Evaluating the combination and comparison of ablative fractional lasers (CO2, Erbium-YAG) with pulsed dye laser (PDL) for treating hypertrophic scars: a systematic review

Systematic review of vascular lasers for the treatment of inflammatory active acne vulgaris

Acne vulgaris is a prevalent skin disorder with significant emotional and psychological impacts. Conventional treatments often have limitations, prompting exploration into alternative therapies like vascular lasers and light treatments. This systematic review evaluates the efficacy and safety of vascular lasers (IPL, PDL, Nd:YAG) on inflammatory acne lesions associated with acne vulgaris. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Studies from 2010 to 2024 were searched in databases (Scopus, Web of Science, PubMed, Embase) using preset terms. Inclusion criteria encompassed English language studies on vascular lasers for inflammatory acne lesions in comparative and randomized controlled trials. Data extraction included study characteristics, patient data, laser parameters, and treatment outcomes. Quality assessment utilized the Cochrane ROB 2 tool. Out of 904 initially retrieved studies, 32 studies involving 1,520 patients met the inclusion criteria. The studies focused on 18 Intense Pulsed Light (IPL), 9 Pulsed Dye Laser (PDL), and 10 Neodymium-Doped Yttrium Aluminum Garnet (Nd:YAG) lasers, with 5 studies comparing two modalities. IPL demonstrated acne vulgaris lesion reduction rates ranging from 42.40% to 61.56%, while PDL achieved reductions of up to 82.5%. Combined therapies, such as PDL/Nd:YAG, resulted in reductions as high as 83.5%. Fractional CO₂ lasers showed acne vulgaris lesion improvement rates of 87.94% ± 14.31, with sustained results at follow-up. Red light-PDT achieved an 85.50% ± 5.39 reduction, outperforming IPL-PDT (75.55% ± 8.09). In comparative studies, Nd:YAG lasers demonstrated slightly superior outcomes over IPL. Adverse effects, including erythema and pain, were generally mild, with severe side effects being rare. Vascular lasers, including IPL, PDL, and Nd:YAG, demonstrate significant efficacy and safety in treating inflammatory active acne vulgaris, with combination therapies often showing superior outcomes. Fractional CO₂ lasers and red light-PDT further expand treatment options. Adverse effects, such as erythema and pain, are generally mild and transient. However, variability in study protocols highlights the need for standardized treatment guidelines and further well-designed trials to optimize protocols and ensure consistent, long-term outcomes.