Traditional medical treatments for acne include a variety of topical and oral medications. The combination of poor compliance, lack of durable remission, and potential side effects are common drawbacks to these treatments. The use of lasers and light devices has increased dramatically in recent years due to the overall ease of treatment, predictable clinical efficacy, and minimal adverse effects. A variety of light and laser devices has been used for the treatment of acne, including the potassium phosphate (KTP) laser, the 585- and 595-nm pulsed dye lasers, the 1450-nm diode laser, radiofrequency devices, intense pulsed light sources, low-intensity light treatment, and photodynamic therapy using 5-aminolevulinic acid and indocyanine green. These devices are thought to target underlying pathogenic factors such as Propionibacterium acnes colonization, increased sebaceous gland activity, and the cutaneous inflammatory response. Lasers in particular also have a central role in the management of acne scarring, which tends to be refractory to medical therapies. Fractional photothermolysis, the 1450-nm diode laser, and pulsed dye lasers have been used in the nonablative treatment of acne scars with significant success. In this article, we review the current status of light- and laser-based treatment of acne and related conditions and briefly review the use of lasers for the treatment of acne scarring.
Acne vulgaris is one of the most common dermatologic conditions and affects the vast majority of people at some point during their lifetime.1 The pathogenesis of acne appears to be multifactorial. Abnormal differentiation and desquamation of follicular keratinocytes result in the formation of microcomedones; however, the formation of actual inflammatory acne lesions appears to depend on the proliferation of Propionibacterium acnes (P. acnes) bacteria in the microcomedones and the metabolization of trapped sebum into proinflammatory free fatty acids.
The treatment of mild acne includes various topical antimicrobials, retinoids, and keratolytics used alone or in combination. These topical modalities require frequent application by the patient and may result in clinically significant skin irritation. Moderate inflammatory acne requires the long-term use of oral antibiotics, which may be associated with increased bacterial resistance. More severe nodulocystic acne or acne resulting in significant dyspigmentation or scarring may require systemic isotretinoin. Isotretinoin is known to be associated with several serious side effects including teratogenicity, requires careful laboratory monitoring, and, more recently, mandatory registration. Many patients require continuous treatment with topical and oral medications for months or years, and compliance with treatment often becomes a major issue. Moreover, even with consistent use of individual and combination therapies, patients often continue to develop new acne lesions for years.
Light- and laser-based treatment options have, in recent years, become established as an alternative to traditional topical and oral medications. Lights and lasers appear to reduce inflammatory acne lesions by targeting some of the main pathophysiologic factors such as P. acnes bacteria, sebaceous gland activity, and by reducing inflammation. The initial therapeutic use of light sources to treat acne relied on the endogenous porphyrins produced by P. acnes, however, this was limited by the small amount of endogenous porphyrins naturally produced. Augmented bactericidal activity subsequently became possible with the addition of exogenous porphyrin precursors, such as aminolevulinic acid. More recently, various lasers, intense pulsed light, and radiofrequency devices have been used for the treatment of inflammatory acne vulgaris. Some of the laser devices provide simultaneous improvements in both inflammatory acne as well as scarring caused by acne. However, laser and light sources do not appear to be very effective for the treatment of noninflammatory comedonal acne.
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