Integrated Cooling-Vacuum-Assisted Non-Fractional 1540-nm Erbium:Glass Laser: A New Modality for the Simultaneous Effective Treatment of Acne Lesions and Scars

November 2018 | Volume 17 | Issue 11 | Original Article | 1173 | Copyright © 2018

Yael Politi MD,a Assi Levi MD,b,c Igor Snast MD,b,c Dean Ad-EL MD,c,d,e Moshe Lapidoth MD MPH b,c

aHerzelia Dermatology and Laser Center, Herzelia Pituach, Israel bDepartment of Dermatology, Laser Unit, Rabin Medical Center, Petah-Tikva, Israel cSackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel dDepartment of Plastic and Reconstructive Surgery, Rabin Medical Center–Beilinson Hospital, Petach Tikva, Israel eSchneider Children's Medical Center, Petah Tiqva, Israel

Abstract

INTRODUCTION: Acne vulgaris is a common skin disorder with a significant impact on patients' quality of life. There is currently no treatment designated to treat acne lesions and scars concurrently. However, mid-infrared lasers may promote neocollagenesis within atrophic scars, while exerting a beneficial effect on acne lesions. OBJECTIVES: To determine the safety and efficacy of an integrated cooling-vacuum-assisted non-fractional 1540-nm Erbium:Glass laser for the treatment of acne lesions and scars. PATIENTS AND METHODS: Twenty-two patients (8 male, 14 female) with mild-to-moderate acne and moderate-to-severe acne scars were included. Patients were treated using a non-fractional 1540-nm Er:Glass laser (Harmony XL™, Alma Lasers Ltd.). Acne lesions and scars were exposed to 3-4 stacked pulses emitted at a rate of 3Hz for up to two passes per treatment session (spot size, 4 mm; fluence, 400-600 mJ/pulse), receiving overall 3-7 treatments with 2-3-week intervals. Patients were followed-up one and three months following their last treatment. Clinical evaluation including (i) overall aesthetic appearance, (ii) acne lesions, and (iii) acne scars, assessed independently by two dermatologists and graded on a scale of 0 (exacerbation) to 4 (76-100 percent improvement); and (iv) pain perception, adverse effects and patients’ satisfaction. RESULTS: All but one patient completed treatment and follow-up and had moderate-to-significant improvement in all outcomes (overall aesthetic appearance, mean 3.9 [1 month] and 3.75 [3 month] improvement; acne lesions, 3.5 [1 month] and 2.3 [3 month] improvement; scarring 4 [1 month] and 4.2 [3 month] improvement). Pain and adverse effects were mild and transient. Patients' mean satisfaction was 4.2. CONCLUSION: Cooling-vacuum-assisted 1540 nm laser is a safe and effective modality for the simultaneous treatment of acne lesions and scars. J Drugs Dermatol. 2018;17(11):1173-1176.

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INTRODUCTION

Acne vulgaris is a common skin disorder affecting more than 85% of adolescences. It frequently continues into adulthood.1,2 It is estimated that more than 10% of the population still experience acne above the age of 30.3 Furthermore, acne may resolve with residual scarring. The actual extent and incidence of residual scarring remains unknown, yet one study found scars among 43% of acne patients.4 Those residual scars often appear at highly visible locations such as the face, and thus may significantly impair one’s esthetic appearance and in turn harm one’s self esteem, social activity, and interpersonal relationships.5Therapeutic modalities for the treatment of acne include: (i) topical agents such as benzoyl peroxide, antibiotics, and retinoids,(ii) systemic modalities such as contraceptive agents, oral antibiotics, and retinoids, and (iii) physical therapies including photodynamic therapy and various lasers emitting light in the visible and infrared range.6–8 Nonetheless, post-acne scarring does occur, either due to lack of treatment or insufficient efficacy of the chosen treatment modality.9 Once scarring develops, a different set of treatment options are available including dermabrasion, surgical treatment, radiofrequency based devices, various lasers, and utilization of dermal fillers. These modalities might be used separately or in combination.10Surprisingly, there is currently no treatment designated to simultaneously treat both acne and acne scars, thus patients who often suffer from this co-morbidity are forced to first treat their active acne, and only weeks-to-months later, when

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