Journal of Clinical and Aesthetic Dermatology

APR 2018

An evidence-based, peer-reviewed journal for practicing clinicians in the field of dermatology

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43 JCAD JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY April 2018 • Volume 11 • Number 4 O R I G I N A L R E S E A R C H A Acne vulgaris is a common self-limiting disorder of the pilosebaceous unit that is seen primarily in adolescents. 1 Acne is often an early manifestation of puberty. In girls, the occurrence of acne might precede their first menstrual cycle by more than one year. The greatest number of cases are seen during the mid-to-late teenage years of life. 2 The key elements in the pathogenesis of acne are follicular epidermal hyperproliferation, excess sebum production, inflammation, and the presence of Propionibacterium acnes (P. acnes). 3 The disease is characterized by a variety of clinical lesions, although one type of lesion might be predominant. The course of acne can be self-limiting, while the sequelae can be lifelong with pitted or hypertrophic scar formation. 3 Comedones and papules form the noninflammatory component, while pustules, nodules, and cysts are the features of the inflammatory variety. Pitted or hypertrophic scarring is more common in patients with inflammatory acne lesions. 3 Acne affects primarily the face, neck, upper trunk, and upper arms. Acne can have a significant impact on the quality of life and psychosocial well-being of the patient. 4,5 Therefore, early and aggressive intervention is necessary, especially in the inflammatory variety of acne vulgaris. 6 Systemic antibiotics 7,8 and retinoids 9 are the mainstay of anti-acne management, followed by topical antibiotics, 10 benzoyl peroxide, 11 and topical retinoids. 12 However, in women of child-bearing age, there are limitations in the systemic management of Grades 3 and 4 acne. Antibiotic resistance and adverse effects of topical anti-acne medications are on the rise, so light-based devices and technologies are proving to be effective in the treatment of acne. 13,14,15–17 Mohanan et al 18 has employed the use of intense pulsed light (IPL) in Indian skin for acne vulgaris with favorable results. Patidar et al 19 studied the efficacy of IPL in the treatment of facial acne vulgaris and compared two different fluences. In this study, we assessed the efficacy and safety of IPL therapy (Magma-F-SR; FormaTK Systems, Tirat Carmel, Israel) as a monotherapy in the treatment of Grades 3 and 4 acne in women of child bearing age. MATERIALS AND METHODS One hundred female patients aged 21 to 30 years with Fitzpatrick Skin Types IV to VI were enrolled in this study. Patients who had not received any anti-acne treatment for at least one month prior to enrollment were included. Patients with a history of herpes simplex or those with associated hormonal disorders (e.g., thyroid disorder, polycystic ovary syndrome) were excluded from this study. Patients who were undergoing treatment for infertility were only included after proper consultation with their treating gynecologist. A detailed lesion count was done prior to treatment and A B S T R A C T Background: Acne vulgaris is a self-limiting, chronic inflammatory disorder of the pilosebaceous unit characterized by exacerbations and remissions. It is often the early manifestation of puberty, and in girls it appears relatively early. In women, acne tends to become aggravated during the menstrual period, pregnancy, and in those who are on progesterone. Acne treatment is divided into two parts: topical and systemic. For Grades 1 and 2 acne, topical treatment is sufficient, while for Grades 3 and 4 acne, systemic drugs such as tetracyclines and retinoids are required to control the symptoms. Chemical peeling with glycolic and salicylic acids, cryosurgery with liquid nitrogen or carbon dioxide, and narrowband ultraviolet light are a few of the supportive procedural treatments available for Grades 3 and 4 acne. Objective: The author sought to determine the efficacy and safety of intense pulsed light (IPL) therapy (Magma-F-SR; FormaTK Systems, Tirat Carmel, Israel) in the treatment of Grades 3 and 4 acne as monotherapy in women of child-bearing age. Materials and Methods: One- hundred female patients with Grades 3 and 4 acne were enrolled in this study. All patients were treated with IPL using a 530nm to 1,200nm filter once a week for a total duration of six weeks. Patient and physician scores were assessed at Weeks 1 and 6 after the last treatment. Clinical photographs were also reviewed to determine the degree of efficacy. Adverse effects were noted. Results: Eighty percent of the patients involved in this study reported a significant reduction in lesion count compared to baseline. The adverse events were minimal-to-mild erythema. Conclusion: IPL therapy with 530nm to 1,200nm filter is an effective and safe modality of treatment as monotherapy in managing inflammatory Grades 3 and 4 of acne vulgaris in women of child-bearing age. KEYWORDS: Acne vulgaris, intense pulsed light therapy, monotherapy Efficacy and Safety Evaluation of High- density Intense Pulsed Light in the Treatment of Grades II and IV Acne Vulgaris as Monotherapy in Dark-skinned Women of Child Bearing Age by A JAY J. DESHPANDE, MBBS, DVD, DNB Dr. Deshpande is with the Maharashtra Medical Foundation Joshi Hospital in Pune, India. J Clin Aesthet Dermatol. 2018;11(4):43–48 FUNDING: No funding was provided for this article. DISCLOSURES: The author has no conflicts of interest relevant to the content of this article. CORRESPONDENCE: Ajay J. Deshpande, MBBS, DVD, DNB; Email: deshpandeajay.68@gmail.com

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