| Objective: Acne vulgaris is a common dermatosis affecting 80% of the population . Propionibacterium acnes synthesize and store a large amount of porphyrins. Once the porphyrin is exposed to visible light it becomes chemically active and transfers to an excited state, resulting in the formation of singlet oxygen, which combines with cell membranes to destroy the P. acnes. To date, different treatments have been used to manage this condition. Antibacterials and retinoids are currently the mainstay of treatment for acne, but their success rate varies due to the emergence of antibiotic-resistant strain and teratogenicity. Phototherapy is emerging as an alternative option to treat acne vulgaris. Studies examining the role of different wavelengths and methods of light treatment have shown that phototherapy with visible light, specifically blue light, has a marked effect on inflammatory acne lesions and seems sufficient for the treatment of acne. Although we known this process is dependent on the rate of production of excited porphyrin molecules, which is influenced by the concentration of porphyrins, the concentration of photons, the temperature, and the wavelength of the photons, but the detail percentage improvement in different types of acne is still not clear. The purpose of this study is to evaluate the LHE for different types of acne vulgaris, as well as attempt to further understand phototherapic role in acne and put them into current clinical practice.Methods:1 The study carried out to examine the clinical effects of low-intensity, visual light on acne. Fourteen patients with mild to moderate acne underwent bi-weekly treatments for four weeks by using the ClearTouch Lite device system (Radiancy , Israel). These fourteen Chinese with symmetrical facial acne were irradiated with low-intensity, visual light on one side of the face selected randomly twice weekly for four consecutive weeks. The other half of the face was left untreated as control. The grade of acne, including comedo, papule, pustule, nodule and cysts were documented by acne grading scale, modified by Michaelsson et al, used for evaluation: The severity of acne was assessed before the treatment, and every session of treatment till the treatment was completed. During each treatment, pulses of light and heat were applied. Fluence range is about 6 J/cm2 in one working cycle (4sec),a pulse duration 1msec. and a wavelength between 430nm and 1100nm. At a distance of near zero cm ,the irradiation dose of light in each session was 30J/cm2 (repeat 5 times of working cycle of irradiation).2 Review the past two years 30 out of 1100 Chinese people in Linerhwen- Yangming Clinics, these thirty cases match the experimental design like PART I, who were the victim of getting mild to moderate acne and underwent bi-weekly treatments for 4 weeks by using the ClearTouch Lite device system. We also analyze the clinical results in each type of acne clearance.Results:1 During the eight sessions,the therapeutic effectiveness(P<0.05,by paired- samples t-test) was first noted after 5th, 4th, 5th,4th sessions of irradiation for overall acne,papule, comedo,and pustule, respectively.At the end of the eighth treatment, the following six group of acne clearance for overall acne , comedo, papule, pustule, nodule, and cyst was 16.92%,58.25% ,72.48%,38.46%,-16.67%,and -13.33%, respectively. Compared with the non-irradiation side, eight sessions of LHE were effective in overall acne (t=4.007936,P=0.003906<0.01), comedo (t=-4.34421, P=0.002464<0.01), papule(t=-4.50861,P=0.001979<0.01),pustule(t=-3.97819,P=0.004072<0.01)treatment.Paired-samples t-test used to assess the therapeutic effectiveness of LHE after each session of treatment. Gender(t=-1.48253,P= 0.157628>0.05), and scar(t=0.123682,P = 0.903108 > 0.05) could not be used as predictive factors of therapeutic effectiveness. Compared with pretreatment, nodule and cystic lesions tended to worsen despite treatment. In addition, the nodulous (t=2.854228, P=0.02134>0.01) andcystic (t=0.793961, P=0.450125>0.01) acne were not related to the therapeutic profile. 2 The correlative coefficient(r) of mean percentage improvement with the cumulative doses for the overall acne, papule, comedo, pustule, nodule, and cyst was known as followings :0.9894(P<0.001),0.994(P< 0.001),0.992(P<0.001), 0.988 (P< 0.001), -0.936(P< 0.001) , and-0.905 (P< 0.001), respectively. Gender(t= -0.78212 , P= 0.445563 ) and scar(t= -2.10328,P= 0.051616) could not be used as concerning factor influenced the therapeutic effectiveness. Papule ,comedo, and pustule showed positive but nodule and cyst showed negative response to cumulative dose till the end of 7th session. In addition,same as PARTI, sessions and the slope of mean percentage improvement of these five types of acne remained almost constant to zero after 7th to 8th sessions(P<0.0001).Conclusions: In this study ,gender(t=-1.48253,P=0.157628>0.05) and scar (t=0.123682,P=0.903108>0.05) were not the concerning factor influenced the therapeutic effectiveness during the treatment. Both increasing of session and cumulative doses could not be as positive correlative outcome of LHE-phototherapy post 7th to 8th session. Clea rTouch pulsed light and heat energy (LHE) technology is effective and safe for the treatment of acne vulgaris especially in comedo , papule,and pustule type. The clearance is better in papule than in comedo, may be due to the anti-inflammative role of red light within visual light spectrum. LHE treatment was not the choice for patients with nodulocystic acne. The lack of response in these patients may be attributed to the existence of deep acne cysts or to the existence of non-P. acnes bacteria. In a recent article, Papageorgiou et al. described the combined blue-red light generally better than blue light alone. Side effects except little rashes and dryness were minimal in all groups . Phototherapy treatments for acne offer hope to millions of suffers unwilling or unable to take systemic medications.
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