“Although light sources have been used to treat acne, many are used with concomitant medication usage or with exogenous agents placed initially on the skin to effect or enhance therapeutic outcome,” says Jerome Garden, M.D., a professor of clinical dermatology and biomedical engineering at Northwestern University in Chicago.
Dr. Garden notes that some light sources used to treat acne may be associated with pain and are limited to use in lighter skin types, as higher skin types too readily absorb the light energy, resulting in possible hyperpigmentation or hypopigmentation.
However, a new study finds that use of dual laser therapy alone in skin types V and VI achieves excellent results with an exceptional side-effect profile.
An earlier study produced in 2014 by Dr. Garden’s group (Abnoeal D. Bakus, Ph.D., Dina Yaghmai, M.D., and Mary C. Massa, M.D.) at Physicians Laser and Dermatology Insitute, Chicago, had already shown a significant reduction in acne lesions for patients with moderate-to-severe active inflammatory acne in lighter skin types (I–IV) through use of combination long-pulsed (LP) and Q-switched (QS) YAG lasers.
“This was accomplished without patients using topical anti-acne medications or oral antibiotics during the laser-therapy period and the follow-up period,” Dr. Garden tells Dermatology Times. “Remarkably, sustained acne resolution was achieved during a follow-up period which extended to a mean of two years.”
The investigators hoped that the current study would show similar results for active inflammatory acne in darker skin types (V and VI), even though the laser energy used was slightly lower than the previous laser study employed.
Both studies used the Lyra (Cutera) LP YAG laser and the RevLite (Cynosure) QS YAG laser during each treatment session.
The new study
All patients for the current study refrained from using topical anti-acne medications and oral antibiotics throughout the therapy and follow-up periods.
“This was based on a previous observation that patients who remained on anti-acne medications during laser therapy would start to respond with less acne,” Dr. Garden says. “But then these patients would start coming off their medications and have a rebound of acne.”
The current study consisted of six patients with a mean age of 33 years and an initial acne severity graded at 3.5 out of 5 (most severe). Three patients were skin-type V and three skin-type VI.
Patients received laser therapy every two to four weeks, depending on acne severity. “However, as the level of acne activity diminished, we spaced sessions out even longer,” Dr. Garden says. Patients averaged eight to 12 treatments.
Patients were treated first with the 1064 nm Lyra LP laser using a 10mm spot size and 60 millisecond (msec) pulse duration, along with energies from 17 to 19 J/cm2.
Afterward, the skin was cooled with ice packs for two to three minutes before being treated immediately with the RevLite QS YAG laser, also a 1064 nm, with a 6mm spot size and 5 to 10 nsec pulse duration, with energies from 0.8 to 1 J/cm2.
Patients were followed for one to 18 months’ post-laser treatment (mean of five months).
Overall acne lesion resolution was graded as 75% improved and overall skin appearance improved by 85%.
In addition, patients who received 14 or more treatment sessions had a 94% acne lesional reduction.
Treatment discomfort was graded by patients themselves on a scale of 1 to 10 (with 10 being the highest level of discomfort). The average level of pain was 2.
“We were also very fortunate, even with these darker patients, that the only side effect we observed was an occasional transient redness and swelling,” says Dr. Garden, who presented study results in April at the annual conference of the American Society for Laser Medicine and Surgery (ASLMS) in San Diego.
“These outcomes compare favorably to those seen earlier in patients who were mainly skin type I-IV with active acne,” Dr. Garden says. “In those patients, there was an 84% reduction in acne lesions at follow-up, with 50% of patients having 90% or greater reduction.”
Mechanism of action
As for the mechanisms of action, “It is probable that the LP YAG impacts sebum production by the sebaceous gland and indirectly P. acnes flora, while the QS YAG may help normalize pilosebaceous duct hyperkeratization,” Dr. Garden explains.
Furthermore, YAG laser therapy has been shown to decrease inflammation and various interleukin and tumor necrosis factors.
Despite these favorable results, “The patients need to have patience, because we use very low energies in order to minimize, if not try to eliminate, all side effects,” says Dr. Garden, who is also director of Physicians Laser and Dermatology Institute in Chicago. “Therefore, it takes a series of treatments, which the patient needs to be aware of before starting. Patients should not expect much of a response until after completing four to eight sessions.”
Combination LP and QS YAG therapy “can effectively and safely treat active acne in all skin types, resulting in persistent remission without further laser treatments and without the need for topical anti-acne medications and oral antibiotics,” Dr. Garden states.
Dr. Garden acknowledges, though, that the cost of these two lasers is about $180,000. However, he says, it may be worth the investment for practices that have adult patients with acne who are not responding to current regimens or patients who would like to avoid topical or oral medications.
These versatile lasers would then be available to such practices for treatment of various other skin issues.
“This is a viable option for the right patient in practices with these lasers,” Dr. Garden says.
Dr. Garden also predicts that as more patients are treated with laser, it will become more likely that experience will show that fewer treatment sessions may be needed.
Disclosure: Dr. Garden is a paid researcher for Cutera and Cynosure.