Lasers, light sources battle acne

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Lasers, light sources battle acne
Jun 1, 2006
John Jesitus
Dermatology Times

Used alone or in combination with aminolevulinic acid (ALA), lasers and light sources have shown effectiveness in treating acne, according to an expert.

Lasers and light sources that have been used alone to treat Propionibacterium acnes include blue lights, KTP and pulsed-dye lasers and intense pulsed light (IPL) sources, says Thomas E. Rohrer, M.D., of Skincare Physicians in Chestnut Hill, Mass., and clinical associate professor of dermatology at Boston University.

"Typically," he tells Dermatology Times, "these technologies require multiple treatments, usually twice weekly for a month." He adds that they have been shown clinically to reduce P. acnes colonization and lesion counts by 30 percent to 60 percent.

STUDY FINDINGS

For example, one study found that treatment with blue light (ClearLight, Lumenis) reduced mean acne lesion count by 60 percent and P. acnes colony count by one to two orders of magnitude (Kawada A et al. J Dermatol Sci. 2002 Nov;30(2):129-135). Similarly, a study of 88 patients treated with ClearTouch (Radiancy), which combines pulsed light and heat, found that this device achieved more than 50 percent reduction in inflammatory lesions in 66 percent of patients (Gregory AN. Cosmetic Derm. 2004;17(5):287-300).

Dr. Rohrer says, "The upside of these treatments is that they are generally fairly quick, painless procedures. The downside is that P. acnes will regenerate itself fairly rapidly, usually within two to three months, so often the acne comes right back."

Among the three modalities, he adds that while none performs head and shoulders above the others, blue light is most efficient, requiring the lowest amounts of energy.

Blue light, KTP, pulsed-dye lasers and IPL devices also can be used in conjunction with ALA (Levulan, Dusa Pharmaceuticals), Dr. Rohrer points out.

"When one adds ALA to the mix, the ALA is somewhat preferentially absorbed by the sebaceous glands. Then, when one activates it with a variety of different light wavelengths, one gets a form of photodynamic excitation where it damages the sebaceous gland and potentially alters the tubule that drains it," he explains. Adding ALA helps to achieve long-term improvements in acne, with some studies showing up to 1.5 years, Dr. Rohrer adds.

TRICKS TO EFFECTIVE TECHNIQUE

Procedurally, Dr. Rohrer says, "The trick is getting decent absorption into the skin."

To that end, he says one can use a variety of cleaners such as alcohol, acetone or even microdermabrasion. Next, he advises leaving the ALA on for 45 minutes to 60 minutes before treating with the light source.

Dr. Rohrer adds, "One must also make sure that patients don't go out in the sun for 48 hours afterwards. The problem with photodynamic therapy (using ALA) is that some people have a photo-toxic reaction" that includes intense redness, swelling and sometimes crusting.

A variety of infrared lasers including the SmoothBeam (Candela), CoolTouch (CoolTouch) and Aramis (Quantel Medical) also are used to treat acne, Dr. Rohrer says.

"These lasers heat the superficial dermis. And although they're not selectively heating the sebaceous glands, these glands reside in the upper dermis and are somewhat heat sensitive," he says.

Therefore, Dr. Rohrer says that when one heats the superficial dermis, changes are produces including decreased sebaceous gland size (Paithankar DY et al. Lasers Surg Med. 2002;31(2):106-114), (Friedman PM et al. Dermatol Surg. 2004 Feb;30(2 Pt 1):147-151) that may straighten the tubule that drains the gland.

PROMISING PILOT, BUT...

A 27-patient pilot study of the SmoothBeam achieved a 98 percent reduction in acne lesions among patients who completed the study (Ross EV et al. presented at ASLMS annual meeting, April 10-14, 2002, Atlanta). Furthermore, Dr. Rohrer says each of the infrared lasers has been shown to achieve acne improvement, with some studies extending to a year and a half.

Nevertheless, he says, "The reality is that these lasers are not going to clear everyone's acne, even though some of the studies show 98 to 100 percent clearing."

Such success rates rarely occur clinically because the patients that one treats with lasers and light sources are those for whom topical and oral medications already have failed, Dr. Rohrer explains.

"We've already sub-selected a group that has difficult acne," he explains, "and of those patients, we're seeing that about 60 to 70 percent improve significantly."

Disclosure: Dr. Rohrer has served as a speaker for Candela Corp., LaserScope, Lumenis Inc. and Radiancy Corp., but he owns no stock in any companies mentioned in this article.

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