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Scottsdale, Ariz. - Lasers and light-based therapies are evolving with increasingly promising results for treatment of acne, but their place is still decidedly only as an adjunct therapy, according to doctors debating the topic at a recent meeting of the Skin Disease Education Foundation.
Inconsistent efficacy, insufficient data, unknown long-term effects and a much higher price than alternative acne therapies were listed as some of the leading drawbacks of laser use for acne.
"A wide variety of wavelengths go after sebaceous glands - from the mid-500 wavelength on," Jerome Garden, M.D., says. "There's interaction, so all you have to do is reduce the sebaceous activity, and (the patient's) back looks better."
With a multitude of causes of acne, there are at least 35 different lasers on the market to treat with various approaches and wavelengths.
Nevertheless, the fall in popularity of isotretinoin (Accutane, Roche Pharmaceuticals) due to the rigid new iPLEDGE prescribing guidelines has given rise to interest in lasers as an alternative. But other, much less expensive medical therapies, such as topical retinoids, topical or systemic antibiotics, are already reasonably effective in the majority of patients, says James Spencer, M.D., a clinical professor of dermatology at Mount Sinai School of Medicine and a private practitioner in St. Petersburg, Fla.
"It is not clear that light therapies are any more effective than systemic medications, and while the high price of laser treatments may be a good thing for us, it's a terrible burden for a 16-year-old and his or her family," Dr. Spencer says.
He seconds Dr. Garden's suggestion that the frequent visits to the office that laser requires only add more inconvenience.
In addition, results from research on lasers still show inconsistencies in their efficacy for acne.
Varying study results
Dr. Spencer describes two studies with very different results from pulsed dye laser (PDL).
In one study in which 31 patients received low-fluence PDL and 10 received a sham treatment, the PDL patients' acne was significantly more improved after 12 weeks than the sham patients' acne (Lancet 2003; 362 (9393):1347-1352).
But in another study involving 40 patients in a split face trial in which one or two low-fluence PDL treatments were applied to half of the face, no significant difference was seen at the 12-week follow-up (JAMA 2004;291(23): 2834-2839).
"It's clear the jury's still out on these," he says.
"I like these devices because I think they make our therapies work faster," says Dr. Gold, assistant clinical professor at the Vanderbilt University School of Medicine, Nashville, Tenn.