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LASERS PROMISE LIGHT RELIEF FROM TEENAGE MISERY OF ACNE
Times Online/ Health News (timesonline.co.uk). October 24, 2003
Oliver Wright
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. 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 realized 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.”
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LIGHT THERAPY IN THE TREATMENT OF ACNE VULGARIS
Elman M, Lebzelter J.
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.
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Nonablative [Non-wounding] laser and light therapies for skin rejuvenation
Arch Facial Plast Surg. 2004 Nov-Dec;6(6):398-409
Kim KH, Geronemus RG.
Laser and Skin Surgery Center of New York, 317 E. 34th Street, New York, NY 10016, USA.
BACKGROUND: Multiple modalities have been described for skin rejuvenation, including ablative and nonablative therapies. Because of the prolonged recovery period associated with ablative procedures that injure the epidermis, nonablative skin treatments have grown increasingly popular. Various laser- and light-based
systems have been designed or applied for promoting skin remodeling without damage to the epidermis.
METHODS: Studies investigating the use of nonablative procedures for facial rhytids [wrinkles] or acne scarring with clinical, histological, and objective quantitative measurements are systematically reviewed.
RESULTS: Nonablative treatments are associated with clinical and objective improvements for the treatment of
facial rhytids and acne scarring. Dermal remodeling seems to occur as a result of thermal injury, leading to dermal fibrosis without epidermal disruption. CONCLUSIONS: Although results are not as impressive as those of ablative treatments, nonablative procedures are effective in the treatment of photoaging and acne scarring. As technology in
nonablative therapies continues to evolve, future laser and light sources may yield even more favorable results.
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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% benzyl 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 benzyl 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), benzyl 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.
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LOW LEVEL LASER THERAPY IN DERMATOLOGY: AN OVERVIEW OF THERAPEUTIC POSSIBILITIES
1Zlatko Simunovic, M.D., F.M.H., 2Tatjana Trobonjaca, M.D. 1Pain Clinic-Laser
Center, Locarno, Switzerland 2Laser Center, Opatija, Croatia
The first application of Low Level Laser Therapy (LLLT) was completed on dermatological disorders like skin ulcers, in the early sixties. In the meantime, dermatological indications for LLLT have increased. Particular effects of LLLT are observed when laser beam is applied on the open wound, which healing can be significantly accelerated especially in patients with delayed or impeded wound healing like
patients with circulatory disorders, diabetic patients, etc. LLLT triggers biostimulative-regenerative processes inside the cell and subsequently causes revitalization of the issue as well. Second effect of LLLT refers to the vasodilatation and neovascularisation of local blood and lymph vessels, thus causing a better removal of waste products and, on the other hand, improved oxygenation and nutrition of damaged tissue.
Analgesic and anti-inflammatory effects of LLLT are also significant when irradiating certain dermatological changes. All effects mentioned before will be discussed in details during the lecture. Therefore, LLLT is used today in dermatology in the treatment of the following conditions: - Ulcus cruris - Burns - Herpes infections – Scar tissue - Keliod - Sclerodermia - Rosacea - Neurodermitis - Eczema - Lichen ruber
planus and scrofulosus - Psoriasis - Haemathoma - Etc.
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AESTHETIC TREATMENTS WITH LOW LEVEL LASER THERAPY
1Tatjana Trobonjaca, M.D., 2Zlatko Simunovic, M.D., F.M.H. 1Laser Center, Opatija
Croatia 2Pain Clinic-Laser Center, Locarno, Switzerland
If taking into the consideration the list of aesthetic disorders which can be treated with either Low Level Laser Therapy (LLLT) or surgical lasers, it is justified to say that laser is also the light of beauty. Although its first applications were focused on serious diseases like skin ulcers and painful conditions, employment of LLLT in aesthetics has initiated in mid seventies. Aesthetic changes are mainly benign
and they won't seriously damage the health state of patient's body, but aesthetic problems are strictly subjective and the same problem causes different psychological reaction in different persons.
Development in modern medicine and technology brought many new techniques and devices, which are successfully used in aesthetics today. Laser is one of the highlights in aesthetics today where it is applied mostly for facial rejuvenation, because the face is psychologically the most sensitive aesthetic area of each person. Facial rejuvenation can be achieved with surgical lasers, which remove superficial layer of atrophic skin,
leaving that area to be self- regenerated. It is an invasive method, while the process of regeneration can last few weeks’ even months, with a prohibition of disposing to the sunlight. On the other hand, skin rejuvenation can be completed with use of LLLT or thermal lasers like Helium Neon (Hone) or infrared (IR). The first one is mostly applied in the treatment of superficial changes, while the IR laser is used for irradiation of deeper
structures. LLLT obtains good results in aesthetics due to its three main effects: biostimulative-regenerative, analgesic and anti-inflammatory effect, which will be presented in this lecture. LLLT can be applied in aesthetics like monotherapy or complementary treatment modality to the topic medications. Frequent indications for LLLT in aesthetics are as follows: - Acne - Cellulite - Striae - Alopecia - Wrinkles - Lentigo senile. This
lecture will cover all relevant details related to LLLT and each condition, with application techniques and recommended individual optimal energy densities.
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