Lasers Med Sci DOI 10.1007/s10103-013-1440-0
ORIGINAL ARTICLE
Intense pulsed light versus benzoyl peroxide 5 % gel in treatment of acne vulgaris Azmy Ahmed Abd El-latif & Faisal Abdel Aziz Hassan & Ahmed Rashad Elshahed & Amr Ghareeb Mohamed & Mohamed L. Elsaie
Received: 14 April 2013 / Accepted: 16 September 2013 # Springer-Verlag London 2013
Abstract Acne is a common disorder affecting the pilosebaceous unit. Despite many advances in the treatments of acne vulgaris the best option is still controversial as the pathogenesis of acne is rather complex, necessitating various combination therapies. The objective of this study is to compare the clinical efficacy of intense pulsed light therapy (IPL) versus benzoyl peroxide 5 % for the treatment of inflammatory acne. Fifty patients of both sexes, (15 males and 35 females) aged (18–27 years), with mild-to-severe acne and Fitzpatrick skin phototype IV were enrolled in this study. The patients were equally divided into two groups. The first group was treated by benzoyl peroxide while the second group was treated by IPL. For both therapies, patients experienced a significant reduction in the mean of the inflammatory lesion counts over the treatment period. Comparing the effects of both therapies, BP produced better results than IPL. The difference in the results was statistically significant at the midpoint of the study. However, this difference was insignificant at the end of study. Treatment with both benzoyl peroxide and IPL resulted in considerable improvement of the acne after 5 weeks of treatment. Comparing the effects of both therapies, BP produced better results than IPL. The difference in the results was statistically significant at the midpoint of the study. However, this difference was insignificant at the end of study. Keywords Intense pulsed light . Acne . Benzoyl peroxide A. A. A. El-latif : F. A. A. Hassan : A. R. Elshahed : A. G. Mohamed Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt M. L. Elsaie (*) Department of Dermatology and Venereology, National Research Centre, Cairo, Egypt e-mail:
[email protected]
Introduction Acne is a common disorder affecting the pilosebaceous unit, clinically characterized by the presence of comedones, inflammatory papules, pustules, and sometimes, nodules and cysts arising commonly during adolescence and causing great psychosocial stress [1]. Despite many advances in the treatments of acne vulgaris the best option is still controversial as the pathogenesis of acne is rather complex, necessitating various combination therapies [2]. Given the limitations of conventional approaches in the treatment of acne due to potential side effects, searching for new, safe, and effective modalities in the acne treatment that have better compliance and sustained effectiveness is continued [3]. Because most patients nowadays tend to seek the least invasive treatments and by entering the era of phototherapy for acne treatment, a rising number of laser or light-based therapies have been introduced as effective and safe acne treatments with minimal side effects [4]. One of these emerging light-based therapies that increasingly become useful is the intense pulsed light (IPL) system [5]. Pathogenesis of acne vulgaris is a multifactorial process that begins with the obstruction of pilosebaceous ducts. Acne lesions are therefore concentrated in areas of maximum sebaceous gland density, including face, neck, upper arms, and back [6]. In recent years, due to better understanding of the pathogenesis of acne, new therapeutic modalities are designed. Availability of new treatment options to complement the existing armamentarium should help to achieve the successful therapy of greater numbers of acne patients, ensure improved tolerability and fulfill patient expectations. Successful management of acne needs careful selection of anti-acne agents according to clinical presentation and individual patient needs [7–12].
Lasers Med Sci
IPL devices employ polychromatic light [13]. Along with emitting wavelengths such as blue and red that can photoactivate porphyrins and target Propionibacterium acnes growth, the broad spectrum delivery by IPL devices is believed to lead to photothermolysis, where the absorption of light by endogenous chromophores in the skin create enough heat and energy to target the blood vessels that supply sebaceous glands in order to reduce sebum production [14]. Two mechanisms of action target acne lesions: a photodynamic effect is evoked by the use of both UV light and visible light that is absorbed by porphyrins (PpIX, coproporphyrin III; absorption peaks are 400, 510, 542, 578, 630, and 665 nm) that are produced by P. acnes. This absorption leads to the generation of reactive oxygen species (ROS) with subsequent bactericidal effects. Another pathway is based on the selective photothermolysis of blood vessels that supply sebaceous glands, which reduces the sebum secretion rate [15]. A third mechanism of action requires an exogenous photosensitizer which is applied to the skin surface. The photosensitizer accumulates in the sebaceous glands and leads to the destruction of the glands after light activation [16]. Current studies using IPL as an anti-acne therapy have led to mixed results. In comparisons with other light sources, IPL was less effective at reducing acne lesions than pulsed dye lasers but more effective than blue-red combination lightemitting diodes [17].
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Methods Fifty patients of both sexes with inflammatory acne lesions and Fitzpatrick skin phototype IV were enrolled in this study; 15 males and 35 females. They were randomly selected from the Dermatology, Venereology & Andrology out-patient Clinics, AL Azhar University Hospitals. This study was performed from December 2010 to October 2011. No medicine or procedures that might affect the course of acne were allowed during the 5-week study period. Each patient involved in this study was informed about his role in the study and his consent was taken. All patients involved in the study fulfilled the following criteria: (a) Their age ranged from 18 to 35 years. (b) They were suffering from inflammatory acne lesions. Patients with history of topical acne treatment or systemic antibiotics within the last 2 weeks, and patients with history of the use of systemic steroids or systemic retinoids within the last 6 months were excluded. Pregnant patients or patients with a history of photosensitivity were excluded as well. All patients were subjected to the following: &
Assessment of acne severity according to Hayashi et al. [21] who used standard photographs and lesion counting to classify acne into four groups. They classified acne
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based on the number of inflammatory eruptions on the face as 0–10=mild, 11–40=moderate, 41–100=severe, and more than 100=very severe. Evaluation included lesion counting and determining the overall severity. Non-inflammatory lesions, if present, would not be counted. The duration of the study was 5 weeks. Clinical assessment and photo documentation was conducted before starting treatment, after the 3rd week as a midpoint evaluation and after the final treatment session. For the investigators’ assessments, these assessments were rated on a 5-point scale (represented as the percentage improvement in lesion count) as follows: Clearance=[greater than or equal to] 90 % improvement of the condition Marked improvement=60 % to 89 % improvement Moderate improvement=40 % to 59 % improvement Mild improvement=10 % to 39 % improvement No improvement=
