Efficacy and safety of intense pulsed light in the treatment of inflammatory acne vulgaris with a novel filter

Acne vulgaris is one of the most common skin diseases affecting young people. Intense pulsed light (IPL) has become a well-recognized method in the treatment of acne vulgaris. We aim evaluate the clinical efficacy and safety of a novel IPL filter at wavelength of 400–600 nm and 800–1,200 nm in the treatment of inflammatory acne lesions. Twenty-one patients with Pillsbury I–III facial acne vulgaris between July 2017 and January 2018 were enrolled in this prospective clinical study. Five sessions of IPL treatment were administered to the subjects at 4-week interval. Final assessment was performed 1 month after the final treatment. One month posttreatment, over 75% subjects exhibited excellent or good response. Of the Pillsbury I–II patients, the effective rate reached 88.24%. The inflammatory lesions were dramatically decreased (25.23 ± 2.76 versus 14.01 ± 1.98) and statistically evident (P = .031). According to Hayashi assessment of acne severity, there was a significant improvement at follow-up visit (P = .022). Moreover, patients reported significant improvements in self-evaluation. The novel IPL filter at wavelength of 400–600 nm and 800–1,200 nm provides an effective option to treatment of inflammatory acne lesions, especially for Pillsbury I–II acne patients, with minimal reversible side effects, such as transient post-inflammatory pigmentation.     

Investigator-blind,placebo-controlled,randomized comparative study on combined vacuum and intense pulsed light versus intense pulsed light devices in both comedonal and papulopustular acne

Abstract

Introduction: The aim was to compare the treatment effectiveness of intense pulsed light (IPL) and vacuum versus IPL with placebo for mild to moderate comedonal and inflammatory acne. Patients and methods: We randomized 180 patients with mild to moderate comedonal and inflammatory acne into three groups: Group A – 60 patients treated with vacuum and IPL, Group V – 60 patients treated with IPL, and Group 0 (control group) – 60 patients who received topical treatment with Sebium H₂O Micellaire Solution. We evaluated the results using the Leeds revised acne-grading system and Cardiff Acne Disability Index. Results: There was a significant reduction in the number of papules, pustules, and comedones in Groups A and V compared with those in the control group (p < 0.001) with a more rapid decrease of the papules from Group A compared with that from Group V. We found an improvement in the clinical aspect (p < 0.001) when we compared Groups A and V with controls. Patients belonging to Group A were more satisfied compared with those belonging to Group V (p = 0.004) and significantly more satisfied compared with those belonging to Group 0 (p < 0.001). In conclusion, we consider that both the devices are efficient, the combination of vacuum and IPL representing a therapeutic option for the comedonal acne.     

420nm强脉冲光联合氯霉素搽剂治疗面部中重度痤疮疗效观察

目的观察420nm强脉冲光联合氯霉素搽剂治疗中重度寻常痤疮的疗效。方法将78例面部中重度寻常痤疮患者随机分为两组,观察组40例采用420nm强脉冲光联合氯霉素搽剂治疗;对照组38例单纯外用氯霉素搽剂治疗。结果观察组和对照组有效率分别为77．5％和47．37％,观察组疗效和有效率明显高于对照组（P〈0．01）。结论420nm强脉冲光联合氯霉素搽剂治疗中重度寻常痤疮的疗效优于单纯外用氯霉素搽剂。     

Photodynamic therapy with intralesional 5-aminolevulinic acid and intense pulsed light versus intense pulsed light alone in the treatment of acne vulgaris: a comparative study

Despite the availability of many treatment modalities for acne vulgaris (AV), few of which provide excellent results. Photodynamic therapy (PDT) was shown to be an effective treatment especially when used with topical 5-aminolevulenic acid (ALA). We compared the efficacy and safety of PDT using intralesional ALA (IL-ALA) with intense pulsed light (IPL) and IPL alone in the treatment of AV. This study was carried on 30 patients with nodulocystic and inflammatory AV on the face and back. The right side of the body was treated with IL-ALA plus IPL, while the left side was treated with IPL alone. All patients experienced a reduction in number of acne lesions on both sides of the body, but the reduction was significantly more in PDT side than IPL only side. Recurrence of the lesions was significantly more likely in the IPL only side. There was no statistically significant difference between the face and back lesions in drug side effects and recurrence of the lesions. We concluded that photodynamic therapy in this cohort is effective in the treatment of AV when combined with IL-ALA. It gives superior results compared with IPL alone with minimal and tolerable side effects and less recurrence rates.     

Phototherapy,photodynamic therapy and lasers in the treatment of acne

Modern acne therapy uses anticomedogenic, antimicrobial, antiinflammatory, and antiandrogenic substances. As an additional approach in recent years, treatments have been developed based on the application of electromagnetic radiation. Visible light or infrared wave lengths are utilized by most techniques, including blue light lamps, intense pulsed light, photodynamic therapy and lasers. This review evaluates the various methods with regard to efficacy and their current role in the management of acne. Although UV radiation has been frequently used to treat acne, it is now regarded as obsolete due to the unfavorable risk‐benefit ratio. Visible light, especially of blue wavelengths, appears to be suitable for the treatment of mild to moderate inflammatory acne. Photodynamic therapy is effective, but, due to considerable immediate side effects, it is best reserved for selected situations. Despite promising observations, intense pulsed light and lasers have to be evaluated in further studies, before they can be recommended.     

Rhodamine intense pulsed light versus conventional intense pulsed light for facial telangiectasias

Facial telangiectasias represent the major aesthetic alterations of several chronic inflammatory disorders arising on facial skin. We herein report on relevant clinical results of a new subtype of intense pulsed light treatments, the so-called rhodamine intense pulsed light (r-IPL), in comparison with conventional IPL (c-IPL) treatments on forty-five patients affected by facial telangiectasias. The aim of this study is to determinate whether r-IPL represents an effective and safe treatment for the most common superficial vascular alterations and could be advised as a first choice therapy for facial telangiectasias.     

新型强脉冲光治疗面部寻常痤疮的疗效观察

2005年7月至2007年8月,我科用具有优化脉冲技术的新型强脉冲光(intense pulsed light,IPL)治疗116例面部寻常痤疮患者,取得满意疗效. 一、临床资料 依据靳培英[1]标准,寻常痤疮严重程度分为轻(Ⅰ级)、中(Ⅱ级和Ⅲ级)、重(Ⅳ级),选择病情为Ⅱ～Ⅲ级的面部寻常痤疮患者116例,男46例,女70例;年龄18～42岁,平均(23.12±5.34)岁;病程2个月至13年,平均(2.76±1.58)年.其中Ⅱ级79例:有粉刺,伴有中等量的丘疹和脓疱,总数31～50个;Ⅲ级37例:有粉刺,伴有大量的丘疹和脓疱,偶见大的炎性损害,分布广泛,总数51～100个,有少数结节.排除标准:有光敏史者;1年内外用或口服光敏性药物者,如维A酸类药物;近期内服用其他药物(如糖皮质激素)者;正在使用其他方法治疗痤疮者;2周内经受日光曝晒者;妊娠及哺乳期患者;有精神疾患者.     

Vitiligo following intense pulsed light treatment

Vitiligo is an acquired depigmenting disorder characterized by the progressive loss of melanocytes from the epidermis and epidermal appendages, which results in milky‐white macular lesions. Various factors are suspected to affect the induction and progression of vitiligo such as emotional shock, sunburn, pregnancy, physical illness and trauma. The intense pulsed light (IPL) device which mostly affects redness and dyspigmentation has a broad spectrum of emissions of white light with wavelengths between approximately 515 and 1200 nm. Adverse effects such as purpura and pigmentary changes are known to be rare. We present a 41‐year‐old woman who developed multiple round, hypopigmented macules on both the cheek and mandibular area following the treatment with IPL for lentigines and dyspigmentation. Based on biopsy and Wood’s lamp examination, diagnosis as vitiligo was made. She was treated with a 308‐nm excimer laser. After 3 months of treatment, almost complete repigmentation was seen but another coin‐sized hypopigmented patch was noted after 5 months later. Herein, we report a case of vitiligo which developed after IPL treatment. This is the first case to be reported which vitiligo developed after IPL treatment. Therefore, dermatologists should be aware of unsighted vitiligo lesion before IPL treatment.     

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

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.     

Use of intense pulsed light in the treatment of scars

Background Reducing erythema and infiltration of inflamed, hypertrophic, and colloidal scars have been a challenge for healthcare providers. Peer‐reviewed scientific data for intense pulsed light systems are lacking. Objective A chronicle of three patients who have participated in the treatment of inflamed, hypertrophic, and colloidal scars, using intense pulsed light. Methods Intense pulsed light with a selection of wavelengths, pulse durations, and energy densities was used on patients with inflamed, hypertrophic, and colloidal scars. Results A definite improvement in scar tissue was observed and achieved in all the cases. Conclusion Intense pulsed light source with the correct outputs is an effective tool for the treatment and improvement of inflamed, hypertrophic, and colloidal scars.     

强脉冲光脱毛的疗效观察及分析

目的 观察强脉冲光脱毛的疗效和治疗时间，以及能量密度、毛发部位及皮肤类型对脱毛效果的影响。方法 574例患者，采用美国科医人公司生产的IPL Quantum HR仪器进行治疗。结果 574例患者中，57例患者自动放弃治疗（只治疗了1次未随访，未记入统计数据），517例患者取得了满意疗效，治疗毛发再生减少，再生时间延迟，再生毛发较前细小，色泽较前变淡。治疗早期，2例发生热损伤。结论 强脉冲光脱毛方便快捷，疗效满意，不良反应少．治疗效果在适当能量密度下与治疗次数呈正相关关系，亦与治疗部位有关。     

Increased in situ expression of melanocortin-1 receptor in sebaceous glands of lesional skin of patients with acne vulgaris

Central or peripheral stress may induce the development of clinical inflammation in the pilosebaceous unit, leading to the development of acne lesions or to exacerbation of pre-existing acne. Melanocortin peptides such as alpha-melanocyte-stimulating hormone and its receptors do not only regulate melanogenesis but can also affect non-pigmentary processes, such as inflammation, apoptosis and sebogenesis. The purpose of the study was to investigate by immunohistochemistry if changes of melanocortin-1 receptor expression exist in acne lesions versus normal skin. In all, 33 patients with acne vulgaris and seven age-matched volunteers without acne participated in the study. Skin biopsies were taken from acne-involved faces, the non-involved thigh skin of the same patients and from normal human skin. Melanocortin-1 receptor immunoreactivity was most prominently detectable in adnexal structures. Sebocytes and keratinocytes of the ductus seboglandularis of acne-involved and non-involved skin showed very intense melanocortin-1 receptor expression in contrast to less intense scattered immunoreactivity in normal skin samples. These data suggest that melanocortin-1 receptor is involved in the pathogenesis of acne.     

Comparative efficacy of short-pulsed intense pulsed light and pulsed dye laser to treat rosacea

Background: Laser and light-based therapies have often been used successfully to treat rosacea. Recently, short-pulsed intense pulsed light (IPL) that emitted pulse durations down to 0.5 ms was found to be effective for rosacea treatment.

Objective: This study evaluated the efficacy of short-pulsed IPL in the treatment of rosacea compared with pulsed dye laser (PDL) using same pulse duration and fluence.

Materials and Methods: Nine patients with rosacea were enrolled in a randomized, split-face trial. Each treatment consisted of four sessions at three-week intervals and followed up until three weeks after the last treatment. Efficacy was assessed by erythema, melanin index, physician’s subjective evaluation, and patient’s satisfaction.

Results: The mean change in erythema index was ?4.93 ± 1.59 for the short-pulsed IPL group and ?4.27 ± 1.23 for the PDL group. The mean change in melanin index was ?2.52 ± 2.45 for the short-pulsed IPL group and ?1.95 ± 1.41 for the PDL group. There was no significant difference in either melanin or erythema index between short-pulsed IPL and PDL treatments, and there were no noticeable adverse events.

Conclusions: There was no significant difference between PDL and short-pulsed IPL treatment using the same energies and pulse. Both PDL and short-pulsed IPL were satisfactory and safe for rosacea treatment.     

Photorejuvenation of the forearms by treating hyperpigmented lesions with intense pulsed light source: a case report

A 55 year old Spanish patient, photo type III, wanted a cosmetic improvement of her forearms. She disliked the hyperpigmentation which made her look older.

METHOD: After having tried several chemical peelings (50% glycolic acid plus 10% kojic acid followed by 15% MM TCA), there was no improvement in the patients's condition and it was decided to initiate intense pulsed light (IPL) treatment.

RESULTS: Improvement was noted after the first session, with a slight pink coloration. At two months post treatment, we noted more than 90% clearance of the hyperpigmentation on the treated areas.

CONCLUSION: This case report confirms that photorejuvenation, by treating hyperpigmented lesions with intense pulsed light source on extra‐facial zones can be very effective and safe.     

The use of lasers and intense pulsed light sources for the treatment of acquired pigmentary lesions in Asians

Asians are prone to the development of lentigines as a result of photoageing. Lasers and intense pulsed light sources have been used in the treatment of lentigines but there is a risk of post‐inflammatory hyperpigmentation in Asian skin. This report examines the role of lasers and intense pulsed light sources in treating lentigines and other acquired pigmentary lesions in Asians.