Hello Tomcua,
Which form of laser?
?One of the main benefits of non-ablative lasers, in contrast to their
ablative counterparts, is that they can clear acne without producing a
notable injury to the outer layer of the skin. Non-ablative therapy
works by targeting the overactive sebaceous glands that are
responsible for acne. The laser emits a wavelength of light that is
strongly absorbed by water within the skin. This generates heat in
and around the sebaceous glands. By creating a mild thermal injury
just below the skin?s surface, a non-ablative laser alters the
structure and function of the sebaceous gland, leading to prolonged
acne clearance.
"I believe that laser-based applications for acne will one day become
the preferred treatment option for acne patients, many of which are
dissatisfied with topical and systemic treatments and are wary of
their risks and side effects," explained Dr. Alster. "I use
non-ablative therapy extensively in my practice, and I've found it to
be a safe and cost-effective treatment that has dramatically changed
my patients' lives for the better." American Academy of Dermatology
http://www.aad.org/public/News/NewsReleases/Press+Release+Archives/Acne/LasersForAcne.htm
Pulsed dye laser
================
According to this University of Michigan, an authoritative source
of information, the pulsed dye laser does not seem very effective in
healing acne.
?Laser therapy is an appealing treatment for acne: no messy creams, no
drugs and minimal risk of side effects.
Unfortunately, there also appears to be no benefit, at least with one
type of laser treatment called pulsed dye laser therapy, according to
new research from the University of Michigan Health System . The
study, which appears in the June 16 issue of the Journal of the
American Medical Association, found pulsed dye laser therapy was not
effective in treating acne.
Many dermatologists already use lasers to treat various conditions,
including wrinkles, scars and acne. However, few randomized,
controlled clinical trials have examined the value of lasers for
treating acne and none show conclusively whether the treatments
actually work.?
?The researchers compared the differences in subjects' acne severity
from the beginning of the study to the conclusion 12 weeks later. In
that time, on average, the side of the face that received treatment
showed the same degree of change ? for better or worse ? as the side
that was not treated, indicating that the laser therapy did not impact
the course of the disease.
A study published last year in the journal Lancet reported positive
results with very similar therapy. That study was published while the
UMHS study was ongoing. The Lancet study did not include a split-face
design, however, and instead used separate participants who received
placebo therapy as a comparison.?
http://www.med.umich.edu/opm/newspage/2004/pulsed.htm
?Of the 40 randomized patients, 14 completed the one-treatment arm of
the study and 12 completed the two-treatment arm. No statistically
significant difference in efficacy was found between groups. In
addition, there was no statistically significant difference between
untreated and treated sides of the face at 12 weeks when compared with
baseline. Other measures to determine differences (e.g., a measure of
sebum production) also showed no differences.?
http://www.findarticles.com/p/articles/mi_m3225/is_5_71/ai_n13681155
This study seemed to report more positive results, but not without warnings:
?Laser treatment for acne "seems reasonable," says Dr. Claudia
Hernandez, a professor of medicine in the dermatology department of
Loyola University Health System. But a lot of questions must be
answered first, she adds.
"This was a small study, and the number of control patients was
small," Hernandez says. "We don't have a long-term follow-up. Would
combination therapy be effective? We might have a study to see what
the optimum dosage is. And what would the eventual cost of treatment
be?"
Caution is also expressed by Dr. Guy F. Webster, a professor of
dermatology at Jefferson Medical College in Philadelphia, in an
accompanying editorial.
"Infrequent treatments that make drugs unnecessary would benefit all
concerned (except drug companies)," Webster writes. "But we are not
yet at the point where acne patients are going to throw out their
antibiotics and line up for the laser. More work is certainly needed,
both to confirm the clinical benefit and best regimen and to elucidate
its mechanism."
http://www.hon.ch/News/HSN/515685.html
JAMA reports:
?Conclusions In this study, the nonpurpuric pulsed dye laser therapy
did not result in significant improvement of facial acne. More
research is needed before this laser therapy may be recommended as an
acne treatment.?
http://jama.ama-assn.org/cgi/content/abstract/291/23/2834?lookupType=volpage&vol=291&fp=2834&view=short
Candela Smooth Beam Laser
=========================
Baylor University reports success with the Candela smooth beam laser:
?The Candela Smooth Beam Laser has been recently FDA approved for the
treatment of acne. In studies of acne on the back in volunteers, there
was 98 percent improvement after four treatments.
"Patients are leaving here amazed," said Dr. Ramsey Markus, assistant
professor of dermatology at Baylor. "The laser appears to be effective
with very few side effects, mainly mild redness that goes away within
a few hours."
The new technology heats the skin and shrinks oil glands, improving
acne gradually during three to five treatments that are generally less
than 15 minutes each. Physicians treat regions of the body that tend
to develop acne, such as the face, back or shoulders.
According to clinical studies, a 60 percent improvement occurs after
just one treatment. After four treatments, the majority of patients
experience near complete resolution of their acne. In addition, this
treatment also treats acne scars.?
http://www.bcm.edu/news/item.cfm?newsID=296
?The Candela Smoothbeam is an exciting new laser technology. The
laser uses a combination of skin heating and cooling to selectively
heat the middle layer of the skin. By heating that layer (the dermis),
it is possible to gently treat a variety of skin problems. The laser
is FDA approved to treat wrinkles, acne and acne scars. In addition
the Smoothbeam laser has been reported to improve sebaceous
hyperplasia and other skin problems.?
One of the benefits to the Smoothbeam laser is the low chance of side
effects. The most common side effect is mild redness in spots lasting
about a few hours. Rare side effects can include blistering or color
changes. Scarring is extremely rare, but possible with any treatment
of the skin. Even though the laser is cutting edge technology, there
is a chance it may not sufficiently treat your skin problem.
Heating the skin hurts! Prior to treatment it is highly recommended to
purchase an over the counter numbing cream called LMX (4 or 5
percent). For best results, 90 minutes prior to treatment rub in a
thin layer of the LMX cream and then immediately apply a generous
layer of cream to the entire treatment area. 30 minutes prior to
treatment re-apply cream to the skin in a super thick layer (like a
mask). It is better to leave the cream on too long, than not long
enough.?
The Baylor site also provides you with estimated prices, as insurance
does not cover cosmetic surgery.
http://www.bcm.edu/dermatology/?PMID=1904
?The Smoothbeam laser is a no down time alternative to skin
resurfacing. The Smoothbeam laser is used to treat applications such
as fine wrinkles, stretch marks and acne scars. The laser emits an
intense beam of light that can be used in a non-ablative mode. The
non-ablative mode includes treatment of the underlying levels of the
skin (the dermal layer) without directly affecting the top layer of
the skin (the epidermis).
Non-ablation is performed to produce a "skin renewal" effect by
applying laser energy to the dermal layer of tissue. A local
anesthetic or topical cream may be applied, but is often unnecessary,
to reduce any discomfort experienced during the treatment since there
is a cooling spray applied during the treatment. The spray protects
and cools the epidermis. There may be some degree of local discomfort
immediately after the laser pulse and for a few hours following the
treatment.? Boston University Cosmetic Center
http://www.bucosmeticsurgery.com/smoothbeam.htm
?Candela's Smoothbeam diode laser goes the extra step of shrinking the
sebaceous glands under the skin, the company and dermatologists said,
reducing the amount of oil the glands produce.
Some dermatologists have already begun using the Candela laser on
facial acne in so-called "off-label" treatments, which are permitted
if early indications show a treatment is safe and effective. The laser
was approved by the FDA for the treatment of wrinkles and back acne in
2002.
"It may be a real alternative to Accutane therapy in those individuals
who can't take Accutane for whatever reason," said Arielle Kauvar, a
clinical associate professor of dermatology at New York University.
Treatment, which takes place in the doctor's office, will cost
approximately $250 for a course of three to five treatments, one each
month, for a total of $750 to $1,250.
Six months after the last treatment, more may be needed, said
dermatologists. There has not been enough experience with the machine
to demonstrate how many patients need ongoing treatments, they said.
"The only drawback that I know of is it's painful," said Dr. Rox
Anderson, director of the laser center at Massachusetts General
Hospital and a professor of dermatology at Harvard Medical School.
Anderson said he has used the laser primarily on adult women. "Most
people have a long-term benefit," he said.?
http://www.boston.com/business/globe/articles/2003/11/25/candela_laser_okd_for_acne/
Fraxel Laser
============
?Dr. Bass, who is clinical assistant professor of plastic surgery and
director of the Minimally Invasive Plastic Surgery Program at New York
University Medical Center in New York City, describes how the Fraxel
laser differs from both nonablative remodeling with lasers or intense
pulsed light sources and resurfacing with CO2 and erbium lasers for
sun-related changes such as wrinkles, superficial pigment and vascular
changes.
"The Fraxel (Reliant Technologies, Inc.) laser represents another way
of incrementally grading the resurfacing treatment from very light to
very heavy. This is accomplished by producing tiny pinpoints of
coagulated tissue within the skin. The number, size and depth of these
'microthermal zones' can be varied to individualize the treatment," he
explains.
"There's nothing like it," he maintains. "It's not like laser
resurfacing with CO2 or Er:YAG, nor is it like nonablative remodeling
using technology such as CoolTouch, Smoothbeam or
Thermage®/Thermacooly?."
"With the Fraxel laser, the skin is not raw, so there is no recovery
time," Dr. Bass says. Although he points out that post treatment
redness may persist for a few days.
http://www.dermatologytimes.com/dermatologytimes/article/articleDetail.jsp?id=137299
?Made possible by the advances in laser communication technology,
125 to 250 microscopic laser beams are delivered into the skin. Each
beam heats both the epidermis and dermis, allowing both superficial
and deep treatment. Although 1,000 to 2,000 pulses are delivered in
each square centimeter, skin cells between the beams are not affected
thereby allowing for incredibly quick healing. By treating a whole
area such as the face with 3-6 sessions, the whole zone eventually is
fully treated.
Fraxel compares very favorably to other treatments in terms of
effectiveness, tolerabilty and side effects. Alternative treatments
exist, however and are good options for some patients, especially
given the patient cost of a Fraxel treatment ($1,000/session for the
full face)?
http://www.bcm.edu/dermatology/?PMID=2331
?Areas and Problems treated by Fraxel:
? Face - Surface wrinkles, brown spots, pigmentation and roughness
? Face, neck and chest - Acne scars
? Neck - Wrinkles and pigmentation
? Chest - Sun damage, wrinkles, freckles, brown spots
? Hands - Age spots, weathered appearance
? Arms - Age spots, rough skin, actinic keratoses
http://www.totaldermatology.com/pages/newfraxel.html
Er:YAG
======
?Because of these advantages, many thought the short-pulsed Er:YAG
laser would supersede the carbon dioxide laser as a superlative
ablative modality. However, initial enthusiasm for the short-pulsed
Er:YAG laser was tempered by poor intraoperative hemostasis and less
impressive clinical improvement (reduced tissue tightening) when
compared to traditional high-energy pulsed or scanned carbon dioxide
laser resurfacing.
In an attempt to overcome the limitations of the short-pulsed Er:YAG
laser, modulated (short-and-long-pulsed) Er:YAG systems were
introduced to facilitate deeper ablation of tissue, improve
hemostasis, and increase collagen remodeling. With the addition of
significant coagulative properties, modulated Er:YAG systems combined
precise control of ablation with the ability to induce dermal collagen
formation by means of thermal injury.
http://www.emedicine.com/derm/topic554.htm
?The results of long-pulsed Er:YAG laser resurfacing for pitted
facial acne scars were excellent in 10 patients (36%), good in 16
patients (57%), and fair in 2 patients (7%). Erythema occurred in all
patients after laser treatment and lasted longer than 3 months in 15
patients (54%). Postinflammatory hyperpigmentation occurred in 8
patients (29%). But the pigmentation faded or disappeared within 3
months. One patient (4%) experienced mild hypopigmentation. Pruritic
symptoms that required medical intervention occurred in 16 patients
(57%). Mild to moderate postoperative acne flare-up occurred in 8
patients (29%). No other adverse effects such as scarring, bacterial
infection, or contact dermatitis were observed. CONCLUSION: In
conclusion, resurfacing with a long-pulsed Er:YAG laser is a safe and
very effective treatment modality for pitted facial acne scars.?
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=21297042&dopt=Citation
Additional Information:
========================
Risks:
?All surgical procedures carry some degree of risk. With the new
Er:YAG and CO2 laser surgery, the risk of scarring is low. Common side
effects may include crusting, mild swelling, and redness or brown
discoloration at the treatment sites. Some patients may require
bleaching creams to help regulate skin color following laser
resurfacing. Pain, bleeding, swelling, and infection are minimized
with newer surgical techniques and meticulous post-operative care.
Pre-operative medication may be given to avoid cold sores. Redness of
the face for up to a few weeks is not uncommon and occasionally, may
persist for months. Side effects are greatly reduced with the milder
non-ablative lasers.?
http://www.aad.org/public/Publications/pamphlets/LaserResurfacingRejuv.htm
?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.?
http://www.aad.org/public/News/NewsReleases/Press+Release+Archives/Acne/AcneDown.htm
?If you choose laser resurfacing, check the qualifications of the
physician. The procedure is generally performed by plastic surgeons
and dermatologists. The physician should be board certified and should
be trained in laser technology specifically for this technique.?
http://www.clevelandclinic.org/dermatology/patient/faqs.htm#laser
Information, from the manufacturer of the Candela smooth beam laser:
http://www.candelalaser.com/Smoothbeam2/pat_pamp_acne.pdf
Fraxel Laser
http://www.reliant-tech.com/downloads/EuroABGfinalReliantv6-041505.pdf
This clinical trial study may interest you:
http://www.clinicaltrials.gov/ct/gui/show/NCT00113425
There you go! I would suggest reading this answer, and visiting a
competent dermatologist. S/he can decide the best course of treatment
for your skin. From my research, the Smoothbeam method seems the
safest and most effective, but your dermatologist can refer you to the
best therapy for you. Please note that I have gleaned this information
from reliable sources, and not from private offices that perform
certain types of laser therapy, who may present biased information.
If this is not the information you were seeking, please request an
Answer Clarification, before you rate. I will be happy to assist you
further, if possible, before you rate this answer.
Sincerely, Crabcakes
Search Terms
============
Laser resurfacing + acne
Laser therapy + acne
Smoothbeam laser + acne
Fraxel laser + acne
Smooth beam laser + acne
Er:YAG laser + acne
comparing laser therapy + acne |
Clarification of Answer by
crabcakes-ga
on
29 Nov 2005 23:27 PST
Hi again Tomcua,
Here is some information on other forms of laser. I still urge you to
exercise caution and speak to a dermatologist that could guide you to
the best phototherapy for you.
?The ClearLight was cleared by the U.S. Food and Drug Administration
based on a 510(k) application. Hence, the manufacturer was not
required to provide the type of evidence of effectiveness that would
be required to support a pre-market approval application (PMA). The
manufacturer's website states that additional multi-center studies are
underway to further support the efficacy of ClearLight technology in
treating acne.
Based on the lack of peer reviewed published medical literature on the
effectiveness of high intensity blue-spectrum (407-420 nm) light in
acne treatment, the ClearLight System is considered investigational
and experimental for this indication. Evidence-based guidelines from
the Institute for Clinical Systems Improvement (2003) concluded that
?[c]linical studies? of the ClearLight System ?to date, are limited?
and that ?[o]utcome data are insufficient.?
The Candela Smooth Beam Laser System differs from the ClearLight in
that the former uses laser, which is light of a single wavelength. In
contrast, the ClearLight uses light of a band of wavelengths in the
ultraviolet-blue spectrum.
There have been a number of recently published studies of laser
therapy of inflammatory acne. These studies, however, have been small
and have not included comparisons with established treatments for acne
vulgaris. In addition, given the small size and limited duration of
published studies, there are unanswered questions about the
generalization of the findings, about uncommon side effects, and the
durability of results of laser treatments.?
http://www.aetna.com/cpb/data/CPBA0656.html
?This study demonstrated that ClearTouchpulsed light and heat energy
(LHE) technology iseffective and safe for the treatment of
acnevulgaris. The treatment response was time-dependent, and occurred
as early as two weeksafter the initial treatment. As part of its
reproduction and metabolismprocess, the P. acne releases high amounts
ofendogenic porphyrin. Once Porphyrin moleculesabsorb photons, they
become chemically activeand transform into a state of aggregation
thatresults in the formation of free oxygen (i.e., typeII
photooxidation). This free oxygen attacks thecell membrane and leads
to the destruction of theP. acne bacterium.
Although sun exposure has a beneficial effect on acne, it is not clear
which wavelengths contribute to the favorable effect of sunlight.
Blue/UV light is theoretically the most effective visible wavelength
for photoactivation of the major endogenous porphyrin component of P.
acnes, because it matches the strongest porphyrin photoexcitation
band. However,blue/UV light has a poor skin penetration depth of less
than 0.25mm. On the other hand, red light penetrates more deeply into
tissue, though it is less effective causing photoexcitation of
porphyrins. In addition, red light when compared to blue light mayalso
have anti-inflammatory reaction.
One of the main limitations of acne light therapy is the fact that
photons have to penetrate through the epidermis before they can reach
the depth necessary for activation of the porphyrins. The depth of
follicleson the face is up to 3 mm and even more on the back.
Calculation of light penetration depth reveals that blue light in the
range 400-430 nm penetrates the skin to a depth of less than 0.25mm.
Thus, even though the excitation coefficient of porphyrins in this
band is very high, since blue photons do not penetrate the skin they
are unable to activate the porphyrins in the acne lesions.
Consequently, it is not the preferred wavelength for acne
phototherapy. Other lower excitation coefficients of porphyrins are in
the green and red bands where penetration depths of photons are in the
range of a few mm and this band is more suitable for acne
phototherapy.?
http://www.radiancy.com/PDF/LHE_Acne_Clinical%20_Results.pdf
?Phototherapy/Ultraviolet Radiation and Laser Therapy/Photodynamic Therapy
Phototherapy, or exposure to ultraviolet radiation or other light
(e.g., Ultraviolet B, Ultraviolet A, red light, blue light, mixed
red-blue light and Psoralens Ultraviolet Actinotherapy), has been
proposed as a treatment for acne vulgaris. Proponents suggest that P.
acnes produces porphyrins, which absorb light energy at the
near-ultraviolet and blue-light spectrum (Kaminsky, 2003), leading to
oxidation and ultimately destroying bacteria. It has also been
theorized that exposure produces a comedolytic action. None of these
hypotheses have been proven, however. Potential short- and long-term
side effects of repeated exposure to ultraviolet radiation include
nausea; itching and burning of the affected area; premature aging and
cancer of the skin; and eye damage.?
http://www.cigna.com/health/provider/medical/procedural/coverage_positions/medical/mm_0043_coveragepositioncriteria_acne_treatment.pdf
?Blue light therapy was one of the first light based therapies for
acne treatment. Blue light works by killing the acne-causing bacteria,
P. acnes, and is used to treat inflammatory acne vulgaris that has not
responded to other acne therapies. The blue-light products of today do
not contain ultraviolet (UV) light, which was a staple of former light
therapy used to treat acne. UV light can damage skin and is no longer
used to treat acne.
Patients receive blue-light therapy in increments. Generally, patients
are treated once weekly for eight weeks or twice weekly for four
weeks. Each session lasts about 15-30 minutes. Side effects are rare.
Most patients see improvement. Regular maintenance is required.
The results of Blue Light therapy alone are enhanced with the addition
of Levulan (Aminolevulinic acid) to the treatment. This procedure
called Photodynamic therapy (PDT) or PDT ALA provides long term acne
reduction.?
http://www.reflectionscenter.com/treatment_options.php
?Blue-light therapy. The FDA approved narrow-band, high-intensity
blue-light therapy for treating acne. Now widely advertised, this is
probably the best-known light therapy for acne treatment. Blue light
works by killing the acne-causing bacteria, P. acnes, and is being
used to treat inflammatory acne vulgaris that has not responded to
other acne therapies. The blue-light products of today do not contain
ultraviolet (UV) light, which was a staple of former light therapy
used to treat acne. UV light can damage skin and is no longer used to
treat acne.
Patients receive blue-light therapy in increments. Generally, eight
sessions are given over a four-week period, and each session lasts
about 15 minutes. Side effects tend to be mild and include temporary
pigment changes, swelling of the treated areas, and dryness. As the
results from the following studies show, many patients ? but not all ?
see noticeable improvement with about 55% clearance:
? 31 patients with symmetrical (same on both sides) facial acne
received blue-light treatment on 1 side of their faces. Blue-light
therapy was given twice a week for four consecutive weeks. The other
side of each patient?s face did not receive any treatment so that
researchers could judge the effectiveness of the blue-light therapy.
The researchers concluded that blue-light therapy is an effective acne
treatment unless the patient has nodulocystic acne lesions, which tend
to worsen when treated with blue light. ?
http://www.skincarephysicians.com/acnenet/article_lasers.html
?Blue Light (415nm)
It has long been known that sunlight (UV) can improve acne. However,
because of photo ageing and medical side effects, UV radiation is not
recommended as a safe treatment for acne.
More recently, a peak wavelength of 415nm, which is outside the UV
range, has been found to be effective at treating acne (1). It is
known that Propionibacterium acnes (P. acne) produce porphyrins during
their normal life cycle (2). Porphyrins absorb light energy at the
near UV and visible blue light spectrum. The irradiation of P. acnes
with blue visible light (415nm) leads to photoexcitation of bacterial
porphyrins, singlet oxygen production and eventually bacterial
destruction (3).?
http://www.beautyskinuk.co.uk/about_beautyskin.htm
?After eight bi-weekly treatments, 80% of the patients with mild to
moderate papulo-pustular acne showed significant improvement of
non-inflammatory, inflammatory and total facial lesions. Inflammatory
lesion count decreased by a mean of 60%. Two weeks after the last
treatment, the count had even further decreased to almost 70%. No side
effects of the treatment were observed. External skin temperatures
increased in a few cases by <1.5°C, however, this was
not noticed by the patients. Twenty percent of the patients did not
respond to the treatment. The lack of response in these patients may
be attributed to the existence of deep acne cysts or to the existence
of non- P.acnes bacteria.?
?Acne photoclearing (APC) by highintensity enhanced narrow-band blue
light is a promising non-invasive alternative to current topical and
parenteral anti-acne remedies.
http://www.aesthetic.lumenis.com/pdf/clearlight_app_notes.pdf
http://www.syneron.com/pdf/elosAcneClinical.pdf
?The data show more than an 80% response to 420nm acne phototherapy
with a significant reduction of 59?67% of inflammatory acne lesions
after only eight treatments of 8?15 minutes. The reduction in lesions
was steady in the follow-ups at 2, 4 and 8 weeks after the end of
therapy. Prolonged remission was evident in the 8 weeks after the end
of therapy. No adverse effects or patient discomfort were noted in any
of the patients.
CONCLUSIONS: Acne phototherapy by high intensity, narrow band
405?420nm light is proven to be an attractive, fast, effective,
non-invasive alternative to current topical and parenteral anti-acne
remedies.?
http://www.acne-advice.com/products/beautyskin/harth_study.pdf
Red Light Laser
?Red Light (660nm)
It has been found that exposure to 660nm low-level wavelengths release
cytokines. Cytokines stimulate fibroblast proliferation and the
production of growth factors, thus influencing the inflammatory
process, healing and ultimately wound repair (4, 5, 6, 7,) and has
been found to significantly improve postoperative open wounds.?
http://www.beautyskinuk.co.uk/about_beautyskin.htm
?Pulsed dye laser has been used in the treatment of acne scarring;
however more recently, lasers have been investigated for the treatment
of active inflammatory acne. Laser therapy at various irradiation
levels or fluences (e.g., low- and mid-level irradiation lasers and
long pulse diode lasers) has been used to destroy active acne lesions
and enlarged sebaceous glands. Lasers are believed to improve active
acne lesions by reducing the presence of P acnes which contain
porphyrins that are destroyed by exposure to light of specific
wavelengths (i.e., blue light of 405-420nm). Lasers may also have
anti-inflammatory affects (i.e., red light of 660nm) which may improve
active acne. Low fluence pulsed dye lasers are less ablative and
purpuric and may be preferred in active acne treatment to limit tissue
damage and potential treatment related scarring. Laser treatment of
active acne lesions may also reduce potential acne scarring that can
occur in severe cases.?
?Two recently published randomized controlled trials (RCT) on pulsed
dye laser for the treatment of acne (in which significant acne
therapies were withheld from patients for a period prior to and during
the course of the trials) have reported conflicting results. Seaton
and colleagues reported on a double-blind RCT of 41 adults with mild
to moderate facial inflammatory acne (patients had a Leeds acne
severity score of between 2 and 7). (2) Patients were randomized to
receive a single low fluence pulsed dye laser treatment or sham
treatment. At twelve weeks, Leeds acne scores fell from 3.8 to 1.9 in
the treatment group and 3.6 to 3.5 in the control group. Total lesion
counts fell by 53% and 9% and inflammatory lesion counts fell by 49%
and 10% in the laser treatment and control groups respectively. While
the authors reported statistically significant improvements, they
concluded that ?laser treatment should be further explored as an
adjuvant or alternative to daily conventional pharmacological
treatments.?
http://www.regence.com/trgmedpol/surgery/sur140.html
ALA + Light Therapy
ALA + light therapy. Studies are investigating the effectiveness of
this therapy in treating acne. Patients receiving this treatment
undergo a two-step process. First, a solution of 5-aminolevulinic acid
(ALA) is applied to the skin to be treated. ALA is a medication that
increases sensitivity to light. When used to treat acne, the ALA is
kept on the skin for a period of time ranging from 15 to 60 minutes.
The length of time depends on the severity of the acne. Step two
involves removing the ALA and treating the skin with light therapy.
Since ALA makes the skin more light sensitive, patients are instructed
to use sun protection for 48 hours after treatment.
Findings from research studies indicate that treatment with blue or
red light after the application of ALA is effective. However, as the
following shows, red light may produce some undesirable side effects:
? 10 patients who received multiple treatments of ALA + red-light
therapy on their backs had a statistically significant reduction in
inflammatory acne lesions. However, the side effects, such as
temporary darkening of the skin and development of folliculitis (an
inflammation of hair follicles that resembles acne), limit
recommendation of this treatment. (United States)6
A recent study that looked at using ALA followed by blue light
concludes that this therapy may be suitable for acne treatment.
(Israel)7
http://www.skincarephysicians.com/acnenet/article_lasers.html
?Many patients require multi-targeted approach. Acne develops when one
or more of the following occurs: excess sebum production, rapid
production of P. acnes, skin cells shed too quickly, and release of
inflammatory substances. For treatment to work it must interfere with
what is causing the acne. This is why the acne treatment prescribed by
a dermatologist often requires patients to use more than one
medication.
Since some of the laser and light therapies target only one cause, a
patient?s acne may not resolve. For example, blue-light therapy
targets only P. acnes, so acne will resolve only when this is the sole
cause. If other factors are present, blue-light therapy will not clear
the acne.?
http://www.skincarephysicians.com/acnenet/article_lasers.html
?In the first study of its kind, conducted at Hammersmith Hospital, Dr
Chu et al evaluated the use of a mixed blue and red light (peaks at
415nm and 660nm) in the treatment of acne vulgaris. 107 subjects were
randomised into four treatment groups. 1. Blue light. 2. Cool white
light (placebo) 3. 5% benzoyl peroxide 4. Mixed blue and red light.?
http://www.beautyskinuk.co.uk/about_beautyskin.htm
?In this study we have evaluated the use of blue light (peak at 415
nm) and a mixed blue and red light (peaks at 415 and 660 nm) in the
treatment of acne vulgaris. One hundred and seven patients with mild
to moderate acne vulgaris were randomized into four treatment groups:
blue light, mixed blue and red light, cool white light and 5% benzoyl
peroxide cream. Subjects in the phototherapy groups used portable
light sources and irradiation was carried out daily for 15 min.
Comparative assessment between the three light sources was made in an
observer-blinded fashion, but this could not be achieved for the use
of benzoyl peroxide. Assessments were performed every 4 weeks. After
12 weeks of active treatment a mean improvement of 76% (95% confidence
interval 66?87) in inflammatory lesions was achieved by the combined
blue?red light phototherapy; this was significantly superior to that
achieved by blue light (at weeks 4 and 8 but not week 12), benzoyl
peroxide (at weeks 8 and 12) or white light (at each assessment). The
final mean improvement in comedones by using blue?red light was 58%
(95% confidence interval 45?71), again better than that achieved by
the other active treatments used, although the differences did not
reach significant levels. We have found that phototherapy with mixed
blue?red light, probably by combining antibacterial and
anti-inflammatory action, is an effective means of treating acne
vulgaris of mild to moderate severity, with no significant short-term
adverse effects.?
http://www.ingentaconnect.com/content/bsc/bjd/2000/00000142/00000005/art03481
?Phototherapy using red light or blue light and photodynamic therapy
are being assessed as potential treatments for acne.?
http://www.emedicine.com/derm/topic2.htm
Photodynamic ICG laser therapy of acne vulgaris
?The goal of this study is to demonstrate the efficacy of the NIR
diode laser phototherapy in combination with topical application of
ICG suggested for soft and thermal treatment of acne vulgaris.? ?The
observations during 1-2 months showed that soft acne treatment
decreased the number of active elements, reduced erythema and
inflammation, and considerably improved the skin state without any
side effects. At high power densities (up to 200 W/cm2), ICG stained
acne inflammatory elements were destroyed for light exposures of 0.5
seconds.
ConclusionsBased on the concept that hair follicle, especially
sebaceous gland, can be intensively and selectively stained by ICG due
to dye diffusion through pilosebaceous canal and its fast uptake by
living microorganisms, by vital keratinocytes of epithelium of the
canal and sebaceous duct, and by rapidly proliferating sebocytes, new
technologies of soft and thermal acne lesions treatment that could be
used in clinical treatment of acne were proposed. Lasers Surg. Med.
33:296-310, 2003. © 2003 Wiley-Liss, Inc.?
http://www3.interscience.wiley.com/cgi-bin/abstract/106569083/ABSTRACT
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14677157&dopt=Abstract
Regards, Crabcakes
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