Optimizing the bactericidal effect of pulsed blue light on Propionibacterium acnes - A correlative fluorescence spectroscopy study.

Propionibacterium acnes infection is the eighth most prevalent disease, affecting 80% of people worldwide. Resistance to antibiotics has been on the rise; over 40% of acne infections now resist commonly used topical and oral anti-acnes antibiotics, making treatment difficult. In our effort to refine blue light as an alternative safe clinically effective treatment, we determined if 100% bacterial suppression is attainable at ultralow irradiances and radiant energies, and explored the relationship between bacterial suppression and fluorescence during treatment. P. acnes were irradiated in vitro repeatedly three times per day at 3- or 4-hour intervals over three or more days, using 3 or 5 J/cm radiant energy of 450 nm pulsed blue light (PBL) at irradiances as low as 2 mW/cm. In another series of experiments, we measured changes in P. acnes fluorescence as bacteria were repeatedly irradiated at various radiant exposures over three to four days. Our results showed that (1) 33% PBL, applied three times per day at 3-hour intervals each day over a three-day period at 2 mW/cm irradiance and 5 J/cm radiant exposure, resulted in100% bacterial suppression (7 log reduction), (2) the absorbed 450 nm light caused P. acnes to fluoresce predominantly in the red spectrum, with the fluorescence diminishing correlatively as treatment was repeated at 3-hour intervals and rising significantly during long periods of no treatment, and (3) treatment at 3-hour intervals gave better results than treatment at 4-hour intervals.