Blue-Light Therapy for Acne Vulgaris: A Systematic Review and Meta-Analysis

Anna Mae Scott; Paulina Stehlik; Justin Clark; Dexing Zhang; Zuyao Yang; Tammy Hoffmann; Chris Del Mar; Paul Glasziou

doi:10.1370/afm.2445

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Figure 1
PRISMA chart.
^aSee Supplemental Appendix at http://www.annfammed.org/content/17/6/545/suppl/DC1.
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Figure 2
Risk of bias.
The risk of bias for all 14 trials was assessed with the Cochrane Collaboration’s Risk of Bias tool.¹³
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Figure 3
Mean difference between groups in the mean number of noninflammatory lesions.
BRA = Brazil; USA = United States of America.
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Figure 4
Mean difference between groups in the mean number of inflammatory lesions.
BRA = Brazil; USA = United States of America.

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Table 1

Characteristics of Included Studies

Study			Participants			Intervention			Comparator			Primary Outcome Investigator Assessment
Author, Year, Location	Unit of Randomization	Follow-Up^a (Weeks)	Mean Age in Years (Range)	Acne Severity Mild Moderate Severe	N Total	Light Wavelength: Blue = 4-500 nm Red = ≥600 nm	Total No. of Sessions	Duration of Exposure (Weeks)	Type	Total No. of Sessions	Duration of Exposure (Weeks)	Primary Outcome Investigator Assessment
Gold et al,²⁰ 2011 (USA)	Lesion	≤1.5	30 (NR)	Mild, moderate	30	Blue	4	0.3	Sham device	4	0.3	NR
Antoniou et al,¹⁶ 2016 (GRC)	Half-face	12	21 (16-30)	Moderate, severe	98	Blue	12	6	No treatment	n/a	n/a	In blue light group, 34% more patients experienced ≥2 IGA grade reductions (P <.0001)
Tzung et al,²³ 2004 (TWN)	Half-face	8	21 (15-32)	Mild, moderate	31	Blue	8	4	No treatment	n/a	n/a	Patients treated with blue light had greater mean % improvement of overall acne severity (45% vs 12%), P <.05
Elman et al,¹⁸ 2003, (ISR)	Half-face	12	19 (NR)	NR	23	Blue	8	4	No treatment	n/a	n/a	NR
Gold et al,¹⁹ 2005 (USA)	Individual	4	31 (13-55)	mild, moderate	25	Blue	8	4	Topical 1% clindamycin	56	4	Narrative only
de Arruda et al,¹⁷ 2009 (BRA)	Individual	6	17 (NR)	Moderate, severe^b	60	Blue	8	4	Topical BPO 5%	56	4	NR
Papageorgiou et al,⁸ 2000^c (UK)	Individual	12	23, 25, 27^d (NR)	Mild, moderate	82	a. Blue b. Blue/red	84	12	Topical BPO 5%	NR	NR	Clear or marked improvement^e: blue/red: 63% of patients, blue 40%, benzoyl: 35%. P value NR.
Kwon et al,³ 2013 (KOR)	Individual	12	23, 24^f (NR)	Mild, moderate	35	Blue/red	56	4	Sham device	56	4	Blue/red: 66% more patients rated clear (IGA = 0) or almost clear (IGA = 1), P <.01
Alba et al,¹⁵ 2017 (BRA)	Individual	10	16 (NR)	Mild, moderate^g	22	Blue/red	10	10	Topical SA peel 10%	10	10	NR
Nestor, et al,²¹ 2016 (USA)	Individual	12	NR (12-18)	Mild, moderate	105	a. Blue/red + cleanser b. Blue/red + cleanser + 1% SA + retinol	84	12	Topical BPO 2.5% + cleanser	168	12	Blue/red + cleanser: 19% improve- ment in IGA scale (P <.001); Blue/red + cleanser + SA + retinol 14%; BPO 5% improvement
Ash et al,²⁴ 2015 (UK)	Individual	12	NR (16-45)	Mild, moderate	41	Blue + topical (SA + glycolic and lactic acids) + moisturizer	28	8	“Control” (details NR)	NR	NR	NR
Chu,²⁶ 1999, NR	Individual	12	NR (NR)	Mild, moderate	107^h	a. Blue b. Blue/red	84	12	Topical BPO 5%	168	12	Narrative only
Miller et al,²⁷ 2017, NR	Individual	12	NR (12-40)	Mild, moderate	NR	Blue/red	1ⁱ	NR	Topical BPO 2.5%	2^j	NR	NR
Ash et al,²⁵ 2013 (UK)	Individual	NR	NR (NR)	Mild, moderate	39	Blue + topical creams	NR	NR	“Control” (details NR)	NR	NR	NR

BPO = benzoyl peroxide; BRA = Brazil; GRC = Greece; IGA = Investigators’ Global Assessment scale for acne; ISR = Israel; KOR = Korea; n/a = not applicable; NR = not reported; SA = salicylic acid; TWN = Taiwan; UK = United Kingdom; USA = United States of America.
↵a This includes the treatment period.
↵b Acne grade II and III on the Brazilian classification scale. Grade II presents comedones and more inflammatory papules; grade III presents pustules in addition to any of grade II.
↵c Reported here are the blue-light, blue/red-light, and benzoyl peroxide groups, not the cool white group.
↵d In blue-light, blue/red-light, and benzoyl peroxide groups respectively.
↵e Marked improvement defined as overall treatment response of 60% to 89%; clearance defined as ³90%.
↵f In blue-light and sham groups, respectively.
↵g Acne grade I and II on the Brazilian classification scale. Grade I represents comedones only; grade II represents comedones and more inflammatory papules.
↵h Total for all 4 groups (blue light, blue/red light, benzoyl peroxide, white light); N for individual groups not reported.
↵i Reported as “1 session per day,” duration NR.
↵j Reported as “2 sessions per day,” duration NR.

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The Article in Brief

Blue-Light Therapy for Acne Vulgaris: A Systematic Review and Meta-Analysis

Anna Mae Scott , and colleagues

Background Acne is one of the most common reasons for clinical consultations. Market and patient demand is high for light therapy as an alternative to antibiotic approaches to acne treatment. However, conclusions about the effectiveness of blue light therapy for acne are limited.

What This Study Found A new systematic review and meta-analysis of 14 randomized controlled trials of blue-light therapy for acne shows methodological and reporting limitations--including small sample sizes, short intervention periods, and variation in reporting quality for acne outcomes. Only three of the trials reported significant improvements in expert-assessed acne severity with blue-light therapy over a control group. The majority of trials do not provide sufficient evidence to conclude effectiveness.

Implications

Because evidence for blue-light therapy is not conclusive, patients should discuss with their clinicians the possible benefits, costs, and alternatives for acne treatment. Blue light therapy may be beneficial for some patients, but more research is needed.