16 weeks (P=0.04) compared with sham treatments. Optical microparticles enable selective photothermolysis of sebaceous glands. This appears to be a well-tolerated, effective treatment for acne vulgaris.
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Affiliation(s)
| | - Fernanda H Sakamoto
- Department of Dermatology, Wellman Center for Photomedicine, Massachusetts General Hospital; Harvard Medical School, Boston Massachusetts, USA
| | - William A Farinelli
- Department of Dermatology, Wellman Center for Photomedicine, Massachusetts General Hospital; Harvard Medical School, Boston Massachusetts, USA
| | - Garuna Kositratna
- Department of Dermatology, Wellman Center for Photomedicine, Massachusetts General Hospital; Harvard Medical School, Boston Massachusetts, USA
| | | | | | | | | | | | - Wang L Cheung
- Department of Pathology, University of Arkansas, Little Rock, Arkansas, USA
| | - Witold D Owczarek
- Department of Dermatology, Military Institute of Medicine, Warsaw, Poland
| | - Anna M Suwalska
- Department of Dermatology, Military Institute of Medicine, Warsaw, Poland
| | | | | | | | | | | | | | - R Rox Anderson
- Department of Dermatology, Wellman Center for Photomedicine, Massachusetts General Hospital; Harvard Medical School, Boston Massachusetts, USA
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Fekrazad R, Ghasemi Barghi V, Poorsattar Bejeh Mir A, Shams-Ghahfarokhi M. In vitro photodynamic inactivation of Candida albicans by phenothiazine dye (new methylene blue) and Indocyanine green (EmunDo®). Photodiagnosis Photodyn Ther 2015; 12:52-7. [DOI: 10.1016/j.pdpdt.2014.12.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 12/20/2014] [Accepted: 12/22/2014] [Indexed: 11/29/2022]
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Savage LJ, Layton AM. Treating acne vulgaris: systemic, local and combination therapy. Expert Rev Clin Pharmacol 2014; 3:563-80. [DOI: 10.1586/ecp.10.27] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Photoelimination of Streptococcus mutans with two methods of photodynamic and photothermal therapy. Photodiagnosis Photodyn Ther 2013; 10:626-31. [PMID: 24284120 DOI: 10.1016/j.pdpdt.2013.07.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 07/03/2013] [Accepted: 07/07/2013] [Indexed: 01/03/2023]
Abstract
BACKGROUND Increasing resistance of oral pathogens to conventional antibacterial agents has resulted to find alternative therapies to overcome resistance development problems; hence this in vitro study was carried out to investigate the efficacy of photoelimination of Streptococcus mutans with two methods of photodynamic and photothermal therapy. METHODS Standard Suspensions of S. mutans were treated in two groups of photodynamic therapy with Toluidine blue O and Rhadachlorin(®) and photothermal therapy by EmunDo(®) and their individual light sources, then Bacterial suspension from each treatment was subcultured on the surface of Mueller-Hinton agar plates and bacterial growth was assessed. The results were analyzed by analysis of variance and Tukey test (p<0.05). RESULTS After treatments significant reduction of S. mutans viability in planktonic culture was observed in both groups of photodynamic and photothermal therapy with no priority. CONCLUSION Photoelimination can be a novel modality in the eradication of S. mutans colonies in near future.
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Aziz-Jalali MH, Tabaie SM, Djavid GE. Comparison of Red and Infrared Low-level Laser Therapy in the Treatment of Acne Vulgaris. Indian J Dermatol 2012; 57:128-30. [PMID: 22615511 PMCID: PMC3352636 DOI: 10.4103/0019-5154.94283] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND/PURPOSE Acne vulgaris is a very prevalent skin disorder and remains a main problem in practice. Recently, phototherapy with various light spectrums for acne has been used. There are some evidences that low-level laser therapy (LLLT) has beneficial effect in the treatment of acne lesions. In this study, two different wavelengths of LLLT (630 and 890 nm) were evaluated in treatment of acne vulgaris. MATERIALS AND METHODS This study was a single-blind randomized clinical trial. Patients with mild to moderate acne vulgaris and age above 18 years and included were treated with red LLLT (630 nm) and infrared LLLT (890 nm) on the right and left sides of the face respectively, twice in a week for 12 sessions, and clinically assessed at baseline and weeks 2, 4, 6, and 8. RESULTS Twenty-eight patients were participated in this study. Ten weeks after treatment acne lesion were significantly decreased in the side treated by 630 nm LLLT (27.7±12.7 to 6.3±1.9) (P<0.001), but this decrease was not significant in the site treated by 890 nm LLLT (26.9±12.4 to 22.2±8.5) (P>0.05). CONCLUSION Red wavelength is safe and effective to be used to treat acne vulgaris by LLLT compared to infrared wavelength.
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Affiliation(s)
- Mir Hadi Aziz-Jalali
- Department of Dermatology, Hazrat-e Rasool University Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Lee JW, Kim BJ, Kim MN, Ahn GY, Aso H. Selective sebaceous gland electrothermolysis as a treatment for acne: a prospective pilot study. Int J Dermatol 2012; 51:339-44. [DOI: 10.1111/j.1365-4632.2011.05255.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kim BY, Choi JW, Park KC, Youn SW. Sebum, acne, skin elasticity, and gender difference - which is the major influencing factor for facial pores? Skin Res Technol 2011; 19:e45-53. [DOI: 10.1111/j.1600-0846.2011.00605.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2011] [Indexed: 11/26/2022]
Affiliation(s)
- BY Kim
- Department of Dermatology; Seoul National University College of Medicine; Seoul; Korea
| | - JW Choi
- Department of Dermatology; Seoul National University College of Medicine; Seoul; Korea
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Haedersdal M, Beerwerth F, Nash J. Laser and intense pulsed light hair removal technologies: from professional to home use. Br J Dermatol 2011; 165 Suppl 3:31-6. [DOI: 10.1111/j.1365-2133.2011.10736.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Jang M, Doh K, Kang J, Jeon Y, Suh K, Kim S. A comparative split-face study of photodynamic therapy with indocyanine green and indole-3-acetic acid for the treatment of acne vulgaris. Br J Dermatol 2011; 165:1095-100. [DOI: 10.1111/j.1365-2133.2011.10472.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Traditional medical treatments for acne vulgaris include a variety of topical and oral medications. The combination of poor compliance, lack of durable remission, and potential side effects are common drawbacks to these treatments. The use of lasers and light devices has increased dramatically in recent years due to the overall ease of treatment, predictable clinical efficacy, and minimal adverse effects. A variety of light and laser devices has been used for the treatment of acne, including the potassium titanyl phosphate (KTP) laser, the 585- and 595-nm pulsed dye lasers, the 1450-nm diode laser, radiofrequency devices, intense pulsed light sources, low-intensity light treatment, and photodynamic therapy using 5-aminolevulinic acid and indocyanine green. These devices are thought to target underlying pathogenic factors such as Propionibacterium acnes colonization, increased sebaceous gland activity, and the cutaneous inflammatory response. Lasers in particular also have a central role in the management of acne scarring, which tends to be refractory to medical therapies. Fractional photothermolysis, the 1450-nm diode laser, and pulsed dye lasers have been used in the nonablative treatment of acne scars with significant success. In this article, we review the current status of light- and laser-based treatment of acne and related conditions and briefly review the use of lasers for the treatment of acne scarring.
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Piérard-Franchimont C, Paquet P, Piérard GE. New approaches in light/laser therapies and photodynamic treatment of acne. Expert Opin Pharmacother 2011; 12:493-501. [PMID: 21269242 DOI: 10.1517/14656566.2011.547476] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Acne is a domain in which the technology and understanding of light/laser therapeutic procedures have advanced considerably. The aim of the paper was to revisit adjunctive physical treatments of acne, including light/laser treatments and photodynamic therapy. This review summarizes findings about such treatment modalities with particular emphasis on efficacy and safety. A number of laser/light-based modalities have been developed to meet the increasing demand for new acne treatments. The current devices correspond, on the one hand, to light-emitting diode therapy and, on the other hand, to the 532-nm potassium titanyl phosphate laser, the 585- and 595-nm pulsed dye laser, the 1450-nm diode laser, the 1320-nm Nd:YAG laser and intense pulsed light. Photodynamic therapy is also available. It is claimed that light/laser treatments might induce a faster response compared with the 1-3 months needed for response to traditional oral and topical treatments. In conclusion, pulsed dye laser shows efficacy in some patients with mild to moderate acne. The relative effectiveness compared with other treatments is unconfirmed; from the published information, evidence-based efficacy assessment of light/laser therapies in acne remains almost impossible.
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Choi YS, Suh HS, Yoon MY, Min SU, Lee DH, Suh DH. Intense pulsed light vs. pulsed-dye laser in the treatment of facial acne: a randomized split-face trial. J Eur Acad Dermatol Venereol 2009; 24:773-80. [DOI: 10.1111/j.1468-3083.2009.03525.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Oh SH, Ryu DJ, Han EC, Lee KH, Lee JH. A Comparative Study of Topical 5-Aminolevulinic Acid Incubation Times in Photodynamic Therapy with Intense Pulsed Light for the Treatment of Inflammatory Acne. Dermatol Surg 2009; 35:1918-26. [DOI: 10.1111/j.1524-4725.2009.01315.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Prieto VG, Zhang PS, Sadick NS. Evaluation of pulsed light and radiofrequency combined for the treatment of acne vulgaris with histologic analysis of facial skin biopsies. J COSMET LASER THER 2009; 7:63-8. [PMID: 16537210 DOI: 10.1080/14764170500231848] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Light and radiofrequency (RF) devices have recently been used to treat acne in selected patients. OBJECTIVE To investigate the safety and efficacy of a combination of pulsed light and RF energy for the treatment of acne. Materials and methods. Thirty-two patients with moderate acne were treated twice weekly for four weeks with the Aurora AC (Syneron Medical Ltd, Yokneam, Israel), a combination of pulsed light and RF energy. Twenty-five patients completed the study. In four patients, the number of hair follicles showing perifolliculitis, the diameters of hair follicles, the diameters of sebaceous glands, and expressions of heat shock protein 70 and procollagen-1 were evaluated before and after treatment. RESULTS The mean lesion count was reduced by 47% (p < 0.05) after eight treatments. Adverse effects-erythema, tingling, and burning-were mild and temporary. The percentage of follicles with perifolliculitis decreased from 58% to 33%, sebaceous gland areas decreased from 0.092 mm2 to 0.07 mm2, and heat shock protein 70 and procollagen-1 expressions did not change. CONCLUSION The combination of optical and RF energies may be an alternative nonablative modality for the treatment of moderate acne. Clinical improvement may be partly due to reductions in both perifollicular inflammation and sebaceous gland areas.
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Affiliation(s)
- Victor G Prieto
- Department of Pathology, U.T.M.D. Anderson Cancer Center, Houston, TX, USA
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Ortiz A, Van Vliet M, Lask GP, Yamauchi PS. A review of lasers and light sources in the treatment of acne vulgaris. J COSMET LASER THER 2009; 7:69-75. [PMID: 16537211 DOI: 10.1080/14764170500206204] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
There are various treatment modalities for acne vulgaris including topical and oral therapy as well as microdermabrasion and chemical peels. Recently, there has been an emergence of novel laser and light sources as a means for treating acne vulgaris. This article will review the advances of laser and light sources in the treatment of acne vulgaris.
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Kim S, Cho KH. Clinical trial of pin-point photodynamic therapy using an optic fiber for the improvement of enlarged facial pores: A case study. J DERMATOL TREAT 2009; 20:36-41. [DOI: 10.1080/09546630802225694] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Car J, Car M, Hamilton F, Layton A, Lyons C, Majeed A. Light therapies for acne. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2009. [DOI: 10.1002/14651858.cd007917] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Hamilton F, Car J, Lyons C, Car M, Layton A, Majeed A. Laser and other light therapies for the treatment of acne vulgaris: systematic review. Br J Dermatol 2009; 160:1273-85. [DOI: 10.1111/j.1365-2133.2009.09047.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Thiboutot D, Gollnick H, Bettoli V, Dréno B, Kang S, Leyden JJ, Shalita AR, Lozada VT, Berson D, Finlay A, Goh CL, Herane MI, Kaminsky A, Kubba R, Layton A, Miyachi Y, Perez M, Martin JP, Ramos-E-Silva M, See JA, Shear N, Wolf J. New insights into the management of acne: an update from the Global Alliance to Improve Outcomes in Acne group. J Am Acad Dermatol 2009; 60:S1-50. [PMID: 19376456 DOI: 10.1016/j.jaad.2009.01.019] [Citation(s) in RCA: 374] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2008] [Revised: 01/06/2009] [Accepted: 01/10/2009] [Indexed: 12/13/2022]
Abstract
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.
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Affiliation(s)
- Diane Thiboutot
- Department of Dermatology, Pennsylvania State University College of Medicine, Hershey, USA.
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Abstract
Lasers frequently are used by dermatologists for their multiple aesthetic applications, but they also can be used to treat a variety of medical dermatology conditions. Conditions such as acne vulgaris, psoriasis, and vitiligo can all be successfully treated with laser, thereby providing the patient with additional therapeutic options. Lasers have also been used for years to improve the appearance of scars. The newer fractionated lasers have been especially effective in enhancing the clinical outcomes of scar revision.
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KIM BJ, LEE HG, WOO SM, YOUN JI, SUH DH. Pilot study on photodynamic therapy for acne using indocyanine green and diode laser. J Dermatol 2009; 36:17-21. [DOI: 10.1111/j.1346-8138.2008.00580.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Hædersdal M, Togsverd-Bo K, Wulf HC. Evidence-based review of lasers, light sources and photodynamic therapy in the treatment of acne vulgaris. J Eur Acad Dermatol Venereol 2008; 22:267-78. [DOI: 10.1111/j.1468-3083.2007.02503.x] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gold MH. Acne vulgaris: lasers, light sources and photodynamic therapy--an update 2007. Expert Rev Anti Infect Ther 2008; 5:1059-69. [PMID: 18039088 DOI: 10.1586/14787210.5.6.1059] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Inflammatory acne vulgaris remains one of the most common dermatologic disorders seen in clinical practice. Medical therapy remains the gold standard for therapy but recent advances have shown that a variety of lasers and light sources may be useful in the treatment of inflammatory acne vulgaris. In addition, the use of 20% 5-aminolevulinic acid has found a useful niche in the treatment of moderate-to-severe inflammatory acne vulgaris.
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Affiliation(s)
- Michael H Gold
- Gold Skin Care Center, Tennessee Clinical Research Center, 2000 Richard Jones Road, Suite 220, Nashville, TN 37215, USA.
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Abstract
BACKGROUND Simple procedural treatments such as comedone extraction and intralesional steroids have been utilized for many years as adjunctive therapy for acne. In the past 5 years, new technologies and procedures have become available that present new options for the treatment of acne. OBJECTIVES The objective was to review, summarize, and evaluate the key studies of procedural therapies for the treatment of acne as well as place them in perspective with current clinical practice. METHODS Studies selected for evaluation had at least 10 patients and clear statements of purpose, acne severity, patient selection, follow-up evaluations, previous and concurrent medications, treatment parameters, methods for evaluating results, and adverse effects. All studies were complete and published (in English) in peer-reviewed journals. RESULTS AND CONCLUSIONS Earlier procedural therapies were adjunctive to medical therapy, such as intralesional steroids, chemical peels, and microdermabrasion. Newer methods include radiofrequency, light or laser, and photodynamic therapy that represent treatment alternatives for systemic medications. Still early in their development, these new procedures provide an important, novel set of options for the treatment of acne. The most developed and studied therapies are blue or blue/red light combinations, 1,450-nm diode laser, and photodynamic therapy with 5-aminolevulinic acid or indocyanine green. Review of the literature of more up-to-date physical procedures provides a starting point for physicians seeking to treat their acne patients safely and effectively with these new methods.
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Chang SE, Ahn SJ, Rhee DY, Choi JH, Moon KC, Suh HS. Treatment of facial acne papules and pustules in Korean patients using an intense pulsed light device equipped with a 530- to 750-nm filter. Dermatol Surg 2007; 33:676-9. [PMID: 17550443 DOI: 10.1111/j.1524-4725.2007.33142.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND A rising number of laser- or light-based therapies are addressing the need for effective acne treatments with minimal downtime. OBJECTIVE The purpose of this study is to evaluate an intense pulsed light (IPL) equipped with a 530- to 750-nm filter for inflammatory acne treatment. PATIENTS AND METHODS Thirty female patients (mean age, 25.7 years) with mild-to-moderate acne were enrolled. While using benzoyl peroxide (BP) gel, one side of the face was treated with the PR filter (acne filter) of the IPL. RESULTS All patients experienced the reduction of inflammatory lesion counts in both sides of face. There was no significant difference between IPL-treated and untreated sides of the face for mean papule plus pustule counts, 3 weeks after three sessions. As to red macules, 63% were good or excellent on the laser-treated side compared to 33% on the untreated side. Improvement of irregular pigmentation and skin tone was detected on the laser-treated side than the untreated side. CONCLUSION This new wavelength band of IPL system was safe and effective in improving acne red macules, irregular pigmentation, and skin tone but did not affect inflammatory acne lesion counts on the skin of Asian persons.
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Affiliation(s)
- Sung-Eun Chang
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Treatment of Facial Acne Papules and Pustules in Korean Patients Using an Intense Pulsed Light Device Equipped with a 530- to 750-nm Filter. Dermatol Surg 2007. [DOI: 10.1097/00042728-200706000-00003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kobayashi T, Tamada S. Selective electrothermolysis of the sebaceous glands: treatment of facial seborrhea. Dermatol Surg 2007; 33:169-77. [PMID: 17300602 DOI: 10.1111/j.1524-4725.2006.33035.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND There are few publications on facial seborrhea treatment. A focused therapy is needed. OBJECTIVE Our aim was to evaluate the efficacy of electrothermolysis of the sebaceous glands. METHODS In the preliminary studies, histologic changes in the cheek skin by electrothermolysis were examined by light microscopy. In the clinical studies, 15 adult women subjects with facial seborrhea were treated four times by the same procedure. A 1.50-mm-long needle with a 0.45-mm base insulation was inserted into pores in the forehead and cheeks, and a high-frequency electrical current was applied for 0.25 to 0.50 seconds with an output of 40 W. Each treatment took 60 to 90 minutes. The subjects returned for 6-months follow-up after their fourth treatment. RESULTS Histology 1 and 6 months later showed fewer sebaceous glands and the development of fibrosis. All 12 subjects who completed the 6-month follow-up gave a subjective assessment of continuous reduction of facial seborrhea. On a scale of 0.0 to 3.0, the mean improvement score was 1.67+/-0.75. The mean reduction rate of skin surface lipids was 31.5% by sebumeter (p< .01). CONCLUSIONS Even though this is a pilot, uncontrolled clinical assessment study, electrothermolysis of sebaceous glands may be an effective and safe approach for facial seborrhea treatment.
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Abstract
Current topical and most oral therapies for acne vulgaris have limited efficacy, especially in moderate to severe cases. Photodynamic therapy with 5-aminolevulinic acid and recently methyl aminolevulinate has been shown to be a safe and effective modality for the treatment of acne vulgaris. Consensus guidelines suggest that 30 to 60 minutes is sufficient 5-aminolevulinic acid contact time before photoactivation with blue light, red light, yellow light, broadband light, halogen, or pulsed dye laser devices. An average of three treatment can yield significant long-term improvement.
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Affiliation(s)
- Mark S Nestor
- Center for Cosmetic Enhancement, 2925 Aventura Boulevard, Suite 205, Aventura, FL 33180-3108, USA.
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Orringer JS, Kang S, Maier L, Johnson TM, Sachs DL, Karimipour DJ, Helfrich YR, Hamilton T, Voorhees JJ. A randomized, controlled, split-face clinical trial of 1320-nm Nd:YAG laser therapy in the treatment of acne vulgaris. J Am Acad Dermatol 2007; 56:432-8. [PMID: 17239987 DOI: 10.1016/j.jaad.2006.10.978] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2006] [Revised: 10/04/2006] [Accepted: 10/26/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND There is a need for additional effective treatments for acne vulgaris. Laser therapy has been explored as a therapeutic option for acne, but rigorously designed studies in this area have been limited. OBJECTIVE We sought to examine the efficacy of an infrared laser in the treatment of acne. METHODS We conducted a randomized, controlled, single-blind, split-face clinical trial of 46 patients with facial acne. Patients received a series of 3 nonablative laser treatments using a novel neodymium:yttrium-aluminum-garnet (Nd:YAG) laser to half of the face. Serial blinded lesion counts and global acne severity rating of standardized bilateral patient photographs were performed. Sebum production was measured, and patient self-assessment surveys were administered. RESULTS A transient but statistically significant improvement in lesion counts of open comedones was demonstrated in treated skin as compared with untreated skin. There were no significant differences between treated and control sides of the face in terms of changes in mean papule or pustule counts. Grading of serial photographs revealed no significant differences between treated and untreated skin. Patient surveys indicated that the majority of patients found the treatments to be at least mildly effective for both acne and oiliness. LIMITATIONS The current study only addresses the efficacy of a single laser system employing a specific treatment regimen. CONCLUSIONS Infrared laser therapy may improve comedonal acne. Additional work is needed to better define the degree and duration of the effect. Patients appear to positively view such therapy for both acne and oily skin.
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Affiliation(s)
- Jeffrey S Orringer
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan 48109-0314, USA.
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Gold MH. Acne and PDT: new techniques with lasers and light sources. Lasers Med Sci 2007; 22:67-72. [PMID: 17225060 DOI: 10.1007/s10103-006-0420-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2006] [Accepted: 06/12/2006] [Indexed: 10/23/2022]
Abstract
Acne vulgaris is one of the most common dermatologic disorders encountered in everyday practice. Treatment options for this often psychologically scarring disease are numerous and, for many individuals, provide relief from the disorder. However, factors such as antibiotic resistance and slow onset of action from many topical therapies have led researchers to seek out alternative therapies, especially for those suffering from moderate to severe inflammatory acne vulgaris. Lasers and light sources are finding increased usage in the treatment of inflammatory acne vulgaris. Light sources including blue lights and intense pulsed lights are becoming regular additions to routine medical management to enhance the therapeutic response. Finally, photodynamic therapy may change many of the acne vulgaris paradigms, as its place is being defined in the treatment of moderate to severe inflammatory acne vulgaris. More and more clinical trials are showing the effectiveness of 5-aminolevulinic acid and photodynamic therapy in the treatment of moderate to severe inflammatory acne vulgaris.
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Affiliation(s)
- Michael H Gold
- Gold Skin Care Center, 2000 Richard Jones Road, Suite 220, Nashville, TN 37215, USA.
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