Blue light phototherapy in the treatment of acne

BACKGROUND: Blue light irradiation is known to be effective against acne. However, the profile of a good candidate is still unclear. METHODS: Thirty-one Taiwanese with symmetrical facial acne were irradiated with blue light on one side of the face selected randomly twice weekly for 4 consecutive weeks. The other half of the face was left untreated as control. Parameters, including scar type, pore size, and facial follicular porphyrin fluorescence intensity, were documented. The severity of acne was assessed before the treatment, after two, four, and eight sessions of treatment, and 1 month after the treatment was completed. RESULTS: Compared with the non-irradiation side, eight sessions of blue light irradiation were effective in acne treatment (P<0.001). Gender (P=0.471), scar type (P-values of pitted, atrophic, and hypertrophic type were 0.688, 0.572, and 0.802, respectively), pore size (P=0.755), and pretreatment fluorescence intensity (P=0.656) could not be used as predictive factors of therapeutic effectiveness. Compared with pretreatment, nodulocystic lesions tended to worsen despite treatment. In addition, the therapeutic effectiveness was not related to the fluorescence intensity change (P=0.812). CONCLUSIONS: Blue light irradiation is effective in acne treatment. Patients without nodulocystic lesions are better candidates for blue light irradiation.     

A new targeted blue light phototherapy for the treatment of acne

BACKGROUND: The effects of blue light phototherapy on inflammatory acne lesions were recently investigated. Many reports have used high-intensity, narrow-band 420 nm UV-free blue light delivery systems. The aim of this study was to evaluate a new blue light system (MultiClear) for targeted blue light phototherapy. METHOD: Ten Japanese patients with acne on the face or back were treated with targeted blue light once or twice a week. Acne severity was graded according to the acne severity score suggested by Allen and Smith (1982). If the acne was prevalent on the back or chest, the acne severity score of Burton et al. (1971) was adopted. The new targeting blue light system is equipped with a flexible optical light guide as a delivery system and the treatment device is placed directly only on the affected area. RESULT: Of the 10 patients, eight had a significantly reduced acne severity score without any side effects. Although two patients discontinued the study because of unsatisfactory results, none of the patients showed any harmful side effects from the targeted blue light phototherapy. CONCLUSION: Targeted blue light phototherapy with MultiClear is effective for the treatment of inflammatory acne lesions. This new irradiation device offers some advantages over previous blue light systems.     

窄谱蓝光治疗寻常痤疮临床疗效观察

目的：观察窄谱蓝光对寻常痤疮的治疗效果。方法：将86例轻、中度寻常痤疮患者分为两组,试验组用窄谱蓝光照射,对照组外用5％硫磺洗剂。采用痤疮综合分级系统（GAGS）评价治疗前、后疗效。结果：试验组和对照组有效率分别为79．55％和 42．85％;GAGS综合分值均较治疗前明显下降（P〈0．01）,但试验组下降更显著。结论：窄谱蓝光治疗轻、中度寻常痤疮疗效好。不良反应小。     

红蓝光联合倒模治疗痤疮疗效评价

目的：评价红蓝光联合倒模治疗轻中度痤疮的疗效和安全性。方法：96例轻中度痤疮患者随机分为实验组（50例）和对照组（46例）。实验组采用红蓝光照射联合倒模治疗;对照组仅用倒模治疗,每周2次,4周后采用痤疮综合分级系统（GAGS）评价疗效,同时观察不良反应。结果：实验组和对照组有效率分别为88.00%和47.83%,差异有统计学意义（P<0.01）,两组均无明显不良反应。结论：红蓝光联合倒模治疗轻中度痤疮安全有效。     

微晶磨削联合红蓝光治疗轻中度寻常痤疮70例临床观察

目的：评价微晶磨削联合红蓝光交替照射治疗轻中度寻常痤疮的临床疗效及安全性。方法：200例轻中度寻常痤疮患者随机分为3组,治疗组采用微晶磨削（1次）联合红蓝光交替照射治疗（每3天1次,疗程4周）;对照1组采用微晶磨削治疗（1次）。对照2组采用红蓝光交替照射（每3天1次,疗程4周）。结果：治疗1周和4周后,治疗组的有效率（66．00％和80．00％）高于对照1组（32．00％和43．00％）和对照2组（21．00％和34．00％）,差异均有统计学意义（均P〈0．05）;对照1组和对照2组的有效率差异无统计学意义（P〉0．05）。三组不良反应有红斑、干燥以及疼痛等。结论：微晶磨削联合红蓝光交替照射治疗轻中度寻常痤疮疗效显著．不良反应轻。     

Non-invasive diagnostic evaluation of phototherapeutic effects of red light phototherapy of acne vulgaris

Background: During the past few years, various phototherapeutic protocols with full‐spectrum visible light or selected wavebands have been investigated in the treatment of acne vulgaris with variable results. Methods: Fifteen women suffering from moderate acne vulgaris of the face were exposed to 20 J/cm² of broad‐band red (λ: 600–750 nm) light twice weekly for 4 weeks. In addition, with the aim to improve the present knowledge of the mechanisms of action of phototherapy, we measured skin sebum, pH, hydration and trans‐epidermal water loss (TEWL). Lesions of the trunk were not irradiated and served as controls. Results: A significant improvement of acne lesions and a significant decrease of skin sebum excretion and TEWL of the face were registered at the end of the therapy and at the 3‐month follow‐up visit. The results could be related to a reduced follicular colonization of Propionibacterium acnes, in that it was lethally damaged by photoactivated endogenous porphyrins. Conclusion: The present findings seem to indicate that red light phototherapy may represent an effective, well‐tolerated, safe, simple and inexpensive treatment option for moderate acne vulgaris.     

Therapeutic efficacy of metronidazole by needle-free jet injection combined with blue light therapy in Moderate-to-Severe facial acne vulgaris

Background

Acne vulgaris is one of the most common dermatological diseases. Some topical treatments for acne used in combination, such as blue light and topical antibiotics (such as metronidazole) by needle-free jet injection (NFJI), are becoming prevalent in clinical practice, but the efficacy remains uncertain.

Methods

In order to investigate the effect of blue light combined with metronidazole by NFJI in the treatment of acne, the 251 enrolled patients were randomly assigned into the blue light group, metronidazole (MNZ) group, and MNZ + blue light group, and then received 6-weeks' treatment. A variety of objective and subjective methods such as clinical pictures, skin barrier physiological parameters (including trans-epidermal water loss (TEWL), stratum corneum hydration, facail surface sebum, erythema and pigmentation), the Investigator Global Assessment score, acne lesion count assessment, Patients' Self-Assessment, and VAS score were used to evaluate the efficacy and side effects of the treatments.

Results

Compared to the baseline, the MNZ + blue light group showed significant improvement in acne lesion count reduction, TEWL, straum corneum hydration, facial surface sebum and erythema (p < 0.05). The MNZ + blue light group showed significant differences compared with the MNZ group and blue light group in terms of acne lesion count reduction and erythema (p < 0.05) Compared to the MNZ group, the MNZ + blue light group demonstrated significant improvement in TEWL and sebum (p < 0.05). While compared to the blue light group, the MNZ + blue light group showed significant improvement in hydration (p < 0.05). There was no statistically significant difference among the three groups in pigmentation (p > 0.05).

Conclusion

The combination of MNZ by NFJI and blue light has a synergistic effect and can relieve acne skin lesion within 6 weeks in the treatment of moderate and moderate–to–severe facial acne vulgaris, meanwhile, this method has a good safety.     

Efficacy of ALA-PDT vs blue light in the treatment of acne

BACKGROUND: Photodynamic therapy (PDT) is based on the principle of using light excitation of a wavelength-specific endogenous or exogenous photosensitizer to destroy the target tissue, and has shown efficacy in the treatment of certain non-melanoma skin cancers. PDT using aminolevulinic acid (5-ALA) has attracted attention in the treatment of acne vulgaris. METHOD: Twenty patients with moderate to severe acne vulgaris on the face were treated with four sessions of topical ALA-PDT with blue light (415 nm) on the right side of the face compared with blue light alone on the left side of the face, each treatment being 1 week apart. Ten percent of topical ALA was applied to acne spots on the right side of the face with a 1-h incubation period and the entire face was treated with 48 J/cm(2) of 415 +/- 5 nm light from an articulated LED planar array. Evaluation was performed by counting acne lesions at baseline, 4, 8, 12 and 16 weeks after the beginning of the treatment. Biophysical measurements included sebum levels and the erythema, and melanin indices. RESULT: At the given assessment times 4, 8, 12 and 16 weeks after the beginning of the treatment, the mean percent reduction in inflamed lesions counts tended to be higher in the ALA-PDT areas; it was 32%, 50.9%, 65.9% and 71.1%, respectively, compared with the blue-light-alone treatment, which was 20.7%, 27%, 57.7% and 56.7%, respectively, but without any statistical significance (P=0.092). There was no demonstrable significant change in sebum excretion, erythema or the melanin index after treatment. The side effects were pain, stinging, peeling, erythema, pruritus, oozing and pustules. These side effects were stronger on the ALA-PDT-treated side. CONCLUSION: From this study, the trend for ALA-PDT with blue light to be superior to blue light alone was observed, but it did not reach statistical significance. ALA-PDT had more side effects.     

窄谱蓝光联合1%克林霉素磷酸酯凝胶治疗寻常痤疮疗效观察

目的观察窄谱蓝光联合外用克林霉素磷酸酯凝胶治疗寻常痤疮的疗效。方法 110例痤疮患者随机分为两组,治疗组58例,采用窄谱蓝光照射联合外用1%克林霉素磷酸酯凝胶治疗;对照组52例,外用1%克林霉素磷酸酯凝胶治疗。结果治疗组和对照组有效率分别为75.9%和25.0%,治疗组疗效和有效率高于对照组(P<0.01)。结论窄谱蓝光照射联合外用1%克林霉素磷酸酯凝胶治疗痤疮疗效优于单用克林霉素磷酸酯凝胶。     

红蓝光照射联合胶原贴敷料治疗寻常痤疮疗效观察

目的观察红蓝光照射联合胶原贴敷料治疗寻常痤疮疗效和安全性。方法126例寻常痤疮患者随机分成两组,试验组采用红蓝光照射联合胶原贴敷料治疗,对照组采用红蓝光照射治疗。结果治疗4周后试验组和对照组患者有效率分别为93．9％和73．3％,差异有统计学意义（P〈0．01）。结论红蓝光照射联合胶原贴敷料治疗寻常痤疮安全有效。     

红蓝光治疗面部轻中度痤疮疗效观察

目的观察红蓝光联合治疗面部痤疮患者的临床疗效和安全性。方法将108例轻、中度痤疮患者随机分成2组,试验组68例采用红蓝光照射联合外用克林霉素磷酸酯凝胶治疗;对照组40例单独应用克林霉素磷酸酯凝胶治疗。于治疗前及治疗第4周、第8周评价疗效及不良反应。结果治疗4周时试验组痊愈率为11.76%,有效率为61.76%;对照组痊愈率7.5%,有效率42.5%,两组差异有统计学意义(P<0.05);治疗8周时实验组痊愈率为23.53%,有效率为85.29%;对照组痊愈率10%,有效率47.5%,两组差异有统计学意义(P<0.05)。实验组与对照组均无明显不良反应。结论应用红蓝光照射治疗轻、中度面部寻常性痤疮安全有效。     

Phototherapy with blue (415 nm) and red (660 nm) light in the treatment of acne vulgaris

In this study we have evaluated the use of blue light (peak at 415 nm) and a mixed blue and red light (peaks at 415 and 660 nm) in the treatment of acne vulgaris. One hundred and seven patients with mild to moderate acne vulgaris were randomized into four treatment groups: blue light, mixed blue and red light, cool white light and 5% benzoyl peroxide cream. Subjects in the phototherapy groups used portable light sources and irradiation was carried out daily for 15 min. Comparative assessment between the three light sources was made in an observer-blinded fashion, but this could not be achieved for the use of benzoyl peroxide. Assessments were performed every 4 weeks. After 12 weeks of active treatment a mean improvement of 76% (95% confidence interval 66-87) in inflammatory lesions was achieved by the combined blue-red light phototherapy; this was significantly superior to that achieved by blue light (at weeks 4 and 8 but not week 12), benzoyl peroxide (at weeks 8 and 12) or white light (at each assessment). The final mean improvement in comedones by using blue-red light was 58% (95% confidence interval 45-71), again better than that achieved by the other active treatments used, although the differences did not reach significant levels. We have found that phototherapy with mixed blue-red light, probably by combining antibacterial and anti-inflammatory action, is an effective means of treating acne vulgaris of mild to moderate severity, with no significant short-term adverse effects.     

红蓝光动力联合复方木尼孜其颗粒及阿达帕林凝胶治疗重度痤疮疗效评价

目的:评价红蓝光动力联合复方木尼孜其颗粒及阿达帕林凝胶治疗重度痤疮的疗效。方法:实验组和对照组均口服复方木尼孜其颗粒和外搽阿达帕林凝胶,实验组加用红蓝光照射。结果:治疗6周后实验组和对照组总有效率分别为92.6%和72.5%,差异有显著性(P0.01)。结论:红蓝光动力联合复方木尼孜其颗粒及阿达帕林凝胶治疗重度痤疮有效。     

当归苦参丸联合红蓝光和维A酸乳膏治疗中度痤疮疗效评价

目的:评价当归苦参丸联合红蓝光、维A酸乳膏治疗中度痤疮的临床疗效和安全性。方法:将入选的118例中度痤疮患者随机分成2组,治疗组(60例)给予当归苦参丸联合红蓝光、维A酸乳膏治疗,对照组(58例)给予红蓝光联合维A酸乳膏治疗,2组患者疗程均为4周。治疗结束时评价两组患者的临床疗效。结果:治疗组与对照组有效率分别为81.60%和55.17%,差异有统计学意义(P0.05)。结论:当归苦参丸联合红蓝光及维A酸乳膏治疗中度痤疮安全有效。     

Topical aminolaevulinic acid-photodynamic therapy for the treatment of acne vulgaris: a study of clinical efficacy and mechanism of action

BACKGROUND: Acne affects 83-95% of 16-year-olds of both sexes, and many seek help from a clinician. Emerging problems with conventional acne treatments, specifically antibiotic resistance of Propionibacterium acnes and fears over the safety and tolerance of oral isotretinoin, create a demand for novel treatment modalities in acne. OBJECTIVES: To study the efficacy of aminolaevulinic acid-photodynamic therapy (ALA-PDT) in the treatment of acne and to identify the mode of action, looking specifically at the effects on surface numbers of P. acnes and on sebum excretion. METHODS: Ten patients (nine men and one woman, age range 16-40 years) with mild to moderate acne on their backs were recruited. Each patient's back was marked with four 30-cm2 areas of equal acne severity. Each site was then randomly allocated to either ALA-PDT treatment, light alone, ALA alone or an untreated control site. At baseline, numbers of inflammatory and noninflammatory acne lesions were counted, sebum excretion measured by Sebutapes (CuDerm, Dallas, TX, U.S.A.) and surface P. acnes swabs performed. ALA cream (20% in Unguentum Merck) was applied under occlusion to the ALA-PDT and ALA alone sites for 3 h. Red light from a diode laser was then delivered to the ALA-PDT and light alone sites (635 nm, 25 mW cm(-2), 15 J cm(-2)). Each patient was treated weekly for 3 weeks. At each visit acne lesion counts were performed and 3 weeks following the last treatment sebum excretion rates and P. acnes swabs were repeated. RESULTS: There was a statistically significant reduction in inflammatory acne lesion counts from baseline after the second treatment at the ALA-PDT site but not at any of the other sites. No statistically significant reduction in P. acnes numbers or sebum excretion was demonstrated at any sites including the ALA-PDT site. CONCLUSIONS: ALA-PDT is capable of clinically improving acne. An alternative mode of action for ALA-PDT other than direct damage to sebaceous glands or photodynamic killing of P. acnes is suggested from the results of this study.     

Light/laser therapy in the treatment of acne vulgaris

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.     

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

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.     

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.