Optimising the design of a broad‐band light source for the treatment of skin

Phototherapy has become a treatment of choice in many areas of medicine. Light can be used to deliver energy to tissue selectively targeting specific structures in order to induce the desired therapeutic outcome. The choice of optical parameters for a specific application is not simple. Wavelength, energy, exposure time and fluence can be varied and induce a wide range of tissue effects. The treatment of the skin with light is probably the one phototherapy application that is most developed in terms of technology and market maturity. White light systems are extensively used to address a range of skin conditions. However, different conditions have different physiology and hence require differing optical parameters. The technology standard is based upon systems, which have a number of different optical filters allowing the output to be tailored to the specific application. This paper discusses the advantages of a diferent type of system, namely the iPulse i300 (Cyden Ltd, Swansea, UK), which uses a single dichroic reflectance filter and whose optical output is changed by varying other parameters in a carefully controlled manner.     

Treatment of inflammatory facial acne vulgaris: Comparison of the 1450‐nm diode laser and conventional physical treatment

The efficacy of the 1450‐nm diode laser in the treatment of inflammatory facial acne was evaluated by comparing it with conventional physical treatment. Seventeen patients received laser treatment on the right side of the face and conventional physical treatment on the other side. The two modalities were compared through photographs, inflammatory acne lesion counts, and a patient questionnaire. Clinical response was evaluated in 16 patients. Evaluation of baseline and follow‐up photographs indicated that more improvement was obtained after laser treatment than by physical treatment in six patients. In two patients, physical treatment yielded better results than laser treatment. Equal effect was obtained in eight patients. All patients had a reduction in the inflammatory acne lesion count on the laser‐treated side, which was statistically significantly greater on the laser‐treated side compared with the side treated physically (p = 0.039, Wilcoxon signed ranks test). By the assessment of patient satisfaction, seven patients preferred laser treatment, two patients preferred physical treatment and three patients found laser treatment equal to physical treatment. Questionnaire details could not be obtained in 4 patients. This study indicates that the 1450‐nm diode laser is a new option for local treatment of acne.     

Light‐emitting diode 415 nm in the treatment of inflammatory acne: An open‐label,multicentric, pilot investigation

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.     

The dual treatment of acne vulgaris using two kinds of ELOSTM (electro optical synergy) system: A simultaneous split‐face trial

Background: RF‐pulsed light with ELOS technology devices have recently been used to treat acne vulgaris in selected patients. Objective: To investigate the safety and efficacy of a combination of two kinds of device with ELOS technology for the treatment of acne. Methods: Ten patients with moderate acne were treated twice weekly for 4 weeks with the Aurora AC® (Syneron Medical Ltd, Yokneam, Israel), a combination of pulsed light and RF energy. Immediately after Aurora AC treatment, all patients were treated weekly only on one facial half with the Matrix IR® (Syneron Medical Ltd), a combination of fractional diode laser and RF energy. Photographic documentations were obtained at baseline, before each treatment session, and 1 and 3 months after the final treatment. Results: At 3 months after treatment, the mean lesion count was reduced by 38% (p<0.05) after eight treatments with the Aurora AC alone. With additional treatment with the Matrix IR, the mean lesion count was reduced by 61%. Conclusion: The combination of Aurora AC and Matrix IR was superior in reducing the acne lesion count, and in extending the length of the remission period.     

The use of a constant spectrum,uniform temporal profile intense pulsed light source for long‐term hair removal in Asian skin

Phototherapy has become a treatment of choice in many areas of medicine. Light can deliver energy to tissue selectively, targeting specific structures in order to induce the desired therapeutic outcome. For the safe and effective removal of unwanted hair, the key optical parameters are wavelength, pulse duration and energy density, and can vary dependent upon skin and hair color. In recent years, the use of broad spectrum white light sources has proved to be safe and efficacious in the removal of hair with minimal short‐ or long‐term side effects. Whilst these highly flexible devices can achieve the desired results, there is scope for improvement. There are two key limitations to these devices: an inability to produce a ‘true’ long pulse matched to the thermal relaxation time of the hair structure and fluctuations in the output spectrum can lead to ineffective treatment with an increased risk of side effects. This paper describes an alternative approach to producing long pulse, constant spectrum optical pulses and presents clinical data showing improved efficacy in long‐term hair removal.     

Is benzoyl peroxide 3% topical gel effective and safe in the treatment of acne vulgaris in Japanese patients? A multicenter,randomized, double‐blind,vehicle‐controlled,parallel‐group study

Benzoyl peroxide (BPO) as an anti‐acne medication is not yet approved in Japan. This study evaluated the efficacy and safety of a once‐daily topical application of BPO 3% gel versus an inert vehicle gel in Japanese acne patients. Three hundred and sixty patients were randomized to receive BPO 3% or vehicle for 12 weeks. The primary efficacy end‐point was absolute change in number of total lesions (TL) from baseline to week 12 to demonstrate the superiority of BPO 3% versus vehicle. Secondary efficacy end‐points were absolute and percent change in TL, inflammatory lesions (IL), non‐inflammatory lesions (non‐IL) and Investigator's Static Global Assessment (ISGA). Change in TL counts from baseline to week 12 for BPO 3% was superior to vehicle (difference, ?21.0; P < 0.001). Absolute and percent reductions in TL, IL and non‐IL counts were greater for BPO 3% at all study visits. The proportion of patients with improvement in ISGA scores was significantly higher with BPO 3% than with vehicle from week 2. All adverse events were mild or moderate. Adverse drug‐related reactions were higher for BPO 3% (30%) than with vehicle (5%). Local tolerability scores of grade 1 or more (slight to moderate) were more frequent with BPO 3% than vehicle with the most significant differences observed in dryness (56% vs 27% at week 1–4), peeling (19% vs 9% at week 1–2) and burning/stinging (58% vs 15% at week 1–12). These results indicate that BPO 3% is effective while maintaining a favorable safety and tolerability profile in Japanese acne patients.     

Cortexolone 17α-propionate 1% cream, a new potent antiandrogen for topical treatment of acne vulgaris. A pilot randomized, double-blind comparative study vs. placebo and tretinoin 0·05% cream

Background Acne vulgaris is a disorder of the pilosebaceous unit in which the androgens contribute to its onset and persistence. The use of antiandrogens is therefore potentially effective; however, antiandrogens for topical use are not available on the market. Cortexolone 17α‐propionate (CB‐03‐01; Cosmo S.p.A, Lainate, Italy) is a new potent topical antiandrogen potentially useful in acne vulgaris. Objectives To evaluate the safety and the topical efficacy of CB‐03‐01 1% cream in acne vulgaris as compared with placebo and with tretinoin 0·05% cream (Retin‐A^®; Janssen‐Cilag). Methods Seventy‐seven men with facial acne scored 2–3 according to Investigator’s Global Assessment (IGA) were randomized to receive placebo cream (n = 15), or CB‐03‐01 1% cream (n = 30), or tretinoin 0·05% cream (n = 32) once a day at bedtime for 8 weeks. Clinical efficacy was evaluated every 2 weeks including total lesion count (TLC), inflammatory lesion count (ILC), acne severity index (ASI) and IGA. Safety assessment included local irritancy score, laboratory tests, physical examination, vital signs and recording of adverse events. Results CB‐03‐01 1% cream was very well tolerated, and was significantly better than placebo regarding TLC (P = 0·0017), ILC (P = 0·0134) and ASI (P = 0·0090), and also clinically more effective than comparator. The product also induced a faster attainment of 50% improvement in all the above parameters. Conclusions This pilot study supports the rationale for the use of topical antiandrogens in the treatment of acne vulgaris. CB‐03‐01 1% cream seems to fit with the profile of an ideal antiandrogen for topical use.