New Erbium laser eases acne treatment

Atlanta - The first U.S. study of a new 1,540 nm erbium: glass laser (Aramis), focusing on facial acne indicates that it is an effective and relatively painless therapy, according to Melissa Bogle, M.D.

The Aramis, a flashlamp-pumped system with contact cryogen cooling, already has approval by the Food and Drug Administration for treatment of inflammatory acne on the back and for perioral and periorbital rhytids.

In a recent study (funded by French manufacturer Quantel Medical), Dr. Bogle, a Houston dermatologist, and colleagues tested the device on 15 patients with moderate-to-severe acne vulgaris. Results peaked six months after treatment, when inflammatory lesions dropped by 79 percent.

Dr. Bogle says, "Results were comparable to other infrared lasers, the SmoothBeam (Candela) and CoolTouch (CoolTouch), but the Aramis has an advantage in that it is much less painful. No anesthetic cream is required. This means less time for doctors and patients."

Key considerations

Dermatologists and patients are seeking alternative therapies for treatment of acne vulgaris due to the side effects associated with Accutane (Roche) and antibiotics.

In comparing the Aramis to competing modalities, physicians should take note of several key points.

"This shrinks the glands but not permanently," Dr. Bogle says. "Patients will need touch-ups."

"They heat collagen in the dermis," Dr. Bogle tells Dermatology Times, "remodeling and rebuilding from underneath so that pitted or rolling scars become shallower over time."

Study parameters

Dr. Bogle's study was open to all Fitzpatrick skin types (half of the participants were Asian, black, or Hispanic) with facial acne of grade three or higher on the Burton Acne Scale.

Patients were treated every other week for eight weeks without anesthesia. The first pass targeted active lesions with six pulses at 10J/cm². The entire face was then treated with a single pass using bursts of four pulses at 10J/cm².

The study end point was eight weeks. Patients returned later (at one month and six months) for evaluation.

Six patients participated in a follow-up study to determine whether an additional treatment would prolong results. Three of those patients served as a control group, receiving no treatment.

Overall success was determined by comparing sebum amounts, lesion counts and appearance (a subjective evaluation of photographs by both patient and investigator).

Results

The number of inflammatory lesions dropped 34 percent after two treatments, 58 percent after four treatments, and 79 percent at six months after the conclusion of treatment. All lesion types decreased in the first month following treatment. The number of papules and nodules continued to decrease thereafter, but pustules showed a small, statistically insignificant increase between the one- and six-month follow-up visits.

While most patients said their faces felt less oily, sebum measurements did not, in fact, change.

In the subjective assessment, which was conducted at the six-month post treatment marker, patients rated improvement at 68 percent. Investigators placed it at 78 percent.

Patients in the follow-up study maintained an 80 percent reduction in lesions at nine months after the treatment end point. Untreated patients maintained a 72 percent reduction.