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<p>Acne vulgaris affects approximately 9.4% of the global population and disproportionately burdens individuals with skin of color (SOC) through persistent postinflammatory hyperpigmentation (PIH) and acne scarring. Conventional therapies primarily target inflammatory lesions but have limited efficacy for pigmentary sequelae. Energy-based devices (EBDs) have emerged as valuable adjuncts, yet most available evidence is derived from studies in lighter skin phototypes. This narrative review evaluates the efficacy, safety, and clinical considerations of EBDs for acne and its sequelae in SOC, with a focus on Fitzpatrick skin types IV–VI. We reviewed clinical trials, case series, and systematic reviews investigating ablative and non-ablative lasers, picosecond lasers, radiofrequency (RF), intense pulsed light (IPL), and combination therapies, assessing outcomes such as acne clearance, acne scar remodeling, PIH improvement, and adverse events. Fractional non-ablative lasers and long-wavelength Nd: YAG devices consistently demonstrated improvements in acne scars and pigmentation, with mostly self-limited PIH, although studies were small (<i>n</i> &lt; 50) and short-term. Picosecond lasers showed promise for both acne scarring and pigmentary disorders with low complication rates, while RF microneedling improved acne scar texture with minimal pigmentary risk due to its chromophore-independent mechanism. IPL and LED therapies yielded modest lesion reductions but variable patient satisfaction. Across modalities, PIH was the most frequent adverse event, typically transient but more common with higher fluence or higher density settings. The current evidence base is limited by small sample sizes, underrepresentation of SOC populations, particularly Black and Afro-Caribbean patients, and a lack of standardized outcome measures. EBDs represent valuable adjuncts for acne and acne scarring in SOC when conservative parameters and tailored protocols are used, with RF microneedling and longer-wavelength lasers appearing most favorable. Larger, SOC-inclusive randomized trials are urgently needed to establish evidence-based guidelines and ensure equitable, safe, and effective acne care.</p>

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Use of energy-based devices for acne and sequelae in skin of color: a review of efficacy, safety, and practice considerations

  • 期刊论文

  • 发表日期：

    2025年12月23日

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  • Sanaa Tasneem,
  • Ali Bayrouti,
  • Duncan MacIntyre,
  • Maria Abou Taka,
  • Ingyun Park,
  • Khalil Khatri

摘要

Acne vulgaris affects approximately 9.4% of the global population and disproportionately burdens individuals with skin of color (SOC) through persistent postinflammatory hyperpigmentation (PIH) and acne scarring. Conventional therapies primarily target inflammatory lesions but have limited efficacy for pigmentary sequelae. Energy-based devices (EBDs) have emerged as valuable adjuncts, yet most available evidence is derived from studies in lighter skin phototypes. This narrative review evaluates the efficacy, safety, and clinical considerations of EBDs for acne and its sequelae in SOC, with a focus on Fitzpatrick skin types IV–VI. We reviewed clinical trials, case series, and systematic reviews investigating ablative and non-ablative lasers, picosecond lasers, radiofrequency (RF), intense pulsed light (IPL), and combination therapies, assessing outcomes such as acne clearance, acne scar remodeling, PIH improvement, and adverse events. Fractional non-ablative lasers and long-wavelength Nd: YAG devices consistently demonstrated improvements in acne scars and pigmentation, with mostly self-limited PIH, although studies were small (n < 50) and short-term. Picosecond lasers showed promise for both acne scarring and pigmentary disorders with low complication rates, while RF microneedling improved acne scar texture with minimal pigmentary risk due to its chromophore-independent mechanism. IPL and LED therapies yielded modest lesion reductions but variable patient satisfaction. Across modalities, PIH was the most frequent adverse event, typically transient but more common with higher fluence or higher density settings. The current evidence base is limited by small sample sizes, underrepresentation of SOC populations, particularly Black and Afro-Caribbean patients, and a lack of standardized outcome measures. EBDs represent valuable adjuncts for acne and acne scarring in SOC when conservative parameters and tailored protocols are used, with RF microneedling and longer-wavelength lasers appearing most favorable. Larger, SOC-inclusive randomized trials are urgently needed to establish evidence-based guidelines and ensure equitable, safe, and effective acne care.