Lasers, Light, and the Treatment of Acne: A Comprehensive Review of the Literature
November 2017 | Volume 16 | Issue 11 | Original Article | 1095 | Copyright © 2017
Lana X. Tong MD MPH and Jeremy A. Brauer MD
The Ronald O. Perelman Department of Dermatology, NYU Langone Health, New York, NY
Introduction: Acne vulgaris is common dermatologic condition with an estimated prevalence of 70 to 87%. Acne has been shown to have a significant impact on patient quality of life and mental health, especially as inflammatory lesions typically occur on cosmetically sensitive areas with the potential for permanent scarring. There have been numerous advances in the treatment of inflammatory acne with light-based and laser devices. Objective: To review the current evidence for light-based and laser treatments in the management of inflammatory acne. Methods: An analysis was conducted of PubMed indexed English language literature regarding management of inflammatory acne using light-based and laser treatments. Results: Evidence for the utilization of laser and light-based therapy for acne was summarized in a comprehensive review. Laser and light-based treatment holds the advantages of improved patient compliance and safety profiles in comparison to pharmacologic therapy. Efficacy of device based treatment varied in comparison to standard topical treatment regimens, often more effective when used in combination therapy. Adverse effects reported were generally self-limited. Discussion: These treatments do and will continue to play an important and enlarging role in the management of acne. Larger scale studies with standardization of treatment protocols are warranted.
J Drugs Dermatol. 2017;16(11):1095-1102.
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Acne vulgaris is a common dermatologic condition affecting individuals of both genders and all skin types with an estimated prevalence of 70 to 87%.1-2 It typically begins in adolescence and can persist into adulthood if left untreated. As the onset of puberty increasingly occurs at a younger age, so has the incidence of acne vulgaris.3 Acne has been shown to be associated with anxiety, depression, and low self-esteem; it can negatively impact quality of life,4 resulting in scarring that may be permanent. Therefore, timely management of acne is crucial to prevent potentially permanent disfigurement, particularly since acne is a treatable disease. The pathogenesis of acne is multifactorial and partially stems from colonization by Proprionibacterium acnes (P. acnes), which is a part of normal skin flora and metabolizes sebaceous triglycerides.5 Other contributory factors include increased sebum production, which can be androgenetic, and hyperkeratinization resulting in follicular impaction, all of which culminate in inflammation of the skin.6 Although numerous topical treatment options for acne exist, scarring acne typically requires systemic therapy, such as oral antibiotics or retinoids. These agents are not without risk of side effects or requirements for lab monitoring, thus rendering them potentially poor candidates for long-term treatment.7,8 Combination therapy is often required and between partial response, cost, contraindications, side effects, and poor compliance, results are not always satisfactory. As laser, light and energy based technologies continue to improve, there is growing interest in minimally-invasive procedurally-based treatment of acne, which often has an improved safety profile as well as potentially fewer issues with patient compliance. Laser, energy, and light-based treatment modalities for acne can be divided into categories based on targets in the skin, specifically P. acnes or the pilosebaceous unit, which consists of the sebaceous glands and the follicular infundibulum. The mechanism of action of these devices can also be described as either photochemical or photothermal. The latter relies on the theory of selective photothermolysis, with endogenous chromophores including porphyrins and water. Light therapies can be combined with an exogenous photosensitizer to amplify their effects. This review focuses on the treatment of inflammatory acne and does not discuss the treatment of acne scarring.
A literature search was conducted of the National Library of Medicine PubMed Database for published studies from 1970 to July 2018 on the management of inflammatory acne. Search strings in the PubMed database used were: “acne,” “acne vulgaris,” “treatment,” “therapy,” “management,” “nanoparticles,” “light,” and “laser.” Non-English language articles were excluded. A