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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46 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 of inflammatory acne with varying degrees of success. Photodynamic therapy using alpha levulinic acid has also been considered effective. 40 In our study, we used IPL therapy as the monotherapy for the treatment of inflammatory acne. IPL acts by multiple mechanisms of actions in acne. IPL reduces the inflammation and sebaceous gland size 41 and downregulates tumor necrosis alpha, 42 thereby reducing the initial lesion count and preventing the formation of new lesions. In our study, we found that the lesion count began decreasing after three sessions and continued to decrease until 12 weeks into the follow-up period. Also, the occurrence of new lesions stopped after three weeks of treatment. IPL enhances the transforming growth factor beta1/Smad3 signaling pathway in acne-prone skin. 43 IPL therapy also induces synthesis of dermal extracellular proteins in vitro as well as increases the amount of dermal collagen and elastic fibers, which reduces risk of scar formation. 44,45 This effect was observed in our study, as there was no scar formation and lesions healed uniformly in our patients. The basic mechanism of action of IPL is selective thermal damage of P. acnes, which produce and store porphyrin. Hyperkeratinization of the pilosebaceous unit due to hormonal changes leads to blocked sebaceous pores. This creates an anaerobic environment for P. acnes that in turn multiply and release porphyrin. IPL penetrates into the hair follicles to target P. acnes by triggering porphyrin activation. 46 In telangiectasia and other vascular disorders, IPL also corrects the dilatation of vessels. 47 This mechanism helps reduce erythema in inflammatory acne, and this was demonstrated in our patients, who displayed marked reduction of erythema after 3 to 4 sessions of treatment. IPL also has bactericidal activity against P. acnes by triggering porphyrin synthesis. This helps reduce active acne lesions and eruption of new lesions. Our findings correlate with this. In our study, continuous mode had uniform photothermal, photochemical, and photo-immunological effects, which helped ensure longer remission and appeared to aid in preventing new lesions from forming in unaffected skin. The double mode of IPL also produces antibacterial and anti-inflammatory effects in the affected skin. IPL might impart post-inflammatory hyperpigmentation and scarring on skin of color when single- or burst-pulse modes are used. 48 Considering this, we used continuous mode followed by double-pulse mode in our study. In both modes (continuous and double), FIGURE 4. Erythema Improvement Scale FIGURE 5. Percentage of the subjects improved following IPL treatment on papules FIGURE 6. Percentage of the subjects improved following IPL treatment on pustules FIGURE 7. Percentage of the subjects improved following IPL treatment on nodules

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