While it is estimated that more than 80 percent of the world?s population is affected by acne at some point during their life, there is still no cure. Until recently, a combination of topical preparations and oral medications, including antibiotics, has been used almost exclusively with varying degrees of success to combat acne. Now, several laser and light-based technologies have recently been demonstrated to improve mild to moderate acne in a few treatment sessions, and with no known systemic side effects.
Speaking today at the American Academy of Dermatology?s Derm Update 2002, dermatologist Arielle N.B. Kauvar, MD, Clinical Associate Professor of Dermatology, New York University School of Medicine, New York, discussed how dermatologists are using laser technology to treat acne by altering the biological mechanisms responsible for this common condition.
Acne is a chronic inflammatory disease of the sebaceous hair follicles. Each follicle contains a tiny hair and multiple sebaceous glands. Under normal circumstances, sebum, the oily substance made by the sebaceous glands, travels up the hair follicle and out to the skin?s surface. However, with acne, sebum is trapped within the follicle and skin bacteria multiplies within the clogged pores. Acne develops on those areas of the skin where sebaceous glands are most numerous: the face, scalp, neck, chest, back, and upper arms and shoulders. Acne typically begins in adolescence, although onset in the twenties or thirties is common.
One approach to treating acne is to target the bacteria that produces the inflammation associated with acne known as Propionobacterium Acnes, or P. acnes. P. acnes releases porphyrins, which are naturally occurring molecules in the body. When porphyrins absorb certain wavelengths of light, free radical damage is produced which destroys the bacteria.
Porphyrins absorb light best in the blue wavelength range – 400 nm to 430 nm. A low intensity blue light source (405 nm to 420 nm) has been studied for the treatment of mild to moderate inflammatory acne. In the study, two 15-minute exposures a week for a period of four weeks produced a 60 percent reduction in acne in 80 percent of patients. Reported remissions from acne lasted as long as three to eight months.
Another way to treat acne using laser technology is to damage the sebaceous glands by a thermal or heat effect. In a recent study, a 1450 nm diode laser was used to perform four treatments one month apart. There was 100 percent clearing of acne in 16 of the 17 patients evaluated six months after the last treatment. Skin biopsies performed immediately after treatment showed heat-induced alterations of the sebaceous glands, reducing the amount of oil produced.
“While lasers have been used successfully for acne scarring for years, their use in actually controlling existing acne is a major breakthrough and could be an excellent alternative for those patients who have had minimal success with traditional therapies,” explained Dr. Kauvar. “However, this treatment is still investigational and not widely available yet. So not all patients will have access to it and the procedure is not covered by insurance.”
Patients need to be aware that many states do not distinguish who can and cannot perform procedures with laser/light sources. “Since skin treatments using lasers can carry potential side effects, they should be performed by a qualified physician or under direct physician supervision. I encourage patients to ask their physician questions about who will be performing laser surgery, including their qualifications,” cautioned Dr. Kauvar.