Light-based, adjunctive, and other therapies for acne vulgaris
- Jeffrey S Dover, MD, FRCPC
Jeffrey S Dover, MD, FRCPC
- Section Editor — Cosmetic Dermatology
- Associate Clinical Professor of Dermatology
- Yale University School of Medicine
- Priya Batra, MD
Priya Batra, MD
- Attending physician
- Mt. Sinai Hospital
- Section Editors
- Robert P Dellavalle, MD, PhD, MSPH
Robert P Dellavalle, MD, PhD, MSPH
- Section Editor — Dermatology
- Associate Professor of Dermatology and Public Health
- Denver VA Medical Center, University of Colorado School of Medicine and Colorado School of Public Health
- Moise L Levy, MD
Moise L Levy, MD
- Section Editor — Pediatric Dermatology
- Clinical Professor of Dermatology and Pediatrics
- Baylor College of Medicine
- Professor of Medicine
- Dell Medical School/University of Texas, Austin
- Mark V Dahl, MD
Mark V Dahl, MD
- Section Editor — Acne and Rosacea
- Professor Emeritus
- Mayo Clinic College of Medicine
Acne vulgaris is a common condition, and there is significant demand for effective acne therapies. Many over-the-counter products are marketed. In addition, a number of procedural therapies are utilized for the treatment of acne vulgaris with variable effectiveness.
The use of over-the-counter and light-based therapies as well as several adjunctive therapies (office-based chemical peels, microdermabrasion, comedo extraction, intralesional glucocorticoids, and heat therapy) will be reviewed here. Conventional therapies, hormonal therapy, and isotretinoin therapy for acne vulgaris are discussed separately. (See "Treatment of acne vulgaris" and "Hormonal therapy for women with acne vulgaris" and "Oral isotretinoin therapy for acne vulgaris".)
OTHER TOPICAL MEDICATIONS
For many people with acne, treatment begins with non-prescription regimens. Numerous products are available, and non-prescription treatments are effective for some individuals. Some of the most common ingredients found in non-prescription acne products include salicylic acid, benzoyl peroxide, sulfur, and alpha hydroxy acids. Tea tree oil has also been used for treatment of acne.
Patients with mild to moderate acne who do not respond to non-prescription products after three months of treatment should be clinically evaluated. Patients with more severe acne should be evaluated earlier, to consider the use of the most effective treatment regimens to prevent or minimize scarring.
Topical non-prescription acne therapies are generally well tolerated. However, rare but serious and potentially life-threatening hypersensitivity reactions to non-prescription topical acne products containing salicylic acid or benzoyl peroxide have been reported . Whether these active ingredients or inactive ingredients are responsible for the reactions is unclear. Symptoms may occur within minutes to one day or longer after product use and may include severe skin reactions, throat tightness, difficulty breathing, feeling faint, or swelling of the eyes, face, lips, or tongue. The US Food and Drug Administration recommends limiting application of these products to one or two small affected areas during the initial three days of use to test for hypersensitivity .
- www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm402722.htm?source=govdelivery&utm_medium=email&utm_source=govdelivery (Accessed on June 26, 2014).
- Bowe WP, Shalita AR. Effective over-the-counter acne treatments. Semin Cutan Med Surg 2008; 27:170.
- Zander E, Weisman S. Treatment of acne vulgaris with salicylic acid pads. Clin Ther 1992; 14:247.
- Gollnick H, Cunliffe W, Berson D, et al. Management of acne: a report from a Global Alliance to Improve Outcomes in Acne. J Am Acad Dermatol 2003; 49:S1.
- Strauss JS, Krowchuk DP, Leyden JJ, et al. Guidelines of care for acne vulgaris management. J Am Acad Dermatol 2007; 56:651.
- Seidler EM, Kimball AB. Meta-analysis comparing efficacy of benzoyl peroxide, clindamycin, benzoyl peroxide with salicylic acid, and combination benzoyl peroxide/clindamycin in acne. J Am Acad Dermatol 2010; 63:52.
- Gupta AK, Nicol K. The use of sulfur in dermatology. J Drugs Dermatol 2004; 3:427.
- Lin AN, Reimer RJ, Carter DM. Sulfur revisited. J Am Acad Dermatol 1988; 18:553.
- Wilkinson RD, Adam JE, Murray JJ, Craig GE. Benzoyl peroxide and sulfur: foundation for acne management. Can Med Assoc J 1966; 95:28.
- Tarimci N, Sener S, Kilinç T. Topical sodium sulfacetamide/sulfur lotion. J Clin Pharm Ther 1997; 22:301.
- Breneman DL, Ariano MC. Successful treatment of acne vulgaris in women with a new topical sodium sulfacetamide/sulfur lotion. Int J Dermatol 1993; 32:365.
- Lewis AB, Radoszyck H. Alpha-hydroxy acids. In: Comprehensive Dermatologic Drug Therapy, 2nd ed, Wolverton SE (Ed), Elsevier, 2007. p.730.
- Tung RC, Bergfeld WF, Vidimos AT, Remzi BK. alpha-Hydroxy acid-based cosmetic procedures. Guidelines for patient management. Am J Clin Dermatol 2000; 1:81.
- Enshaieh S, Jooya A, Siadat AH, Iraji F. The efficacy of 5% topical tea tree oil gel in mild to moderate acne vulgaris: a randomized, double-blind placebo-controlled study. Indian J Dermatol Venereol Leprol 2007; 73:22.
- Bassett IB, Pannowitz DL, Barnetson RS. A comparative study of tea-tree oil versus benzoylperoxide in the treatment of acne. Med J Aust 1990; 153:455.
- Haedersdal M, Togsverd-Bo K, Wulf HC. Evidence-based review of lasers, light sources and photodynamic therapy in the treatment of acne vulgaris. J Eur Acad Dermatol Venereol 2008; 22:267.
- Hamilton FL, Car J, Lyons C, et al. Laser and other light therapies for the treatment of acne vulgaris: systematic review. Br J Dermatol 2009; 160:1273.
- Jang MS, Doh KS, Kang JS, et al. A comparative split-face study of photodynamic therapy with indocyanine green and indole-3-acetic acid for the treatment of acne vulgaris. Br J Dermatol 2011; 165:1095.
- Kim BJ, Lee HG, Woo SM, et al. Pilot study on photodynamic therapy for acne using indocyanine green and diode laser. J Dermatol 2009; 36:17.
- Omi T, Munavalli GS, Kawana S, Sato S. Ultrastructural evidence for thermal injury to pilosebaceous units during the treatment of acne using photopneumatic (PPX) therapy. J Cosmet Laser Ther 2008; 10:7.
- Shamban AT, Enokibori M, Narurkar V, Wilson D. Photopneumatic technology for the treatment of acne vulgaris. J Drugs Dermatol 2008; 7:139.
- Wanitphakdeedecha R, Tanzi EL, Alster TS. Photopneumatic therapy for the treatment of acne. J Drugs Dermatol 2009; 8:239.
- Lee WL, Shalita AR, Poh-Fitzpatrick MB. Comparative studies of porphyrin production in Propionibacterium acnes and Propionibacterium granulosum. J Bacteriol 1978; 133:811.
- Ashkenazi H, Malik Z, Harth Y, Nitzan Y. Eradication of Propionibacterium acnes by its endogenic porphyrins after illumination with high intensity blue light. FEMS Immunol Med Microbiol 2003; 35:17.
- Sakamoto FH, Lopes JD, Anderson RR. Photodynamic therapy for acne vulgaris: a critical review from basics to clinical practice: part I. Acne vulgaris: when and why consider photodynamic therapy? J Am Acad Dermatol 2010; 63:183.
- Thiboutot D, Gollnick H, Bettoli V, et al. New insights into the management of acne: an update from the Global Alliance to Improve Outcomes in Acne group. J Am Acad Dermatol 2009; 60:S1.
- Pariser DM, Eichenfield LF, Bukhalo M, et al. Photodynamic therapy with methyl aminolaevulinate 80 mg g(-1) for severe facial acne vulgaris: a randomized vehicle-controlled study. Br J Dermatol 2016; 174:770.
- Morton CA, Szeimies RM, Sidoroff A, Braathen LR. European guidelines for topical photodynamic therapy part 2: emerging indications--field cancerization, photorejuvenation and inflammatory/infective dermatoses. J Eur Acad Dermatol Venereol 2013; 27:672.
- Taylor MN, Gonzalez ML. The practicalities of photodynamic therapy in acne vulgaris. Br J Dermatol 2009; 160:1140.
- Sakamoto FH, Torezan L, Anderson RR. Photodynamic therapy for acne vulgaris: a critical review from basics to clinical practice: part II. Understanding parameters for acne treatment with photodynamic therapy. J Am Acad Dermatol 2010; 63:195.
- Ryou JH, Lee SJ, Park YM, et al. Acne-photodynamic therapy with intra-lesional injection of 5-aminolevulinic acid. Photodermatol Photoimmunol Photomed 2009; 25:57.
- Shaaban D, Abdel-Samad Z, El-Khalawany M. Photodynamic therapy with intralesional 5-aminolevulinic acid and intense pulsed light versus intense pulsed light alone in the treatment of acne vulgaris: a comparative study. Dermatol Ther 2012; 25:86.
- Yeung CK, Shek SY, Bjerring P, et al. A comparative study of intense pulsed light alone and its combination with photodynamic therapy for the treatment of facial acne in Asian skin. Lasers Surg Med 2007; 39:1.
- Papageorgiou P, Katsambas A, Chu A. Phototherapy with blue (415 nm) and red (660 nm) light in the treatment of acne vulgaris. Br J Dermatol 2000; 142:973.
- Gold MH, Rao J, Goldman MP, et al. A multicenter clinical evaluation of the treatment of mild to moderate inflammatory acne vulgaris of the face with visible blue light in comparison to topical 1% clindamycin antibiotic solution. J Drugs Dermatol 2005; 4:64.
- Chang SE, Ahn SJ, Rhee DY, et al. Treatment of facial acne papules and pustules in Korean patients using an intense pulsed light device equipped with a 530- to 750-nm filter. Dermatol Surg 2007; 33:676.
- Sakamoto FH, Doukas AG, Farinelli WA, et al. Selective photothermolysis to target sebaceous glands: theoretical estimation of parameters and preliminary results using a free electron laser. Lasers Surg Med 2012; 44:175.
- Paithankar DY, Sakamoto FH, Farinelli WA, et al. Acne Treatment Based on Selective Photothermolysis of Sebaceous Follicles with Topically Delivered Light-Absorbing Gold Microparticles. J Invest Dermatol 2015; 135:1727.
- Kempiak SJ, Uebelhoer N. Superficial chemical peels and microdermabrasion for acne vulgaris. Semin Cutan Med Surg 2008; 27:212.
- Kessler E, Flanagan K, Chia C, et al. Comparison of alpha- and beta-hydroxy acid chemical peels in the treatment of mild to moderately severe facial acne vulgaris. Dermatol Surg 2008; 34:45.
- Atzori L, Brundu MA, Orru A, Biggio P. Glycolic acid peeling in the treatment of acne. J Eur Acad Dermatol Venereol 1999; 12:119.
- Lee HS, Kim IH. Salicylic acid peels for the treatment of acne vulgaris in Asian patients. Dermatol Surg 2003; 29:1196.
- Grimes PE. The safety and efficacy of salicylic acid chemical peels in darker racial-ethnic groups. Dermatol Surg 1999; 25:18.
- Lloyd JR. The use of microdermabrasion for acne: a pilot study. Dermatol Surg 2001; 27:329.
- Spencer JM. Microdermabrasion. Am J Clin Dermatol 2005; 6:89.
- Katz BE, Truong S, Maiwald DC, et al. Efficacy of microdermabrasion preceding ALA application in reducing the incubation time of ALA in laser PDT. J Drugs Dermatol 2007; 6:140.
- Goldstein BG, Goldstein AO. Diagnostic procedures. In: Practical Dermatology, 2nd ed, Mosby-year Book, Inc, 1997. p.26.
- Levine RM, Rasmussen JE. Intralesional corticosteroids in the treatment of nodulocystic acne. Arch Dermatol 1983; 119:480.
- www.thermaclear.com/clinical-results.cfm (Accessed on May 22, 2009).
- Badgwell Doherty C, Doherty SD, Rosen T. Thermotherapy in dermatologic infections. J Am Acad Dermatol 2010; 62:909.
- OTHER TOPICAL MEDICATIONS
- Salicylic acid
- Benzoyl peroxide
- Alpha hydroxy acids
- Tea tree oil
- LIGHT/LASER THERAPIES
- Mechanism of action
- Evidence for efficacy
- Emerging therapy
- ADJUNCTIVE THERAPIES
- Office-based superficial chemical peels
- Comedo extraction
- Intralesional glucocorticoids
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS