Combined 400-600nm and 800-1200nm Intense Pulsed Phototherapy of Facial Acne Vulgaris
November 2019 | Volume 18 | Issue 11 | Original Article | 1116 | Copyright © November 2019
J. Matthew Knight MD
Knight Dermatology Institute, Orlando, FL
Background and Objective: Laser and light-based therapies are relatively new treatment options for acne vulgaris patients. Intense pulsed light (IPL) is believed to exploit the photosensitivity of P. acnes residing in the pilosebaceous units at lower wavelengths and induce anti-inflammatory effects by influencing cytokine release at higher wavelengths. Our study aimed to assess the clinical safety and efficacy of a novel dual-band “notch” acne filter (400-600nm and 800-1200nm) in improving inflammatory and non-inflammatory lesions in patients presenting with mild-to-moderate acne.
Materials and Methods: The study was designed as a single-site, prospective study of 10 patients with Fitzpatrick skin types II-V presenting with mild to moderate inflammatory facial acne vulgaris. A total of five whole-face light treatments were conducted at 1-2-week intervals with an IPL system (Lumenis M22 System, Lumenis Ltd.) equipped with a dual-band “notch” acne filter (400-600nm and 800-1200nm). Follow-up visits were performed at 1 and 4 weeks following the last treatment session. Acne mean change from baseline was assessed using the 4-point Investigator Global Assessment (IGA) scale. Comprehensive facial photographs were taken, and lesions were counted at screening, treatment 4, and both 1- and 4-week follow-up visits. The investigator and the patients assessed overall improvements in appearance, using the 5-point Likert scale. Subjects also completed the Cardiff Acne Disability Index (CADI) questionnaire and rated their satisfaction from treatment. Subject-reported pain, using the visual analog scale (VAS), and downtime were also recorded.
Results: Treatment impact on overall lesion clearance was most substantial at 4 weeks follow-up, at which 50% of patients showed at least a 50% reduction from baseline of lesion counts (P<0.0001). IGA scores improved throughout the course of the study, and significant improvements in the overall skin condition was noted, with mean 1.63-point and 1.50-point increases from baseline in the acne improvement ratings, at 1- and 4-weeks follow-up, respectively (P=0.0074, 0.0063). Patient-assessed CADI improved throughout the treatment and follow-up visits, peaking at a 3.22-point and 4.9-point average reductions from baseline at 1-week follow-up (P=0.0001) and 1-month follow-up (P<0.0001), respectively. The majority of the patients (80%) rated their acne lesions as improved, much improved, or very much improved at 4-weeks follow-up (P=0.0004). Significant enhancements were also noted for skin texture. Eighty percent of the patients reported overall satisfaction with treatment outcomes, while 60% rated their satisfaction as “good” or “very good” at 4-weeks follow-up (P<0.0001). Treatments were well tolerated, with mean per-session VAS scores being ≤3.77, while the mean downtime was negligible (a few hours).
Conclusion: The use of an IPL device equipped with a proprietary “notch” acne filter elicited a significant effect on acne vulgaris. No severe pain, erythema, edema, folliculitis, crusting or exfoliation was noted, emphasizing the safety of our technique.
J Drugs Dermatol. 2019;18(11):1116-1122.
Acne vulgaris is estimated to affect up to 87% of the population, predominately adolescents and young adults, and is associated with significant, and occasionally permanent, morbidity and psychological burden.1,2 Key pathogenic elements include hypercornification of the pilosebaceous unit and increased sebum production,2,3 which fosters the colonization of Propionibacterium acnes (P. acnes) in the pilosebaceous ducts. In turn, the hair follicles become inflamed, triggering the upregulation of pro-inflammatory mediators.4,5
The clinical manifestations of acne range from micro-comedones to inflamed papules, pustules, and nodules, the latter of which can lead to permanent atrophic or hypertrophic scarring.6 Conventional treatments, such as topical and systemic antimicrobials, anti-inflammatories, hormones, and retinoids, have been proven to be effective in targeting the pathogenic factors of acne vulgaris.7,8,9 Although these regimens are standard first-line treatment modalities, they are seldom 100% effective. Additionally, such remedies carry the risk of skin irritation, antibiotic resistance, hematologic abnormalities, and in some cases, teratogenicity. Moreover, obtaining the patients’ long-term compliance can be challenging, thus leading to greater difficulty in treating acne.7,10,11