Laser Therapy for Acne Treatment

By Erin Broadus

Spring 2007

References Alam, Murad, Te-Shao Hsu, Jeffrey S. Dover, David A. Wrone, and Kenneth A. Ardnt.

Nonablative laser and light treatments: histology and tissue effects – a review. 2003. Lasers Surg. Med. 33:30-39.  

Battle Jr., Eliot F. Treating skin of color. 2006. Advance for Physician Assistants 14: 32-33.   Bernstein, Eric F. A pilot investigation comparing low-energy, double-pass 1450 nm laser

treatment of acne to conventional single-pass, high-energy treatment. July 26, 2006. Available at www.interscience.wiley.com . Accessed 30 September 2006.

Elman, Monica and Joseph Lebzelter. Light therapy in the treatment of acne vulgaris. 2004.     Dermatol Surg. 30: 139-146.] Epocrates Online, Acne Vulgaris. September 2006. Available at: http://online.epocrates.com. Accessed 30 September 2006. Friedman, Paul M., Ming H. Jih, Arash Kimyai-Asadi, and Leonard H. Goldberg. Treatment of

inflammatory facial acne vulgaris with the 1450-nm diode laser: a pilot study. 2004. Dermatol. Surg. 30:147-151.

Mariwalla, Kavita and Thomas E. Rohrer. Use of lasers and light-based therapies for treatment of acne vulgaris. 2005. Lasers Surg. Med. 37:333-342.  Nouri, Keyvan and Christopher J. Ballard. Laser therapy for acne. 2006. Clin Dermatol.

24:26-32. Rotunda, Adam M., Anand R. Bhupathy, and Thomas E. Rohrer. The new age of acne

therapy: light, lasers, and radiofrequency. 2004. J Cosmet Laser Ther. 6:191-200.

Epidemiology – Who It Affects 40 million adolescents

Males > Females 25 million adults

Females > Males Geriatric population

Favre -Rocuchot 15 % will seek Tx 30% of all derm visits ANYONE WITH

SKIN!!

Pathophysiology – How Acne Develops

1 - Androgens stimulate sebum production and proliferation of keratinocytes in hair follicles.

2 - Sheets of desquamated keratin obstruct the follicle opening, which forms the precursor to acne

3 - This results in sebum accumulation and swelling of the follicle.

4 - P. acnes colonize and proliferate in the plugged follicle

5 - This causes the hydrolyzation of sebum triglycerides into free fatty acids. This further plugs the follicle and pro-inflammatory mediators causes inflammation of the follicle and surrounding dermis.

Traditional Treatment Methods Antibiotics - reduce inflammation caused by acne Topical Agents - unplug follicles and kill bacteria Accutane - decrease oil production

History of Laser Utilization Used for almost the past 100 years First therapies - simple conventional lamps

controlled with a filter In the past, lasers have used sunlight exposure as

a way to treat acne due to its initial anti-inflammatory effects. However, this has proved to be potentially carcinogenic due to the exposure of UVA (aging) and UVB (burning) waves

Has become a more common modality in the last decade

How Lasers Work P. acnes produce a type of chromophore, a molecule that is

absorbed into the skin, called a porphyrins. When these porphyrins are excited by the absorption of light

(photoactivation), they form free oxygen radicals. This causes membrane damage and cell death, which in turn

kill the bacteria within (P. acnes). Each chromophore has a specific absorption spectrum of its

own. Porphyrins are absorbed the most at light wavelengths near 400 nm. The highest absorption occurs at around 415 nm (blue visible light), called the Soret band.

Porphyrins are well absorbed into the skin at the Q bands (purple & red visible light) between 450-700 nm.

Types of Lasers Blue light: ClearLight, Blu-U, Omnilux Blue Blue and red combination light: Acne Lamp Broad-Spectrum: ClearTouch, StarLux KTP (green light): Aura Pulsed Dye Laser (yellow light): Photogenica

VStar, N-Light, V-Beam 1450 nm Diode Laser: Smoothbeam Er:glass 1540 nm: Aramis

Blue Light Study Blue light emits at

wavelengths from 405-420 nm (should be the most effective to irradiate P. acnes).

35 patients with mild-moderate lesions on the face and trunk over a 4-week period.

Benefits 80% of patients saw an

improvement in lesions

Blue-Red Combination Study Light combination therapy reduced

P. acnes colonization numbers more than blue light alone b/c its wavelength is 625-740 nm. At this longer wavelength, it penetrates better into the skin.

12 weeks - 15 minutes each day. Benefits

58% reduction in non-inflammatory lesions

76% reduction in inflammatory lesions.

KTP Study KTP emits a wavelength of 532 nm (green

visible light) and penetrates the skin 1-2 mm. The KTP laser is able to also photoactivate

bacterial porphyrins such as P. acnes. 11 patients for 2 weeks twice weekly. Benefits

No adverse effects 36% saw a reduction in mild-mod. acne lesions Sebum production decreased by 28%

Disadvantages Little effect on P. acnes

Pulsed Dye Laser(PDL) Emits a wavelength of

585 or 595 nm (yellow visible light). Yellow light is applied to the skin to destroy P.

acnes thereby creating oxygen because its chromophore is oxyhemoglobin.

AE - hyperpigmentation.. 100% of patients reported an 80% decrease in

inflammatory lesions. @ 3 months - Patients still were improving.

1450-nm Diode Laser Penetrates to the level of the

mid-dermis Causes thermal damage to the

sebaceous gland resulting in the destruction of sebocytes that contain P. acnes.

Benefits More than half showed a 65% reduction in lesions. Significant decreased lesion count in back acne After 6 months, five of the patients did not need

additional acne treatments. AE – pain (Cooling spray used to preserve

epidermis) and hyperpigmentation

Er:glass 1540 nm It penetrates 0.4 to 2 mm and also has a

target of intracellular water. 20 patients over a two-month period w/

treatments every 2 weeks for a total of 4 treatments.

Benefits There was a 70% decrease in lesion count

after the first and third months. Patients also reported a decrease in skin

oiliness. AE – pain (cooling spray used)

Advantages It is also a noninvasive and sometimes pain free

process Patient eliminates the trouble of treating hard-to-

reach areas, such as the back Practitioner can control the depth of treatment Faster response than antibiotics Fewer treatments needed Not having to remember to apply products or take

any medication

Limitations Cost: $250-1000/treatment Inconvenience of traveling to the office Safety of irradiation

Good Candidates Some patients fail or will not tolerate other

treatments Side effects from non-laser treatments Many patients face compliance challenges Patients that have failed to do well on Accutane

or as a last resort before Accutane Lesions on difficult-to-reach areas: neck, upper

chest, back and upper arms

Convincing Laser Evidence Largest reduction in acne lesions: 1450 nm Diode

Laser 83% reduction in lesions seen after just three

treatments.

Longest lasting effects: PDL Patients were still seeing improvements at the

3 month mark.

Least number of adverse effects: KTP Laser No adverse effects seen

Conclusions MOA of Lasers - inactivation of P. acnes It is important to treat both the cause and the symptoms of

acne in order to successfully manage it. Light-based therpaies and lasers should not be used to

replace existing acne treatment. They should be used to supplement and complement

conventional medical treatment. There are many different types of lasers that can be used

in combination with conventional approaches.

Future Research The exact wavelength in the spectrum for the

most efficacious treatment of acne has not yet been determined.

Lasers should be made more available in Family Practice, Internal Medicine, and Pediatricians’ offices because a great majority of patients (85%) does not seek the expertise of a dermatologist for acne treatment