Suggested citation: Bani A, Pecani N, Vasili E, Hoxha M, Kondakciu A, Xinxo S. The effectiveness of phototherapy compared to standard medication in the treatment of Acne Vulgaris. Alban Med J 2017;1:39-47.
The effectiveness of phototherapy compared to standard medication in the treatment of Acne Vulgaris
Artur Bani1, Niko Pecani2, Ermira Vasili2, Mevlud Hoxha1, Anisa Kondakciu3, Sonila Xinxo4
1 Regional Hospital, Berat, Albania;
2 University Hospital Center “Mother Teresa”, Tirana, Albania;
3 Health Center, Kutalli, Berat, Albania;
4 Institute of Public Health, Tirana, Albania.
Corresponding author: Artur Bani, MD;
Address: Regional Hospital, Berat, Albania;
E-mail: arturbani@yahoo.com
Abstract
Aim: To assess the effectiveness of phototherapy with Pulsed Light and Heat Energy (LHE) versus local and local and systemic medication in the treatment of mild and moderate forms of acne.
Methods: This study involved 235 individuals with various forms of Acne vulgaris in Berat region, Albania. During a period of five years, there were treated with phototherapy 119 patients with Acne vulgaris (68 with a moderate form and 51 with a mild form), whereas 116 patients underwent standard treatment (48 patients with a mild form and 68 patients with a moderate form). Assessment of treatment effectiveness was based on the number of inflammatory and non-inflammatory elements at the beginning of the therapy and in the intervals after 2 sessions, 4 sessions, 6 sessions, 8 sessions, 1 month after treatment with Phototherapy and 2, 4, 6, 8, 10, and 12 weeks after standard treatment.
Results: One month after the treatment with Phototherapy, the inflammatory and non inflammatory elements cleaning reached 67.9±6.2% in the mild form and 68.4±6.5% in the moderate form of Acne vulgaris. Three months after the treatment with local treatment, the inflammatory and non inflammatory elements cleaning reached 59.4±5.8 in the mild form and 71.4±7.2 after treatment with local plus systemic in the moderate form of Acne vulgaris.
Conclusion: The treatment of Acne vulgaris with phototherapy LHE as mono-therapy is a medical alternative which gives good clinical results in a relatively short period of time (one month) and with minimal side effects.
Keywords: acne vulgaris, phototherapy, standard treatment.
Introduction
Acne vulgaris is a frequent skin disease affecting 80%-85% of adolescents and young adults at any time during their lives. Acne vulgaris is the most common skin disease and is characterized by non-inflammatory, open or closed comedones and by inflammatory papules, pustules, and nodules. Acne vulgaris affects the areas of skin with the densest population of sebaceous follicles. These areas include the face, the upper part of the chest and the back.
The pathophysiology of acne involves four key mechanisms of action: abnormal proliferation and differentiation of keratinocytes, increased sebum production, hyperproliferation of Propionibacterium acnes, and an inflammatory response initiated by bacterial antigens and cytokines (1).
P acnes is an anaerobic organism present in acne lesions (2). The presence of P acnes promotes inflammation through a variety of mechanisms. P acnes stimulates inflammation by producing pro-inflammatory mediators that diffuse through the follicle wall (3).
Studies have shown that P acnes activates the toll-like (TL) receptor 2 on monocytes and neutrophils. Activation of the TL receptor 2 then leads to the production of multiple proinflammatory cytokines, including interleukins (IL) 12 and IL8 and tumor necrosis factor (TNF). Hypersensitivity at P acnes may also explain why some individuals develop inflammatory acne vulgaris while others do not (3,4). Inflammation may be a primary phenomenon or a secondary phenomenon.
To date, the evidence suggests a secondary inflammatory response to P acnes (4,5). However, IL-alpha expression has been identified in microcomedones, and it may play a role in the development of acne (6,7).
Propionibacterium acnes is an obvious target for acne phototherapy since it is central to the inflammatory process (1).
P. acnes makes porphyrins, which are present in the follicle, in proportion to its population. Once the porphyrin is exposed to visible light, it becomes chemically active and transfers to an excited state, resulting in the formation of singlet oxygen, which combines with cell membranes to destroy the P acnes (8).
This process depends on the rate of production of excited porphyrin molecules, which is influenced by the concentration of porphyrins, the concentration of photons, the temperature, and the wavelength of photons (1).
The aim of this study was to compare the clinical efficacy of Phototherapy (LHE) compared to the standard treatment of acne vulgaris in Albanian patients.
Methods
This study involved 235 individuals with various forms of acne vulgaris in Berat region, Albania. During a period of five years, there were treated with phototherapy 119 patients with Acne vulgaris (68 with a moderate form and 51 with a mild form), whereas 116 patients underwent standard treatment (48 patients with a mild form and 68 patients with a moderate form).
In the first group, the study included a total of 119 patients treated with phototherapy with a mean age of 18.1±3.3 years (62.5% were females and 37.5% were males). The minimum age was 14 years and the maximum was 27 years (Table 1).
Table 1. Demographic data of the patients treated with phototherapy
The inclusion criteria applied for Phototherapy included: age over 14 years old, general good health, the ability to comply with the study protocol and an acne severity grade of mild to moderate form. Exclusion criteria included patients under 13 years old, pregnant or lactating women, having a history with herpes simplex, suffering from collagenosis, having been treated with retinoid within the past six months, treated with sulfonamides, tetracycline, thiazides, antidepressant tryciclic, non-steroidal anti-inflammatory drugs, suffering from epilepsy, history of skin cancer, or sun burn within the last 30 days.
Treatment parameters of phototherapy
Depending on the skin’s phototype, the energy level setting was done for each patient before commencing the treatment (Table 2).
Table 2. Energy level setting by skin phototype