Comparison of turbo‐PUVA and conventional American‐style PUVA in the treatment of psoriatic patients

Background: Ultraviolet (UV)A protective properties of dihydroxyacetone (DHA) have been used as a topical UV‐resisting barrier to optimize psoralens and UVA (turbo‐PUVA). Starting doses and increments were based on the DHA diffuse reflectance spectroscopy‐derived protection factor. Objective: To evaluate the efficacy of turbo‐PUVA in psoriatic patients using a simpler method for determining starting doses and increments, in comparison to the conventional American‐style PUVA photochemotherapy. Methods: Thirty psoriasis patients (15 on American‐style PUVA and 15 on turbo‐PUVA) were evaluated, each receiving PUVA twice weekly. Starting UVA dose was determined according to skin phototype for the American‐style PUVA group and according to the patient's skin phototype × DHA SPF 3 in turbo‐PUVA group. UVA increments used were 0.5–1.5 J/cm² per treatment in American‐style PUVA and 25% of the previous dose in turbo‐PUVA. Results: Turbo‐PUVA group showed a significantly lower mean cumulative dose, a significantly higher psoriasis area and severity index score reduction, lesser mean number of treatment sessions, and less duration of treatment till remission (188.44±106.2 J/cm², 92.164±1.975%, 11.2±3.52 session, and 1.4±0.44 months, respectively) than conventional American‐style PUVA group (255.13±18.304 J/cm², 74.725±10.976%, 30±0.00 sessions, and 3.75±0.00 months, respectively). Conclusion: Turbo‐PUVA is more effective and time convenient for the treatment of psoriasis with less cumulative dose than the conventional American‐style PUVA.     

Low‐dose UVA1 phototherapy for scleroderma: what benefit can we expect?

Background The first reports of the application of ultravioletA₁ (UVA₁) phototherapy for scleroderma go back only to 1995, but since then, several studies have proven its effectiveness in this disease. Objectives To evaluate the effectiveness of low‐dose (35 J/cm²) UVA₁ phototherapy in patients with scleroderma, trying to define the subgroups that benefit most from this treatment. Methods Retrospective analysis of patients diagnosed with clinical and/or histological scleroderma, undergoing low‐dose UVA₁ phototherapy between 2003 and 2010. Results We studied 21 patients (20 women and one man) aged 10–75 years (mean 50). Eighteen with morphea performed a total of 29 treatments, with an average of 33 sessions per treatment per patient, a mean dose of 31 J/cm² per session and an average cumulative dose of 1662 J/cm² (310–4270). The three patients with systemic scleroderma underwent a total of five treatments, with an average of 26 sessions per treatment per patient, a mean dose of 29.5 J/cm² per session and an average cumulative dose of 1160 J/cm² (660–1695). Using the modified Rodnan skin score, in the group of patients with morphea, a marked improvement was found in 77.8% patients and a moderate improvement was found in 11.1% patients. In the systemic scleroderma group, a patient with complete remission of the skin sclerosis is emphasized. Conclusions Our experience allows us to conclude that low‐dose UVA₁ phototherapy is a well tolerated option, with excellent results mainly in patients with morphea. This treatment is a valuable contribution to these patients, given the limited therapeutic options available.     

Treatment of angiokeratoma of Mibelli alone or in combination with pulsed dye laser and long‐pulsed Nd: YAG laser

Treatment of angiokeratoma of Mibelli is usually challenging because of the location, the pathogenetic condition and the cosmetic requirements. We present our characteristic treatment with the application of pulsed dye laser PDL and lpNd:YAG laser. All of these lesions were treated by topical anesthesia with Emla. Combined dual PDL‐lpNd:YAG (PDL: 595 nm, 5 mm/7 mm, 0.5 ms, 8–10 J/cm²; lpNd:YAG: 3 mm/5 mm, 15 ms, 90–120 J/cm²) treatment was used to treat lesions which with moderate to severe hyperkeratosis and hyperplasia. To the maculopapule ones, the energy density of lpNd:YAG might upgrade to 150 J/cm². Singular PDL (595 nm, 5 mm/7 mm, 0.5 ms, 9–12 J/cm²) treatment was used to treat lesions which with slight hyperkeratosis and hyperplasia. Continuous airflow cooling was always applied during the laser treatment. The treatment interval was 6–12 weeks. Of the 5 patients, 3 of them were cured and 2 of them were improved. All of them were satisfied with the cosmetic results. We recommended the combined dual PDL‐lpNd:YAG laser in treating severe hyperkeratotic and hyperplastic angiokeratoma of Mibelli. It can aid in achieving a desirable outcome whilst also reducing the required treatment sessions. However, most patients felt painful during the operation and experienced a severe long term recovery time after operation.     

Side‐by‐side comparison of photodynamic therapy and pulsed‐dye laser treatment of port‐wine stain birthmarks

Background Pulsed‐dye laser (PDL)‐mediated photothermolysis is the current standard treatment for port‐wine stain (PWS) birthmarks. Vascular‐targeted photodynamic therapy (PDT) might be an alternative for the treatment of PWS. Objectives To compare clinical outcomes of PDT and PDL treatment of PWS. Methods Two adjacent flat areas of PWS lesions were selected from each of 15 patients (two male and 13 female; age 11–36 years) and randomly assigned to either single‐session PDL or PDT. PDL was delivered using a 585‐nm pulsed laser. PDT was carried out with a combination of haematoporphyrin monomethyl ether (HMME) and a low‐power copper vapour laser (510·6 and 578·2 nm). Clinical outcomes were evaluated colorimetrically and visually during follow‐up. Results A total of nine red PWS lesions and six purple PWS lesions were treated. For red PWS, colorimetric assessment showed that the blanching rates of PDL and PDT at 2 months ranged from ?11% to 24% and 22% to 55%, respectively. For purple PWS, blanching rates of PDL and PDT ranged from 8% to 33% and 30% to 45%, respectively. Overall, there was a significant difference between the blanching effect of single‐session PDL treatment and a single‐session PDT treatment. Conclusions This side‐by‐side comparison demonstrates that PDT is at least as effective as PDL and, in some cases, superior. The true value of PDT for the treatment of PWS deserves further investigation.     

Genotoxic effects of 1064‐nm Nd:YAG and 532‐nm KTP lasers on fibroblast cell cultures

Background. Several different laser types are used in cutaneous surgery. The neodymium:yttrium–aluminium–garnet (Nd:YAG) and frequency‐doubled Nd:YAG (KTP, potassium titanyl phosphate) lasers are widely used in dermatology. Objectives. To investigate the possible genotoxic effects on fibroblasts of irradiation with a 1064‐nm Nd:YAG laser and a 532‐nm KTP laser. Methods. Fibroblast cell cultures were exposed to each of the lasers, using 10‐mm spot size at 60 ms pulse duration with 10, 20, 40 J/cm² and 3, 6, 12 J/cm² fluences, respectively. Fibroblasts in passages 1–6 were used. During laser irradiation, 96‐well microplate cultures were kept on a cooling block and transported on ice and in the dark, and processed immediately for single‐cell gel electrophoresis (SCGE) assay (also known as a comet assay). Results. DNA damage was determined by computerized assessment of comet assay. There was increasing damage with increasing numbers of passages. For the Nd:YAG laser, the greatest damage occurred on passages 5 and 6, whereas the greatest damage appeared at passages 3 and 4 for KTP and returned to baseline at passages 5 and 6. Damage also increased with each dose increment for both wavelengths. At the highest dose for both wavelengths (Nd:YAG 40 J/cm² and KTP 12 J/cm²), damage was higher with the Nd:YAG laser. Conclusions. Different patterns of cellular damage were seen for different cell‐culture passages, treatment doses, and laser wavelengths. These dose ranges are generally used for the treatment of vascular and pigmented lesions and for rejuvenation purposes. As replicative ageing or cell senescence is one of the critical factors determining the extent of cell damage induced by laser therapy, these results may have important implications for clinical practice.     

Laser‐assisted depigmentation for resistant vitiligo: a retrospective case series with long‐term follow‐up

Background Blanching creams are used to depigment and to achieve uniform skin tone in widespread vitiligo. Length of the treatment and side‐effects strongly limit their use in common practice. Objectives To assess the long‐term efficacy and tolerance of Q‐Switched (QS) lasers for depigmenting the remaining unaffected skin in vitiligo. Methods Retrospective study of vitiligo patients treated with QS lasers in the Department of Dermatology of the University Hospital of Nice, France, from 2002 to 2011. Localizations and the percentage of body surface area of treated lesions, the total number of sessions and the possible relapses and side‐effects, were analysed. Global satisfaction of the patients was evaluated on a visual analogical scale. Results Sixteen areas of normally pigmented skin were treated in six patients. The median number of sessions to achieve a complete depigmentation was 2 (1–6). The mean duration of follow‐up was 36 months (19–120). One third of the patients had no relapse. A complete repigmentation was observed after 21 months in one patient; a 50% repigmentation was noted in one patient, 7 months after the end of the treatment. Two patients showed a minimal repigmentation (<25%), 18 months and 9 years after the first laser treatments. The repigmentations were effectively treated with a maintenance session. The mean total number of sessions performed during this period was 3 (1–20). Side‐effects were limited to transient purpura and crusts. The satisfaction of the patients was excellent (mean 9/10). Conclusions QS lasers appear as an efficient and safe modality for depigmenting normal skin in vitiligo.     

The dual 980‐nm and 1470‐nm diode laser for vascular lesions

Transcutaneous use of dual diode lasers is a new option in dermatology. The aim of the study was to demonstrate the transcutaneous application of a dual laser in dermatologic outpatients. We used a laser system that combines 980 nm and 1470 nm wavelengths for treatment of vascular lesions. Fifty‐six adult Caucasian patients of Fitzpatrick skin type I‐III, 32 females and 24 males with mean age of (41 ± 3.7) years were included. We treated 497 vascular lesions of skin and lips. Complete clearance was achieved in cherry angiomas, venous lakes, lip hemangioma, and spider nevi in 100% after a single treatment. Patients with couperose and/or facial telangiectasia needed several treatment sessions. Mild to moderate pain during the laser shots was noted in all patients. No adverse events were recorded. The dual 980‐nm/1470‐nm diode laser is a safe and effective tool for common vascular lesions.     

Comparison study of a long‐pulse pulsed dye laser and a long‐pulse pulsed alexandrite laser in the treatment of port wine stains

Background: Port wine stains (PWSs) are commonly treated by the pulsed dye laser. Recently, a long‐pulse pulsed alexandrite laser was used to treat bulky vascular malformations. Objective: In the present study, we compare the efficacy and complications of the long‐pulse pulsed dye laser (LPPDL) and the long‐pulse pulsed alexandrite laser (LPPAL) in the treatment of PWSs. Methods: Eleven patients with Fitzpatrick skin types III–IV were enrolled in this study. One section of each patient's PWS was treated with LPPDL and another section was treated with LPPAL. The patients' PWSs were evaluated for efficacy of elimination of erythema and for treatment‐related side effects. Results: Both LPPDL and LPPAL treatment are effective in the treatment of PWSs. Hyperpigmentation was seen in two areas treated with LPPDL and in three areas treated with LPPAL. Hypopigmentation was seen in one area treated with LPPAL, but not in any of the areas treated with LPPDL. There was no scarring. Conclusion: LPPAL works best with hypertrophic, purple PWSs, while LPPDL yields better clinical improvements with the flat, pink PWSs. Targeting of deoxyhemoglobin, deeper penetration, and higher fluence may explain the effectiveness of LPPAL in purple, hypertrophic PWSs. However, there is a risk of dyspigmentation when using the LPPAL.     

Successful treatment of resistant alopecia areata with a phototoxic dose of ultraviolet A after topical 8-methoxypsoralen application

Background: The efficacy of a phototoxic dose of ultraviolet A (UVA) after topical application of 8‐methoxypsoralen (8‐MOP) in the treatment of alopecia areata (AA) was evaluated previously in only one study. However, the possibility of spontaneous regrowth of hair cannot be excluded as sessions were carried out every 3 months. Objective: To determine the efficacy of a phototoxic dose of UVA after topical application of 8‐MOP in the treatment of AA resistant to other lines of treatment. Subjects/Methods: Thirty‐five patients with AA were treated by topical 8‐MOP application to the lesions followed by UVA irradiation using a phototoxic dose every 3 months for a maximum of four sessions. Severity grading of AA was carried out using the Severity of Alopecia Tool (SALT) score before and after treatment. Results: Fifty‐seven percent of patients showed a positive treatment response (40% showed complete and 17% showed partial response) with significant improvement of SALT score. The mean cumulative UVA dose was 22±8.3 J/cm². Mild reversible side effects were observed in 63% of patients after the first session. Conclusion: Phototoxic psoralen and ultraviolet A therapy after topical application of 0.1% 8‐MOP is an effective treatment option for resistant AA, with low total cumulative UVA dose, few treatment sessions, and minimal reversible side effects.     

Removal of amateur blue-black tattoos in Arabic women of skin type (III-IV) with Q-switched alexandrite laser

Background and Objectives Tattoos in Arabic society used to have a cosmetic importance on the face of females. These were usually amateur tattoos done by non‐professional women in the tribe. Because Islam as a religion prohibited its practice and its application, people became concerned about removing the old tattoos by any means. Nowadays, laser is considered an effective method of tattoo removal. Here, we report our experience in the removal of tattoos in Arabic women of skin type III–IV using the Q‐switched alexandrite laser. Study Design/Materials and Methods Twenty female subjects aged 35–50 years from similar racial and ethnic background with amateur tattoos were treated using the Q‐switched alexandrite laser. Fluence threshold was determined and a spot test was made. Q‐switched alexandrite laser with a fluence range 4.0–7.5 J/cm² (mean 6.05) was used at 6–12‐week intervals. Total treatment numbers ranged from three to six sessions (mean 4.15) with single‐pulse technique application. Results More than 95% lightening was achieved in five patients after three to six sessions at fluence range of 6–7.5 J/cm² and > 75% lightening in 10 subjects after three to six sessions of treatment at fluence range of 4–7.5 J/cm². Pinpoint bleeding was observed in one case but no pigmentary alteration or scarring was seen. Conclusion Tattoo pigment removal by Q‐switched alexandrite laser is an effective method in skin type (III–IV) with minimal side effects, which gives high patient satisfaction.     

Copper vapour laser (578 nm) and flashlamp-pumped pulsed tunable dye laser (585 nm) treatment of port wine stains: results of a comparative study using test sites

The copper vapour laser (CVL), emitting at 578 nm, has recently become available for treating vascular skin lesions. Its place in the management of port wine stains (PWS) requires clarification. We have compared a CVL with a pulsed tunable dye laser (PTDL; 585 nm) in 43 patients with macular, blanchable PWS. Test areas were performed with the CVL, using a Hexascan and an energy fluence just sufficient to produce immediate tissue change (mean fluence 18.2J/cm² and mean pulse width 50 ms). Test areas were performed with the PTDL using a 5-mm spot at 6.5 J/cm². Assessments were made after 4 months, subjectively using a clinical fading score and objectively using an index of light absorbence derived from reflectance spectrophotometry. The fading produced by the PTDL was significantly better than the CVL, as determined by clinical assessment (mean fading scores 2.41 and 1.67, respectively, P<0.0005) and reflectance spectrophotometry (mean absorbence index 149 and 157 respectively, P<0.0005). These results indicate that the PTDL is the preferred treatment for most macular, blanchable PWS. However, in a proportion of lesions responses were equivalent with both lasers, and in a small proportion, the CVL produced a better response.     

Immediate post‐irradiation dermoscopic vascular changes versus purpura as a therapeutic endpoint in pulsed‐dye laser treatment of port wine stains

Pulsed‐dye laser (PDL) is the treatment of choice for port wine stain (PWS), and the development of purpura is considered a therapeutic endpoint. Changes in PWS vasculature observed by dermoscopy immediately after laser irradiation have been suggested to predict the minimal effective fluence. The current study aimed at comparing these changes with purpura as a therapeutic endpoint. Fifty‐six PWS patients, randomized into two groups, received five monthly PDL sessions (595 nm and 10 mm spot size). At the first visit, patients received multiple gradually increasing test irradiations. Patients in the first group were treated with the lowest dose that resulted in 24‐hr‐lasting purpura, while patients in the second group were treated with the lowest dose that resulted in vessel disappearance observed by dermoscope. No statistically significant differences were observed between the two groups (the dermoscopic and the purpuric) regarding mean average improvement (42.4 and 37.32%, respectively, p = .32), grade of improvement (p = .44), and the rate of side effects (0 and 13.79%, respectively, p = .13). In conclusion, the immediate post‐irradiation vessel disappearance (detected by dermoscope) is comparable, in safety and efficacy, to purpura as a therapeutic endpoint and maybe more time‐saving and more accepted cosmetically.     

Prospective study of topical 5‐aminolevulinic acid photodynamic therapy for the treatment of severe adolescent acne in Chinese patients

Acne vulgaris is one of the most common skin diseases in adolescents. In the present study, we aimed to evaluate the effectiveness and safety of topical 5‐aminolevulinic acid (ALA)‐mediated photodynamic therapy (PDT) for the treatment of severe acne in Chinese adolescent patients. Twenty‐one Chinese adolescent patients aged 12–18 years with Pillsbury III–IV severe facial acne were treated with three courses of ALA‐PDT. A 5% ALA lotion was applied topically for 60 min followed by irradiation with light‐emitting diode light at 633 nm with a light intensity of 75–80 mW/cm² and a light dose of 90–96 J/cm². Clinical assessment was conducted before and after each treatment, and at each follow‐up session. The total effective rates were 85.71%, 90.48%, and 95.23% after the three PDT sessions, and at the 4‐ and 8‐week follow ups, respectively. ALA‐PDT is an effective treatment for severe adolescent acne vulgaris, and is associated with mild and reversible side‐effects.     

Topical application of 5-aminolevulinic acid followed by 595-nm pulsed dye laser irradiation for the treatment of recalcitrant port-wine stains: A primary study

Abstract

Objective: To evaluate the effectiveness and safety of topical application of 5-aminolevulinic acid (ALA) followed by pulsed dye laser (PDL) irradiation for the treatment of recalcitrant port-wine stain (PWS). Methods: Thirty-five patients (19 females and 16 males) with recalcitrant PWS were treated with topical application of 20% ALA and then irradiated with a 595-nm PDL (energy density of 6.5–9.0 J/cm² and pulse duration of 6 or 10 ms) at 6–8 weeks intervals. Clinical improvement of lesions was evaluated by comparing photographs of lesions at baseline and 2 months after the last treatment. Results: Topical ALA spreading followed by irradiation with a 595-nm PDL improved PWS in 21 out of 35 patients who were previously recalcitrant to PDL treatment alone. Side effects were limited to transient erythema, vesicle formation, edema and mild purpura with no obvious subsequent scarring or undesirable pigment changes. Conclusion: The topical application of ALA followed by irradiation with a 595-nm PDL is an effective and safe treatment for PWS recalcitrant to PDL therapy alone.     

Acne treatment by methyl aminolevulinate photodynamic therapy with red light vs. intense pulsed light

Various methods of photodynamic therapy (PDT) for acne have been introduced. However, comparative studies among them are still needed. We performed this study to compare the effect of methyl aminolevulinate (MAL) PDT for acne between red light and intense pulsed light (IPL). Twenty patients were enrolled in this eight‐week, prospective, split‐face study. We applied MAL cream over the whole face with a three‐hour incubation time. Then patients were irradiated with 22 J/cm² of red light on one‐half of the face and 8–10 J/cm² of IPL on the other half during each treatment session. We performed three treatment sessions at two‐week intervals and followed‐up patients until four weeks after the last session. Inflammatory and non‐inflammatory acne lesions were reduced significantly on both sides. The red light side showed a better response than the IPL side after the first treatment. Serious adverse effects after treatment were not observed. MAL‐PDT with red light and IPL are both an effective and safe modality in acne treatment. Red light showed a faster response time than IPL. After multiple sessions, both light sources demonstrated satisfactory results. We suggest that reducing the total dose of red light is desirable when performing MAL‐PDT in Asian patients with acne compared with Caucasians.     

Penetration enhancement of two topical 5‐aminolaevulinic acid formulations for photodynamic therapy by erbium:YAG laser ablation of the stratum corneum: continuous versus fractional ablation

Please cite this paper as: Penetration enhancement of two topical 5‐aminolaevulinic acid formulations for photodynamic therapy by erbium:YAG laser ablation of the stratum corneum: continuous versus fractional ablation. Experimental Dermatology 2010; 19 : 806–812. Abstract: 5‐Aminolaevulinic acid (ALA) is used in photodynamic therapy (PDT). Response rates of PDT vary widely, which may be because of the limited uptake of topically applied photosensitisers. We investigated skin penetration and fluorescence induction of protoporphyrin IX (PpIX) after applying either 20% ALA cream or 20% aminolaevulinic acid solution on laser‐stripped stratum corneum (SC) in an ex vivo full‐thickness porcine skin model. Both formulations are used in clinical practice. To enhance the skin penetration of ALA, we used two different 2940‐nm erbium:yttrium–aluminium–garnet (Er:YAG) laser systems to partially ablate the SC: continuous and fractional ablation. Different fluences were applied ranging from 0.5 to 1.5 J/cm² (continuous ablation) and from 4 to 24 J/cm² (fractional ablation). Fluorescence microscopy was used for detecting PpIX‐induced fluorescence. Compared to skin without laser pretreatment, mean fluorescence intensity (MFI) of PpIX was enhanced 13.8‐fold after continuous ablation with 1.0 J/cm² and 7.3‐fold after fractional ablation with 4 J/cm²; each laser procedure was followed by 4‐h incubation with lipophilic ALA cream. Optimal parameters for continuous ablation without damage to the epidermis were 1 J/cm² for both formulations, fractional ablation was best with 4 J/cm². Histological evaluations of laser‐treated skin showed necrosis and apoptosis, depending on light dose. In laser‐stripped skin, PpIX fluorescence was detected earlier and reached deeper epidermal layers than in untreated skin. Continuous laser ablation induced higher PpIX fluorescence levels than fractional ablation. This method offers a promising new tool for enhancing ALA penetration in PDT without damaging the underlying tissue.     

An evaluation of the efficacy of a single‐session 577 nm pro‐yellow laser treatment in patients with postacne erythema and scarring

Erythema and scarring are among the most common complications of severe inflammatory acne. In this study, we aimed to share our experience with pro‐yellow laser and document the efficacy and safety of this treatment in postacne erythema and scarring. The study included 40 patients, 24 (60%) females, and 16 (40%) males with a mean age of 29.5 ± 8.16 (min. 18 years, max. 57 years). The pro‐yellow laser was applied to all patients as a single session with irradiation of 22 J/cm². Improvement in postacne erythema and scars were evaluated after the treatment. The study included 40 patients, 24 patients (60%) were females and 16 patients (40%) were males with the mean age of 29.5 ± 8.16 (ranged between 18 and 57 years old). A total of 21 patients (52.5%) had good improvement (51%‐75% regression), 10 patients (25%) had excellent improvement (76%‐100% regression), and a moderate improvement (26%‐50%) was detected in 9 patients (22.5%). Also, there were mild improvement (1%‐25%) in 20 patients (76.9%) and a moderate improvement (26%‐50%) in 6 patients (23.1%). We found that pro‐yellow laser is highly effective in the treatment of postacne erythema, while its effectiveness was mild to moderate in atrophic acne scars. Also, it has been observed that the pro‐yellow laser system can be used safely immediately after cessation of systemic isotretinoin treatment.     

Comparison of quality of facial scars after single low‐level laser therapy and combined low‐level with high‐level (PDL 595 nm) laser therapy

The main goal of our study was to compare the quality of resulting facials scar 12 weeks after single and combined laser therapy. Forty‐one children from age 1.5 to 5 years with facial scars after injury participated in the study. Thirty‐one underwent laser therapy, 14 were treated using single low‐level laser therapy (670 nm, fluence 3–5 J/cm^?2), and 17 underwent combined high‐level laser therapy with non‐ablative pulsed dye laser (PDL; 595 nm, spot size 7 mm, delay 0.45 ms or 1.5 ms, fluence 9–11 J/cm^?2, cryogen spray/delay 20/30 ms) and low‐level laser therapy. The control group consisted of 10 untreated children. Before treatment and at week 4, 8, and, 12 the scars were evaluated using the POSAS questionnaire. A statistically significant improvement in scars (between ratings before treatment and 4 weeks after therapy, before treatment and 8 weeks after therapy and before treatment and 12 weeks after therapy) was observed in all parameters in both treatment groups (p < 0.0001). For the HLLT+LLLT group the most significant enhancement in the quality of scars was found for all items and at all evaluations, except pigmentation and pliability. There was no improvement observed in quality of facial scars in the control group.     

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

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.     

Successful ultraviolet A1 phototherapy in the treatment of localized scleroderma: a retrospective and prospective study

Background Ultraviolet (UV) A1 phototherapy is an effective anti‐inflammatory treatment modality that influences fibroblast functions. Objectives To document the effects of UVA1 treatment in patients with localized scleroderma (LS) in a retrospective study (at least 6 months after UVA1 treatment) and in a prospective study before and immediately after medium‐dose UVA1 irradiation. Methods In total, 30 patients (retrospective study n = 17, prospective study n = 13) with LS receiving UVA1 phototherapy five times weekly (for 3–6 weeks) were investigated. Improvement was documented using standardized questionnaires and clinical evaluation (using modified Rodnan skin score, Cutometer and 7·5‐MHz ultrasound measurements). Levels of collagen I and collagen III metabolites were measured in serum and urine. Results In the retrospective study, medium‐dose UVA1 phototherapy had been performed 6 months–3 years earlier (cumulative dose 750–1400 J cm^?2; mean ± SD number of irradiations 19·3 ± 3·8). Fourteen of 17 patients (82%) reported an improvement in symptoms following UVA1 therapy. In the prospective study, skin elasticity increased in 77% of the patients following medium‐dose UVA1 phototherapy (cumulative dose 750–1250 J cm^?2; mean ± SD number of irradiations 20·8 ± 4·0). 7·5‐MHz ultrasound measurements showed a mean reduction of lesional skin thickness of 13% compared with skin thickness before UVA1 phototherapy. The ratio of deoxypyridinoline to creatinine was significantly elevated in about two‐thirds of the patients. Conclusions This open study showed a positive short‐ and long‐term efficacy of UVA1 phototherapy in patients with LS, with a reduction in sclerotic plaques, an increase in skin elasticity and a reduction of lesional skin thickness. UVA1 phototherapy had a significant effect on collagen metabolism. UVA1 phototherapy can be regarded as a safe treatment modality for patients with LS.