Comparison of the efficacy of Q-switched versus long-pulsed fractional 1064 nm Nd: YAG laser in the treatment of active facial acne: a double-blind, randomized, controlled, split-face clinical trial

Purpose Acne vulgaris affects approximately 80% of individuals at some point during life. There are different treatment options including topicals, systemic antibiotics, systemic retinoids, hormonal treatments, intralesional injections, and various lasers. Fractional neodimium-doped yttrium aluminum garnet (Nd: YAG) 1064 nm laser has been used to treat acne scars and there are also reports on its use in active acne. The aim of this split-face clinical trial is to compare effects of long-pulse (LP) with quality-switched (QS) Nd: YAG laser on facial active acne. Methods This is a double-blind, randomized, controlled, split-face clinical trial comparing LP vs. QS 1064 nm Nd: YAG laser for treatment of active acne in 20 participants with age range of 18–50 years. Patients underwent treatment for 3 sessions with 3 week intervals and were followed for 4 weeks after the final session. Assessments were performed using global acne grading system (GAGS) and revised Leeds scores and physician global assessment and patient global satisfaction. Results At final follow up, the means reduced in all three groups compared to before treatment. Both QS and LP lasers decreased means of Leeds and GAGS scores at the final follow up compared to before treatment; mean percentage change was compared for QS and LP groups for both Leeds and GAGS scores. The percentage change was higher in QS laser group compared to LP laser group for both Leeds (50% and 32% change for QS and LP groups, respectively) and GAGS scores (42% and 34% change for QS and LP groups, respectively); however, a statistically significant difference was reported only for Leeds scores (p = 0.04) and was not significant for GAGS score (p = 0.36). At all sessions, the physician’s global assessment (PGA) mean scores were significantly higher in both treatment groups compared to control (p = 0.001). Patient’s global satisfaction (PGS) scores were significantly higher in both treatment groups compared to control (p = 0.001). In LP group, 2 cases of pain and 2 cases of post-inflammatory hyperpigmentation (PIH) were reported. In QS group, 3 cases of prolonged erythema were reported. Conclusion Both long pulsed 1064 nm Nd: YAG and Q-switched 1064 nm Nd: YAG lasers are effective in reducing the severity of active acne lesions and can be a potential treatment for active acne; howeevr, QS Nd: YAG laser outperformed LP Nd: YAG in terms of efficacy and safety.