Trend: Combining non-laser light devices, PDT

While patients with mild-to-moderate acne have been shown in studies to respond well to treatment with blue or red light-emitting diode (LED) devices, new research indicates results might be better with combinations of light colors with photodynamic therapy (PDT).

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Especially blue and red LED devices shine in acne treatment, according to James Swan, M.D., dermatologist, professor of medicine (dermatology), Loyola University Medical Center, Maywood, Ill., and senior author of a review and clinical experience on light-emitting diodes published June 2015 in the Journal of Clinical and Aesthetic Dermatology.¹

“There are a number of non-laser light devices, and some are used as solo, light only, and some are used as part of a photodynamic therapy treatment with levulinic acid or other photo-sensitizers,” Dr. Swan says. “Results vary somewhat. Blue light is probably the first one to be used and has some moderate benefit. Red likewise has benefit. LED treatments seem to work better when red and blue are used together and even better when combined with photodynamic therapy. But they all work; red, separately, blue, separately,” he says.

There are new devices that combine red and blue light. Blue LED light, 400nm to 470nm, is best suited to target P. acnes in acne vulgaris, according to the review. Studies looking at patients treated with blue LED devices for mild-to-moderate acne suggest the device type reduces lesion counts by 50 to 60 percent and even clears patients, as well as reduces lesion size and erythema. Treatment regimens vary, and included 8-, 10- or 20-minute blue LED (415 nm) treatments over four weeks, as well as two weekly 20-minute treatments for four to eight weeks. Combining blue LED treatment with aminolevulinic acid (ALA) didn’t seem to improve results but did increase side effects. ¹

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While the review did not look specifically at acne treatment with red LED devices, which penetrate tissue deeper than other visible wavelengths, Dr. Swan says that red LED (like blue) effectively targets P. acnes. But acne treatment efficacy improves with combination blue (415nm) and red (640) LED devices. This includes the use of at-home combination devices, which in one study decreased inflammatory acne lesions by 77 percent and noninflammatory lesions by 54 percent. ¹

NEXT: The more combinations, the better?

The more combinations, the better?

In their discussion, the review authors wrote “it appears as though combination blue-red PDT, ALA/[methylester aminolevulinic acid or MAL]-PDT, and [infrared] therapies have been shown to have the greatest success as dermatologic therapies for acne, photodamage, wrinkles, and scar appearance.”

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A new LED device, which combines green and red, as part of a photodynamic therapy (PDT) treatment, might be the most effective, yet, according to Dr. Swan.

“It was highly effective for even severe acne. And that was not the case with the other devices,” Dr. Swan says.

Chinese researchers studied the efficacy and safety of this LED device in acne as the light source in photodynamic therapy of 46 patients with moderate to severe acne vulgaris. According to the study, patients were “illuminated during ALA-PDT with two wavelengths of light (543-548nm, and 630 ± 6nm, respectively) after 2h of incubation with ALA. Each patient received treatment once every 30 days for two or three sessions.”

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The researchers report the ALA-PDL regimen had an overall effectiveness rate of 89.13%, or was effective in 41 of the 46 patients. The technology’s clinical effectiveness increased with increasing acne severity, maximum efficacy was seen at the 12-week follow-up, and no severe adverse events were reported. ²

NEXT: Treatment pearls

Pearls

Dermatologists treating acne patients with LED devices should keep in mind that adjunctive therapy with tretinoin might increase light sensitivity. Oral doxycycline interacts with UVA and, therefore, shouldn’t be a problem with any of the LED therapies used in acne, according to Dr. Swan.

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Non-laser light is an alternative for people who want a non-medication treatment or can’t tolerate certain therapies and need more holistic acne treatment options. Even patients who simply prefer at-home treatments should improve with at-home LED devices, although studies have indicated they’re not as effective as in-office LED technologies, Dr. Swan says.

Limitations to LED therapy include the need to have a series of treatments and insurance coverage issues.

“They have to have regular treatments, so if they’re away at school, their availability would be an issue,” Dr. Swan says.

In addition to its favorable safety profile, LED therapy seems to have one advantage over other types of acne treatment: longevity.

“There tends to be a remission associated [with LED treatment for acne]. Some of the studies report a three- to six-month remission after a course of treatment, when usually acne patients have to be more chronically treated,” Dr. Swan says.

Finally, he says, the reason for the trend toward more combination LED treatment is different devices and treatments target different factors and structures.

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“Some of the targets are the P. acnes, the bacteria, and the blue light and the red light are going to target those, primarily. When you’re doing photodynamic therapy, you’re getting damage to the sebaceous glands. Then with some of the lasers, the IPL or the lasers, they target both the sebaceous glands and P. acnes,” he says. “People tend to use what they have available to them, but if you’re planning to purchasing a treatment, the combination ones would probably be the way to go.”

Disclosure: Dr. Swan reports no relevant disclosures.

References:

1. Opel DR, Hagstrom E, Pace AK, Sisto K, Hirano-Ali SA, Desai S, Swan J. Light-emitting Diodes: A Brief Review and Clinical Experience. J Clin Aesthet Dermatol. 2015 Jun;8(6):36-44. Review. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4479368/

2. Dong Y, Zhou G, Chen J, Shen L, Jianxin Z, Xu Q, Zhu Y. A new LED device used for photodynamic therapy in treatment of moderate to severe Acne vulgaris. Photodiagnosis Photodyn Ther. 2015 Jun 23. http://www.ncbi.nlm.nih.gov/pubmed/26116283