Lasers and acne
Do they work to clear acne?
What is it?
Laser therapy aims to prevent run-of-the-mill "zits" (papules and pustules), and appears to be less effective with non-inflammatory acne (whiteheads and blackheads) and severe lesions (cysts and nodules).1 Lasers, much like at-home light devices, work on the premise of exciting compounds called porphyrins, which live inside acne bacteria.2 When the lasers excite the porphyrins, the porphyrins damage the bacteria wall, effectively killing the bacteria.3 Less acne bacteria should help reduce symptoms of acne. Laser treatment may also reduce sebum (skin oil) levels. Laser treatment requires trips to the doctor's office, and costs $200-$500 per treatment. Doctors usually recommend three treatments, about a month apart, though some doctors recommend more treatments, and sometimes more frequently. The kinds of lasers that doctors use on acne patients include Diode, Pulsed Dye, Fractional, KTP, InfraRed, Potassium Titanyl Phosphate, Nd:YAG, IPL, Glass, and Pulsed Light and Heat Energy (LHE), as well as a new "vacuum" laser called Isolaz.4-5 Doctors sometimes apply a photosensitizer such as aminolevulinic acid (ALA) or methylaminolevulinate (MAL) prior to laser treatment. Photosensitizers makes the skin more sensitive to light, and may help produce more porphyrins within bacteria.1,6-7
Does it work?
Several studies attempting to gauge laser effectiveness exist. However, these studies are almost all small cohort (just a few people), sometimes lack split face design (compare one side of the face to the other), tend to lack long follow up (so it's hard to tell if results last), and often employ no controls. Still, almost all of the studies show at least some improvement in acne symptoms. Consensus amongst researchers is that results are temporary since colonies of acne bacteria grow back quickly. Results are also incomplete, meaning lasers alone usually do not completely clear acne.9 The studies show anywhere from 36% clearance to 83%.2,10-19
Some patients experience pain or discomfort during treatment. Depending upon the laser used, patients report varying levels of redness after treatment as well as some inflammation and skin peeling and sometimes blistering and/or crusting. ALA treatment may cause skin darkening and/or folliculitis (inflammation of hair follicles), and requires absolute avoidance of sunlight for 30 hours after treatment to minimize such effects.12
At this time, it's hard to say whether lasers are worth the time and effort, and if so, which lasers are best. A systematic review of the 19 avaialable 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 optical treatments with lasers...possess the potential to improve inflammatory acne on a short-term basis...optical treatments for acne today are not included among first-line treatments."13 Since insurance rarely if ever covers such procedures, patients need to weigh the cost/benefit ratio. Both proper topical treatment with The Acne.org Regimen, as well as isotretinoin (Accutane) for people with severe acne, can provide more predictable, consistent, and complete clearing.
The Holy Grail
When you delve deeply into literature on lasers and acne, you find one study where researchers combined long duration ALA exposure with intense laser therapy.20 Results from this study points toward potential long term damage to sebaceous (oil) glands. Since acne cannot exist without sebaceous glands, this research is intriguing. Unfortunately, most patients in these trials experienced skin darkening and/or folliculitis. Still, this is an area well worth further investigation.
- Orringer JS, et al. "Photodynamic therapy for acne vulgaris: A randomized, controlled, split-face clinical trial of topical aminolevulinic aid and pulsed dye laser therapy." Journal of Cosmetic Dermatology. 2010; 9(1): 28-34.
- "porphyrin." Encyclopedia Britannica. 2010. Encyclopedia Britannica Online. 29 Jan. 2010 <http://www.britannica.com/EBchecked/topic/470697/porphyrin>.
- Hamilton FL, et al. "Laser and other light therapies for the treatment of acne vulgaris: systematic review." British Journal of Dermatology. 2009; 160(6): 1273-85.
- Omi T, et al. "Ultrastructural evidence for thermal injury to pilosebaceous units during the treatment of acne using photopneumatic (PPX) therapy." Journal of Cosmetic and Laser Therapy. 2008; 10(1): 7-11.
- Boixeda P, Calvo M and Bagazgoitia L. "Recent advances in laser therapy and other technologies." Actas Dermo-Sifiliograficas. (2008); 99(4): 262-268.
- Yeung CK, et al. "Liposome-encapsulated 0.5% 5-aminolevulinic acid with intense pulsed light for the treatment of inflammatory facial acne: A pilot study." Dermatological Surgery. 2011; 37(4): 450-459.
- Haedersdal M, et al. "Long-pulsed dye laser versus long-pulsed dye laser-assisted photodynamic therapy for acne vulgaris: A randomized controlled trial." Journal of the American Academy of Dermatology. 2008; 58(3): 387-394.
- Shaaban D, Abdel-Samad-Z, El-Khalawany M. "Photodynamic therapy with intralesional 5-aminolevulinic acid and intense pulsed light versus intense pulsed light alone in the treatment of acne vulgaris: a comparative study." Dermatology and Therapy. 2012; 25(1): 86-91.
- Erceg A, et al. "The efficacy of pulsed dye laser treatment for inflammatory skin diseases: A systematic review." Journal of the American Academy of Dermatology. 2013; 69(4): 609-615.
- Kim BJ, et al. "Pilot study on photodynamic therapy for acne using indocyanine green and diode laser." Journal of Dermatology. 2009; 36(1): 17-21.
- Tzung TY, Wu KH and Huang ML. "Blue light phototherapy in the treatment of acne." Photodermatology, Photoimmunology & Photomedicine. 2004; 20(5): 266-9.
- Ross EV. "Optical treatments for acne." Dermatologic Therapy. 2005; 18(3): 253-66.
- Haedersdal M, Togsverd-Bo K and Wulf HC. "Evidence-based review of lasers, light sources and photodynamic therapy in the treatment of acne vulgaris." Journal of the European Academy of Dermatology and Venereology. 2008; 22(3): 267-278.
- Bowes LE, Manstein D, Anderson RR. "Effects of 532 nm KTP laser exposure on acne and sebaceous glands." Lasers in Surgery and Medicine. 2003; 18: S6-7.
- Seaton ED, et al. "Pulsed-dye laser treatment for inflammatory acne vulgaris: Randomised controlled trial." Lancet. 2003; 362: 1347-52.
- Elman M, Lask G. "The role of pulsed light and heat energy (LHE) in acne clearance." Journal of Cosmetic Laser Therapy. 2004; 6: 91-5.
- Prieto VG, Zhang PS, Sadick NS. "Evaluation of pulsed light and radiofrequency combined for the treatment of acne vulgaris with histological analysis of facial skin biopsies." Journal of Cosmetic Laser Therapy. 2005; 7: 63-8.
- Jung JY, 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." Journal of the American Academy of Dermatology. 2012; 66(4): 626-33.
- Lee EJ, et al. "An open-label, split-face trial evaluating efficacy and safety of photopneumatic therapy for the treatment of acne." Annals of Dermatology. 2012; 24(3): 280-6.
- Lloyd Jr MM. "Selective photothermolysis of the sebaceous glands for acne treatment." Laser Surg Med. 2002; 31: 115-120.
- Borelli C, et al. "In vivo porphyrin production by P. acnes in untreated acne patients and its modulation by acne treatment." Acta Dermato-Venereologica. 2006; 86(4): 316-9.