Laser, light devices useful for clearing acne, scars recalcitrant to standard treatments

Dubai, United Arab Emirates - While topical and oral therapies remain the gold standard approach for treating acne, laser and light sources are effective for acne lesions and scarring, and can be particularly useful in cases recalcitrant to standard therapeutic approaches.

“Laser and light sources have come of age and are proving to be very useful in the treatment of numerous medical and cosmetic conditions in dermatology including acne and acne scarring,” says Andreas D. Katsambas, M.D., professor, department of dermatology, Andreas Sygros Hospital for Skin and Venereal Diseases, Athens, Greece. Dr. Katsambas spoke at the Dubai World Dermatology & Laser Conference & Exhibition.

Gentler treatment

Ablative, nonablative and fractional lasers sources can be used to effectively treat acne scars, but of these modalities, Dr. Katsambas says nonablative fractional laser sources are often the preferred choice. Compared to ablative laser sources, nonablative and fractional lasers are typically associated with much less downtime, he says, and are more tolerable for the patient.

“There is a very mild, cosmetically acceptable erythema following nonablative fractional laser treatment and after five to six treatment sessions, most patients will see about 70-80 percent improvement in their lesions,” Dr. Katsambas says.

While ablative laser treatments will usually have a more dramatic impact and are ultimately more effective in improving the cosmesis of acne scars, patients can expect as much as two weeks of downtime with ablative lasers, while the downtime typically associated with nonablative fractional lasers can be as little as one to two days, he says.

Avoiding PIH

Postinflammatory hyperpigmentation (PIH) is a potential side effect following laser therapy, which can be more of an issue in patients with darker Fitzpatrick skin types. According to Dr. Katsambas, the risk of PIH can be as high as 90 percent after ablative laser therapy, which is in stark contrast to the only 13 percent risk in patients following nonablative fractional laser treatment. Although PIH is typically a transient side effect, Dr. Katsambas says it can last for as much as six months in patients treated with ablative lasers, compared to a maximum of one week following nonablative fractional laser treatment.

“This difference in downtime can be crucial to the patient who has a very busy work and social life and cannot afford weeks or months of persistent erythema and the other side effects typically associated with the more intense ablative laser therapy,” Dr. Katsambas says.

Depending on the severity of acne scarring, Dr. Katsambas will typically perform four to six nonablative fractional laser treatments spaced one month apart. Dr. Katsambas also advises his patients to avoid sun exposure at least two weeks following acne scar laser treatments. He prefers to perform these treatments in the winter months in order to help minimize the overall risk of PIH.

Propionibacterium acnes (P. acnes) is one of the major causes of acne and produces different porphyrin types such as coproporphyrin and protoporphyrin. According to Dr. Katsambas, light therapy using blue or red light as well as photodynamic therapy (PDT) are ideally suited for the treatment of acne because the porphyrins synthesized by P. acnes in the sebaceous follicles act as photosensitizers and attract the therapeutic light.

Combination treatments

The choice of blue or red light or PDT to treat acne depends on several factors, including the type and severity of the acne lesions the patient has, the age of the patient and the downtime the patient is willing to endure.

“Photodynamic therapy can achieve excellent outcomes; however, the approach is often associated with pain, and the subsequent inflammation following treatment could last for a week or longer,” Dr. Katsambas says. “As a result, some patients may shy away from PDT and choose other treatments such as blue or red light, which may be less effective, but are much better tolerated by patients and have minimal downtime.”

Dr. Katsambas says he still uses topical and oral therapies in his acne patients, and only if there are contraindications to these will he move ahead with laser and light sources. Due to the unsettling increase in antibiotic resistances seen in acne, Dr. Katsambas prefers to refrain from prescribing oral and topical antibiotics in his acne patients. Except for isotretinoin, he says he will often combine laser and light therapy with other acne treatments including contraceptives, retinoids, benzoyl peroxide or azelaic acid.

“We are very fortunate to have an ever-expanding armamentarium to treat every form of acne of all severities. If for one or another reason a therapy proves ineffective, we can easily choose another proven approach and often achieve good to excellent clinical outcomes in our patients,” Dr. Katsambas says.

Disclosures: Dr. Katsambas reports no relevant financial interests.