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Low-intensity indocyanine-green laser phototherapy of acne vulgaris: Pilot study.

Genina EA, Bashkatov AN, Simonenko GV, Odoevskaya OD, Tuchin VV, Altshuler GB.Saratov State University, Optics Department, Astrakhanskaya 83, Saratov 410026, Russia.

Near infrared (NIR) diode laser low-intensity (soft) phototherapy with the topical application of indocyanine green (ICG) has been suggested for treatment of acne vulgaris. Twelve volunteers with acne lesions on their faces and/or backs were enrolled in the experiment. Skin areas of the subjects that were 4x5 cm(2) were stained with ICG solution for 5 min before laser irradiation (803 nm) at a power density up to 50 mW/cm(2) for 5 to 10 min.

For 75% of the subjects, a single treatment was provided and for the other 25%, eight sequential treatments over a period of a month were carried out. Observations a month after the completion of the treatment showed that only the multiple treatments with a combination of ICG and NIR irradiation reduced inflammation and improved the state of the skin for a month without any side effects. A month after treatment, the improvement was about 80% for the group receiving multiple treatments. Single treatments did not have a prolonged effect. (c) 2004 Society of Photo-Optical Instrumentation Engineers.

J Biomed Opt. 2004 Jul-Aug;9(4):828-34.

Light therapy in the treatment of acne vulgaris

Elman M, Lebzelter J.Dermatol Surg. 2004 Feb;30(2):139-46

Dermatology and Lasers Clinic, Tel Aviv Msq, Caesarea, Israel.

BACKGROUND : Over the past decade, lasers and light-based systems have become a common modality to treat a wide variety of skin-related conditions, including acne vulgaris. In spite of the various oral and topical treatments available for the treatment of acne, many patients fail to respond adequately or may develop side effects. Therefore, there is a growing demand by patients for a fast, safe, and side-effect-free novel therapy.

OBJECTIVES : To address the role of light therapy in the armamentarium of treatments for acne vulgaris, to discuss photobiology aspects and biomedical optics, to review current technologies of laser/light-based devices, to review the clinical experience and results, and to outline clinical guidelines and treatment considerations. RESULTS. : Clinical trials show that 85% of the patients demonstrate a significant quantitative reduction in at least 50% of the lesions after four biweekly treatments. In approximately 20% of the cases, acne eradication may reach 90%. At 3 months after the last treatment, clearance is approximately 70% to 80%. The nonrespondent rate is 15% to 20%.

CONCLUSIONS : Laser and light-based therapy is a safe and effective modality for the treatment of mild to moderate inflammatory acne vulgaris. Amelioration of acne by light therapy, although comparable to the effects of oral antibiotics, offers faster resolution and fewer side effects and leads to patient satisfaction.

 

Lasers promise light relief from teenage misery of acne

Times Online
By Oliver Wright
October 24, 2003 



ACNE, long the curse of teenagers, could be cured by a treatment first developed to iron out wrinkles, according to doctors at a London hospital. Low Level Laser Therapy normally used in private beauty salons has been tested at the Hammersmith Hospital in West London on 30 patients who were suffering mild to moderate acne.

Within 12 weeks their acne had halved, while those on a dummy treatment showed no improvement. Those with the most severe symptoms displayed the most striking improvement, mostly within the first month of treatment. This is significantly faster than most conventional antibiotic treatments, which can take as long as eight months to work.

Acne is the most common skin disease, affecting more than 90 per cent of adolescents, and a large number of people in their forties and fifties.

The study, published in today’s Lancet, showed that a single five-minute session could have a dramatic effect on acne for up to 12 months.

Doctors used a treatment called pulse dye laser therapy in which the affected area is exposed to short bursts of light. The process had been used to combat wrinkles as it is known to stimulate the production of collagen.

Tony Chu, the dermatologist who led the trial, said that it was being used on acne scarring when doctors realised that it appeared to have an effect on “live” acne as well.

“We were brought in to see if the anecdotal evidence worked in a clinical trial and we found out it was very successful,” he said. “However, we still do not know exactly how it works and that is an area we are now working on.”

Dr Chu said that the spots of one patient taking part in the trial disappeared altogether. Several others lost up to 70 or 80 per cent of their acne.

The treatment, which is already available in some private clinics, costs £300 a session. Dr Chu added that if their latest research was successful an application might be made to the National Institute for Clinical Excellence for the treatment to be covered by the NHS.

“This treatment appears to be showing the same kind of efficacy as antibiotics, but without the potential side effects,” he said. “What we need to do now is see if it works as well on acne around other parts of the body, and work out the treatment which is most clinically effective.”

In an accompanying commentary Guy Webster, a dermatologist from Jefferson Medical College, Philadelphia, said that the treatment could well be cost-effective in the longer term. “The possibility that laser treatment is effective in acne is important in health economics terms,” he said. “Infrequent treatments that make drugs unnecessary would benefit all concerned — except drug companies,” he said.

“But more work is needed, both to confirm the clinical benefit and best regimen and to elucidate its mechanism.”

However, many patients are already enthusiastic. Rachel White, 21, from Ely, Cambridgeshire, paid for the treatment, known commercially as NLite, after antibiotics and creams failed to cure her acne. “It got quite bad sometimes,” she said. “I couldn’t go out without putting on a lot of make-up. I tried all sorts of remedies, but although they helped a bit, they didn’t really work.

“This treatment literally takes only five minutes. I got better with each treatment. Now there’s no scaling and the spots are much less prominent. On good days I don’t have any spots at all, it’s completely clear. Otherwise there’s just one or two, and they’re very small. I feel much more confident.”

Phototherapy with blue (415 nm) and red (660 nm) light in the treatment of acne vulgaris.

 

Papageorgiou P, Katsambas A, Chu A.

Unit of Dermatology, Imperial College of Science, Technology and Medicine, Hammersmith Hospital, DuCane Road, London W12 0NN, U.K.

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.

Laser Therapy by Jan Tunér 4.1.1 Allergy, acne systica gravis and eczema

Laser therapy will reduce the symptoms of local allergic reactions through its anti-inflammatory and pain relieving effect. This has been demonstrated by Sakihama [652]. The effect of HeNe laser on irritant and allergic contact dermatitis of the mouse ear and on histamine release from rat peritoneal mast cells was studied. Irradiation (12.2 J/cm²) was performed at various intervals before and after the challenge of an irritated contact dermatitis (ICD) or allergic contact dermatitis (ACD). The laser did not influence the ICD but the allergic response was decelerated. The spontaneous histamine release was inhibited by laser irradiation, while substance P and compound 48/80induced histamine release were not inhibited.

Literature:

Simunovic [958] used a combination of GaAlAs point irradiation and HeNe scanning to treat acne and acne scars in a two centre study on 80 patients. In the first therapy group, low level laser therapy was used as monotherapy, and in the second it was used in combination with topical application of tetracycline. Both groups included acute as well as chronic cases. Monotherapy demonstrated relief of all local clinical symptoms. Used in combination with tetracycline, the healing process was accelerated and there was a decrease in tetracycline side effects and reduced occurrence of relapses. In all patients treated with laser therapy, scars were significantly prevented or reduced.

Ailioaie [981] and Tulebaev [555] report on positive effects on allergic rhinitis using laser therapy.

Ailioaie [1204] reports promising result in the laser treatment of children's allergic purpura. This condition, of unknown aetiology, is characterised, by migratory polyarthralgia or polyarthritis, abdominal pain, vasculitis of the small vessels and in the kidney. Conventional therapy consists of NSAIDs to control subjective problems, antibiotics when indicated and corticosteroids in acute phases. The prognosis for recovery is generally good, though symptoms fequently (25-50%) return over a period of several months. In the Ailioaie study, 31 children aged 2-16 years were divided into two group (15/16) after clinical and laboratory tests. One group was given conventional therapy, whereas the other was treated with a laser scanner of 670 (50 mW) and 830 (300 mW) nm in combination, 4-10 J/cm². Scanning was performed daily for 21 days. The clinical outcome was good in both groups but in the laser group the improvement was spectacular during the first 10 days and all final scores measured were better in the laser group. Hematuria, indicating renal, involvement, was noted in 18.75% of the non-laser treated children.Read more about the book "Laser Therapy" >>

AcneNet Spotlight Article
Laser treatment for acne: What you should know

With all the hype, it may seem that lasers and other light therapies are light-years ahead of other acne treatments. That’s not necessarily true. At least, it’s not true today. The following tells you what you can expect from this type of acne treatment.

  1. Laser treatment or light therapy might be a part of an acne treatment plan. Rarely can a laser or light treatment alone clear acne. This type of treatment works best when used along with other acne treatment such as medicine applied to the skin.
  2. Laser or light therapy may help when other acne treatment has not worked. Some patients who did not see clearer skin with strong acne medicine have seen results when a laser or light therapy was added to their treatment plan.
  3. Results are unpredictable. Lasers and other light treatments do notwork for everyone. Right now, there is no way to know who will see clearer skin and how much the skin will clear with a laser or light therapy.
  4. Most people see some clearing, but not 100% clearing. For example, people who receive blue light average 30% to 60% clearing after a series of treatments.
  5. To get the best results, you need a series of treatments. For example, if blue light is an option, you may need 1 or 2 treatments per week for a month. Each treatment usually lasts about 15 minutes.
  6. Results tend to be temporary. To maintain your results, you may need to use acne medicine that you apply to your skin.
  7. Treatment can be expensive, and insurance may not cover the costs. Prices range greatly. You should discuss the costs with your dermatologist and find out whether insurance will cover the treatment. If insurance does not cover the cost, you may be able to use money you have set aside in a Flexible Spending Account or Medical Savings Account.
  8. Good skin care helps deliver best results. To get the best results from acne medicine, you need to practice good skin care. This is true after laser or light treatment, too.
  9. Side effects are possible from lasers and other light therapies.After treatment, some people have redness. Swelling also can occur. These can last for a few hours or a few days. Side effects that are more serious sometimes occur.
  10. If you wish to get laser or light therapy for your acne, consult a board-certified dermatologist. The American Academy of Dermatology recommends that you discuss your options and expectations with a board-certified dermatologist before undergoing any laser or other light treatment. Experience is the best defense against serious side effects. You can find a dermatologist who specializes in laser procedures at:

Lasers and light therapies offer promise 
With more research, lasers and light therapies may become a great treatment option for all types of acne. Lasers and light therapies could simplify confusing treatment plans. They could eliminate acne treatments that irritate the skin. They may even free us from the possible side effects associated with today’s strongest acne medicines.

Research continues, and the future looks bright.http://www.skincarephysicians.com

 

Acne phototherapy with a 1450-nm diode laser: an open study

Natusko Konishi, Hideki Endo, Naoki Oiso, Shigeru Kawara, and Akira Kawada

her Clin Risk Manag. 2007 March; 3(1): 205–209.

Published online 2007 March.

 

 

The purpose of this study was to investigate the efficacy of phototherapy with a newly-developed 1450-nm diode laser in patients with mild to moderate acne. An open study was performed in acne patients who were treated up to five times with a two week interval. Acne lesions were reduced by 63%. Only one patient discontinued treatment due to vesicle formation as an adverse effect. Phototherapy using this diode laser source was effective and well tolerated in acne patients, suggesting that this phototherapy may be a new modality for the treatment of acne.

Keywords: acne vulgaris, phototherapy, 1450-nm diode laser, sebaceous gland

Acne vulgaris is the most common dermatologic disorder. It affects approximately 85% of individuals aged between 12 and 24 years at some time (Leyden 2003). Various modalities have been performed for acne treatments, eg, topical and oral antibiotics, retinoic acids, and phototherapies (Cunliffe and Goulden 2000Kawada, Aragane, Tezuka, et al 2002Van De Kerkhof et al 2006). In phototherapies, blue light sources (Sigurdsson et al 1997Papageorgiou et al 2000Kawada, Aragane, Kameyama, et al 2002) and photodynamic therapy (PDT) using topical 5-aminolevulinic acid (ALA-PDT) (Hongcharu et al 2000) have been reported to be effective for acne vulgaris. Blue light is a theoretically effective phototherapy since exposure to blue visible light induces photoexcitation of porphyrins fromPropionibacterium acnes, singlet oxygen production, and subsequent bacterial destruction (Kawada, Aragane, Kameyama, et al 2002). ALA-PDT utilizes visible light-induced phototoxic reaction of ALA-derived protoporphyrin IX (PpIX) accumulated in the target lesions of acne (Hongcharu et al 2000).

Recent reports demonstrate that laser therapies including 532-nm potassium titanyl phosphate laser, 585-nm pulsed dye laser, 1450-nm diode laser, and 1540-nm Er:glass laser are clinically effective in acne vulgaris (Friedman et al 2004Mariwalla and Rohrer 2005Nouri and Ballard 2006). We performed an open study of a newly-developed 1450 nm diode laser as phototherapy of acne vulgaris. This diode laser was shown to be effective and well tolerated by acne patients, suggesting that this diode laser therapy could be a possible new treatment modality for acne.

Acne treatments: Emerging therapies for clearer skin

Up-and-coming acne treatments may help clear stubborn acne. Learn more about new acne treatments and what they can and can't do for you.http://www.mayoclinic.com

 

With the right treatment, you can keep acne under control. But what's the best acne treatment for you? Many options are available, including prescription creams and antibiotics, which target the various causes of acne. But even with the wide range of acne treatments, chronic breakouts may still be difficult to treat.

New acne treatments — such as blue light therapy or diode laser therapy — may be an effective option but are often reserved for people who don't respond to more traditional therapy.

Laser and light therapy

How acne develops

Most laser- and light-based therapies reach the deeper layers of skin without harming the skin's surface. Some laser systems are thought to damage the oil (sebaceous) glands, causing them to produce less oil. Other laser and light therapies target Propionibacterium acnes (P. acnes), the bacterium that causes acne inflammation. These therapies can also improve skin texture and lessen the appearance of scars, so they may be good treatment choices for people with both active acne and acne scars.

Several types of laser and light therapies exist:

  • Blue light therapy. Exposing the skin to a low-intensity blue light source is believed to destroy P. acnes. This painless procedure is usually done through a series of sessions. P. acnes multiplies rapidly, however, so ongoing treatment is necessary for best results. Possible side effects of blue light therapy include temporary redness and dryness in the treated areas. A newer type of light therapy that includes a combination of blue and red light may be more effective than blue light alone.
  • Pulsed light and heat energy therapy. Together, pulsed light and heat energy is thought to destroy P. acnes and shrink sebaceous glands, which decreases oil production. Side effects of this therapy include temporary redness in the treated areas.
  • Diode laser therapy. Diode lasers can destroy sebaceous glands in the dermis, the thick middle layer of skin, without harming the outer layer of skin. Laser treatment may be painful, but the pain can be controlled with analgesics applied to the skin before treatment. Side effects of diode laser therapy include temporary redness and swelling of the treated areas.
  • Photodynamic therapy. This therapy combines topical medications and light-based therapies. During treatment, a medication, called a photosensitizing agent, is applied to your skin to enhance the effects of light therapy. This is followed by blue, red, pulsed light or another type of light therapy. Side effects can include redness, swelling, crusting and acne flare-ups.
  • Photopneumatic therapy. This therapy uses vacuum suction to remove the oil and dead skin cells from within the sebaceous glands. The targeted area is then treated with blue and red light therapy to destroy P. acnes and reduce inflammation.

Still unknown is who would benefit the most from laser and light therapies, the effectiveness of these treatment options, and what the long-term risks or benefits might be. Furthermore, laser and light therapy acne treatments can be expensive and may not be covered by your insurance company.

Steroid injections

Steroid injections are most often used for nodules and cysts — two types of acne that cause large, painful lumps beneath the surface of the skin. These types of acne can take weeks to resolve on their own. After a steroid injection, the acne lesion flattens, and symptoms resolve within two to four days. Though effective, complications can include:

  • Thinning of the skin (atrophy)
  • Appearance of small blood vessels on the surface of the skin (telangiectasia)
  • Skin tone that turns lighter than normal (hypopigmentation)

Steroid injections are typically used as a temporary or occasional fix for stubborn acne lesions. They aren't used to treat widespread acne because of potential complications and the need for frequent doctor visits.