Acne

Semin Cutan Med Surg. 2013 Mar;32(1):41-52.

Lowlevel laser (light) therapy (LLLT) in skin: stimulating, healing, restoring.

Avci P1, Gupta A, Sadasivam M, Vecchio D, Pam Z, Pam N, Hamblin MR.

Author information

  • 1Department of Dermatology, Harvard Medical School, BAR 414 Wellman, Center for Photomedicine, Massachusetts General Hospital, 40 Blossom Street, Boston, MA 02114, USA.

Abstract

Lowlevel laser (light) therapy (LLLT) is a fast-growing technology used to treat a multitude of conditions that require stimulation of healing, relief of pain and inflammation, and restoration of function. Although skin is naturally exposed to light more than any other organ, it still responds well to red and near-infrared wavelengths. The photons are absorbed by mitochondrial chromophores in skin cells. Consequently, electron transport, adenosine triphosphate nitric oxide release, blood flow, reactive oxygen species increase, and diverse signaling pathways are activated. Stem cells can be activated, allowing increased tissue repair and healing. In dermatology, LLLT has beneficial effects on wrinkles, acne scars, hypertrophic scars, and healing of burns. LLLT can reduce UV damage both as a treatment and as a prophylactic measure. In pigmentary disorders such as vitiligo, LLLT can increase pigmentation by stimulating melanocyte proliferation and reduce depigmentation by inhibiting autoimmunity. Inflammatory diseases such as psoriasis and acne can also be managed. The noninvasive nature and almost complete absence of side effects encourage further testing in dermatology.

Indian J Dermatol.  2012 Mar;57(2):128-130.

Comparison of Red and Infrared Low-level Laser Therapy in the Treatment of Acne Vulgaris.

Aziz-Jalali MH, Tabaie SM, Djavid GE.

Source

Department of Dermatology, Hazrat-e Rasool University Hospital, Tehran University of Medical Sciences, Tehran, Iran.

 

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.

 

J Cosmet Laser Ther. 2011 Dec;13(6):308-14.

 

Clinical efficacy of home-use blue-light therapy for mild-to moderate acne.

Gold MH, Sensing W, Biron JA.

Source

Gold Skin Care Center, Department of Dermatology, School of Nursing, Vanderbilt University School of Medicine, Vanderbilt University , Nashville, TN , USA , Fudan University (Shanghai Medical University), Shanghai, China, and China Medical University, Shenyang, China.

 

Abstract

Abstract Introduction: Blue-light light-emitting diode (LED) therapy has become widely used for the treatment of inflammatory acne. In this study we evaluated the efficacy of a home use blue-light LED application in improving lesions and shortening their time to clearance.

Methods: This was an IRB approved randomized self-control study. For each patient (n = 30), 2 similar lesions, one of each side of the face were chosen for treatment with either a blue-light LED hand-held or sham device. Treatments (n = 4) were conducted twice daily in the clinic and lesions were followed-up till resolution. Reduction in blemishes size and erythema and the overall improvement were evaluated by both the physician and the patients. Time to lesion resolution was recorded.

Results: There was a significant difference in the response of lesions to the blue-light LED application as opposed to the placebo in terms of reduction in lesion size and lesion erythema as well as the improvement in the overall skin condition (p < 0.025). Signs of improvement were observed as early as post 2 treatments. Time to resolution was significantly shorter for the blue-light LED therapy.

Conclusion: The results support the effectiveness of using blue-light LED therapy on a daily basis for better improvement and faster resolution of inflammatory acne lesions.

 

J Cosmet Laser Ther.  2011 Dec;13(6):303-7.

Evaluation of 532-nm KTP laser treatment efficacy on acne vulgaris with once and twice weekly applications.

Yilmaz O, Senturk N, Yuksel EP, Aydin F, Ozden MG, Canturk T, Turanli A.

Source

Department of Dermatology, School of Medicine, Ondokuz Mayis University, Samsun, Turkey.

Abstract

BACKGROUND:

Light-based therapies and lasers have been proposed for the treatment of acne vulgaris but the efficacy and application periods of 532-nm KTP laser treatment are not clear.

OBJECTIVE:To evaluate the efficacy and safety of 532-nm KTP laser and compare the effects of once and twice weekly applications in the treatment of mild to moderate acne vulgaris.

METHODS:

Totally 38 patients were treated once weekly and twice weekly in group I and in group II respectively. One half of the face of each patient was treated with 532-nm KTP and the other half was remained as untreated. Patients were evaluated at the beginning, one and four weeks after the last treatment session with Michaëlsson acne severity grading score (MASS).

RESULTS:

Statistically significant improvement was found at second control (p = 0.005) in group I, and at the first (p = 0.004), and second (p < 0.001) controls in group II for treated sides. For both groups, changes of MASS were insignificant for untreated sites. Improvement of MASS of treated sides was not statistically significant between two treatment groups for both controls.

CONCLUSION:

532-nm KTP laser treatment may be an alternative method in selected acne vulgaris patients. No significant difference was noted between once and twice weekly applications.

 

J Drugs Dermatol.  2011 Jun;10(6):596-602.

 

Evaluation of self-treatment of mild-to-moderate facial acne with a blue light treatment system.

Wheeland RG, Dhawan S.

Source

Department of Dermatology, University of Missouri Healthcare, 1 Hospital Drive, Columbia, MO 65212, USA. wheelandr@health.missouri.edu

 

Abstract

INTRODUCTION:

This study evaluated the efficacy and tolerability of treating mild-to-moderate facial acne using a new, hand-held, light-emitting diode blue light device in conjunction with a foam cleanser containing 5% glycolic acid and 2% salicylic acid plus a skin rebuilding serum containing 1.25% salicylic acid, 0.5% niacinamide, 0.08% liposomal-based azelaic acid and superoxide dismutase.

METHODS:

Volunteers with mild-to-moderate facial inflammatory acne used the blue light device twice daily for eight weeks, plus the cleanser before treatments and the serum after each evening treatment.

RESULTS:

Among 33 subjects aged 25-45 years old, 28 completed. In a 3 cm x 5 cm target area receiving a daily dose of ~29 J/cm2, treatment was associated with significant reductions from baseline in the inflammatory lesion count from week 1 onward (P? .01) and in the non-inflammatory lesion count from week 4 onward (P? .05). The number of flares was significantly reduced from baseline from week 2 onward (P? .05), and flare severity and flare redness were significantly reduced from baseline from week 4 onward (P? .01 and P? .05, respectively). At week 8, more than 90 percent of subjects reported improvements in their skin's overall appearance, clarity, radiance, tone, texture and smoothness. In addition, 82 percent were satisfied, very satisfied, or extremely satisfied with the blue light treatment system and 86 percent agreed the treatment system was much gentler than traditional acne treatments.

CONCLUSION:

The blue light treatment system offers effective, rapid, convenient and well tolerated treatment of inflammatory and non-inflammatory acne lesions. The majority of subjects consider it much gentler than traditional acne treatments and it facilitates effective treatment without the need for antibiotic exposure. The blue light treatment system and blue light therapy alone are attractive treatment options for acne vulgaris, both as alternatives to traditional acne treatments and as adjunctive treatments to complement existing therapies.

 

Skin Therapy Lett.  2007 Dec-2008 Jan;12(10):1-6, 9.

Efficacy of lasers and PDT for the treatment of acne vulgaris.

Gold MH.

Source

Gold Skin Care Center, Tennessee Clinical Research Center, Nashville, TN, USA.

Abstract

Acne vulgaris can represent a therapeutic challenge in terms of managing ongoing symptoms and preventing scar formation. While the copious variations of available treatments address milder forms of the disease, until recently, therapies for resistant or moderate-to-severe forms were limited to systemic agents that were accompanied by potentially severe side-effects. With the addition of lasers, light sources, and aminolevulinic acid-photodynamic therapy (ALA-PDT) therapies, dermatologists may now have viable new alternatives for treating all grades of acne severity that circumvent the negative side-effects associated with many conventional options.

Ann Dermatol Venereol. 2009 Oct;136 Suppl 6:S351-8.

Light-emitting diodes (LED)

[Article in French]

Cartier H, Le Pillouer-Prost A, Grognard C.hcartier@hotmail.com

Abstract

LED home-use is now widely spread. In dermatology, numerous reports have stated their results for many indications: wound healing process, rejuvenation, acne and, of course, photodynamic therapy. Nevertheless, fluence, pulse duration and color of the LED are so variable as it is difficult to bring well codified results. But how should you not be interested in this field? It is already any more a near future but well and truly a therapeutic reality…

Br J Dermatol. 2009 Jun;160(6):1273-85. Epub 2009 Feb 23.

Laser and other light therapies for the treatment of acne vulgaria: systematic review.

Hamilton FL, Car J, Lyons C, Car M, Layton A, Majeed A.

Department of Primary Care and Social Medicine, Imperial College London, UK. f.hamilton@imperial.ac.uk

BACKGROUND: Acne is common and can lead to scarring of the skin, as well as to psychological distress and reduced self-esteem. Most topical or oral treatments for acne are inconvenient and have side-effects. Laser and other light therapies have been reported to be convenient, safe and effective in treating acne.

OBJECTIVES: To carry out a systematic review of randomized controlled trials of light and laser therapies for acne vulgaris.

METHODS: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, PsycInfo, LILACS, ISI Science Citation Index and Dissertation Abstracts International for relevant published trials.

RESULTS: We identified 25 trials (694 patients), 13 of light therapy and 12 of light therapy plus light-activated topical cream (photodynamic therapy, PDT). Overall, the results from trials of light alone were disappointing, but the trials of blue light, blue-red light and infrared radiation were more successful, particularly those using multiple treatments. Red-blue light was more effective than topical 5% benzoyl peroxide cream in the short term. Most trials of PDT showed some benefit, which was greater with multiple treatments, and better for noninflammatory acne lesions. However, the improvements in inflammatory acne lesions were not better than with topical 1% adapalene gel, and the side-effects of therapy were unacceptable to many participants.

CONCLUSIONS: Some forms of light therapy were of short-term benefit. Patients may find it easier to comply with these treatments, despite the initial discomfort, because of their short duration. However, very few trials compared light therapy with conventional acne treatments, were conducted in patients with severe acne or examined long-term benefits of treatment.

J Drugs Dermatol. 2009 Mar;8(3):239-41.

Photopneumatic therapy for the treatment of acne.

Wanitphakdeedecha R, Tanzi EL, Alster TS.

Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.

BACKGROUND: A wide variety of laser and light-based therapies have been utilized for acne vulgaris; however, current techniques have been limited by photosensitivity issues or inconsistent results.

OBJECTIVE: To determine the clinical efficacy and side-effect profile of photopneumatic therapy for the treatment of facial acne vulgaris.

METHODS: Twenty adults with mild to severe facial acne vulgaris received 4 successive treatments at 2-week intervals with a combined photopneumatic device (intense pulsed light [IPL]: fluences = 3.6-4.2 J/cm2; negative pressure = 3 psi). Clinical improvement was evaluated on a quartile grading scale using comparative digital photographs at baseline, and 1 month and 3 months after the final treatment. Acne lesion counts were obtained at baseline, prior to each treatment session, and at the end of the study.

RESULTS: Modest reduction in acne lesion counts and global clinical improvement was seen in the majority of patients. Patients with severe acne experienced the most clinical improvement. Side effects were mild and limited to transient erythema and rare purpura. Most patients experienced acne worsening early in the treatment course.

CONCLUSION: Photopneumatic therapy is a safe and effective treatment for acne vulgaris. Patients with more severe acne respond best to treatment.

J Cosmet Laser Ther. 2009 Jun;11(2):125-8.

A study to determine the effect of combination blue (415 nm) and near-infrared (830 nm) light-emitting diode (LED)therapy for moderate acne vulgaris.

Sadick N.

Weill Cornell Medical College, New York, NY, USA. nssderm@sadickdermatology.com

BACKGROUND AND OBJECTIVE: Acne vulgaris remains a major problem in dermatological practice. Phototherapy for acne with blue (415 nm) and red (633 nm) light-emitting diode (LED) arrays has recently attracted attention. This pilot study assessed the efficacy of the combination of 415 nm and near-infrared (IR) LED therapy for moderate acne.

METHODS: Seventeen individuals were recruited: 13 females and four males. Skin types ranged from type II to type VI, and the acne grades at baseline ranged from Burton grade 1 to 5. Patients underwent twice-weekly 20-minute sessions of LED therapy for 4 weeks, alternating between the blue (415 nm) and near-IR (830 nm) heads. No other treatment was allowed. Results were assessed and compared with the baseline values at 1, 4 and 8 weeks post-treatment.

RESULTS: Six individuals failed to complete the study. Eleven individuals showed improvement ranging from 0% to 83.3%. A downward shift in the Burton grade was seen overall. Non-inflammatory lesion counts increased in four patients, but improved in the other seven by an average of 48.8%. No adverse effects were reported.

CONCLUSIONS: The combination therapy for acne produced results which were less effective in the reduction of inflammatory lesions than those achieved with the previously reported blue/red combination. Further study with a much larger patient population is warranted.

Semin Cutan Med Surg. 2008 Sep;27(3):207-11.

Evidence for laser- and light-based treatment of acne vulgaris.

Munavalli GS, Weiss RA.

Dermatology, Laser, and Vein Specialists of the Carolinas, Charlotte, NC 28207, USA. gmunava@yahoo.com

Acne is a very prevalent skin disorder, affecting more than 85% of adolescents and often continuing into adulthood. Active acne and its sequelae, especially permanent scarring, may cause longstanding psychological or emotional harm in patients. Novel and promising treatments with laser/light devices (such as blue light, red light, pulsed dye laser, infrared lasers, light-emitting diodes, and pulsed light) have been reported to have varying degrees of efficacy for treatment. The authors compiled a summary of evidence-based literature on laser/light treatment for acne to assist clinicians to more appropriately identify treatment options, should they choose to supplement current medical antiacne therapies.

J Cosmet Dermatol. 2008 Sep;7(3):180-8.

An assessment of the efficacy of blue light phototherapy in the treatment of acne vulgaris.

Ammad S, Gonzales M, Edwards C, Finlay AY, Mills C.

Cardiff University, Cardiff, UK. s_ammad@yahoo.com

BACKGROUND: Acne vulgaris is a common skin condition that affects 8 out of 10 people. It varies from mild to severe, and different treatments target various aspects of the disease. Propionibacterium acnes, one of the culprits involved in the pathogenesis of acne vulgaris, is the main target of all major medical treatments used. Studies conducted in recent years have shown favorable effects within the visible light spectrum for the treatment of acne vulgaris.

OBJECTIVE: In this study, we have evaluated the use of intense blue light within the spectral range of 415-425 nm (peak 420 nm) in the treatment of acne vulgaris.

METHODS: Twenty-one patients with mild to moderate facial acne were treated with blue light phototherapy. All patients were given 14-min treatment sessions twice a week for 4 weeks. Acne severity was assessed using the Leeds Technique for grading and lesion counts. Disability was assessed using the Dermatology Life Quality Index (DLQI). In addition, standard digital and cross-polarized light photographs were taken and graded by a blinded evaluator. Visual analog scale (VAS) scores and cultures for P. acnes were carried out before starting the treatment and upon completion of the treatment.

RESULTS: Significant improvement was achieved in the Leeds Acne Grade (P = 0.001). The inflammatory (P = 0.001) and noninflammatory (P = 0.06) lesion counts also improved significantly. A similar change was noted in the DLQI (P = 0.001); a degree of significance was also achieved in the patients' and the investigators' VAS scores (P = 0.01 and P = 0.001, respectively). P. acnes colony counts failed to show a significant decrease at the end of the treatment and remained almost constant (P = 0.660).

CONCLUSIONS: We believe that blue light does appear to have some role in the management of acne and may be beneficial for the treatment of a select group of mild to moderate acne patients.

J Drugs Dermatol. 2008 Apr;7(4):347-50.

Handheld LED array device in the treatment of acne vulgaris.

Sadick NS.

Weill Medical College of Cornell University, Department of Dermatology, New York, NY, USA. nssderm@sadickdermatology.com

The successful treatment of acne still remains problematic. Conventional therapies often prove inconsistent with unacceptable side effects and recurrence rates, leading to patient noncompliance. A thermal phototherapy treatment using a combination of blue light and red light has recently attracted much attention and seems to offer an effective alternative. The objective of this study was to evaluate the efficacy of blue light (415 nm) in combination with red light (633 nm) in the reduction of inflammatory lesions on the face of subjects (n=21) with mild to moderate acne vulgaris after a course of 8 20-minute (blue) or 30-minute (red) alternated light treatments, self-administered by a handheld unit over a period of 4 weeks. Lesion counts progressively reduced throughout the 4-week light therapy period and continued to reduce up to 8 weeks posttherapy, with a final average reduction of 69% seen 8 weeks after the treatment course (P>.001). This pattern is similar to previously reported studies.

J Eur Acad Dermatol Venereol. 2008 Mar;22(3):267-78. Epub 2008 Jan 23.

Evidence-based review of lasers, light sources and photodynamic therapy in the treatment of acne vulgaris.

Haedersdal M, Togsverd-Bo K, Wulf HC.

Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.

Background There is a considerable need for effective and safe treatment for acne vulgaris.  Objective In a systematic review with an evidence-based approach to assess the effects of optical treatments for acne vulgaris. Methods Original publications of controlled clinical trials were identified through searches in PubMed and the Cochrane Library. Results A total of 16 randomized controlled trials (RCT) and 3 controlled trials (CT) were identified, involving a total of 587 patients. Interventions included photodynamic therapy (PDT; 5 RCTs), infrared lasers (4 RCTs), broad-spectrum light sources (3 RCTs, 1 CT), pulsed dye lasers (PDL; 2 RCTs, 1 CT), intense pulsed light (IPL; 1 RCTs, 2 CTs), and potassium titanyl phosphate laser (1 RCT). The randomization method was mentioned in 6 of 16 RCTs, and one trial described adequate allocation concealment. Most trials were intraindividual trials (12 of 19), which applied blinded response evaluations (12 of 19) and assessed a short-term efficacy up to 12 weeks after treatment (17 of 19). Based on the present best available evidence, we conclude that optical treatments possess the potential to improve inflammatory acne on a short-term basis with the most consistent outcomes for PDT [up to 68% improvement, aminolevulinic acid (ALA), methyl-aminolevulinic acid (MAL) and red light]. IPL-assisted PDT seems to be superior to IPL alone. Only two trials compare optical vs. conventional treatments, and further studies are needed. Side-effects from optical treatments included pain, erythema, oedema, crusting, hyperpigmentation, pustular eruptions and were more intense for treatments combined with ALA or MAL. Conclusion Evidence from controlled clinical trials indicates a short-term efficacy from optical treatments for acne vulgaris with the most consistent outcomes for PDT. We recommend that patients are preoperatively informed of the existing evidence, which indicates that optical treatments today are not included among first line treatments.

J Drugs Dermatol. 2008 Feb;7(2):139-45.

Photopneumatic technology for the treatment of acne vulgaris.

Shamban AT, Enokibori M, Narurkar V, Wilson D.

Laser Institute for Dermatology and European Skin Care, Santa Monica, CA 90404, USA.

OBJECTIVE: Treatment of acne vulgaris with light sources necessitates multiple targets including Propionibacterium acnes and sebaceous glands. Traditional light sources such as blue light capitalize on P acnes bacteria as targets while infrared lasers and radiofrequency devices target the sebaceous gland. A novel device combining vacuum and a unique broadband light source was designed to combine multiple targets for the effective treatment of acne. The objective of this study was to demonstrate the safety and efficacy of a novel device that uses a combination of broadband light and pneumatic energy for the treatment of acne vulgaris.

METHODS: In a retrospective multicenter study, clinical data were collected from 56 patients with mild to severe acne. Patients had been treated 2 to 4 times with a portable photopneumatic device (Aesthera PPx, Aesthera Corporation, Pleasanton, CA) that delivers broadband light (400 to 1200 nm) to the treatment site via a hand piece. For 11 of the 56 patients, 3 independent physicians blinded to the study treatment or duration evaluated PPx efficacy by comparing photographs taken before and after PPx treatment.

RESULTS: For the 56 patients, the median physician-rated clearance increased from 50% after a single treatment to 90% after the fourth treatment, whereas the median patient-rated clearance improved from 50% after a single treatment to 78% after the fourth treatment. On a 4-point scale, both physician-rated and patient-rated median overall satisfaction levels increased from a 3 after a single treatment, to 4 after the second, third, and fourth treatments. Clinically significant adverse events were not observed. For the 11 patients evaluated by photography, the median papule and pustule lesion counts decreased from 8 to 3 and from 2 to 0, respectively. Median acne severity (Burton scale) decreased from 4 before treatment to 2 after the final treatment, and the median improvement was 4.5 (scale 1-5). The median erythema rating decreased from 2 before treatment to 1 after the final treatment (scale 1-4). Adverse events were limited to mild erythema. The median acne clearance was 3 (scale 1-4).

CONCLUSION: Photopneumatic technology provides a safe and effective treatment of mild to severe acne vulgaris.

Dermatol Surg.  2007 Oct;33(10):1228-33; discussion 1233.

Red light phototherapy alone is effective for acne vulgaris: randomized, single-blinded clinical trial.

Na JI, Suh DH.

Source

Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea.

Abstract

BACKGROUND:

Recently, a demand for safe and effective treatment of acne has been increasing. Although visible light has attracted attention as a new option, the effect of red light alone has not yet been evaluated.

OBJECTIVES:

The objective was to assess the efficacy of red light phototherapy with a portable device in acne vulgaris.

METHODS:

Twenty-eight volunteers with mild to moderate acne were treated with portable red light-emitting devices in this split-face randomized trial. The right or left side of the face was randomized to treatment side and phototherapy was performed for 15 minutes twice a day for 8 weeks. Clinical photographs, lesion counts, and a visual analog scale (VAS) were used to assess each side of the face at baseline and Weeks 1, 2, 4, and 8, and a split-face comparison was performed.

RESULTS:

The percent improvement in noninflammatory and inflammatory lesion counts of the treated side was significant compared to the control side (p<.005). VAS decreased from 3.9 to 1.9 on the treatment side and the difference between the treatment and control sides was significant at Week 8 (p<.005).

CONCLUSIONS:

This study shows that red light phototherapy alone can be a new therapeutic option for acne vulgaris.

J Drugs Dermatol. 2007 Aug;6(8):838-40.

Combination of a new radiofrequency device and blue light for the treatment of acne vulgaris.

Braun M.

Vancouver Laser and Skin Care Centre Inc, Vancouver, BC, Canada. info@vancouverlaser.com

Acne vulgaris is the most common skin disease treated by physicians. Current topical and oral treatments may have short- and long-term negative consequences. Since radiofrequency (RF) energy has been shown to reduce sebum production and 410-nm blue light has been shown to kill Propionibacterium acnes (P. acnes) cells, these modalities in combination should be a highly effective treatment of acne vulgaris with little or no downtime or risk. This case report describes the efficacy and safety of RF energy (Accent, Alma Lasers Inc, Buffalo Grove, IL) and blue light (BLU-U, Dusa Pharmaceuticals, Inc, Wilmington, MA) used in combination to treat grade 4 cystic acne and acne scars in an Asian woman of skin type IV. The results were considered excellent by both investigators and the patient, with improvement in the skin tone as an added cosmetic benefit.

J Cosmet Laser Ther. 2006 Jun;8(2):71-5.

Combination blue (415 mm) and red (633 nm) LED phototherapy in the treatment of mild to severe acne vulgaris.

Goldberg DJ, Russell BA.

Skin Laser & Surgery Specialists of New York/New Jersey, and Department of Dermatology, Mount Sinai School of Medicine, New York, NY 10022, USA. drdavidgoldberg@skinandlasers.com

BACKGROUND AND OBJECTIVE: Acne vulgaris represents both a challenge to the treating dermatologist and a major concern for the patient. Conventional treatments have proved inconsistent with often unacceptable side effects and high rates of recurrence. Non-thermal, non-laser, phototherapy for acne with a combination of blue and red light has recently attracted attention. The present study was designed to assess the efficacy of this combination phototherapy.

METHODS: Twenty-four subjects, Fitzpatrick skin types II-V, with mild to severe symmetric facial acne vulgaris were recruited for the study. Subjects were well matched at baseline in terms of both age and duration of acne. Subjects were treated over eight sessions, two per week 3 days apart, alternating between 415 nm blue light (20 minutes/session, 48 J/cm2) and 633 nm red light (20 minutes/session, 96 J/cm2) from a light-emitting diode (LED)-based therapy system. Patients received a mild microdermabrasion before each session. Acne was assessed at baseline and at weeks 2, 4, 8 and 12.

RESULTS: Twenty-two patients completed the trial. A mean reduction in lesion count was observed at all follow-up points. At the 4-week follow-up, the mean lesion count reduction was significant at 46% (p=0.001). At the 12-week follow-up, the mean lesion count reduction was also significant at 81% (p=0.001). Patient and dermatologist assessments were similar. Severe acne showed a marginally better response than mild acne. Side effects were minimal and transitory. Comedones did not respond as well as inflammatory lesions.

CONCLUSIONS: Combination blue and red LED therapy appears to have excellent potential in the treatment of mild to severe acne. Treatment appears to be both pain- and side effect-free.

J Cosmet Laser Ther.  2006 Apr;8(1):31-3.

Light-emitting diode 415 nm in the treatment of inflammatory acne: an open-label, multicentric, pilot investigation.

Tremblay JF, Sire DJ, Lowe NJ, Moy RL.

Source

UCLA School of Medicine, Los Angeles, CA, USA.

Abstract

BACKGROUND:

The management of acne remains a challenge, with current therapies linked to significant side effects and patient non-compliance. Phototherapy using blue light has been proven in the treatment of acne vulgaris and offers the clinician an effective alternative.

OBJECTIVE:

To determine the effect of narrowband light-emitting diode (LED) blue light in the reduction of inflammatory and non-inflammatory lesions in patients with mild to moderate acne and to evaluate patient tolerance of the therapy.

METHODS:

Forty-five patients were treated with high-intensity pure blue light, 415 nm and 48 J/cm2, receiving two treatments of 20 minutes per week for a period of 4-8 weeks. Clinical assessment was performed at baseline, and 2, 4 and 8 weeks after treatment. A patient's therapeutic response was measured using a global improvement scoring system.

RESULTS:

The mean improvement score was 3.14 at 4 weeks and 2.90 at 8 weeks. Nine patients experienced complete clearing at 8 weeks. The treatment was well tolerated, with 50% of patients highly satisfied with the treatment.

CONCLUSION:

This open-label study suggests the therapeutic efficacy of high-intensity LED pure blue light in the treatment of acne vulgaris with no reported side effects.

Dermatol Ther. 2005 May-Jun;18(3):253-66.

Optical treatments for acne.

Ross EV.

Dermatology Department, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134, USA. evross@nmcsd.med.navy.mil

Light-based treatments for acne are becoming increasingly commonplace in dermatology. This article reviews various light approaches in acne therapy. Methods are discussed from an anatomical and a functional perspective. The emphasis is on the practicality of treatment as well as the pros and cons of various devices. Also, a review of the recent literature is presented. The article is intended to give the reader a panoramic view of this still-young and developing area. Most likely, light-based acne treatment will receive more popularity as dermatologists learn how to integrate this type of therapy within the context of more established drug agents.

1: Hautarzt. 2005 Nov;56(11):1027-32.

Light, laser and PDT therapy for acne

[Article in German]

Borelli C, Merk K, Plewig G, Degitz K.

Klinik für Dermatologie und Allergologie der Ludwig-Maximilians-Universität München. c.borelli@med.uni-muenchen.de

In recent years, a number of studies have evaluated the treatment of acne using electromagnetic waves, such as lasers, photodynamic therapy, visible light or radio waves. While the efficacy of laser treatment is still uncertain, photodynamic therapy shows promising results, but with marked side-effects, as destruction of sebaceous glands. Treatment with blue light (405-420 nm wavelength) also appears effective and can be regarded as an treatment option for inflammatory acne.

Semin Cutan Med Surg. 2005 Jun;24(2):107-12.

Lasers and light therapy for acne vulgaris.

Bhardwaj SS, Rohrer TE, Arndt K.

Department of Dermatology, University of Minnesota, USA.

Acne vulgaris remains an emotionally and debilitating dermatologic disease, and is conventionally treated with a variety of oral and topical therapies with a number of significant side effects. An evolving understanding of laser-tissue interactions involving Propionibacterium acnes-produced porphyrins, and the development of infrared nonablative lasers to target sebaceous glands, has lead to the development of an escalating number of laser, light and radiofrequency devices for acne. Used as monotherapy or in combination, these devices are showing promise as a method to clear acne in a convenient, non-invasive manner, though there remains a clear need for long-term data and randomized, blinded studies.

J Cosmet Dermatol. 2005 Dec;4(4):318-20

Light/laser therapy in the treatment of acne vulgaris.

Nouri K, Villafradez-Diaz LM.

Department of Dermatology, University of Miami School of Medicine, Miami, FL.

Acne vulgaris is one of the most prevalent skin diseases known. As common as this condition is, the social and psychological consequences are limitless. Although current treatments are available and include topical or oral antibiotics, it is crucial to develop a less risky and more effective therapy such as light/laser therapy. This article focuses specifically on the benefits of the light/laser treatment on acne vulgaris. Porphyrins accumulated in the bacteria, Propionibacterium acnes, one of the etiologic factors involved in the pathogenesis, allows phototherapy to be a successful modality. They have specific absorption peaks at which lasers have optimal effects. The longer the wavelength of the light is, the deeper its penetration and thus the greater its damage to the sebaceous glands. Although blue light is best for the activation of porphyrins, red light is best for deeper penetration and an anti-inflammatory effect. Ultraviolet (UV) light, although it may have initial an anti-inflammatory effects, has been proven to be potentially carcinogenic and have adverse effects such as aging (by UV-A) and burning (by UV-B). Previous studies indicate successful long-term intervention and selective damage of the sebaceous glands by using a diode laser with indocyanine green (ICG) dye. Mid-infrared lasers have been found to decrease lesion counts while also reducing the oiliness of skin and the scarring process. Nonablative laser treatment of acne scars using the Er:YAG laser with a short-pulsed mode has been successful in reducing the appearance of scars by stimulating neocollagenesis. The light/laser therapy has started to be explored with promising results in highly selected patients that require further investigation in greater populations and well-designed protocols.

J Dermatolog Treat.  2005;16(4):219-23.

An open study to determine the efficacy of blue light in the treatment of mild to moderate acne.

Morton CA, Scholefield RD, Whitehurst C, Birch J.

Source

Department of Dermatology, Falkirk Royal Infirmary, Falkirk, UK. colin.morton@fvah.scot.nhs.uk

Abstract

BACKGROUND:

The effective management of acne remains a challenge; achieving an optimal response whilst minimizing adverse events is often difficult. The rise in antibiotic resistance threatens to reduce the future usefulness of the current mainstay of therapy. The need for alternative therapies remains important. Phototherapy has previously been shown to be effective in acne, with renewed interest as both endogenous and exogenous photodynamic therapies are demonstrated for this condition.

OBJECTIVES:

To determine the effect of narrowband blue light in the reduction of inflammatory and non-inflammatory lesions in patients with mild to moderate acne and to evaluate patient tolerance of the therapy.

METHODS:

We performed an open study utilizing a blue LED light source in 30 subjects with mild to moderate facial acne. Two weeks after screening, lesions were counted and recorded by lesion type. Over 4 weeks, patients received eight 10- or 20-minute light treatments, peak wavelength 409-419 nm at 40 mW/cm2. Assessments were taken at weeks 5, 8 and 12 and lesion counts were recorded. Repeated measures-ANOVA and Dunnett's tests, respectively, allowed assessment of the different scores over time and permitted comparison of mean counts.

RESULTS:

An overall effect on inflammatory counts was observed at week 5, and a statistically significant decrease in inflamed counts was detected at the week 8 assessments, which continued to week 12. There was little effect on non-inflamed lesions. The treatment was well tolerated with adverse events experienced generally rated as being mild and usually self-limiting.

CONCLUSIONS:

Eight 10- or 20-minute treatments over 4 weeks with a narrowband blue light was found to be effective in reducing the number of inflamed lesions in subjects with mild to moderate acne. The treatment had little effect on the number of comedones. The onset of the effect was observable at the first assessment, at week 5, and maximal between weeks 8 and 12. Blue light phototherapy using a narrowband LED light source appears to be a safe and effective additional therapy for mild to moderate acne.

Am J Clin Dermatol. 2004;5(4):211-6.

Phototherapy in the treatment of acne vulgaris: what is its role?

Charakida A, Seaton ED, Charakida M, Mouser P, Avgerinos A, Chu AC.

Department of Dermatology, Faculty of Medicine, Hammersmith Campus, Imperial College, London, UK. e.charakida@imperial.ac.uk

Acne vulgaris is a common dermatosis affecting 80% of the population. To date, different treatments have been used to manage this condition. Antibacterials and retinoids are currently the mainstay of treatment for acne, but their success rate varies. Phototherapy is emerging as an alternative option to treat acne vulgaris. Studies examining the role of different wavelengths and methods of light treatment have shown that phototherapy with visible light, specifically blue light, has a marked effect on inflammatory acne lesions and seems sufficient for the treatment of acne. In addition, the combination of blue-red light radiation seems to be superior to blue light alone, with minimal adverse effects. Photodynamic therapy has also been used, even in nodular and cystic acne, and had excellent therapeutic outcomes, although with significant adverse effects. Recently, low energy pulsed dye laser therapy has been used, and seems to be a promising alternative that would allow the simultaneous treatment of active acne and acne scarring. Further studies are needed to clarify the role of phototherapy as a monotherapy or an adjuvant treatment in the current management of acne vulgaris.

Dermatol Surg. 2004 Feb;30(2 Pt 1):139-46.

Light therapy in the treatment of acne vulgaris.

Elman M, Lebzelter J.

Dermatology and Lasers Clinic, Tel Aviv Msq, Caesarea, Israel.

BACKGROUND: Over the past decade, lasers and light-based systems have become a common modality to treat a wide variety of skin-related conditions, including acne vulgaris. In spite of the various oral and topical treatments available for the treatment of acne, many patients fail to respond adequately or may develop side effects. Therefore, there is a growing demand by patients for a fast, safe, and side-effect-free novel therapy.

OBJECTIVES: To address the role of light therapy in the armamentarium of treatments for acne vulgaris, to discuss photobiology aspects and biomedical optics, to review current technologies of laser/light-based devices, to review the clinical experience and results, and to outline clinical guidelines and treatment considerations.

RESULTS: Clinical trials show that 85% of the patients demonstrate a significant quantitative reduction in at least 50% of the lesions after four biweekly treatments. In approximately 20% of the cases, acne eradication may reach 90%. At 3 months after the last treatment, clearance is approximately 70% to 80%. The nonrespondent rate is 15% to 20%.

CONCLUSIONS: Laser and light-based therapy is a safe and effective modality for the treatment of mild to moderate inflammatory acne vulgaris. Amelioration of acne by light therapy, although comparable to the effects of oral antibiotics, offers faster resolution and fewer side effects and leads to patient satisfaction.

J Cosmet Laser Ther. 2004 Dec;6(4):191-200.

The new age of acne therapy: light, lasers, and radiofrequency.

Rotunda AM, Bhupathy AR, Rohrer TE.

Division of Dermatology, David Geffen School of Medicine, UCLA Medical Center, Los Angeles, CA, USA.

BACKGROUND: Current treatments for acne vulgaris include topical and oral medications that counteract microcomedone formation, sebum production, Propionibacterium acnes, and inflammation. Concerns about the short- and long-term consequences of these medications, along with technological advancements, have to significant progress in the management of acne. These developments include light, laser, and radio frequency, which may offer faster onset of action, equal or greater efficacy, and greater convenience than traditional approaches. CONCLUSION: Research emphasizing long-term follow-up and comparative, randomized trials is necessary to determine whether these emerging technologies will become a viable alternative to standard therapies such as antibiotics.

Cutis. 2003 May;71(5):353-4.

Lasers, light, and acne.

Hirsch RJ, Shalita AR.

Wellman Laboratories of Photomedicine, Massachusetts General Hospital, Boston 02114, USA. rjhirsch@partners.org

Acne vulgaris is a highly prevalent disease with significant potential for physical and emotional scarring. Acne lesions have long been noted to improve after exposure to sunlight. This improvement may be secondary to activation of endogenous porphyrins produced by Propionibacterium acnes. Recently, several investigators have presented studies in which light of particular wavelengths has been used to treat acne vulgaris. In this article, we review the results of these studies as we look to the future of light-based acne treatment.