Light therapies for acne: abridged Cochrane systematic review including GRADE assessments

Abstract

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 (QE). We included 71 RCTs (4211 participants, median sample size 31). Results from a single study (n = 266, low QE) showed little or no difference in effectiveness on participants' assessment of improvement between 20% aminolevulinic acid (ALA) photodynamic therapy (PDT), activated by blue light, versus vehicle plus blue light, whereas another study (n = 180) of a comparison of ALA-PDT (red light) concentrations showed 20% ALA-PDT was no more effective than 15%, but better than 10% and 5% ALA-PDT. Pooled data from three studies, (n = 360, moderate QE) showed that methyl aminolevulinate (MAL)-PDT, activated by red light, had a similar effect on changes in lesion counts, compared with placebo cream with red light. Several studies compared yellow light to placebo or no treatment, infrared light to no treatment, gold-microparticle suspension to vehicle, and clindamycin/benzoyl peroxide (C/BPO) combined with pulsed dye laser to 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 QE). Carefully planned studies, using standardised outcome measures, and common acne treatments as comparators are needed.

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