Treatment of Moderate to Severe Acne and Scars With a 650-Microsecond 1064-nm Laser and Isotretinoin

June 2020 | Volume 19 | Issue 6 | Original Article | 646 | Copyright © June 2020


Published online May 29, 2020

Michael H. Gold M.D.a, Natalia E. Manturova MD PHDb, Larisa S. Kruglova MD PHDc, Evgeniya V. Ikonnikova MDc

aGold Skin Care Center, Nashville, TN bCosmetology and Cellular Technologies, The Pirogov Russian National Research Medical University, Moscow, Russia cCentral State Medical Academy of the Administrative Department of President of the Russian Federation, Moscow, Russia

Abstract
Background: Laser procedures for acne and acne scars have traditionally been postponed for at least 6 to 8 months after the end of systemic isotretinoin therapy. Lower dosages with more modern laser devices having unique energy parameters of high power in microsecond pulse durations have made it possible to administer laser therapy during or shortly after completion of isotretinoin therapy, thus reducing the risk of side effects of isotretinoin.

Methods: Patients with moderate to severe facial acne (n=46) and atrophic scars enrolled in a 6-month study. Genetic analysis of patients revealed the presence of polymorphisms of genes Col1A2, MMP3, ESR1, MMP1, and MMP7, which can lead to scar formation. Patients underwent low-dosage isotretinoin therapy (0.2-0.3 mg/kg/day) in combination with facial laser treatment using a 650-microsecond, 1064-nm Nd: YAG laser. Acne severity was graded using the Investigators Global Assessment (IGA) scale and quality of life was evaluated by the Dermatology Life Quality Index (DLQI).

Results: IGA parameters decreased from 1.8 ± 0.2 (mean ± SD) initially to 0.5 ± 0.4 at the end of the study, a 72.3% reduction which was significant (P<0.01). The DLQI index decreased from 10.1 ± 1.3 initially to 2.8 ± 1.2, a 72.3%, a significant reduction (P<0.01). Inflammatory elements resolved without scarring. Laser treatment was well tolerated and improvement in pre-existing scars was noticeable.

Conclusions: The 650-microsecond, 1064-nm laser in combination with low-dose isotretinoin is safe and effective in patients with acne complicated by atrophic scars and genetically prone to post-acne scarring.

J Drugs Dermatol. 2020;19(6):   doi:10.36849/JDD.2020.5108

INTRODUCTION

Tradition holds that laser procedures to treat acne vulgaris should be postponed at least 6 to 8 months after the end of systemic therapy with isotretinoin. This is based on data suggesting that dermabrasion or laser therapy during isotretinoin treatment may induce keloid formation or delay the repair of skin integuments (ie, skin scar tissue).1-7 The validity of this practice has recently been questioned.8-12 In their consensus recommendations, Spring and colleagues10 reported insufficient evidence that physicians should delay manual dermabrasion, cutaneous surgery, superficial chemical peels, laser hair removal, and fractional ablative and nonablative laser procedures in patients receiving or recently completing therapy with isotretinoin. The authors did not, however, recommend mechanical dermabrasion and fully ablative laser therapy while patients underwent systemic isotretinoin treatment. Two months later the American Society of Dermatologic Surgery reported its consensus recommendations regarding the safety of lasers, dermabrasion, chemical peels, energy devices, and skin surgery during and after isotretinoin use.11 The Task Force concluded that evidence was lacking that physicians should delay procedures with chemical peels and nonablative lasers (ie, hair removal lasers and lights, vascular lasers, fractional devices) in patients currently or recently exposed to isotretinoin, and that superficial and focal dermabrasion, when performed by a well-trained professional, may also be safe.

Mysore and colleagues,12 after reviewing published studies, reported that evidence for avoiding a variety of procedures (fractional CO2 resurfacing, fractional Nd:YAG laser, fractional infrared lasers, laser hair removal, microdermabrasion using