Intense pulsed light versus benzoyl peroxide 5 % gel in treatment of acne vulgaris

The impact of oral isotretinoin on ovarian functions of acne patients complaining of polycystic ovarian syndrome: a prospective study

BACKGROUND

Women have polycystic ovarian syndrome (PCOS) at higher rates than any other endocrine condition with an average incidence rate of 6 to 8%. Acne is an immune mediate common condition frequently affecting adolescents and adults and is often associated with PCOS. The objective of the study was to assess the impact of oral isotretinoin on ovarian functions of acne patients suffering from PCOS. Forty women with a clinical diagnosis of acne as well as PCOS participated in this prospective clinical trial. Participants were given oral doses of isotretinoin ranging from 0.5 to 1 milligram per kilogram (mg/kg), for a total of 120 to 150 mg/kg. To establish baseline values of hormone levels, on days 2-5 of the menstrual cycle, venous blood samples were obtained. Moreover, global acne grading system (GAGS), follicle count, and bilateral ovarian volumes were evaluated both before and after isotretinoin treatment.

RESULTS

A significant reduction in global acne score from pre-treatment levels to post-treatment levels was observed (11.58 ± 5.857 vs. 1.65 ± 1.369). Ovarian volume was significantly reduced from 10.26 ± 1.539 before treatment to 8.74 ± 1.436 after treatment on the right side (P < 0.001) and from 11.08 ± 1.564 before treatment to 9.36 ± 1.479 after treatment on the left side (P < 0.001). A significant reduction in free testosterone level and hirsutism scores were observed after treatment (P < 0.001; P < 0.01 respectively.

CONCLUSION

Isotretinoin may exert beneficial effects in hyperandrogenic women with PCOS and needs to be further evaluated by large multicentre controlled trials.

Topical timolol maleate 0.5% after fractional carbon dioxide laser versus fractional carbon dioxide laser alone in treatment of acne scars: split face comparative study

Acne is a common inflammatory condition that mostly involves the face, chest and back. A number of different modalities had been employed for treating scars of which laser remains to be a pivotal choice. We aimed to compare the efficacy of topical timolol maleate 0.5% after fractional CO2 (AFCO2) laser versus fractional CO2 Laser alone for treatment of atrophic acne scars. A split-face comparative clinical experiment on 30 cases of atrophic post-acne scars that were treated on one side with ablative fractional CO2 laser followed by timolol application while with only ablative fractional CO2 laser on the other side. Following treatment, both sides demonstrated significant improvement with the laser + timolol treated side showing better improvement; yet not significantly higher than the laser only treated side. In conclusion, both topical timolol maleate 0.5% after fractional CO2 laser and fractional CO2 laser may achieve comparable significant improvement. The good safety profile, easy accessibility, low cost, and non-invasive nature merits the use of timolol in acne scars pending verification by larger sample reproduced and controlled trials.

Efficacy of Oxybrasion and Cosmetic Acids on Selected Skin Parameters in the Treatment with Acne Vulgaris

Purpose

The present study aimed to evaluate the efficacy of an oxybrasion treatment applied alone and an oxybrasion treatment combined with cosmetic acids in improving acne-prone skin and selected skin parameters.

Patients and Methods

A single-blind placebo study in a sample of 44 women diagnosed with acne vulgaris was conducted. Group A (n = 22) had a series of five oxybrasion treatments, while group B (n = 22) received a synergy of five oxybrasion treatments and a mixture of phytic, pyruvic, and lactic and lactic ferulic acids at 40% pH 1.4. Cosmetic treatments were performed every 14 days, and The Derma Unit SCC3 apparatus (Courage & Khazaka, Cologne, Germany) Sebumeter SM 815 and Corneometer CM825 and GAGS scale were used to check their effectiveness.

Results

A Bonferroni post hoc test showed that group A and B did not differ from each other in acne severity before treatment (p = 1.00). However, these samples differed significantly after treatment (p < 0.001), suggesting that combined treatment of oxybrasion and cosmetic acids has a better effect than oxybrasion alone. Also, two treatment conditions (before and after) were statistically different for groups A and B separately (p < 0.001), indicating a similar efficacy of both treatments on acne severity.

Conclusion

Cosmetic treatments improved acne-prone skin and selected skin parameters. Better results were obtained by combining an oxybrasion treatment with cosmetic acids.

Clinical Trial Approval

The clinical trial with ID ISRCTN 28257448 approved this study.

Novel technique for rosacea treatment using optimal pulse technology: In vivo and clinical studies

BACKGROUND

Rosacea is a chronic inflammatory skin disease affecting the face, and the current treatment effect is not satisfactory. Based on the photomodulation of optimal pulse technology (OPT), we developed a novel treatment mode, namely, advanced OPT with low energy, three pulses, and long pulse width (AOPT-LTL).

AIMS

We aimed to explore the feasibility and underlying molecular mechanisms of AOPT-LTL treatment in a rosacea-like mouse model. Furthermore, we evaluated the safety and efficacy in patients with erythematotelangiectatic rosacea (ETR).

MATERIALS AND METHODS

Morphological, histological, and immunohistochemical analyses were used to investigate the efficacy and mechanisms of AOPT-LTL treatment in the LL-37-induced rosacea-like mouse model. Moreover, 23 patients with ETR were included and received different times of treatment at intervals of 2 weeks depending on the severity of their condition. The treatment effect was assessed by comparing clinical photographs at baseline, 1 week, and 3 months after treatment, combined with the red value, GFSS, and CEA scores.

RESULTS

After the AOPT-LTL treatment of the mice, we observed that the rosacea-like phenotype, inflammatory cell infiltration, and vascular abnormalities were significantly ameliorated, and the expression of the core molecules of rosacea was significantly inhibited. In the clinical study, the AOPT-LTL treatment exerted satisfactory therapeutic effects on erythema and flushing of ETR patients. No serious adverse events were observed.

CONCLUSIONS

AOPT-LTL is a safe and effective method for the treatment of ETR.

Use of Patient-Reported Outcomes in Acne Vulgaris and Rosacea Clinical Trials From 2011 to 2021: A Systematic Review

Importance

Acne and rosacea have substantial implications for quality of life, and it is therefore important to ensure the patient's voice is being captured in pivotal randomized clinical trials (RCTs). Although patient-reported outcome measures (PROMs) are a valuable tool to capture the patient perspective, little is known about use of PROMs in RCTs on acne and rosacea.

Objective

To characterize the use of PROMs in RCTs on acne and rosacea.

Evidence Review

A systematic literature search was conducted using the search terms acne vulgaris and rosacea in the following databases: MEDLINE through PubMed, Embase, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews. A modified search hedge for RCTs from the McGill Library was applied. All phase 2, 3, and 4 RCTs published between December 31, 2011, through December 31, 2021, that evaluated the efficacy and safety of therapies for acne and rosacea vs any comparator were eligible for inclusion.

Findings

A total of 2461 publications describing RCTs were identified, of which 206 RCTs met the inclusion criteria (163 trials [79%] on acne and 43 [21%] on rosacea). At least 1 PROM was used in 53% of trials (110) included; PROM use was more common in rosacea RCTs (67% [n = 29]) compared with acne RCTs (50% [n = 81]). At least 1 dermatology-specific (13% [n = 27]) or disease-specific (14% [n = 28]) PROM was included in the RCTs analyzed. Only 7% of trials (14) included a PROM as a primary outcome measure. There was no statistically significant increase in PROM inclusion over the study period (11 of 21 trials in 2011 vs 5 of 12 trials in 2021).

Conclusions and Relevance

In this systematic review, PROMs were included in approximately one-half of acne and rosacea RCTs performed over the study period. In addition, PROMs were rarely used as a primary outcome measure, and inclusion of PROMs has not increased substantially over the past 10 years. Increasing use of PROMs in RCTs can ensure that the patient's perspective is captured during the development of new treatments for acne and rosacea.

Intense pulsed light treatment for inflammatory skin diseases: a review

Although intense pulsed light (IPL) has been commonly used in the field of medical cosmetics in recent years, the exact outcomes of IPL in the treatment of inflammatory skin diseases remain unclear. To assess the clinical evidence for the use of IPL in the treatment of various inflammatory skin diseases and propose evidence-based recommendations, we searched for relevant publications in the PubMed and Web of Science databases and provided updated information. The inflammatory skin diseases treated with IPL consisted of acne vulgaris, rosacea, psoriasis, hidradenitis suppurativa (HS), atopic dermatitis (AD), Riehl's melanosis, lupus erythematosus, cutaneous sarcoidosis, pilonidal cysts, and pigmented actinic lichen planus (PALP). The efficacy of IPL treatment for these inflammatory skin diseases was described and evaluated. Forty-two studies were included to provide this assessment. The evidence suggests that IPL can effectively and safely improve acne vulgaris and rosacea (recommendation grade B). For other described inflammatory skin diseases, IPL can be used as a tentative or supplementary treatment (recommendation grade C and D). The main complications include transitory erythema, edema, and pain, with the possibility of hyperpigmentation, blisters, and a burning sensation in some individuals.

Isotretinoin plus 420 nm intense pulsed light versus isotretinoin alone for the treatment of acne vulgaris: a randomized, controlled study of efficacy, safety, and patient satisfaction in Chinese subjects

Either isotretinoin or intense pulsed light (IPL) proved to be effective to alleviate acne lesions, but the combined treatment has rarely been reported. The study aimed to evaluate the efficacy, safety, and patient satisfaction of isotretinoin and 420 nm IPL combined treatment. Forty-seven patients with facial acne with Global Evaluation Acne (GEA) graded 2-4 were randomized into study group and control group. The patients in the control group received oral isotretinoin for 8 weeks. The patients in the study group were treated with oral isotretinoin for 8 weeks, together with a biweekly 420 nm IPL treatment for 4 weeks. Topical agents included adapalene and fusidic acid. Efficacy was evaluated using digital photographies taken at baseline and week 12 by an independent dermatologist, including GEA grade, lesion count, lesion reduction percentage, and effective rate. All patients completed a questionnaire about dermatology life quality index (DLQI) and satisfaction visual analog scale (VAS) on week 12, and were followed up for another 2 months. Adverse events were recorded. The patients in the study group experienced significant reduction in GEA grade, total lesions, and inflammatory lesions on week 12, compared with the control group (p < 0.05). The patients in the study group reported lower DLQI and higher VAS satisfaction (p < 0.05) and experienced lower incidence of relapse (p < 0.05). No severe adverse event was identified in both groups. Compared with isotretinoin alone, isotretinoin and 420 nm IPL combined treatment proved to be more effective within limited treatment duration. It was well-tolerated and the patients' satisfaction was high.

Efficacy of IPL therapy for the treatment of acne vulgaris: A meta-analysis

BACKGROUND

Intense pulse light (IPL) has been adopted by numerous patients. However, no existing study has analyzed the efficiency and safety of IPL in the treatment of acne vulgaris.

OBJECTIVE

To assess the efficiency and safety of IPL in the treatment of acne vulgaris.

METHODS

Electronic databases, including Embase, Cochrane Library, and MEDLINE, were retrieved to identify related studies. In this study, the primary and secondary outcomes were the mean percentage reduction of inflammatory acne lesion improvement (MPRI) and the mean percentage reduction of noninflammatory acne lesion improvement (NMPRI), respectively. Between-study heterogeneities were assessed using the I ²  statistic.

RESULTS

Eight randomized controlled trials (RCTs) including 450 patients were enrolled into the present analysis. With regard to MPRI, the result of IPL group was poorer than that of control group [mean deviation (MD) = -4.37 (95% confidence interval CI: -7.83, -0.91), P = .01]. In addition, the efficiency of IPL was poor among African and Asian populations [MD = -3.87 (95% CI: -7.36, -0.37), P = .03; MD = -28.37 (95% CI: -52.26, -4.18), P = .02]. Meanwhile, difference in the efficiency between IPL and 1064 nm Nd:YAG was not statistically significant [MD = -3.25 (95% CI: -7.01, -0.51). P = .09]. Besides, the efficiency of IPL was lower than that of PDL [MD = -28.37 (95% CI: -52.26, -4.18), P = .02]. There was no statistically significant difference in the efficiency between IPL and other treatments for NMPRI. With regard to adverse effects, erythema (46.73%) and pain (39.13%) were the most common.

CONCLUSIONS

IPL is not so efficient as other supplementary therapies. For inflammatory acne lesions, the efficiency of IPL is poorer than that of PDT. Difference in geographic regions may affect the IPL efficiency. However, the results obtained in this study should be cautiously interpreted due to the heterogeneities and the lack of studies with a large sample size.

A retrospective assessment and comparison of the effectiveness of benzoyl peroxide; the combination of topical niacinamide, gallic acid, and lauric acid; and the combination of benzoyl peroxide and erythromycin in acne vulgaris

Acne vulgaris is a chronic inflammatory skin disease that mostly develops during adolescence and continues throughout adulthood. It affects the face, the main location of cosmetic appearance. Despite many developments in acne treatment, various combination therapies are needed to create the best option. Ninety patients were included in this study. We used the global acne grading system (GAGS) and the lesion counting and photographic standards that were used by Hayashi et al., to assess acne severity. The patients were randomly divided into three groups as group 1 (using only 5% BPO, twice a day), group 2 (using only the combination of 5% BPO + 3% erythromycin, twice a day), and group 3 (using only the combination of 4% niacinamide + 1% gallic acid + 1% lauric acid, twice a day). Thirty patients were included in each group. The scores were evaluated at weeks 0, 2, 4 and 8, and compared with each other. As a result of the study, all three treatment types were found to be effective. The combination of 4% niacinamide + 1% gallic acid + 1% lauric acid can be used as an alternative topical treatment for acne vulgaris to prevent resistance against topical antibiotics and the side effects of some other treatments.

Efficacy of 595- and 1319-nm pulsed dye laser in the treatment of acne vulgaris: a narrative review

Acne is one of the commonest problems of adolescence with almost half of the patients experiencing persistence into adulthood. Pulsed dye lasers (PDL) with wavelengths of 585 and 595 nm targeting hemoglobin have been used for the treatment of this condition and its sequelae. Recent introduction of PDL with a higher wavelength of 1319 nm has been reported to offer some benefit to acne patients. We reviewed the literature on the use of 595-nm and 1319-nm PDL in the management of acne. A PubMed literature search for search terms "pulsed dye laser," "acne laser therapy," "light therapy for acne," "595 nm and acne," "1319 nm and acne" was done. Studies, series and case reports were included. These lasers were compared to other lasers and light sources such as 532-nm Potassium Titanyl Phosphate laser, 585-nm PDLs, 1450-nm diode laser, 1540-nm erbium glass laser, intense-pulsed light (IPL), photodynamic therapy, red and blue light and short-pulsed 1064 nm laser utilized in acne management regarding their efficacy. Improvement in acne grading, scale severity or reduction in lesion count indicated substantial efficacy of the laser system utilized.

Nd:YAG laser vs IPL in inflammatory and noninflammatory acne lesion treatment

BACKGROUND

Several topical and systemic therapies are available for the treatment of acne vulgaris but are associated with several limitations, and recently, intense pulse light (IPL) and long-pulsed 1064 nm Nd: YAG laser have shown efficacy.

AIMS

The current study aimed to compare the efficacy of Nd:YAG laser and IPL in inflammatory and noninflammatory acne lesions.

PATIENTS AND METHODS

Thirty patients with inflammatory and noninflammatory facial acne were assigned randomly and equally into two groups, the Nd:YAG and IPL groups. The patients received three sessions of laser 2 weeks apart, and the clinical improvement was assessed by the reduction in the number of lesions.

RESULTS

At baseline, the two groups showed a nonsignificant difference as regards total number (P = .476), inflammatory (P = .457), and noninflammatory lesions (P = .420). The improvement in total lesions was significant in the Nd:YAG Group but nonsignificant in the IPL Group (P < .001, P = .13, respectively). Three patients (20%) in the IPL Group showed exacerbation after the first and second sessions. One month after the last session, the difference in improvement between noninflammatory and inflammatory lesions showed a significant difference in the Nd:YAG Group (P = .017) and a nonsignificant difference in the IPL Group (P = .823). Nd:YAG, compared to the IPL Group, showed a significant difference as regards the improvement score in noninflammatory lesions (P = .0099) and a nonsignificant difference in inflammatory lesions (P = .4295).

CONCLUSION

The significant improvement in noninflammatory lesions and the absence of a significant flare-up of acne as seen among patients treated with IPL make Nd:YAG a better therapeutic modality for acne.

Combined treatment of hidradenitis suppurativa with intense pulsed light (IPL) and radiofrequency (RF)

BACKGROUND

Hidradenitis suppurativa is a chronic inflammatory disease with high burden. Treatment options are often unsatisfactory. We assessed the effect of a combination therapy of intense pulsed light (IPL) and radiofrequency (RF).

METHODS

The explorative study included 47 patients and was performed as a prospective, monocentric, randomized, three-arm parallel-group design trial with a prior 12 weeks observation period. Treatment arms were IPL and RF monotherapies or IPL + RF combination therapy. After 12 weeks, all patients received IPL + RF for additional 12 weeks (cross-over). Primary endpoint was the change in active lesion numbers, secondary endpoint the change in Dermatology Quality of Life Index (DLQI).

RESULTS

After 12 weeks, active lesion counts of the IPL + RF group decreased more than in the IPL group (p = .044); the decrease in DLQI was significantly higher in the IPL + RF and RF groups compared to IPL. Prolonged 24-week treatment with IPL + RF obtained better results as 12 weeks. Overall, disease burden after 24 weeks of treatment compared to disease fluctuation during the observation period was significantly lower (change in active lesions -3.6, p = .001; in DLQI -5.2, p = .003).

CONCLUSIONS

IPL + RF treatment appears to represent a promising therapeutic option that leads to reduction of disease activity without severe side effects.

A visible-light-driven photoelectrochemical molecularly imprinted sensor based on titanium dioxide nanotube arrays loaded with silver iodide nanoparticles for the sensitive detection of benzoyl peroxide

A novel ultrasensitive photoelectrochemical sensor for benzoyl peroxide (BPO) was constructed under visible light irradiation.

The efficacy and safety of non-pharmacological therapies for the treatment of acne vulgaris: A systematic review and best-evidence synthesis

BACKGROUND

Acne vulgaris is a multifaceted skin disorder, affecting more than 85% of young individuals worldwide. Pharmacological therapy is not always desirable because of the development of antibiotic resistance or the potential risk of adverse effects. Non-pharmacological therapies can be viable alternatives for conventional therapies. However, sufficient evidence-based support in the efficacy and safety of non-pharmacological therapies is lacking.

OBJECTIVE

To assess the efficacy and safety of several non-pharmacological therapies in the treatment of acne vulgaris.

METHODS

A systematic literature review, including a best-evidence synthesis, was performed to identify literature. Three electronic databases were accessed and searched for studies published between January 2000 and May 2017.

RESULTS

Thirty-three eligible studies were included in our systematic review. Three main types of non-pharmacological therapies were identified laser- and light-based therapies, chemical peels and fractional microneedling radiofrequency. The majority of the included studies demonstrated a significant reduction in acne lesions. However, only seven studies had a high methodologic quality. Based on these seven trials, a best-evidence synthesis was conducted. Strong evidence was found for glycolic acid (10-40%). Moderate evidence was found for amino fruit acid (20-60%), intense pulsed light (400-700 and 870-1200 nm) and the diode laser (1450 nm). Initially, conflicting evidence was found for pulsed dye laser (585-595 nm). The most frequently reported side-effects for non-pharmacological therapies included erythema, tolerable pain, purpura, oedema and a few cases of hyperpigmentation, which were in most cases mild and transient.

CONCLUSION

Circumstantial evidence was found for non-pharmacological therapies in the treatment of acne vulgaris. However, the lack of high methodological quality among included studies prevented us to draw clear conclusions, regarding a stepwise approach. Nevertheless, our systematic review including a best-evidence synthesis did create order and structure in resulting outcomes in which a first step towards future research is generated.

Current treatments of acne: Medications, lights, lasers, and a novel 650-μs 1064-nm Nd: YAG laser

The treatment of acne, especially severe acne, remains a challenge to dermatologists. Therapies include retinoids, antibiotics, hormones, lights, lasers, and various combinations of these modalities. Acne is currently considered a chronic rather than an adolescent condition. The appropriate treatment depends on the patient and the severity of disease. The purpose of this study was to review current therapies for acne of all severities and to introduce the 650-μs 1064-nm laser for the treatment of acne.

Efficacy of Intense-pulsed Light Therapy with Topical Benzoyl Peroxide 5% versus Benzoyl Peroxide 5% Alone in Mild-to-moderate Acne Vulgaris: A Randomized Controlled Trial

Objective:

Acne vulgaris is a disease of pilosebaceous unit with multifactorial pathogenesis and threats patients' social functioning. There is a growing research to find faster, more effective, and easy to use treatments. The aim of this study is to evaluate the efficacy of benzoyl peroxide 5% (BP) with and without concomitant intense-pulsed light (IPL) therapy in mild-to-moderate acne vulgaris.

Methods:

In this controlled trial, 58 eligible patients with mild-to-moderate acne and Fitzpatrick skin phototype III and IV were randomly allocated to two groups. All patients were asked to use a thin layer of BP every night. The IPL therapy was administered at the end of first, 2^nd, and 3^rd months. Acne Global Severity Scale (AGSS), Acne Severity Index (ASI), and total lesion counting (TLC) along with patient satisfaction were recorded. Patients were also examined 1 month after the final therapeutic visit.

Findings:

The IPL group showed greater reduction in AGSS (P < 0.001) and TLC (P = 0.005) than the control group. However, the difference in ASI was not significant (P = 0.12). Patients in IPL groups were more satisfied than control group (P < 0.001).

Conclusion:

Adding IPL to BP can result better response to BP alone. In acne treatment, combination therapy such as IPL and other topical agents should be kept in mind.

Light-based therapies in acne treatment

The use of light and laser in the treatment of acne is increasing as these modalities are safe, effective, and associated with no or minimal complications when used appropriately. These light and laser sources are also being used in combination with pharmacological and/or physical measures to synergize their effects and optimize the therapeutic outcome. This review focuses on optical devices used in treating acne and serves to delineate the current application of various methods, including their utility and efficacy.