Lasers and acne
Do lasers work to clear acne?
What is it?
Lasers are a treatment option performed in a doctor’s office aimed at preventing light-to-moderate acne, although it has shown some promise in the treatment of severe acne (cysts/nodules).1 Laser therapy tends to work better and have fewer side effects on lighter skin tones, and works by concentrating light, which penetrates the skin. Much like at-home light devices, lasers work primarily on the premise of exciting compounds that bacteria produce called porphyrins.2 When the laser light excites the porphyrins, this damages the bacterial wall, effectively killing the bacteria.3 Fewer acne bacteria should help reduce symptoms of acne. Laser treatment may also reduce sebum (skin oil) levels. Lower sebum levels are associated with lower incidence and severity of acne. Lastly, lasers may have anti-inflammatory properties. Since acne is at its root an inflammatory disease, reducing inflammation can help reduce acne as well.1 Laser treatment normally requires three treatments, about a month apart, at the doctor's office, and costs $200-$500 per treatment, or $600-$1500 total. Doctors sometimes recommend more treatments and/or more frequent treatments, depending on the doctor’s opinion and the severity of acne. Results are incomplete and temporary, and thus laser treatment is not amongst the most popular treatments prescribed.
Types of lasers
Doctors use various types of lasers for the treatment of acne. They are characterized based on the color and wavelength of light that they emit. Generally speaking, the different types of light penetrate more or less deeply into the skin. There are 3 types: (1) pulsed-dye lasers (PDL), (2) potassium titanyl phosphate lasers (KTP), and (3) infrared lasers. All PDL lasers emit yellow 585-595nm light, and all KTP lasers emit green 532nm light. Infrared lasers come in different types, each of which emits a different colorless wavelength above 1000nm. Infrared lasers include the 1450nm diode (1450nm), erbium:glass (1550nm or 1540nm) and Nd:YAG (1064nm and 1320nm) lasers.1 Most lasers used in the treatment of acne are called fractional lasers, for instance the Fraxel® laser. These lasers point light at very small columns of skin, and therefore produce fewer side effects than lasers that shine light on larger areas of the skin. In the last few years, a new infrared “vacuum” laser called Isolaz® has also become available.4-6 This laser uses a vacuum to isolate and “suck up” a small area of the skin on which laser light is then applied.5 There is also a kind of PDL laser, which uses not only light but also heat, called the pulsed light and heat laser. Generally speaking, infrared lasers penetrate the skin more deeply than other lasers7, followed by PDL, and finally KTP, although the depth to which a laser can penetrate also depends on the darkness of the skin. Darker skin prevents the light from penetrating as far.7-8
Does it work?
Scientists have produced several studies attempting to gauge the effectiveness of lasers for acne. However, these studies are almost all small cohort (just a few people), sometimes lack split-face design (comparing one side of the face to the other), tend to lack long (follow-up so it is hard to tell if results last), rely on patient reports of acne severity (which is subjective), and often employ no controls (so there is nothing to compare results against). Regardless, almost all of the studies show at least some improvement in acne symptoms, with results ranging from 36% to 83% clearance.1,9-21 Consensus amongst researchers is that results of laser treatment are temporary, since colonies of acne bacteria grow back quickly. Results are also incomplete, meaning lasers alone usually do not completely clear acne.9 However, scientists are studying newer lasers in an attempt to increase effectiveness, reduce side effects, and extend treatment results for longer periods of time.
Lasers can also be used alongside other treatments. One study that compared the results of laser treatment in combination with salicylic acid treatment showed that using the laser treatment in addition to salicylic acid treatment resulted in a better improvement in acne than salicylic acid alone.15 This result suggests that laser treatment may be beneficial if used in combination with other treatments.15
Light therapy options that are not laser-based: Doctors have various light therapy options available to their patients such as intense pulsed light (IPL) treatment, which uses flash lamps to generate high intensity light that is not as concentrated as laser light, as well as LED light treatment. Overall, the concentrated light used in laser treatment has been shown to be more effective in treating acne than other light therapy options, including IPL or LED.1 One exception may be photodynamic therapy (PDT), which involves first applying a topical photosensitizing agent and then shining light on the sensitized skin, and tends to produce better results than other light therapy options.
Most of the side effects of laser therapy are transient and mild. Some patients experience pain or discomfort during treatment. Patients report varying levels of redness after treatment, as well as some inflammation and skin peeling and sometimes blistering and/or crusting.1,22 The severity of these side effects varies based on the type of laser used. The deeper a laser penetrates the more severe the side effects tend to be. For example, infrared lasers 1450 diode can cause considerable pain that requires the use of a topical anesthetic.1 However, with the use of a topical anesthetic, pain is well tolerated.1,20 KTP and PDL lasers can cause bruising, which usually goes away within ten days. KTP and PDL lasers can also cause some temporary darkening of the skin, especially in people with darker skin who have exposed themselves to the sun prior to the procedure.20
At this time, laser therapy is not considered a “first line treatment,” meaning it is best to try other, more effective and reliable treatments first. It is also difficult to discern from the data we currently have available which lasers are best. A 2008 systematic review of the 19 available controlled studies on lasers and acne, published in The Journal of the European Academy of Dermatology and Venereology, concluded:
...most of the studies were of suboptimal methodological quality...we conclude that [light] treatments with lasers...possess the potential to improve inflammatory acne on a short-term basis...[however] [light] treatments for acne today are not included among first-line treatments."11
- Nestor, M. S., Swenson, N. & Macri, A. Physical Modalities (Devices) in the Management of Acne. Dermatol Clin 34, 215–223 (2016).
- Porphyrin. (2009). https://www.britannica.com/science/porphyrin.
- Hamilton, F. L. et al. Laser and other light therapies for the treatment of acne vulgaris: systematic review. Br J Dermatol 160, 1273–1285 (2009).
- Boixeda, P., Calvo, M. & Bagazgoitia, L. [Recent advances in laser therapy and other technologies]. Actas Dermosifiliogr 99, 262–268 (2008).
- Narurkar, V. A., Gold, M. & Shamban, A. T. Photopneumatic technology used in combination with profusion therapy for the treatment of acne. J Clin Aesthet Dermatol 6, 36–40 (2013).
- Omi, T., Munavalli, G. S., Kawana, S. & Sato, S. Ultrastructural evidence for thermal injury to pilosebaceous units during the treatment of acne using photopneumatic (PPX) therapy. J Cosmet Laser Ther 10, 7–11 (2008).
- Lasers in Medicine, http://www.laserandhealthacademy.com/en/public/lasers%5Fmedicine/ (2016).
- Mustafa, F. H. & Jaafar, M. S. Comparison of wavelength-dependent penetration depths of lasers in different types of skin in photodynamic therapy. Ind J Phys 87, 203–209 (2012).
- Elman, M. & Lask, G. The role of pulsed light and heat energy (LHE) in acne clearance. J Cosmet Laser Ther 6, 91–95 (2004).
- Faghihi, G., Isfahani, A. K., Hosseini, S. M. & Radan, M. R. Efficacy of intense pulsed light combined with topical erythromycin solution 2% versus topical erythromycin solution 2% alone in the treatment of persistent facial erythematous acne macules. Adv Biomed Res 1, 70 (2012).
- Haedersdal, M., Togsverd-Bo, K. & Wulf, H. C. Evidence-based review of lasers, light sources and photodynamic therapy in the treatment of acne vulgaris. J Eur Acad Dermatol Venereol 22, 267–278 (2008).
- Jung, J. Y. et al. Prospective randomized controlled clinical and histopathological study of acne vulgaris treated with dual mode of quasi-long pulse and Q-switched 1064-nm Nd:YAG laser assisted with a topically applied carbon suspension. J Am Acad Dermatol 66, 626–633 (2012).
- Kim, B. J., Lee, H. G., Woo, S. M., Youn, J. I. & Suh, D. H. Pilot study on photodynamic therapy for acne using indocyanine green and diode laser. J Dermatol 36, 17–21 (2009).
- Lee, E. J. et al. An open-label, split-face trial evaluating efficacy and safty of photopneumatic therapy for the treatment of acne. Ann Dermatol 24, 280–286 (2012).
- Lekakh, O. et al. Treatment of Acne Vulgaris With Salicylic Acid Chemical Peel and Pulsed Dye Laser: A Split Face, Rater-Blinded, Randomized Controlled Trial. J Lasers Med Sci 6, 167–170 (2015).
- Prieto, V. G., Zhang, P. S. & Sadick, N. S. Evaluation of pulsed light and radiofrequency combined for the treatment of acne vulgaris with histologic analysis of facial skin biopsies. J Cosmet Laser Ther 7, 63–68 (2005).
- Ross, E. V. Optical treatments for acne. Dermatol Ther 18, 253–266 (2005).
- Seaton, E. D. et al. Pulsed-dye laser treatment for inflammatory acne vulgaris: randomised controlled trial. Lancet 362, 1347–1352 (2003).
- Tzung, T. Y., Wu, K. H. & Huang, M. L. Blue light phototherapy in the treatment of acne. Photodermatol Photoimmunol Photomed 20, 266–269 (2004).
- Jih, M. H. & Kimyai-Asadi, A. Laser treatment of acne vulgaris. Semin Plast Surg 21, 167–174 (2007).
- Angel, S., Boineau, D., Dahan, S. & Mordon, S. Treatment of active acne with an Er:Glass (1.54 microm) laser: a 2-year follow-up study. J Cosmet Laser Ther 8, 171–176 (2006).
- Babilas, P. et al. Experience with non-ablative fractional photothermolysis with a dual-mode laser device (1,440/1,320 nm): no considerable clinical effect on hypertrophic/acne scars and facial wrinkles. Lasers Med Sci 26, 473–479 (2011).