Comparative Efficacy Between Intense Pulsed Light Narrow Spectrum And Broad Spectrum In The Treatment Of Post Acne Erythema (PAE)

Objective:Post-acne erythema（PAE）is one of the most common physical sequelae that arise after acne regression,a variety of therapeutic options have been described with various clinical outcomes.Intense pulsed light with different wavelengths has been widely used in the treatment of various skin cosmetic problems including rosacea,facial telangiectasia,pigmentary disorders,acne vulgaris and related sequelae such as PAE,PIH and atrophic scars.In this study we aimed to evaluate the efficacy and safety of narrow-spectrum and broad-spectrum filters of IPL for the treatment of Post acne erythema,in terms of clearance rate,recurrence rate of erythema and acne,faster response,and patient satisfaction to provide a rational guide for clinicians.Methods:A prospective randomized controlled study of 60 patients diagnosed with persistent post-acne erythema for at least six months were assigned equally into three groups:1^stgroup received narrow spectrum with vascular filter（530-650nm and 900-1200nm）treatment,energy（20-22cm²）,pulse duration（4-6ms）,pulse delay（20-30ms）.;the 2^ndgroup received a broad spectrum with（560/590-1200nm）filters treatment,energy（17-19J/cm²）,pulse duration（3-3ms）,pulse delay（20-30ms）for560nm,and（3.5-3.5ms）,pulse duration（30-40ms）for 590nm,the broad-spectrum filters were used according to patient’s skin color;the blank group did not receive any specific treatment.Patients in IPL treatment groups each received 4 sessions with an interval of one month.According to patient’s facial photographs,CAT（CEA,Area,and Telangiectasia）were used to grade the clearance rate of post acne erythema before and after treatment,Investigators Global Assessment（IGA）were used to assess the improvement score index after the treatment,Cardiff Acne Disability Index（CADI）used to evaluate the impact of post acne erythema on patients Quality of Life before and after treatment.Adverse effects and acne relapse were recorded,self-satisfaction scale was filled one month later after the last session at the follow-up.Results:As compared with the baseline:1.CAT（CEA,Area,Telangiectasia）scale components of three scales:（1）（0-4）Point clinical erythema severity（CEA）:There was no significant difference of CEA score before the treatment in IPL vascular group,560/590nm group and the blank control group（P>0.05）,after the treatment the three groups had a statistically significant differences in CEA score（H=27.677,P<0.05）.IPL vascular group showed a statistically significant difference of CEA score before and after the treatment（Z=-4.008,P<0.05）,IPL 560/590nm group showed a significant decrease of CEA score（Z=-2.517,P<0.05）before and after the treatment,the blank control group showed statistically changes of CEA score（Z=-2.041,P=0.041）before and after the treatment.A significant difference of CEA score between IPL vascular group and IPL（560/590-1200nm）,（P<0.05）.IPL vascular group and the blank control group showed a statistically significant difference of CEA score,（P<0.05）.Also,there was a statistically significant difference of CEA score between IPL 560/590-1200nm and the blank control group,（P<0.05）.The results shows that IPL vascular group showed more effective results of CEA score than IPL 560/590nm group and blank control group,（P<0.05）.（2）（1-3）Point using the Palm method（AREA）:Before the treatment,IPL560/590nm group showed a statistical significant difference of Area score in comparison with IPL vascular and the blank control groups,（P<0.05）,a statistical significant difference of Area score in the three groups after the treatment（H=18.587,P<0.05）.There was a statistical significant difference of Area score in IPL vascular group after the treatment in comparison with the IPL 560nm/590nm group and the blank control group（P<0.05）,between the three groups IPL vascular group showed the most effective results of Area score.（3）（0-2）Point Telangiectasia score:The score of telangiectasia in all patients were scored 0,as all of the patients in the three groups were presented with no telangiectasia.（4）Total score（CEA×AREA+Telangiectasia）:IPL 560nm/590nm group before the treatment had a statistical significant increase of total score in comparison with IPL vascular and blank control group（P<0.05）,after the treatment there was a statistical significant difference of total score between the three groups（H=25.707,P<0.05）.Total score of IPL vascular group after the treatment showed a statistically significant decrease in comparison with IPL 560nm/590nm group and the blank control group（P<0.05）,IPL vascular group before and after the treatment showed a significant difference（P<0.05）,it shows that IPL vascular group total score result is the most effective.2.Percent improvement of Post acne erythema:Investigator’s Global Assessment Scale（IGA）:IPL vascular group and IPL 560nm/590nm group had a statistically significant difference of the improvement rate（P<0.05）,the improvement rate of post acne erythema in IPL vascular group was higher than that in the blank control group（P<0.05）,which shows that IPL vascular group has the highest improvement rate.3.Cardiff Acne Disability Index（CADI）:Results showed there was no significant difference of CADI score before the treatment between the three groups（H=0.856,P=0.652）,before and after the treatment CADI score of IPL vascular group showed a statistically significant difference（P<0.05）.CADI score in IPL vascular group showed the most effective results.4.Patient self-satisfaction evaluation:The patient’s total satisfaction in IPL vascular group,IPL 560nm/590nm group and the blank control group was about（95%,40%,10%,respectively）,results shows that IPL vascular group has the highest satisfaction rate in comparison with the other two groups.5.Pain assessment:All the patients（20/20）treated with M22 IPL vascular filter well tolerated the treatment during the four session,Patients treated with M22 IPL560/590nm filter（3/20）has scored their pain as 3 points,the pain were disappeared within 24 hours after the session.6.Recurrence rate:In IPL 560/590nm group,40%（8/20）patients had acne relapse after four treatment sessions,15%（3/20）patients had acne replace in the blank control group,while no acne relapse were found in IPL vascular group.7.Adverse reaction evaluation:IPL vascular group:5 patients（25%）in IPL had flushing（redness）after the treatment,no other reactions were seen.IPL 560/590n group:All the patients（20/20）had flushing redness after the treatment,2 patients（10%）had pigmentation after receiving 590nm treatment,3 patients（15%）had blisters.Conclusion:1.Post acne erythema lesions can be effectively treated using IPL narrow spectrum with vascular filter（530-650 nm and 900-1200 nm）.2.According to CAT score,IPL vascular filter was found to be more effective in reducing the severity of erythema with a higher overall degree of improvement after treatment compared to IPL（560-1200nm/590-1200nm）filters.3.In terms of Cardiff Acne Disability Index（CADI）scale,IPL vascular filter showed an improvement in Quality of Life for patients with post acne erythema.4.IPL vascular group treatment has a low incidence rate of adverse effects（no pigmentation,some redness,no blisters）and a well-tolerated pain sensation during treatment compared to the IPL 560/590nm filter.5.IPL vascular filter has no acne recurrence after the treatment in comparison with IPL 560/590nm and self-treatment（the blank control group）.