INTRODUCTION
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.
METHODS
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
