Acne, rosacea and sun damage are some of the most prevalent skin conditions treated by dermatologists. Fortunately, recent advances in laser therapies are providing new hope for millions of people who struggle with these conditions everyday.
Speaking today at the American Academy of Dermatology?s (AAD) Derm Update 2003, dermatologist Mark Steven Nestor, MD, PhD, Clinical Associate Professor, Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Miami, Fla., discussed how lasers and light devices used alone or in conjunction with certain photo sensitizing agents, or photodynamic therapy, is improving the treatment of acne, rosacea and sun damage.
Lasers are typically thought of as cosmetic devices, but from their inception in the field of dermatology almost 30 years ago, lasers have been used for the treatment of clinical conditions, as well, said Dr. Nestor. In addition, photodynamic therapy has been used investigationally to treat various conditions such as retinal problems associated with the eyes and precancerous conditions of the esophagus or bladder. However, dermatologists have recently combined the use of lasers and light devices with elements of photodynamic therapy to make great strides in the treatment of prevalent facial skin conditions.
Photodynamic therapy using a topical medication called aminolevulinic acid has been approved by the Food and Drug Administration (FDA) to treat actinic keratosis (AKs), an early potential sign of skin cancer. Unfortunately, initial treatment using this medication overnight, combined with laser therapy, was found to be both difficult and uncomfortable for the patient. However, recent developments using aminolevulinic acid with lasers and light sources for shorter treatment periods (i.e. one hour), called ‘short contact’ photodynamic therapy, have yielded much more positive results.
A typical short contact photodynamic therapy treatment begins with a light microdermabrasion. This technique is used to remove any dead skin cells on the surface of the face, which allows for better penetration of the aminolevulinic acid. The microdermabrasion is followed by a topical application of aminolevulinic acid, which is left in place for approximately 30 to 60 minutes. The medication is then removed using an alcohol swab, soap and water. Finally, the patient is treated with a laser or light source.
According to Dr. Nestor, Photodynamic therapy is an essentially painless procedure for the patient. While initial results may be seen as early as the first session, some patients require a series of three to five sessions to see significant results. However, it really depends on the patient and the severity of the skin condition being treated.
Short contact photodynamic therapy has proven successful in the treatment of moderate to severe cystic acne, a condition usually treated with the long-term use of antibiotics or isotretinoin. However, antibiotic treatments and isotretinoin can be associated with certain side effects, and antibiotics have limited effectiveness in many patients. Acne treatments using short contact photodynamic therapy with aminolevulinic acid and lasers or light sources appear to have positive effects in significant numbers of individuals. Patients usually undergo three procedures, and side effects have included some slight facial redness. New studies also highlight that certain FDA approved light sources (blue light) can improve inflammatory acne in just a few short sessions without any side effects.
It generally takes around two to six weeks to see significant results for patients with acne, said Dr. Nestor. While it is still early in the investigational process, photodynamic therapy, as well as light-based therapy for acne, appears to provide long-term improvement for patients. It is anticipated that FDA trials on this treatment will begin very soon.
Short contact photodynamic therapy, as well as intense pulse light photorejuvenation, have also been used to successfully treat patients with rosacea, a common skin condition that causes redness and swelling on the face, as well as thickening of the skin. Until now, the primary treatment for rosacea has been antibiotics (both oral and topical). Antibiotic treatment has had some success in reducing the blood vessels and redness associated with rosacea. However, dermatologists are finding that intense pulse light photorejuvenation and short contact photodynamic therapy, again using aminolevulinic acid, may also successfully improve the redness and thickening skin of patients with this condition.
In addition to acne and rosacea, short contact photodynamic therapy treatments have made significant cosmetic improvements in patients with long-term sun damage.
The symptoms of sun damage, such as rough skin, pigmentary problems, wrinkles, and certain early signs of skin cancer, have exploded in recent years due to the thinning ozone layer and various lifestyles associated with sun exposure. Therefore, sun damage is one of the most prevalent conditions treated by dermatologists, said Dr. Nestor. The latest photodynamic therapy techniques are giving patients another option for the treatment of sun damage and are improving their cosmetic outlook.
Short contact photodynamic therapy appears to be an important step in the treatment of acne, rosacea and sun damage. This combination treatment is also finding success in a variety of other conditions such as keratosis pilaris (severely dry skin), certain types of warts, molluscum (a non-cancerous skin growth), and excessive oiliness of the skin.