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

Journal of Drugs in Dermatology, Jan-Feb, 2005 by Michael H. Gold, Jaggi Rao, Mitchel P. Goldman, Tancy M. Bridges, Virginia L. Bradshaw, Molly M. Boring, April N. Guider

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Both groups of patients noted that the therapies were well tolerated with no significant adverse events reported in either group of patients. Improvement Scores and Global Improvement Scores were similar between both groups of patients.

Discussion

Acne vulgaris is one of the most common dermatologic conditions presenting to dermatologists for evaluation and treatment. It has been estimated that from 70% to 96% of our population will suffer from acne at some point in their lifetime. Reports have indicated that 40 million American adolescents and 25 million American adults are afflicted with acne vulgaris. (1) One third of these patients will likely present for evaluation and therapy, and acne vulgaris accounts for more than 30% of all dermatology visits each year. (2)

The etiology of acne vulgaris is multifactorial, with both genetic and hormonal influences known to play a significant role in the disease process. Family history can be found in the majority of cases of acne vulgaris. Hormonal influences for the development of acne vulgaris are known to commence at the time of puberty; however, hormonal influences can be involved in acne vulgaris at any point in one's lifetime.

The pathogenesis of acne vulgaris is complex and involves microbial proliferation, inflammation, and abnormal desquamation of the follicular epithelium. Simplified, acne vulgaris is a disorder of the pilar unit and sebaceous glands where hormonal influence, primarily an increase in the production of androgens, causes dilation and obstruction of the pilo-sebaceous unit. These are evident as non-inflammatory acne vulgaris lesions, commonly known as open and closed comedones. As a result of the pilo-sebaceous unit obstruction, there is a proliferation of bacterial growth, predominantly growth of Propionobacterium acnes (P. acnes). Clinically, inflammatory acne lesions are produced, including papules, pustules, and cysts. (3)

The traditional treatment of mild to moderate acne vulgaris involves a myriad of topical and systemic medications. The medications include both topical and systemic antibiotics, topical benzoyl peroxides, topical salicylic acids, topical and systemic retinoids, and various combinations of the topical medicines. Hormonal therapy is also used, on occasion, in the treatment of acne vulgaris. All of these medications have shown effectiveness in therapy of acne vulgaris and the majority of dermatologists will utilize a combination approach when treating the patient afflicted with acne vulgaris. Each group of medications, however, has potential adverse effects, which could possibly limit their overall effectiveness in treating those with acne vulgaris. Some of the topical medications are irritating to the skin and many of these require extended use to show a positive effect in the therapy of acne vulgaris. The common systemic antibiotics, although effective in many cases of acne vulgaris, have, at times, significant adverse events and have recently shown a high percentage of drug resistance, up to 40% reported. (1,4) Recently, a report of increased exposure to systemic antibiotics and a potential association with breast cancer may have an effect on our prescribing habits with these agents. (5) Systemic retinoids, very useful for recalcitrant acne vulgaris cases, have teratogenic and psychological concerns, which have limited their overall use. (1)