A comprehensive systematic review on the efficacy, safety, tolerability, and relapse rates of modern procedural therapies for inflammatory and non-inflammatory acne vulgaris.

Abstract

Procedural therapies are increasingly recognized as effective adjunctive treatments for acne vulgaris alongside topical and systemic options. This systematic review aims to provide a comprehensive overview of the efficacy, safety and relapse rate of various procedural therapies in managing acne vulgaris. Data from 160 studies involving 8121 patients were analyzed across four major databases up to 2024. Treatment approaches were stratified into six categories: Light therapies (n = 55), Chemical Peelings (n = 20), Lasers (n = 21), Radiofrequency (n = 5), Comparative Studies (n = 18), Combination Studies (n = 36), and other modalities (n = 5). Photodynamic therapy (PDT) using Intense Pulsed Light and Aminolaevulinic acid showed a 56.66% median improvement rate for inflammatory acne but had low tolerability due to pain and burning sensations, Limiting its use.Among chemical peels, Salicylic Acid at 30% had the highest efficacy at 85%, followed by Glycolic Acid at 80.25%. In contrast, Jessner Solution and 25%Trichloroacetic acid were less effective and increased the risk of post-inflammatory hyperpigmentation (PIH).Comparing lasers and light therapies showed that PDL had less efficacy compared to light therapies, but Nd:YAG was more effective, especially in noninflammatory lesions, with fewer flare-ups. Fractional Microneedling Radiofrequency (RF) was more effective and had lower recurrence rates in comparison to lasers and RF. The evolution in acne vulgaris management highlights the growing prominence of procedural therapies, each offering varying levels of efficacy and safety profiles.