Evaluating the effect of tranexamic acid as mesotherapy on persistent post-acne erythema: A before and after study.

BACKGROUND: Acne vulgaris is a common skin disease that is more common in young population and it can be associated with some sequels after resolving the lesions. Post-inflammatory erythema is one of these complications that can be disturbing for patients and does not have any definite treatment. This study was aimed to evaluate the efficacy and safety of tranexamic acid (TA) as mesotherapy in treatment of post-acne erythema (PAE) treatment. METHOD: This clinical trial study was performed in the dermatology clinic on 17 patients with persistent PAE (3 months after acne recovery). Two sessions of treatment were performed by a physician with 2-week intervals; TA was injected as mesotherapy into the right side of each patient's face as the case group, while the opposite side was used as the control group. A Visioface device was used to compare before and after treatment photographs of each side of the face in color mode with quantitative measures such as lesions count, area, and area percent. RESULTS: Finally, 15 patients completed treatment sessions. There were statistically significant differences in right side lesions before and after treatment with p-values of 0.047, 0.002, and 0.035 for count, area, and area percent, respectively. There was no significant difference before and after treatment in terms of count, area. and area-percent on the left side. CONCLUSION: According to the results of this study, TA injection as mesotherapy for resolving PAE can be effective. However, due to small sample size, further studies are needed.

Evaluation of the safety and efficacy of a fractional picosecond 1064 nm laser for post-acne erythema in adult Chinese patients.

OBJECTIVE: To evaluate the efficacy and safety of fractional 1064 nm picosecond Nd:YAG laser (FPNYL) in the treatment of post-acne erythema (PAE) of adult Chinese. MATERIALS AND METHODS: A total of 22 patients received 1 session of treatment and were followed up at the eighth week. Primary outcomes were measured by the Clinician erythema assessment scale (CEAS). Secondary outcomes included a global aesthetic improvement scale (GAIS) and patients' assessment of satisfaction on a five-point scale. Pain scores and adverse effects were also evaluated. RESULTS: Twenty-two patients with Fitzpatrick skin types III and IV were enrolled in the study and completed all treatments and follow-up visits. The mean CEAS scores fell from 2.74 ± 0.80 to 1.95 ± 0.75 (p < 0.05). The mean GAIS of PAE improvement was 2.46 ± 0.68. Erythema percentile scores by VISIA increased from 32.63 ± 7.0 to 45.75 ± 11.45 (t = 5.442, p = 0). The patient satisfaction score was 1.86 ± 1.17. The pain scores were 3.27 ± 1.17 for the FPNYL treatment (varied from 2 to 6). There were moderate erythema and oedema, which last for 3.84 ± 0.78 days. There were overall 68.18% (15/22) patients who felt pruritus in different degrees and 27.27% patients who encountered acne eruptions (white head type). No scar, hyperpigmentation or hypopigmentation was found. CONCLUSION: Treatment with fractional 1064 nm picosecond Nd:YAG laser is effective and safe for PAE of Chinese patients.

Treatment protocols and efficacy of light and laser treatments in post-acne erythema.

BACKGROUND: Post-acne erythema is described as erythema due to release of inflammatory cytokines, dilatation of microcapillaries within papillary dermis and thinning of epidermis. The erythema usually fades; however, it can persist for months. AIM: In this review, we decided to evaluate efficacy of light and laser treatments in acne-induced erythema. METHODS: We searched PUBMED, Embase, Cochrane, and Google Scholar for relevant key words. Inclusion criteria were randomized clinical trials (RCTs) that evaluated efficacy of laser or light in PAE until September 2021. RESULTS: Twelve RCTs were selected for the final assessment. Light and laser treatments included pulsed dye laser (PDL), intense pulsed light (IPL), Q-switched neodymium-doped yttrium aluminum garnet (QS Nd:YAG), fractional photothermolysis, alexandrite, solid-slate 589-1319 nm, and pro-yellow laser. CONCLUSION: Light and laser treatments are effective treatment modalities in reduction of acne-induced erythema along with active acne lesions and atrophic acne scars.

A split face comparative study using a novel triple combination therapy for the treatment of persistent post acne erythema.

Persistent post acne erythema (PAE) is common cosmetically unacceptable and challenging sequelae of acne lesions. Tranexamic acid (TXA) is an antifibrinolytic agent that shows a positive effect on wound healing in several studies, and it showed benefits in treating skin diseases like melasma, rosacea erythema and ultraviolet induced pigmentations. Oxymetazoline (OXZ) is a synthetic, highly selective agonist for alpha 1A-adrenoceptor. It is a potent vasoconstrictor. OXZ hydrochloride 1% cream was approved by the FDA in January 2017 as a topical treatment for persistent facial erythema in rosacea patients. Brimonidine tartrate (BMT) is highly selective α2 adrenergic receptor agonist, results in direct, potent vasoconstriction of small arterioles and veins. In 2013, brimonidine 0.33% gel was the first topical therapy to be FDA approved for the treatment of persistent facial erythema from rosacea. To evaluate the efficacy and safety of topical triple combination (TXA 5% + OXZ 1.5% + BMT 0.33%) in the treatment of PAE planned as split face comparative study. This study was conducted on 40 patients diagnosed with persistent PAE for at least 3 months, the right side of the face was treated with topical triple combination in liposomal base and was compared to the left side to which topical lipocream (placebo) was applied as a control. Our treatment plan lasted for 3 months. According to the investigator's global assessment of photographs and computerized analysis of erythema using image analysis software, topical triple combination applied on the right side of face was significantly effective in diminishing PAE when compared to topical placebo left side. Topical triple combination is a safe and cost-effective treatment for PAE.

Successful treatment of the face post acne erythema using a topically applied selective alpha 1-Adrenergic receptor agonist, oxymetazoline 1.5%, a controlled left to right face comparative trial.

BACKGROUND: Post-inflammatory erythema (PIE) is a common sequalae of acne inflammation, persistent post acne erythema (PAE) is cosmetically unacceptable and sometimes its complete clearance could not be achieved. Oxymetazoline (OXZ) is a synthetic, direct-acting, sympathomimetic agonist that is highly selective for the 1α-adrenoceptor. It is a potent vasoconstrictor and well known for its ability to clinically 'get the red out'. AIM: The aim of this study was to evaluate the efficacy and safety of topical oxymetazoline (OXZ) 1.5% in treatment of post acne erythema (PAE) in a left to right face comparative study. METHODS: This study was conducted on 40 patients diagnosed with post acne erythema for at least 3 months, the left side of the face was treated with topical OXZ 1.5% in liposomal base and was compared to the right side to which topical lipogel was applied as a control. RESULTS: According to the investigator's global assessment of photographs and the analysis of erythema with image analysis software, topical OXZ was significantly effective in diminishing PAE when compared to topical placebo lipogel. CONCLUSION: Topical OXZ is a safe and effective treatment for post-acne erythema.

A comparative split-face study of intense pulsed light versus 595-nm pulsed dye laser in the treatment of post-acne erythema / 中华皮肤科杂志

Objective To evaluate and compare the clinical efficacy and safety of intense pulsed light (IPL) versus 595-nm pulsed dye laser (PDL) for the treatment of post-acne erythema.Methods A randomized split-face clinical trial was conducted.A total of 20 patients with post-acne erythema were enrolled,and randomized to receive treatment with IPL on one half of the face and 595-nm PDL on the other facial side once every 4 weeks for 3 sessions.Digital photographs were taken using the VISIA,and erythema index was recorded before each treatment and one month after the last treatment.The severity of bilateral facial erythema was evaluated based on a 4-point grading scale before the first treatment and after the last treatment.Pain scores and adverse reactions were recorded using a visual analogue scale (VAS) after each treatment,and a patient satisfaction survey was conducted by questionnaire at the last follow-up.Results The mean erythema index on the IPL side before and after treatment was 472.25 ± 86.02 and 357.15 ±82.71 respectively,and that on the PDL side before and after treatment was 476.40 ± 74.25 and 360.05 ± 64.83 respectively.Repeated measures analysis of variance (ANOVA) showed that the erythema indices on both treated sides significantly decreased over time (F =197.666,P ＜ 0.001),and the efficacy of IPL was better than that of PDL (F =1 173.909,P ＜ 0.001).Erythema severity grades on the IPL side as well as on the PDL side significantly differed between before and after treatment (Z =28.735,31.450,respectively,both P ＜ 0.001).As VAS showed,the pain score on the PDL side was significantly lower than that on the IPL side (t =2.468,P ＜ 0.05).Among the 20 patients,17 and 15 assessed their improvement as good or excellent after PDL and IPL treatment respectively,but there was no significant difference between the two groups (Z =2.696,P ＞ 0.05).The adverse reactions included erythema,burning sensation,tense sensation,blistering and hyperpigmentation on IPL-treated side,and erythema and purpuric reactions on the PDL-treated side,which all disappeared in a few hours to several days.Conclusions Both IPL and 595-nm PDL are effective and safe for the treatment of post-acne erythema,and are worthy of clinical promotion and application.IPL shows superiority in the efficacy,but elicits higher pain sensation compared with PDL.

Low-fluence 585 nm Q-switched Nd:YAG laser: a novel laser treatment for post-acne erythema.

BACKGROUND: Persistent post-acne erythema is one of the most common aesthetic sequelae to arise after active acne resolves. The treatment remains challenging due to lack of effective laser modalities. OBJECTIVES: To evaluate the safety and efficacy of a low-fluence 585 nm Q-switched Nd:YAG laser for the treatment of post-acne erythema. MATERIALS & METHODS: Twenty-five patients with post-acne erythema were treated with a low-fluence Q-switched Nd:YAG laser using the 585 nm Gold Toning™ handpiece (5 mm spot size, 5-10 ns, 0.30-0.55 J/cm(2) , 2-4 passes) for three sessions at 2-week intervals. Erythema lesion (macules) count, inflammatory acne (papules, pustules) count, erythema index, degree of post-acne erythema and overall improvement in post-acne erythema and acne scar were assessed at baseline, every 2 weeks and 6 weeks after the last treatment. Subjective degrees of satisfaction were also evaluated. Adverse events were recorded and pain was scored using a visual analog scale (VAS). RESULTS: At 6 weeks after 3 sessions of laser treatment, all patients demonstrated clinical improvement. Erythema lesion counts decreased by 20.1% (versus baseline) after the first treatment (P = 0.004), by 32.7% after the second treatment, by 46.5% at 2 weeks after the third treatment and by 58.7% at the 6-week follow-up (all P < 0.001). Significant improvements were also noted in erythema indices (22.29 ± 2.4 to 17.51 ± 1.8) and mean post-acne erythema scores after the first treatment (both P < 0.001). The mean scores of independent physician assessments were 4.04 ± 0.9 in term of the improvement of post-acne erythema and 3.44 ± 0.9 in the improvement of scarring. In addition, we could observe a significant decrease in inflammatory acne lesion counts after two laser treatments with a decrease in mean lesion counts by 67% at the 6-week follow-up. Treatment was well-tolerated and adverse effects were limited to transient erythema and edema at treatment sites. CONCLUSIONS: Low-fluence 585 nm Q-switched Nd:YAG laser treatment is safe and effective for the treatment of post-acne erythema with minimal discomfort and quantifiable improvement in the appearance of early acne scarring and inflammatory acne.