PubMed · 14197250
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W E MCDANIEL. 1964. ACNE.. https://pubmed.ncbi.nlm.nih.gov/14197250/
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BACKGROUND: Low-fluence (low irradiation energy density) pulsed-dye lasers (PDLs) have been used for atrophic acne scarring, and anecdotal experience suggests that long-term improvements in inflammatory acne can be seen after one PDL treatment. Our aim was to compare the efficacy and tolerability of such PDL treatment with sham treatment in patients with facial inflammatory acne in a double-blind, randomised controlled trial. METHODS: We recruited 41 adults with mild-to-moderate facial inflammatory acne. We randomly assigned patients to PDL (n=31) or sham treatment (n=10). Treatment was given at baseline and patients were seen after 2, 4, 8, and 12 weeks. Assessors and participants were unaware of treatment allocations. Primary outcome measures were acne severity after 12 weeks and adverse events at any time. Secondary measures were change in lesion counts after 12 weeks and change in acne severity with time. Analysis was by intention-to-treat. FINDINGS: After 12 weeks, acne severity (measured by Leeds revised grading system) was reduced from 3.8 (SD 1.5) to 1.9 (1.5) in the PDL group and 3.6 (1.8) to 3.5 (1.9) in the sham group (p=0.007). Treatment was well tolerated. Total lesion counts fell by 53% (IQR 19 to 64) in PDL patients and 9% (-16 to 38) in controls (p=0.023), and inflammatory lesion counts reduced by 49% (30 to 75) in PDL patients and 10% (-8 to 49) in controls (p=0.024). The most rapid improvements were seen in the first 4 weeks after treatment. INTERPRETATION: PDL therapy improves inflammatory facial acne 12 weeks after one treatment with no serious adverse effects.
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Three women developed severe acne vulgaris within several weeks to a few months after either insertion of a levonorgestrel IUD (two women, 27 and 33 years of age) or subcutaneous implantation of an etonogestrel implant (26-year-old woman). The first woman had had acne previously; her IUD was removed and she was transferred to oral contraception with cyproterone-ethinyloestradiol. The second woman was treated with a peeling cream. The third woman changed to an oral anticonceptive and was treated with isotretinoin. The acne disappeared in all three patients. Progestagens have androgenic activity, even in low doses, and it is well known that androgenic stimulation of the sebaceous glands can cause acne vulgaris. The possibility that acne vulgaris may be an adverse reaction is probably not always considered. When asking the patient about her use of drugs, one should therefore ask specifically about an IUD or a subcutaneous implant.