Terapia láser de baja potencia en el acné vulgar

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Abstract

RESUMEN Introducción: el acné es una enfermedad multifactorial que afecta en estructura y función a la unidad pilosebácea. Se presenta en los adolescentes y se padece mundialmente. En los casos más severos, puede involucrar al grupo familiar en su esfera afectiva y económica. La terapia láser de baja potencia se ha empleado como opción de procedimiento médico alternativo para el tratamiento de esta enfermedad; por su acción antibacteriana, antiedematosa y estimulante del sistema inmunitario. Objetivo: determinar el comportamiento del acné vulgar en pacientes con terapia láser de baja potencia. Materiales y métodos: se realizó un estudio descriptivo, prospectivo, en pacientes con formas clínicas leves y moderadas de acné vulgar que acudieron a la consulta de Dermatología del Hospital Universitario Comandante “Faustino Pérez Hernández”, provincia Matanzas, entre junio del 2015 a junio del 2016. Se estudiaron las variables: edad, sexo, color de la piel, nivel de escolaridad, clasificación del acné, número de lesiones inflamatorias por hemicara, su tamaño, respuesta al tratamiento y grado de satisfacción. Se procesaron en el paquete estadístico SPSS para Windows, versión 16.0. Resultados: la mayor frecuencia de presentación fue de 18-25 años, sexo femenino y raza blanca. Respuesta satisfactoria independiente a su clasificación, con 15 sesiones, dos veces por semana. Conclusiones: el láser de baja potencia mejora y acorta el tiempo de evolución del acné vulgar.

Translated abstract

ABSTRACT Introduction: acne is a multifactor disease that affects the structure and function of the pilosebaceous unit. It is a global condition that starts during adolescence. It can involve the family in its affective and economic sphere in the most severe cases. Low-power laser therapy is used as an alternative medical procedure for the treatment of this disease due to its antibacterial, antiedematous and immune-stimulant action. Objective: to determine the behavior of acne vulgar in patients under low potency laser therapy. Materials and methods: a descriptive, prospective study was carried out in patients suffering mild and moderated clinical forms of acne vulgaris who assisted the Dermatology consultation of the University Clinico-surgical Hospital “Faustino Perez Hernandez”¨, Matanzas province, from June 2015 to June 2016. The studied variables were age, sex, race, scholarship, acne classification, number of inflammatory lesions per hemiface, lesson size, answer to treatment and satisfaction level. Data were processed with the SPSS statistical package, 16.0 version for Windows. Results: the highest presentation frequency was in people aged 18-25 years, of the female sex and white race. The answer was satisfactory independently to classification with 15 sessions, twice a week. Conclusion: low potency laser improves and reduces acne vulgaris evolution time.

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Most cited references 15

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Epidemiology of acne vulgaris.

K Bhate, H Williams (2013)

Despite acne being an almost universal condition in younger people, relatively little is known about its epidemiology. We sought to review what is known about the distribution and causes of acne by conducting a systematic review of relevant epidemiological studies. We searched Medline and Embase to the end of November 2011. The role of Propionibacterium acnes in pathogenesis is unclear: antibiotics have a direct antimicrobial as well as an anti-inflammatory effect. Moderate-to-severe acne affects around 20% of young people and severity correlates with pubertal maturity. Acne may be presenting at a younger age because of earlier puberty. It is unclear if ethnicity is truly associated with acne. Black individuals are more prone to postinflammatory hyperpigmentation and specific subtypes such as 'pomade acne'. Acne persists into the 20s and 30s in around 64% and 43% of individuals, respectively. The heritability of acne is almost 80% in first-degree relatives. Acne occurs earlier and is more severe in those with a positive family history. Suicidal ideation is more common in those with severe compared with mild acne. In the U.S.A., the cost of acne is over 3 billion dollars per year in terms of treatment and loss of productivity. A systematic review in 2005 found no clear evidence of dietary components increasing acne risk. One small randomized controlled trial showed that low glycaemic index (GI) diets can lower acne severity. A possible association between dairy food intake and acne requires closer scrutiny. Natural sunlight or poor hygiene are not associated. The association between smoking and acne is probably due to confounding. Validated core outcomes in future studies will help in combining future evidence.

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A review of the use of combination therapies for the treatment of acne vulgaris.

J Leyden (2003)

Acne is a disease of the pilosebaceous unit, involving abnormalities in sebum production, follicular epithelial desquamation, bacterial proliferation, and inflammation. The major classes of therapeutic agents are topical and systemic retinoids, antimicrobial agents, and systemic hormonal drugs. Combination therapy with a topical retinoid and an antibiotic can normalize follicular epithelial desquamation and reduce bacterial proliferation. The new retinoids (eg, adapalene) have an additional antiinflammatory action along with their effect on the preclinical microcomedo and, coadministered with a topical or an oral antibiotic, are a rational initial therapy for all but the most severe forms of acne. Retinoids can also be used alone for long-term maintenance to prevent the reemergence of comedones and inflammatory acne lesions and to spare the use of antibiotics, thus helping to reduce the risk of bacterial resistance.

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Development and characterization of a novel antiacne niosomal gel of rosmarinic acid.

Abhishek Budhiraja, Garima Dhingra (2015)

The antibacterial and anti-inflammatory potential of rosemarinic acid (ROA), a naturally occurring ester of caffeic acid has been well reported. Antibacterial effect of ROA is attributed to nucleoid damage with an increase in spatial division and condensation of genetic material. ROA has been found dynamic against many human pathogenic bacterial strains but its inhibitory prospective has never been established against skin inflammations caused by Propionibacterium acne. The skin surface in acne prone areas is colonized with Staphylococcus aureus and Propionibacterium acnes which contribute to inflammation and acne. Resistance to current antimicrobial therapies suggested the need to explore new antimicrobial agents against acne. Present work included the preparation of ROA-loaded niosomes and their in vitro antimicrobial evaluation against P. acne and S. aureus. This work also included the development of niosomal gel of rosmarinic acid for sustained delivery to bacteria infected cells. Niosomes of rosmarinic acid were formulated by reverse phase evaporation method using different ratio of span 85 and cholesterol. The prepared formulations were evaluated for its vesicle size, entrapment efficiency, in vitro release study and antibacterial activity. In vivo study of developed formulation was conducted on Swiss albino mice in comparison with solution of plain drug and a marketed formulation of benzoyl peroxide. It was evident that niosomes are novel carrier for delivery of naturally occurring antimicrobial agents, in deeper tissues of skin. The results showed that drug-loaded niosomes dispersed in the gelling agent are an effective delivery system for treatment of acne vulgaris.