Turning to combinations for combatting acne

Today, for the treatment of acne, many dermatologists are moving to the combination therapy market for better, more rapid results.

"I tell patients that we have traditional medicines that are still the standards. However, because we live in an age in which we have technology in our everyday lives, we can take technology and use it to our advantage in the medical world," he explains.

"Because they are not covered by insurance, we try and to maintain our acne laser and light prices at a reasonable level - one that almost everybody can afford," he tells Dermatology Times.

Lasers and light sources are also helpful for potential Accutane (Roche) patients. Under the iPLEDGE program, patients who request Accutane have a 30-day wait as mandated by the FDA. However, other acne treatment can begin during the waiting period.

"During those 30 days, I have the opportunity to educate my patients and get them on other treatments while we are waiting. I can clear a lot of patients with lasers and light sources combined with other traditional treatments. Then, if that doesn't work, we can start Accutane. I find most of my patients will get a lot better more quickly with the light sources, and then they do not need Accutane," Dr. Gold says.

Taking a look at light

A wide variety of lasers and light sources are available to dermatologists to treat acne.

"In our office, we have different lasers and light sources that we use. These range from intense blue light sources, to diode lasers, to nd:YAG lasers, which specifically target the sebaceous gland and make acne better. We frequently use blue light sources, which are FDA-cleared to treat mild to moderate acne," Dr. Gold says.

Pain varies depending on the type of laser.

"Some of the blue light sources are totally painless. Some of the longer wavelength light sources are somewhat more painful. You can take that into consideration and choose your patients wisely," he adds.

Dr. Gold treats many of his acne patients with photodynamic therapy (PDT) using aminolevulinic acid (ALA), a photosensitizing agent on the skin, which makes the light from the lasers work better. FDA clinical trials are ongoing for PDT.

"Anecdotally, results of using PDT have been published for the last three or four years in many settings, so we know that using ALA with blue light or intense pulse light makes acne go away very quickly," he says.

For example, 75 percent to 80 percent of patients with moderate-to-severe acne can be cleared using two or three PDT treatments with an ALA-blue light or ALA-intense light treatments over a four-to-six week period. This is done with medicine because combining traditional medicine with PDT yields a better result, according to Dr. Gold.

Devising effective combinations

Dr. Gold's experience and research have helped him learn what works well together in different situations.

"We try to optimize what works best for each situation. We started seeing that the traditional medicines could be used together and then light source therapy could be added on depending on the patient's needs," he says.

"I can clear - not cure - almost everybody that walks through my door with acne. It is picking the right therapy and then using the right tool with it."