Light therapies for acne: abridged Cochrane systematic review including GRADE assessments.
We undertook a Cochrane review of randomized controlled trials (RCTs) evaluating the effects of light-based interventions for acne vulgaris. We searched the Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase, LILACS, ISI Web of Science and grey literature sources (September 2015). We used the Grading of Recommendations Assessment, Development and Evaluation Working Group approach to assess the quality of evidence (QoE). We included 71 RCTs (4211 participants, median sample size 31). Results from a single study (n = 266, low QoE) showed little or no difference in effectiveness on participants' assessment of improvement between 20% aminolaevulinic acid (ALA) photodynamic therapy (PDT), activated by blue light, vs. vehicle plus blue light, whereas another study (n = 180) comparing ALA-PDT (red light) concentrations showed that 20% ALA-PDT was no more effective than 15% ALA-PDT but better than 10% and 5% ALA-PDT. Pooled data from three studies (n = 360, moderate QoE) showed that methyl aminolaevulinate PDT, activated by red light, had a similar effect on changes in lesion counts vs. placebo cream with red light. Several studies compared yellow light with placebo or no treatment, infrared light with no treatment, gold microparticle suspension with vehicle and clindamycin/benzoyl peroxide (C/BPO) combined with pulsed dye laser with C/BPO alone. None of these showed any clinically significant effects. Most studies reported adverse effects, but inadequately, with scarring reported as absent, and blistering only in studies on intense pulsed light, infrared light and PDT (very low QoE). Carefully planned studies, using standardized outcome measures and common acne treatments as comparators, are needed.
Andrija Stampar School of Public Health, School of Medicine, University of Zagreb, Zagreb, Croatia.
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J
Barbaric
Welsh Institute of Dermatology, University Hospital of Wales, Cardiff, U.K.
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R
Abbott
Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
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P
Posadzki
Department of Primary Care and Public Health, Imperial College London, London, U.K.
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Car
Public Health Program, Stetson University, DeLand, FL, U.S.A.
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LH
Gunn
Department of Dermatology, Harrogate and District NHS Foundation Trust, Harrogate, U.K.
A M
AM
Layton
Department of Primary Care and Public Health, Imperial College London, London, U.K.
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A
Majeed
Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.|Department of Primary Care and Public Health, Imperial College London, London, U.K.
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Car
D000152:Acne Vulgaris / Q000628:therapy*; D000328:Adult; D000622:Aminolevulinic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D005260:Female; D000077002:GRADE Approach; D017612:Gold Compounds / Q000627:therapeutic use; D006801:Humans; D007259:Infrared Rays / Q000627:therapeutic use; D008297:Male; D010778:Photochemotherapy / Q000379:methods; D017319:Photosensitizing Agents / Q000627:therapeutic use; D010789:Phototherapy / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
D017612:Gold Compounds; D017319:Photosensitizing Agents; C475457:methyl 5-aminolevulinate; D000622:Aminolevulinic Acid