51. Lasers and lights to treat acne
Doctor Jacob here, and we're talking about lasers and lights for the treatment of acne. Right now, this is a very hot topic for research.
The perfect laser to treat acne would effectively destroy or reduce the sebaceous gland or oil gland's function. If you can destroy the oil gland with a laser, that would be ideal, but so far such a device doesn't exist.
If anybody here could make such a device, contact me and we'll put it to the test, and if it works we can cure acne with a laser. Right now there is a lot of research into exactly how one might be able to achieve targeting the sebaceous glands with laser, and of course, without targeting the rest of the face; it has to be something extremely safe.
Currently there are two light-based approaches to treating acne. The first is for more minor acne - clogged pore acne with a little bit of inflammation. It's called photopneumatic therapy. It's been around for almost a decade now, and it kind of works. The downside is that it requires multiple treatments and it's expensive. It's called Isolaz and what happens is there is a hand piece of this machine which sits on the face; the machine treats a localized area of skin and then it moves on to the next localized area of skin when the operator moves the hand piece from one area of the face to the next adjacent area. In a given area, a suction device pulls up the skin and with pneumatic technology sucks any clog from the pores, actually sucking out oil, sebum and this type of junk. So it actually sucks out the clog from the pores and then a flash lamp delivers a pulse of broadband light, in the visible spectrum. That supposedly is supposed to have antibacterial and anti-inflammatory properties to the light. This has been evaluated in only a few studies, and the improvements have been relatively modest. It takes multiple treatments to see any effect, and it's kind of an expensive therapy for patients, because insurers generally do not cover the treatment.
Of note, if there is a pregnant patient with mild acne, it may be worth considering because it's certainly safe during pregnancy. However, I would only recommend pursuing this if some of the topical options that we've talked about earlier in the show haven't been working.
Next up, there is a totally separate technology called photodynamic therapy, which can be used to treat acne. This can be used to treat more moderate and even some severe cases of acne. Again, it's poorly covered by insurances, so it can get expensive. Typically, treatments are done every two weeks. What happens is a photo-sensitizing cream or solution is applied to the skin, and the skin is allowed to incubate. Basically, the patient just waits about an hour and a half or so. After that time period, a certain wavelength of light is administered at a certain energy, which is all dose-controlled. The patient undergoes this session to activate this photo-sensitizing chemical that was previously applied to the skin. This creates reactive oxygen species within the skin, destroying propionibacterium acne's bacteria. There are many studies looking at different light sources and different photo-sensitizing chemical derivatives to see which is the best, and it's still an area of active study. Some studies even look at using sunlight to activate the chemical.
Unfortunately, many patients experience a burning or stinging sensation, sometimes resulting in the discontinuation of therapy during the treatment. I still consider this technology for the treatment of acne to be experimental. Pregnant women should not undertake photodynamic therapy.
In summary, there are two commercially-available options: Isolaz and photodynamic therapy. Photodynamic therapy has had more success in treating more serious types of acne - moderate and sometimes even severe, on the face and off the face - but the holy grail yet remains to be discovered. If there is a very safe way to selectively target oil glands within the skin, within the pores, that's the holy grail of laser and light therapy for the treatment of acne.
Until that happens, I'm Doctor Jacob. We'll see you next time.
Mild Acne - Moderate Acne - Severe (Cystic) Acne - Hormonal Acne - Acne During Pregnancy - Acne & Breastfeeding - Retinol - Anti-acne Cleanser - Anti-acne Toner - Benzoyl Peroxide - Zinc Monomethionine & Fish Oil - Pimple Spot Treatment - Blemish Treatment - Scar Treatment - Sunscreen - Moisturizer - Avoiding Exacerbators - Comedogenic Ingredient List - Azelaic Acid - Birth Control Pills - Clindamycin - Doxycycline - Isotretinoin - iPledge - Spironolactone - Minocycline - Bactrim (SMX/TMP)