screen. And she's finally able to tolerate topical retinol because her skin is healthier. The interesting part from her perspective is how quickly she started seeing a result, almost after every session, which really helped establish trust with her, so I was able to guide her during the ups and downs of therapy. So, for the dermatologist reader: Use your expertise and customize it to the patient. She's had maybe four or five treatments to be completely clear from active lesions and I think next week is her sixth or seventh treatment to help with scarring and any hyperpigmentation.Dr. Saedi: I've talked to patients about using this laser with Accutane, oral antibiotics, or by itself. It contributes so nicely to any phase of acne or treatment, whether they want to speed the onset of result if you’re clearing up deeper lesions with a topical and oral regimen, or if they're just using topicals. And some of my Accutane patients also see clearer results, we improve PIH or erythema. Rapid clearance makes a big difference psychologically.Dr. Henry: I treat acne patients every two weeks and tell them they should see improvement by about two to four treatments. Once they're happy I also transition to monthly. I am quite impressed by how quickly they see improvement, especially with the nodules.Dr. Roberts: What might be causing this early onset result? Dr. Chilukuri: I presume it’s the anti-inflammatory component or that we’re shrinking, almost vaporizing, some of the sebaceous glands.Dr. Burgess: I really don’t know why, but it really works, almost like intralesional injection of triamcinolone acetonide.Dr. Roberts: Are the nodules less red? Dr. Henry: Yes, definitely.Dr. Burgess: Less inflamed, yes. The size, inflammatory response, everything is diminished.Dr. Chilukuri: Also, the laser is very gentle over the nodules, which can otherwise be very painful. Many people don’t want or can’t afford Accutane or are afraid of needles, so they avoid lab draws.Dr. Saedi: I've switched many patients from intralesional injection to just the 650-microsecond 1064nm Nd:YAG laser, and they've been very happy. There is an inherent risk with intralesional injections.Dr. Roberts: I don't like to do them because while it usually goes well, if not, it’s right in the middle of the face. I'd be happy to put down my syringe for the laser.Dr. Chilukuri: We actually had a patient so upset with us for not going for the injections that she walked out of the office. We got her back in, did the laser, and she called up apologetic the next morning, asking to continue treatment with the laser because it worked better.Dr. Chilukuri: We had another patient, a woman in her late forties with several children and acne, maybe better categorized as folliculitis, covering her back and chest. She was frustrated and was very non-compliant with topicals. She had amazing improvement over the entire back and chest with one laser treatment, only needed three sessions for complete clearance and she’s been clear more than a year, without topicals. Compliance with topicals is so important, so this may be a great alternative for difficult compliance cases, such as with men.Dr. Campbell-Chambers: The key points with acne treatment are how quickly we see results, and versatility, because a lot of these acne patients also have hirsutism and/or scarring, so it’s ideal to treat multiple indications at the same time. I tend toward combination treatment. We must stress that when we're using retinoids, advise patients to stop for at least three days before and after the laser. Patients get excited about how quickly they see results compared to traditional medical treatments.Dr. Roberts: What about treating PIH secondary to acne with this device? Dr. Saedi: I love it for that indication, it works well for residual active acne or residual PIH. We see reduced pigmentation and erythema after one treatment, which keeps patients coming back. For the most part I don't stop tretinoin before or after the laser treatments, I haven't really had problems with irritation or PIH unless someone has very sensitive skin.Dr. Campbell-Chambers: I think the 650-microsecond 1064nm Nd:YAG laser is revolutionary for PFB. For many PFB patients— ironically, more females than males in my practice come for that—it has changed their lives. Patients with traditional long pulse Nd:YAG experience are thrilled about the treatment experience and results with this device. I recommend the standard monthly treatment protocols, but the settings seem to be a bit conservative. I've been able to go a bit higher in SOC patients, with better efficacy on hair removal as well. Sometimes I do a few extra pulses on the actual PFB lesion, but I tend to use just one pass for the hair removal itself.Dr. Roberts: What do you do for the standard PFB patient?
