Self‐Reported Acne Severity,Treatment, and Belief Patterns across Multiple Racial and Ethnic Groups in Adolescent Students

Abstract: Acne vulgaris is a common condition among adolescents regardless of age, gender, and race. We compare the frequency, severity, help‐seeking behavior, treatment, and beliefs about acne among students based on race, ethnicity, gender, and age. Anonymous surveys were administered to 1,214 students aged 10–19 years of varied gender, race, and ethnicity in public middle and high schools in New Jersey. Results showed the frequency and severity of acne were high (76% and 65%, respectively) and more prevalent in white compared to non‐white respondents (RR = 1.13, 95% CI = 1.04–1.24 and RR = 1.22, 95% CI = 1.09–1.37, respectively), and also in older compared to younger ages (RR = 1.24, 95% CI = 1.17–1.32 and RR = 1.43, 95% CI = 1.32–1.55, respectively). The majority of respondents (83%) reported never having seen a physician for their acne; however, those reporting acne of some severity were more likely to have seen a physician compared with those who did not report acne (21% vs. 8%, p < 0.001). Blacks who reported mild or moderate severity of acne were more likely to have seen a health professional compared to white respondents with same the acne severity (RR = 3.63, 95% CI = 2.06–6.37 and RR = 3.06, 95% CI = 2.02–4.65, respectively). Conversely, Hispanic respondents with mild or moderate acne were less likely to have seen a health professional compared to whites with the same acne severity (RR = 0.56, 95% CI = 0.35–0.89 and RR = 0.47, 95% CI = 0.26–0.86, respectively). Beliefs about external factors affecting acne also varied by race and ethnicity. In conclusion, the severity, frequency, and beliefs about acne all play a role in help‐seeking behaviors, which vary to a significant extent by race and ethnicity.     

Low‐cumulative dose isotretinoin treatment in mild‐to‐moderate acne: efficacy in achieving stable remission

Background Aimed at the reduction of post‐treatment relapse of severe acne, the cumulative dose of oral isotretinoin should be ≥120 mg/kg. However, data on the appropriate oral isotretinoin treatment regimen in mild and moderate acne are lacking. Objective The purpose of this study was to determine the efficacy of an isotretinoin‐sparing protocol in inducing permanent remission of mild and moderate acne. Methods In this open, prospective, non‐comparative study, 150 patients affected with mild‐to‐moderate acne were treated with isotretinoin until complete recovery and for a further month of treatment, independent of the total cumulative dose reached. Patients then underwent a 1‐year maintenance therapy with adapalene 0.1% cream. Patients were followed up for a further year, without any treatment. Results A total of 139 patients completed the study. Overall, patients received a mean of 80.92 mg/kg cumulative dose of isotretinoin. In the 2‐year follow‐up, relapse only appeared in 13 patients (9.35%). Conclusion Comparing our findings with published data, this isotretinoin‐sparing regimen was shown to be effective in inducing stable remission and preventing acne relapses in patients with mild‐to‐moderate acne. Low‐cumulative dose regimens may potentially lead to a lower incidence of side‐effects and to lower costs than higher doses.     

Acne as seen by adolescents: results of questionnaire study in 852 French individuals

Acne can have an important psychological impact. We surveyed 852 adolescents aged 12-25 years about their knowledge of acne and its treatment in a non-medical context. The study involved a questionnaire administered to callers to a youth telephone helpline in France. Callers were categorized into those who currently had acne, those who had had acne previously, and those who had never had acne. Most respondents (66.2%) had experienced acne symptoms, which were mild in 50.2% of cases and severe in 16% of cases. Often, acne had been long-lasting (>12 months in 49.6% of cases). Many thought that gender, excess weight, eating dairy products, and physical activity did not influence acne, and that frequent washing could improve acne. Eating chocolate and snacks, smoking cigarettes, sweating, not washing, touching/squeezing spots, eating fatty foods, using make-up, pollution, and menstruation were thought to worsen acne. The majority (80.8%) did not believe acne to be a disease, but rather a normal phase of adolescence, yet 69.3% agreed it should be treated. There was a preference for topical vs. systemic treatment. Many (38.6%) of the respondents with acne had not consulted a physician. Almost two-thirds of respondents wanted more information about acne. Providing more information about acne might increase the likelihood of them consulting a physician and getting better treatment for the condition.     

Common Use of Prescription Off‐Label Acne Therapy in Children Younger Than 12 Years Old

Acne is occurring more frequently in younger age groups, but most available treatments are considered off‐label in young children. As the epidemiology of acne has changed to include younger children over the past 20 years, neither regulators, pharmaceutical companies, nor clinicians have understood the need or value of obtaining regulatory sanctions for problems physicians have managed using clinical judgment. The objective of this study was to analyze the frequency of off‐label acne treatment according to age and other demographic factors. We searched the National Ambulatory Medical Care Survey from 1993 to 2010 for visits in children younger than 12 years of age for the diagnosis of International Classification of Diseases, Ninth Revision, code 706.1. We tabulated leading acne treatments and assessed factors associated with off‐label prescribing. Off‐label but appropriate acne treatments were used in 29% of acne visits for children younger than 12 years of age. Dermatologists were more likely than pediatricians to prescribe off‐label treatment (p < 0.001). The most frequently used off‐label treatments were topical retinoids, followed by oral antibiotics. There was no significant trend in the rate of off‐label prescribing over time (p = 0.40). Off‐label treatment is well within the standard of care for young children with acne. More data on the use of topical retinoids in young children will improve our understanding of their use, which may help optimize treatment outcomes for children with acne.     

Acne: prevalence, perceptions and effects on psychological health among adolescents in Aydin, Turkey

Background Acne vulgaris is a common disease among adolescents and known to have adverse effects on psychological status. Methods A cross‐sectional study was conducted on 600 participants by means of a questionnaire designed for this study in high school students. In addition, an objective evaluation of acne in participants was undertaken. The questionnaire consisted of questions about acne, General Health Questionnaire (GHQ) and Rosenberg Self‐Esteem Scale (RSES). Results Five hundred and sixty‐three questionnaires out of 600 were answered and 550 adolescents who gave permission for examination were evaluated. The study population consisted of 303 girls and 260 boys between the ages 13 and 19, and the mean age was 15.24 ± 1.05 years. Acne prevalence was 63.6% with 29.2% non‐inflammatory and 34.4% inflammatory acne. It was more prevalent and severe in boys than in girls. Not the objective but the subjective severity of acne and opinion that one could benefit from acne treatment was found to be related to anxiety, depression and self‐esteem. Factors implicated among causes of acne were food, bad skin hygiene and hormones in decreasing frequency. Forty‐eight per cent of adolescents expect a maximum duration of 4 weeks for treatment. Conclusion Despite the high prevalence of acne, there is still much deficiency of knowledge and wrong beliefs about acne. This indicates that there is an urgent need for education about etiopathogenesis, potential complications and importance of effective treatment for acne. Effective treatment may make significant contributions for the mental health of adolescent and as well as adult populations.     

Psychological Impairments in the Patients with Acne

Background:

The psychological impacts of acne appearance and its-related negative emotional reactions have been proved; however, these reactions are varied in different populations.

Aim:

We investigated whether acne and its severity affected psychological functioning in those who suffered from this disorder among Iranians.

Materials and Methods:

One hundred and six patients with acne vulgaris who consecutively attended the dermatology outpatient clinics in Semnan city in 2008 were included. Among them, 103 patients met the study''s inclusion criterion and agreed to participate. One hundred and six age and gender cross-matched healthy volunteers were included as controls that attended the clinic with their diseased relatives. All acne patients were evaluated using the Symptom Check List-90 (SCL-90).

Results:

According to the American Academy of Dermatology classification, 25.2% of the patients had mild acne, 50.5% moderate acne, and 24.3% severe acne. A higher percentage of participants than controls required further evaluation and psychological consultant when studying each psychological problem. The most common psychological symptoms requiring treatment due to disturbed daily activities in acne group were psychoticism (34.0%) and depression (31.1%), respectively. Significant positive correlations were observed between the duration of illness and SCL-90 total score. When evaluating the SCL-90 scores, patients with multiple sites of involvement were affected more severely than those with a single site of involvement.

Conclusion:

Acne vulgaris has significant effects on psychological status. Effective concomitant anti-acne therapy and psychological assessment make significant contributions for the mental health and should be strongly recommended.     

Treatment of Preadolescent Acne in the United States: An Analysis of Nationally Representative Data

The prevalence of acne in younger children is increasing. Of the acne treatments that the U.S. Food and Drug Administration (FDA) has approved for ages 12 years and older, it is unclear which medications are being prescribed off‐label for this younger patient population. The purpose of this study is to compare the therapies being prescribed to preadolescent patients with acne (defined in this study as ages 7 to 11 years) with those being prescribed to adolescent patients (ages 12 to 18 years) and to determine whether prescribing patterns differ between dermatologists and pediatricians. Leading therapies for the treatment of children with a diagnosis of acne were collected from the National Ambulatory Medical Care Survey (NAMCS) from 1993 to 2009. Data were stratified according to age group and physician specialty. Physicians prescribed a wide variety of FDA‐approved and off‐label medications to preadolescent patients with acne. The leading medications were topical treatments, including adapalene (14.4%), benzoyl peroxide (12.8%), and tretinoin (12.5%). Treatment of this age group differed substantially between specialties, with dermatologists frequently prescribing topical retinoids and primary care physicians preferring antibiotics, particularly oral antibiotics. Limitations included a lack of data on acne severity and morphology through NAMCS, as well as the absence of longitudinal data. With the limited number of FDA‐approved treatment options, off‐label prescribing for acne in preadolescent patients is common. Furthermore, this study identified a potential knowledge gap between pediatricians based on their prescribing patterns in this patient population.     

Acne vulgaris – Psychosomatic aspects

More than a cosmetic nuisance, acne can produce anxiety, depression, and other psychological problems that affect patients' lives in ways comparable to life‐threatening or disabling diseases. Emotional problems due to the disease should be taken seriously and included in the treatment plan. A purely dermatological therapy by itself may not achieve its purpose. Even mild to moderate disease can be associated with significant depression and suicidal ideation, and psychologic change does not necessarily correlate with disease severity. Acne patients suffer particularly under social limitations and reduced quality of life. Psychological comorbidities in acne are probably greater than generally assumed. Attention should be paid to psychosomatic aspects especially if depressive‐anxious disorders are suspected, particularly with evidence of suicidal tendencies, body dysmorphic disorders, or also in disrupted compliance.Therefore, patients who report particularly high emotional distress or dysmorphic tendencies due to the disease should be treated, if possible, by interdisciplinary therapy. The dermatologist should have some knowledge of the basics of psychotherapy and psychopharmacology, which sometimes must be combined with systemic and topical treatment of acne in conjunction with basic psychosomatic treatment.     

Efficacy of the combined use of a facial cleanser and moisturizers for the care of mild acne patients with sensitive skin

Acne is a common skin disease that involves the seborrheic area of the face and results from the obstruction of hair follicles followed by inflammation. Careful face washing helps to improve and prevent acne; however, intensive washing has a risk of inducing skin barrier impairment and dry skin, especially in sensitive skin. We hypothesized that skin care combining mild skin cleansing and intensive moisturizing (“combination skin care”) may be effective in the care of acne in subjects with dry skin and/or sensitive skin. We developed a combination skin care with a weakly acidic foaming facial skin cleanser based on a mild detergent, an aqueous lotion with eucalyptus extract and a moisturizing gel containing pseudo‐ceramide and eucalyptus extract. To optimize an ideal facial skin care system for mild acne on sensitive skin, we performed a 4‐week clinical trial with 29 post‐adolescent Japanese women with mild acne with dry and sensitive skin. The acne significantly decreased after this trial accompanied by the improvement of dry skin, a significantly increased endogenous ceramide level in the stratum corneum and an elongated alkyl chain length of the non‐hydroxy acyl sphingosine type ceramide. No adverse events due to the test samples were observed. Based on diagnosis by a dermatologist, 97% of the subjects found the combination skin care to be “useful” or “slightly useful”. Based on these findings, the combined use of a facial skin cleanser and moisturizers is safe and effective for the care of acne in post‐adolescent Japanese women with sensitive skin.     

Self‐Reported Help‐Seeking Behaviors and Treatment Choices of Adolescents Regarding Acne

Abstract: Acne vulgaris is a common condition affecting adolescents that they often choose to treat on their own rather than seek out and follow medical advice. Using data from an anonymous survey administered to 1,214 students in public middle and high schools in New Jersey, we compared the self‐reported acne frequency, severity, and beliefs of students based on their help‐seeking behaviors, treatment choices, and treatment adherence. Chi‐square analyses were performed for data comparison. A large proportion of students in this sample (57%) treated their own acne, and a much smaller proportion (17%) have sought medical care. Students who saw a health professional reported acne of higher frequency and severity than those who did not (p = 0.01). Severity also appeared to affect treatment adherence, with students who adhered to recommended treatments reporting more frequent (p < 0.001) and more severe (p = 0.02) acne than those who chose to self‐treat. Beliefs and knowledge varied most significantly according to treatment adherence. In conclusion, most adolescent students treat their own acne. Self‐assessment of acne severity plays a significant role in the tendency to seek out and adhere to medical treatment. Beliefs and knowledge may also affect adherence, suggesting a role for physicians to influence adherence rates through patient education. Because the majority of students are getting information from nonphysician sources, there may be a need to evaluate the resources they are using to make sure they are receiving appropriate, helpful information.     

Acne Vulgaris in Preadolescent Children: Recommendations for Evaluation

Acne vulgaris in infants and children often triggers extensive laboratory evaluation out of concern about associated endocrinopathy. Clinical parameters to help guide evaluation of these children have not been defined. This was a retrospective chart review of 24 preadolescent patients with acne and a review of related medical literature. Two age‐related subsets were identified: 12 patients who developed acne before the age of 15 months, 75% male, with comedonal and inflammatory lesions; and 12 patients who developed acne between the ages of 2 and 7 years, 75% female, with primarily comedonal lesions. Laboratory evaluation in 13 of the patients was unremarkable. Bone age was advanced in 1 of the 11 children imaged. Premature adrenarche was diagnosed in four patients; all four had additional clinical signs of puberty and growth parameters >90th percentile. None required additional treatment. Our cohort of preadolescent children presenting with acne included an equal number of patients in two distinct subsets: infantile and childhood‐onset acne. Literature review identified a rare third subset presenting with acne, signs of advanced puberty, and associated endocrinopathy. There was no evidence of endocrinopathy in our patients with infantile acne. Two‐thirds of our patients with childhood‐onset acne had no additional clinical signs of puberty and no evidence of endocrinopathy. A focused history and physical examination is sufficient to evaluate the majority of infants and children with acne. Hand X‐ray for bone age is a useful screening test. Further evaluation and endocrinology referral are warranted in preadolescents with acne and advanced bone age or additional clinical evidence of early puberty.     

Acne vulgaris and depression: a retrospective examination

Background  Acne vulgaris is a common skin disease that affects patients both physically and mentally.
Purpose  To examine the prevalence of reported depression in acne patients.
Methods  Patient information was obtained from a medical claims database and analyzed using the Total Resource Utilization Benchmarks™ process. Benchmarks in this study include: age, gender, co-morbid depression, antidepressant utilization, and acne treatment modality. Depression prevalence in acne patients was compared with general population.
Results  Depression was two to three times more prevalent in acne patients than in the general population, with a reported 8.8% of acne patients having clinical depression. The majority of cases of depression and antidepressant therapy utilization were observed in acne patients aged 18 and over with the highest percentage in the 36–64 age group. Approximately 65.2% of the acne patient population was female, with twice as many reported to have depression as males (10.6% females vs. 5.3% males).
Limitations  This analysis included only patients that sought treatment for their acne and had also reported having clinical depression. This may underestimate the total prevalence of acne and associated depression.
Conclusions  Acne is a disease that affects people of all ages both physically and psychologically. A correlation exists between clinical depression and acne patients, particularly those older than 36. "There is no single disease which causes more psychic trauma and more maladjustment between parents and children, more general insecurity and feelings of inferiority and greater sums of psychic assessment than does acne vulgaris" (Sulzberger, 1948 ¹ ).     

Acne vulgaris

Acne vulgaris is worldwide the most common skin disease. Acne is an inflammatory disorder in whose emergence androgens, PPAR ligands, the IGF-1 signaling pathway, regulating neuropeptides and environmental factors are probably involved. These factors interrupt the natural cycling process in the sebaceous gland follicle and support the transition of microcomedones to comedones and inflammatory lesions. Proinflammatory lipids and cytokines are mediators for the development of acne lesions. Bacterial antigens can potentate the inflammatory phenomena. Acne is predominantly treated with combination therapy. Selecting a treatment regimen depends on the exact classification of acne type and severity. The development of scars is the main criterion for the choice of systemic therapy. Retinoids for mild comedonal acne and the combination of retinoids with antibiotics and/or benzoyl peroxide for mild to moderate papulopustular acne are the drugs of first choice for topical treatment. The use of topical antibiotics is not recommended any more because of the development of resistant bacterial strains. Systemic antibiotics, in combination with topical retinoids and/or benzoyl peroxide, for moderate papular/nodular acne and isotretinoin for severe nodular/conglobate acne are the columns of systemic acne treatment. Systemic anti-androgens are used in women against moderate papulopustular acne. Due to advances in the understanding of the underlying inflammatory mechanisms in recent years the development of new therapeutic agents with good efficacy and better side effect profile should be expected in the future.     

Cardiff Acne Disability Index in Sarawak, Malaysia

Background

Acne is considered a cosmetic nuisance in Malaysia since no insurance coverage is provided for its treatment. Its psychological impact is unknown.

Objective

The aim of this study is to determine the impact of acne on quality of life and its relationship with severity.

Methods

A cross-sectional study using the Cardiff acne disability index (CADI) and Global Acne Grading System for acne severity grading was done in three government-run dermatology clinics in Sarawak, Malaysia.

Results

The study cohort of 200 patients had a mean CADI score of 5.1. Most of the patients (59.5%) had mild CADI impairment, with the domain of feelings most affected. Patients with a family income <1,000 United States Dollor/month had a higher mean CADI (mean 5.5 vs. 4.4; p=0.04). Females, indigenous groups, and patients with tertiary education tended to have more severe CADI impairment (p>0.05). The correlation between CADI and mild acne severity was low (Pearson correlation coefficient=0.35; p<0.001) but became insignificant for moderate and severe acne.

Conclusion

Acne impairment in Sarawak was moderate and must be addressed. It should be viewed as a psychologically disabling disease requiring optimal management and resource allocation.     

Spotlight on Adapalene in Acne Vulgaris

Adapalene (Differin) is a retinoid agent indicated for the topical treatment of acne vulgaris. In clinical trials, 0.1% adapalene gel has proved to be effective in this indication and was as effective as 0.025% tretinoin gel, 0.1% tretinoin microsphere gel, 0.05% tretinoin cream and 0.1% tazarotene gel once every two days; however, the drug was less effective than once-daily 0.1% tazarotene gel. It can be used alone in mild acne or in combination with antimicrobials in inflammatory acne and has proved efficacious as maintenance treatment. Adapalene has a rapid onset of action and a particularly favorable tolerability profile compared with other retinoids. These attributes can potentially promote patient compliance, an important factor in treatment success. Adapalene is, therefore, assured of a role in the first-line treatment of acne vulgaris.     

Acne analysis,grading and computational assessment methods: an overview

Introduction: This paper presents a comprehensive review of acne grading and measurement. Acne is a chronic disorder of the pilosebaceous units, with excess sebum production, follicular epidermal hyperproliferation, inflammation and Propionibacterium acnes activity. Most patients are affected with acne vulgaris, which is the prevalent type of acne. Acne vulgaris consists of comedones (whitehead and blackhead), papules, pustules, nodules and cysts. Objectives: To review and identify the issues for acne vulgaris grading and computational assessment methods. To determine the future direction for addressing the identified issues. Methods: There are two main methods of assessment for acne severity grading, namely, lesion counting and comparison of patient with a photographic standard. For the computational assessment method, the emphasis is on computational imaging techniques. Results: Current acne grading methods are very time consuming and tedious. Generally, they rely on approximation for counting lesions and hence the assessment is quite subjective, with both inter and intra‐observer variability. It is important to accurately assess acne grade to evaluate its severity as this influences treatment selection and assessment of response to therapy. This will further help in better disease management and more efficacious treatment. Conclusion: Semi‐automated or automated methods based on computational imaging techniques should be devised for acne grade assessment.     

Acne sans P. acnes

Acne vulgaris is a common disease that carries an enormous financial and psychosocial impact. Androgens, excessive sebum production, ductal hypercornification, changes in the microbial flora, as well as inflammation and immunological host reactions are considered the major contributors to acne pathogenesis. Despite extensive research on acne pathogenesis, the exact sequence of events and their possible mechanisms leading to the development of a microcomedone and its transformation into an inflamed lesion has remained unclear. There is a significant amount of in vitro evidence suggesting a possible pathogenetic role for Propionibacterium acnes in comedogenesis as well as inflammation in inflammatory acne. However, the microbiological data from non‐inflamed as well as inflamed acne lesions, cultured individually, do not entirely support the hypothesis that these micro‐organisms are actually responsible for their initiation. There appears to be comedones and inflamed lesions in which there is no clear evidence of Propionibacterium acnes involvement. Considering this microbiological data, alongside the in vitro evidence, we have tried to delineate the possible sequence of events and their mechanisms, leading to the development of a microcomedone and its transformation into an inflamed lesion. Based on the available literature we have analysed the evidence of both non‐inflamed as well as inflamed acne lesions occurring in the absence of Propionibacterium acnes from the pilosebaceous follicles. We propose that the development of an inflamed acne lesion depends on an imbalance between the pro‐inflammatory and anti‐inflammatory pathways rather than the incitement of inflammation by Propionibacterium acnes.     

Persistent Acne in Women

Acne is traditionally regarded as a skin disorder of the teenage years. However, recent epidemiologic studies have shown that a significant number of female patients aged >25 years experience acne. One recent community-based UK study estimated the prevalence of facial acne in adult women aged between 26 and 44 years to be 14%. It is not clear whether there is a true increase in acne in this age group or whether these patients are less tolerant of their acne and/or better informed of available therapies and so seek advice. The reasons for persistent acne are not fully understood. External factors such as use of certain cosmetics, ingestion of drugs, and endocrine abnormalities should all be considered when managing these patients. Post-adolescent acne in females can be divided into 'persistent acne', which represents a continuation of acne from adolescence into adult life, and 'late-onset' acne, which describes significant acne occurring sometimes for the first time after the age of 25 years. The clinical picture of each of these forms of acne in adult females can differ slightly from conventional adolescent disease. The course of each form is more indolent. Because of these variations, the approach to investigation and management of these cases may have subtle differences when compared with that for teenage disease. Acne treatment should aim to reduce sebum, comedogenesis, propionibacteria population, and inflammation. Treatment selection will depend on the acne grade and site as well as the patient's preference and ability to comply with therapy. Maintenance therapy plays an important role in managing this group of patients. As the response to treatment is inevitably slow, patients must be encouraged to adhere to the chosen treatment regimen. This article reviews the literature on persistent acne in women in terms of clinical presentation and possible etiologic factors, and outlines principles of therapy related to managing these cases.     

Clinical and histological evaluation of 1% nadifloxacin cream in the treatment of acne vulgaris in Korean patients

Objectives Nadifloxacin is a fluoroquinolone with broad‐spectrum antibacterial activity. Although it is used as an acne treatment in some European countries, it has not been used to treat Korean acne patients. We aimed to evaluate the clinical efficacy and safety of 1% nadifloxacin cream and the histological changes it incurs when used to treat mild to moderate facial acne in Korean patients. Methods An eight‐week, randomized, prospective, split‐face, double‐blind, vehicle‐controlled trial was performed. All participants were treated with 1% nadifloxacin cream on one‐half of the face and vehicle cream on the other, twice per day for eight weeks. Results At final visits, inflammatory acne lesions were reduced by 70% on nadifloxacin‐treated skin and increased by 13.5% on vehicle‐treated skin; non‐inflammatory acne lesions showed reductions of 48.1 and 10.1%, respectively. A significant difference was observed between the two treatments at four weeks. Histopathological examinations of the acne lesions showed decreased inflammation and interleukin‐8 expression but no change in transforming growth factor‐β expression in nadifloxacin‐treated skin compared with vehicle‐treated skin after eight weeks of treatment. Conclusions Nadifloxacin 1% cream is an effective, safe, and well‐tolerated topical treatment for Korean patients with mild to moderate acne vulgaris. Histopathological changes after nadifloxacin treatment were well correlated with clinical outcomes. Therefore, nadifloxacin can be used as an effective and safe treatment option in the management of mild to moderate acne in Asian subjects.     

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.