Acne Treatment With 3-Step Broadband Light Protocol
November 2016 | Volume 15 | Issue 11 | Original Article | 1382 | Copyright © 2016
Patrick Bitter Jr. MD
Advanced Aesthetic Dermatology, Los Gatos, CA
BACKGROUND AND OBJECTIVE: A new 3-step protocol using broadband light allows patients with moderate to severe in ammatory acne to avoid potential side effects of systemic acne treatments and the risks and uncertainties associated with laser and light treatments to date. The protocol also addresses acne scarring and, with appropriate modi cations, all skin types. METHODS: The protocol consists of 6 to 8 treatments performed with a single device that allows the user to select wavelength, spot size, uence, and pulse duration. Step 1 uses blue light with a large spot size and low uence to kill Propionibacterium acnes. Step 2 features red and yellow light with a smaller spot size and higher uence, which together exert anti-in ammatory effects and trigger neocollagenesis. Step 3 employs visible and infrared (IR) light with a high uence and 12-second pulse length, delivered with a constant motion technique, to enhance previous results while also targeting areas of frequent breakouts. RESULTS: Challenging cases treated with the protocol include a young adult female with a nearly decade-long history of in ammatory and cystic acne. Her skin remained clear more than 6 months post-treatment. She reported her scarring reduction at 90%. Having treated more than 100 patients with the protocol, the author reports that approximately 80% of patients clear completely or achieve at least a 75% improvement in their in ammatory acne. Acne improvements start appearing 2 to 3 days after a treatment session. Red, purple, raised, or depressed acne scars less than 1 to 2 years old begin to fade 1 to 3 weeks post-treatment. CONCLUSION: The 3-step protocol is safe and effective for patients with moderate to severe in ammatory acne and acne scarring. J Drugs Dermatol. 2016;15(11):1382-1388.
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Afflicting an estimated 9.4% of the world’s population,1 acne remains the most common dermatological diagnosis. Systemic treatments such as isotretinoin and antibiotics can reduce the presence of moderate to severe acne, but these treatments can take several months to work and expose patients to unwanted risks and side effects that range from increased antibiotic resistance to potential teratogenicity.2Lasers and light sources avoid such side effects, but using these treatments for acne can result in problems such as postinflammatory hyperpigmentation (PIH). Various authors have reported use of intense pulsed light (IPL) for acne, using a variety of treatment protocols, often involving topical aminolevulinic acid (ALA) as a photosensitizer, or concomitant use of other medical or procedural treatments that increase the regimen’s complexity while obscuring the contribution of IPL. While many such reports highlight treatment successes,3,4,5 to date no standardized treatment regimen that clinicians can reliably reproduce has evolved. Reports commonly omit crucial details such as the treatment technique and number of pulses performed, as well as how treatment impacted one of acne’s most distressing sequelae: acne scars.This report introduces a novel 3-step regimen using a single broadband light device (BBL, Sciton). The device provides unprecedented flexibility in terms of indications and treatment parameters, and the ability to treat patients of all skin types safely.
Step 1: After slipping the narrowband blue light filter into the device’s handpiece, perform 3 passes over areas of active acne, such as the forehead, cheeks, neck, and upper back, using a large spot size (15 x 45 mm) and fairly low fluence (4 to 6 J/cm2), delivered for 240 to 300 ms (with skin types IV and V at the higher end of this spectrum) per pass. At these settings, a typical cheek undergoes 70 to 80 pulses (one pulse per second) total. As with blue light acne treatments using ALA, the blue light in Step 1 reacts with porphyrins naturally present in P. acnes, causing a photoreaction that kills these bacteria.6,7Step 2: Perform 2 to 3 sequential – not stacked – passes over areas of active acne and red or purple scars using yellow and red light (560 or 590 nm filter), with a smaller spot adapter (15 x 15 mm square or 11 mm circular), 15 J/cm2 fluence, 15 ms pulse duration, and crystal cooling at 15°C. Mechanism: Step 2 appears to have a powerful anti-inflammatory effect on active lesions, while also causing areas of red and purple inflammation to begin dissipating in 1 to 2 days and red or purple scars to begin fading within 7 to 10 days. One to 3 weeks post-treatment, new collagen begins filling in areas of depressed scarring.Step 3: Using a constant-motion application technique, move the handpiece back and forth over areas of active or frequent breakouts, using visible and infrared light (590-1,200 nm, aka the SkinTyte filter) at 8 to 15 W/cm2 with a 12-second pulse