How effective is laser treatment for acne

The advancement in science brings with it new modalities of treatment for medicine. One of it is laser technology. It has found application in various fields of medicine, such as surgery and dermatology. Laser is being used extensively in various surgical operations, liposuction, varicose veins ablation and aesthetic treatments.

Light therapy is the latest addition in the arsenal of treatment for acne. Laser, which produces a high-energy beam of light of precise wavelength, is the most common light source in acne therapy. It selectively damages Propionibacterium acnes, the bacteria responsible in the formation of acne.  It acts on the porphyrins, the pigment being produced by the said bacteria, which in turn causes sensitization and its subsequent destruction.  

The popularity of laser and other light-sources is prompting several studies regarding its application in acne treatment.  Under investigation are broad-spectrum continuous wave visible-light sources (blue light and blue-red light), specific narrow-band light, intense pulsed light (IPL), pulsed dye lasers (PDL), potassium titanyl phosphate lasers, infrared diode lasers and photodynamic therapy (PDT) with or without photosensitizing agents (aminolevulinic acid or methyl-aminolevullinic acid).

To date substantial evidence in support of light therapy as mode of treatment in acne is lacking. Outcomes of some trials are contradictory. In a study by Haedersdal , red-light-activated methyl-aminolevulinic acid-PDT and aminolevulinic acid-PDT were efficacious in 50-60% of patients up to 20 weeks after one to three weeks of treatment. In another study by Wiegell et al, effect lasted up to 1 year after treatment.  Moreover, IPL-assisted PDT seems to be more effective than IPL alone.

Some studies compared the efficacy of broad-spectrum light sources versus existing topical treatments. Blue light twice-weekly for 4 weeks was reported to be superior to topical clindamycin. Mixed blue-red light daily for 12 weeks reduced more acne lesions than BPO.

Kumaresan and Snirivas evaluated the efficacy of single against burst-pulse mode in IPL therapy. They have concluded that IPL as single therapy was beneficial in the treatment of acne. Results also showed that burst-pulse mode was better than the single pulse mode in clearing acne.

Despite the studies, laser treatment is not considered the first choice in the treatment of acne today. It only serves as an adjunct to medical therapy.  Significant improvement is observed when laser is utilized in combination with topical and systemic medications.

References:

1. Treating acne vulgaris: systemic, local and combination therapy: Adjunctive therapies. Medscape
2. Kumaresan M, Srinivas CR. Efficacy of IPL in treatment of acne vulgaris : Comparison of single- and burst-pulse mode in IPL. Indian J Dermatol [serial online] 2010 [cited 2011 Feb 27];55:370-2. 

Related Articles:

1. Can chocolates cause acne flare-ups
2. Hormonal treatment for acne
3. What are adjunctive therapies for acne
4. Why should pimples be a cause for concern

Can chocolates cause acne flare-ups?

Ghirardelli chocolate

Have you ever noted pimple breakouts after indulging on your favorite brown sweets? Or have you ever associated zit eruptions with chocolates? Well, there may be truth in your observation after all.

Earlier studies revealed no direct connection between chocolate consumption and acne breakouts. Tests that were conducted before to suggest the association of diet and acne have used chocolate candies, containing added ingredients such as milk, sugar and nuts. So far only milk was proven to have a direct link to acne exacerbation.

However, at the recently concluded 69^th Annual Meeting of the American Academy of Dermatology a report was presented associating acne with consumption of pure chocolate.

In a study conducted at the University of Miami Miller school of Medicine in Florida, researchers have involved 10 healthy male subjects between 18 to 35 years of age with a history of facial acne vulgaris, who had at least I, but no more than 4 acneiform lesions (blackhead or whiteheads, papule and cyst). They were instructed to consume 6 ounces of 100% Ghirardelli chocolate daily for duration of 1 week.

A significant increase in the number of lesions was found, suggesting a strong correlation between the amount of chocolate that was consumed and the amount of acneiform lesions developed.

Further studies though are needed to establish the relationship between chocolate and acne and the mechanism that is involved in it.

Source:

Chocolate May Exacerbate Acne in Men. Medscape Medical News. 

Why should pimples be a cause for concern?

When I was about 10 years of age my skin began to change. I started having bumps on my face. I begged my father to bring me to a doctor. But people back then didn’t believe that pimples need to be treated. They adhere to the belief that it would disappear on its own upon reaching adulthood. Until now some people still think that way about pimples or acne. But why do we need to seek medical care for it?

First of all, acne is a cause of embarrassment for most teenagers and even adults. Their once smooth skin becomes rough and bumpy. They could not even look straight into other people’s faces anymore.  They were afraid of being stared at or laughed at. These people experience impaired self esteem, anxiety and clinical depression as a direct consequence of acne, which can lead to social isolation, interpersonal difficulties and even suicidal ideation. In a study of 60 adult patients with acne, Lasek et al. found that patients reported emotional effects as a consequence of their skin condition that were similar in magnitude to those reported by patients with psoriasis, which is traditionally regarded as a condition causing significant psychological disability. According to the results of a retrospective Swedish cohort study it was observed that the risk for attempted suicide was increased in patients with severe acne 6 months before and after treatment.  Even mild/moderate acne can be associated with significant depression and suicidal ideation.

Secondly, acne can leave scars which are permanent. It would be there for life even after the pimples are long gone. Patients who scar have an even higher prevalence of psychological morbidity when compared with non-scarring acne sufferers. Scars are difficult to remove even with the advent of dermabrasion and laser resurfacing.

What is Acne Vulgaris?

Acne vulgaris refers to the inflammation of a pilosebaceous unit in areas rich in sebaceous or oil glands, such as the face, neck, chest or back. It is the medical term for pimples. Most people call the huge zits on the face acne. It is a common misconception. Acne is characterized by a combination of lesions, such as blackheads (open comedones) and whiteheads (closed comedones), inflammatory papules and pustules and the nodulocystic lesions. Severe cystic acne affecting other areas aside from the face is called acne conglobata.

open comedones

Acne occurs at the onset of puberty due to the complex interaction of gonadotrophic hormones and bacteria (Propionibacterium acnes) in genetically predisposed individuals. Androgens stimulate increased sebum production by sebaceous glands. On the other hand, bacteria secrete lipase which converts lipids to fatty acids. The combination of sebum and fatty acids causes a sterile inflammatory reaction in the pilosebaceous unit with resultant hyperkeratinization of the lining of the follicle and its subsequent plugging. This is how comedones are being formed.  When comedones rupture into the dermis it resembles a foreign body, giving rise to an inflammatory response with pustule and abscess formation. Destruction of the surrounding tissue leads to scar formation. multiple erythematous papules and comedone

The tendency to develop acne runs in families. It can be triggered by certain factors such as exposure to acnegenic mineral oils, intake of drugs (lithium, hydantoin, topical and systemic corticosteroids  and oral contraceptives),  endocrine factors (polycystic ovary syndrome), emotional stress, lack of sleep, occlusion and pressure on the skin by leaning face on hands or telephones and improper care of the skin.

Can some food aggravate acne condition?

Population-based and migration studies have suggested a correlation between diet and acne. Large, well-controlled, observational studies have demonstrated that diets high in dairy products are associated with an increase in the risk for and severity of acne. The relationship between milk and acne severity may be explained by the presence in dairy of normal reproductive steroid hormones or the enhanced production of polypeptide hormones such as IGF-1, which can increase androgen exposure, and thus, acne risk. Recent findings also describe an association between a high-glycemic-index (i.e., carbohydrates that break down quickly during digestion and release glucose rapidly into the bloodstream) diet and longer acne duration. No study has established a positive association between acne and chocolate, saturated fat, or salt intake.

Treatment measures to be carried out by the patient

• .     Wash your face with soap twice a day. Do not scrub too roughly.
•      Do not use greasy cream on the face.
•      Avoid pancake-type makeup which may contain oil, grease or wax.
•     Boys should not use oils, greases, pomades or hair tonics. Shave regularly.
•     Have at least 8 hours of sleep each night.
•     When getting out in the sun do not use oily or greasy suntan preparations.
•      Don’t prick pimples on your own as this may lead to scarring.

Medical treatment for acne

The choice of acne therapy is largely determined by the severity and extent of the disease, but should be influenced by a number of other factors including disease duration, response to previous treatments, predisposition to scarring and post-inflammatory hyperpigmentation, as well as patient preference and economics. Patients with mild acne usually require topical treatment alone. Those with more extensive acne should be prescribed topical agents in conjunction with appropriate oral therapy. 
Many topical preparations for acne are available. These are:

•  topical retinoids
•  benzoyl peroxide
•  azelaic acid 
•  topical antibiotics

Most of the time a combination of these agents is necessary for a successful outcome. Antibiotics and/or hormonal treatments are employed for more severe or treatment-resistant disease. Systemic retinoids provide extremely efficacious therapy for severe disease that has not responded to combination therapy.

Your dermatologist should guide you on the step-by-step approach to treatment of acne. Bear in mind that resolution of pimples doesn't happen overnight. Response to treatment might be slow and there could even be a flare-up of acne on the onset of treatment. Any local preparation that was prescribed should be continued for months or even  years if you continue to have complexion problems.

You may experience occasional flare-ups and when this happens it is imperative that you begin active medical therapy with your dermatologist to avoid scarring of the skin.

References:

1. Diet and Acne, A Myth? Medscape
2. Severe Acne Linked to Suicide Risk Even Before Treatment Is Started. Medscape 
3. Acne Conglobata. Emedicine. Medscape
4. Treating Acne Vulgaris,:Systemic, Local and Combination Therapy. Medscape
5. Does Diet Really Affect Acne? Medscape