Nonablative light-based therapy evolving

"Patients are continuing to look for modalities that will provide the desired cosmetic and clinical outcomes without downtime, and while they and physicians have embraced new technologies fulfilling that goal, they are looking beyond what is available to strategies that yield even greater efficacy and safety," says Dr. Nestor, clinical associate professor, department of dermatology and cutaneous surgery, University of Miami School of Medicine, Miami.

"With recent developments, we are now able to apply nonablative technology to treat and cosmetically enhance skin affected by a variety of dermatologic diseases and sun damage. As a result, the line separating cosmetic and medical treatment for skin problems is now blurring."

In addition, devices are being combined with devices by using nonablative phototherapy together with botulinum toxin (Botox, Allergan) or filler injections to enhance cosmetic outcomes for facial rejuvenation. And as yet another layer, cosmeceuticals and sun protection are being added to both of the above approaches to further maintain skin health and appearance.

"Available data show these multimodal strategies are yielding much better results than have been achieved in the past. Now, researchers are taking the next step to more systematically investigate the various options in order to see what particular combinations work best for different indications," Dr. Nestor says.

The evolution of nonablative photorejuvenation into a PDT-based approach represents one area of significant recent progress, as it allows treatment of a broad spectrum of problems affecting aged skin. The PDT is being performed using 5-ALA applied for short contact times (30 minutes to 60 minutes) and various light sources, particularly intense pulsed light (IPL) devices, but also the pulsed dye laser and blue light sources. The benefits of those treatments include improvement in the appearance of vascular and pigmented lesions along with unwanted signs of dermal and epidermal structural changes. In addition, efficacy has been demonstrated for treating other consequences of photodamage, including actinic keratoses and superficial non-melanoma skin cancers.

"Nonablative photorejuvenation with IPL was excellent for addressing red and brown skin imperfections, but it had no effect on actinic damage, little effect on the sebaceous glands and only a minimal effect on wrinkles. Using this combined drug-device approach, we are seeing greater benefits with respect to immediate cosmetic improvement. However, what is more exciting is that data collected through lengthening follow-up shows those cosmetic benefits are being maintained for at least a year, accompanied by significant decreases in the number of new nonmelanoma facial skin cancers," Dr. Nestor says.

PDT has also brought acne into a new frontier. While some consistently good results have been achieved using 420 nm blue light as monotherapy, a drawback of that intervention was its relatively limited duration of its effect. The blue light treatment is thought to decrease inflammatory lesions by eradicating Propionibacterium acnes secondary to photoexcitation of endogenous bacterial protoporphyrin. However, acne recurs because of bacterial recolonization, Dr. Nestor explains.

Disclosure: Dr. Nestor has served as an adviser, consultant and speaker to a number of pharmaceutical and laser/light source manufacturers who market products mentioned in this article.