New York - Dermatologists are finding a variety of ways of combining topical therapies with new technologies to get better results in the treatment of numerous skin conditions, such as wrinkles and other sun damage.
For rosacea, the application of the potent photosensitizer aminolevulinic acid (ALA) in combination with laser therapy is one of the best treatments currently available. One drawback is that it takes an hour for the skin to absorb ALA in order to get the additional benefits from the laser treatment.
Seeking shorter routes
"It was just so inconvenient for people to have to sit around the office for an hour or more," says Bruce E. Katz, M.D., director of the JURA Skin and Laser Center in New York City.
"Some doctors have patients wait three hours for optimal absorption. People get antsy and nobody really thought about the way to make this work faster," he says.
So Dr. Katz started trying to figure out how to make the ALA absorb more quickly. He tried a variety of alternative combinations to improve the results, but found no difference except when he added microdermabrasion to the ALA/laser regimen.
"We even tried ultrasound to help drive the ALA into the skin, but it didn't seem to work well with this particular chemical," he says.
What Dr. Katz did find was that the addition of microdermabrasion prior to the application of ALA dramatically shortens the amount of time needed for the ALA to be absorbed.
"By itself, it takes ALA an hour after application to be absorbed into the skin, but by performing microdermabrasion before applying the ALA, it only takes 10 minutes to work. It really is quite impressive in terms of its results," Dr. Katz tells Dermatology Times.
Dr. Katz performs two passes of microdermabrasion first.
Then, he applies a 20 percent solution of ALA and is able to follow that in just a few minutes with a 10 mm spot size with 40 ms pulse duration starting at about 3.5 joules from a pulsed dye laser.
This system shortens a procedure that used to last more than an hour and a half and makes it much more acceptable to more patients.
"The microdermabrasion takes about five minutes, the laser takes about 10 minutes - so with the wait time for the ALA absorption down to 10 minutes, the whole thing can be done in just a little over a half hour. That really does make it a lunchtime procedure. The patient doesn't even really have any noticeable irritation; everyone usually just goes back to work or to school - it's not a problem," he says.
Dr. Katz says he uses the DiamondTome (DiamondTome) microdermabrasion machine for this particular procedure because he didn't want to use crystals.
"You don't want crystals to accumulate on the skin - you would have to make sure they were all removed, otherwise it might impede the penetration of the ALA. This is much better."
The procedure still must be done three to five times with about a two-week interval between treatments, depending on the patient's condition. Now, however, patients can get the same results without having to give up several hours in their busy lives.