Laser Treatment For Acne Holds Promise

Small Study Looks At Alternative To Antibiotics, Accutane

< October 29, 2003 >Fifteen minutes of laser light may control acne for up to three months, according to a report in the medical journal The Lancet.

British dermatologists used a pulsed-dye laser, a standard piece of equipment in many dermatology centers but one that has not been aimed at acne.

"We found it to be a very effective treatment," says Dr. Edward D. Seaton, a researcher at Hammersmith College of Medicine and a co-author of the small study. "The acne melted away."

Antibiotics, Accutane Imperfect Solutions

Effective laser treatment for acne would be a welcome development, Dr. Seaton says.

Experts report that resistance is developing against the antibiotics now used against acne, and Accutane, a widely used non-antibiotic drug, has been reported to have psychological effects that may lead to depression.

The treatment used in this study, pulsed-dye lasers, emit visible light that is absorbed by hemoglobin. They have been used to treat port wine stains and other blood-related skin conditions. They also can reduce fine wrinkles and scars caused by severe acne.

The Hammersmith trial was based on observations that some patients getting treatment for those conditions had "striking and longstanding improvements in inflammatory acne," the authors report in The Lancet.

The new study included 41 people with mild to moderate acne, ranging from teenagers to individuals in their 40s. Of these participants, 31 people were treated with a laser and 10 people had a "pretend" procedure.

Over the next three months, acne severity was halved in the people who got the real treatment, with no change in those who got the fake therapy.

"One zap doesn't cure the condition," Dr. Seaton says. "It controls it. Patients respond for two to three months, then get problems again and must have another treatment."

More research is needed on more patients, Dr. Seaton says, in part because it is not clear yet why laser light is effective against acne. "We're looking at the way the lasers work, trying to find the mechanism," he says.

There are several reasons to hope that laser treatment proves out, Dr. Seaton says. Its effects were felt almost immediately during the study, while it takes six to eight weeks for current treatments using antibiotics and lotions to take effect.

Medications must also be taken every day and can have bothersome side effects. The only side effect of the laser treatment was brief discomfort in two patients.

More Laser Therapy Study Needed

Laser treatment for acne holds promise, but a lot of questions must be answered first, says Dr. Claudia Hernandez, a professor of medicine in the dermatology department of Loyola University Health System.

"This was a small study, and the number of control patients was small," Dr. 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?"

Dr. Guy F. Webster, a professor of dermatology at Jefferson Medical College in Philadelphia, says in an accompanying editorial in The Lancet that infrequent treatments that make drugs unnecessary would be a benefit.

"But we are not yet at the point where acne patients are going to throw out their antibiotics and line up for the laser," Dr. Webster writes. "More work is certainly needed, both to confirm the clinical benefit and best regimen and to elucidate its mechanism."

Always consult your physician for more information.

What Is Acne?

Acne is a disorder of the hair follicles and sebaceous glands. The glands become clogged, leading to pimples and cysts.

Acne is very common - nearly 17 million people in the US are affected by this condition. Acne most often begins in puberty. During puberty, the male sex hormones (androgens) increase in both boys and girls, causing the sebaceous glands to become more active - resulting in increased production of oil (sebum).

The sebaceous glands produce sebum that normally travels via hair follicles to the skin surface. However, skin cells can plug the follicles, blocking the sebum coming from the sebaceous glands. When follicles become plugged, skin bacteria (called Propionibacterium acnes, or P. acnes) begin to grow inside the follicles, causing inflammation.

Acne progresses in the following manner:

Eventually, the plugged follicle bursts, spilling oil, skin cells, and bacteria onto the skin surface. In turn, the skin becomes irritated and pimples or lesions begin to develop.

Acne can be superficial (pimples without abscesses) or deep (when the inflamed pimples push down into the skin, causing pus-filled cysts that rupture and result in larger abscesses).

Other causes of acne may include the following:

Acne can be aggravated by squeezing the pimples or by scrubbing the skin too hard. Skin may also become irritated with friction or pressure from helmets, backpacks, or tight collars. Some environmental conditions such as pollution or humid conditions can also irritate the skin.

Always consult your physician for more information.

Online Resources

(Our Organization is not responsible for the content of Internet sites.)

American Academy of Dermatology

Centers for Disease Control and Prevention (CDC)

National Institute of Arthritis and Musculoskeletal and Skin Diseases

National Institutes of Health (NIH)

National Library of Medicine

US Department of Health and Human Services (HHS)

For more information on health and wellness, please visit health information modules on this Web site.

Acne Treatment

Topical medications are often prescribed to treat acne. Topical medication can be in the form of a cream, gel, lotion, or solution.

Examples include:

Systemic medications, or oral antibiotics, are often prescribed to treat moderate to severe acne, and may include the following:

Treatment for severe, cystic, or inflammatory acne may include
isotretinoin (Accutane®), an oral medication used to prevent extensive scarring.

Isotretinoin reduces the size of the sebaceous glands that produce the skin oil, increases skin cell shedding, and affects the hair follicles, thereby reducing the development of acne lesions.

Isotretinoin can clear acne in 90 percent of patients. However, the drug has major unwanted side effects, including psychiatric side effects.

It is very important to discuss this medication with your physician. 

Acne Scarring Treatment

Specific dermatological procedures to minimize acne scars will be determined by your physician based on:

Although acne often is a chronic condition, even if it lasts only during adolescence, acne can leave life-long scars. Acne scars typically look like "ice pick" pit scars or crater-like scars.

Although proper treatment for acne may help minimize scarring, several dermatological procedures may help to further minimize any acne scars, including the following:

dermabrasion
Dermabrasion may be used to minimize small scars, minor skin surface irregularities, surgical scars, and acne scars.

As the name implies, dermabrasion involves removing the top layers of skin with an electrical machine that "abrades" the skin.

As the skin heals from the procedure, the surface appears smoother and fresher.

chemical peels
Chemical peels are often used to minimize sun-damaged skin, irregular pigment, and superficial scars.

The top layer of skin is removed with a chemical application to the skin. By removing the top layer, the skin regenerates, often improving the skin's appearance.

collagen injections
One type of collagen, which is derived from purified bovine (cow) collagen, is injected beneath the skin to replace the body's natural collagen that has been lost.

Injectable collagen is generally used to treat wrinkles, scars, and facial lines.

laser resurfacing
Laser resurfacing uses high-energy light to burn away damaged skin. Laser resurfacing may be used to minimize wrinkles and fine scars.

punch grafts
Punch grafts are small skin grafts used to replace scarred skin. A hole is punched in the skin to remove the scar, which is then replaced with unscarred skin (often from the back of the earlobe).

Punch grafts can help treat deep acne scars.

autologous fat transfer
An autologous fat transfer uses fat taken from another site on your own body and it is injected into your skin.

The fat is placed beneath the surface of the skin to elevate depressed scars. This method is used to correct deep contour defects caused by scarring from nodulocystic acne.

Because the fat may be reabsorbed into the skin over a period of months, there may be a need for the procedure to be repeated.

Always consult your physician for more information.