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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45 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 which subsided within 30 minutes. Pre- and post-treatment photographs of three patients are depicted in Figures 1 to 3. Patient satisfaction scores revealed that 74 of the 93 (approximately 80%) patients noticed good-to-excellent improvement; 10 of the 93 (approximately 11%) patients reported fair-to-good improvement; and seven (approximately 9%) showed poor response. Assessment by a blinded evaluator and pre- and post-photography revealed significant reductions in total lesion count as well as improvements in erythema (Figures 4–7). DISCUSSION The lesions caused by acne vulgaris can be either noninflammatory or inflammatory. Black and white comedones (Grades 1 and 2) are noninflammatory lesions, while inflammatory lesions (Grades 3 and 4) are papules, pustules, nodules, and cysts. Scarring is more common in association with the inflammatory variety of acne lesions. 20 Overall, the prognosis of acne is favorable. Treatment regimens should be initiated early and be sufficiently aggressive to prevent permanent sequelae. Acne treatment is divided into two parts: topical and systemic. Grades 1 and 2 acne lesions can be managed by topical treatment in the form of either retinoids, 21 benzoyl peroxide, topical antibiotics, 22 dapsone, 23 and azelaic acid. 24 However, for Grades 3 and 4, acne systemic drugs are typically needed to prevent scarring. Tetracyclines, 25 macrolides, 26 trimethoprim- sulfamethoxazole, 27 dapsone, 28 retinoids, 29 and oral contraceptives 30 are the currently available systemic drugs for acne. Levofloxacin, 31 zinc, 32 and cephalexin 33 have also been tried as treatments for inflammatory acne vulgaris. A short course of oral steroids might be useful for managing fulminant nodular cystic acne. Systemic retinoids are considered teratogenic and thus use is discouraged in women of child-bearing age. 34 Also, for individuals with infertility issues, the patients and their treating gynecologists might be reluctant to use any systemic medication, as it might interfere with ovulation. Chemical peels using various alpha and beta hydroxy acids can be used to treat inflammatory acne safely in such cases. 35 Narrowband ultraviolet B light, 36 pulsed dye laser, 37 IPL, 38 and light-emitting diodes 39 have also been used in the treatment A B A B A B A B FIGURE 2. A) Baseline and B) Week 6 after) treatment using intense pulsed light therapy. FIGURE 3. A) Baseline and B) Week 6 after) treatment using intense pulsed light therapy.

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