ACNE & ACNE SCAR LASER TREATMENTS

ACNE TREATMENT OPTIONS USING COSMETIC LASERS

While mild acne may be successfully treated with over the counter topical methods, a physician must treat severe acne. One of the therapeutic methods becoming very popular is skin laser treatments for acne and many other conditions.

Why laser treatments are so effective in acne or acne scar treatments?

For years, traditional oral and topical acne treatments have not treated the main cause of acne... overactive, oil producing sebaceous glands.

Now, lasers and light-based therapies offer a long-term solution by directly altering the structure and function of the sebaceous (oil) glands, causing them to produce less oil which drastically reduces acne lesions without significant side effects. Light therapy targets Propionibacterium acnes, the bacterium that causes acne inflammation and infection. These therapies can also improve skin texture and lessen the appearance of scars, so they may be excellent alternatives for people with both active acne, acne scars and superficial wrinkles.

New laser treatments don't require much healing time so that patients can resume normal activities quickly.

How do the lasers work in the treatment for acne?

The laser creates a mild thermal injury just below the skin's surface, which alters the structure of the sebaceous glands. This allows for effective, long-lasting acne clearance. As the laser penetrates into the skin, heat is generated in and around the sebaceous glands in the upper layers of the skin. The cooling device also emits a cooling spray, which protects the skin, thus minimizing the discomfort during the treatment.

What types of acne laser and light treatments are used today?

Laser energy and light therapies can be provided by many sources. Each laser emits a specific wavelength delivering energy with a specific depth of penetration. Different wavelengths effectively target different areas of the skin without damaging surrounding areas. This results in better healing of the skin after treatment and the incidence of complications is lowered. When lasers were first used they were not as precise and have been replaced by newer laser technology. These newer lasers can target the source of the acne, such as the sebaceous glands and P. acne without hurting the surrounding skin.

There are 2 types of skin laser treatments: Ablative and non-ablative.

Ablative Acne Laser Treatments

Ablate literally means to remove by cutting, abrading, or evaporating.

When ablative lasers are used for the treatment of acne or acne scars, (atrophic acne scars) the skin surface will be red and weepy afterwards as the top layer(s) has been removed. Healing time will depend on the type of laser used, the therapy given and your specific healing tendencies.

Types of ablative lasers are:

Pulsed or scanned carbon dioxide - (CO2) laser

Erbium/Erbium-Yttrium-Aluminum-Garnet - (Er:YAG) laser

The type of laser, or a combination of lasers used for your specific treatment depends on the type, or types of acne and acne scars that you have. Results can be seen usually within 2-4 weeks.

Atrophic scar resurfacing with a CO2 laser has shown scar improvements of 50%-80%. These clinical benefits are due to the immediate collagen shrinkage with subsequent collagen remodeling after ablative laser skin resurfacing.

Pulsed Er:YAG lasers have also been used for the treatment of atrophic scars. The short-pulsed Er:YAG laser was developed as a more benign alternative to CO2 laser skin resurfacing. The wavelength emitted by the Er:YAG laser corresponds to the peak absorption coefficient of water and is absorbed more efficiently by superficial, water-containing tissue than does the wavelength of the CO2 laser.

Whether a CO2 or Er:YAG laser system is used to treat atrophic facial scars, the goal of treatment is to soften depressions and stimulate new collagen formation to fill-in the defects.

Because ablative lasers are more aggressive than other forms of acne treatments, side-effects and complications may occur more often with ablative laser scar resurfacing. Expected side-effects in the immediate postoperative period include intense erythema, edema, and wheeping. The degree of erythema typically improves spontaneously over time without requiring specific treatment. Other complications may include infection, acne or milia formation, and hypo/hyperpigmentation. With the Erbium/Erbium-Yag, the complications, side-effects and down-times may be significantly reduced.

Your physician will expand in more detail on the prevention of possible complications of ablative laser acne and acne scar treatments.

Non-Ablative Acne Laser Treatments

There are basically two groups of non-ablative laser treatments for acne: those that cause changes in the sebaceous glands and those that destroy the bacteria that infects the plugged pores in acne.

The diode lasers, and Nd:Yag lasers are used to produce alterations in the sebaceous glands to decrease production of sebum that causes the plugging.

On the other hand, there are the Pulse dye lasers, lights (non-laser) and photodynamic therapies (used in conjunction with lasers and lights) that go after the bacteria that causes the infected lesions of acne.

Those patients who are looking to minimize treatment discomfort and downtime tend to choose nonablative laser therapies. With these forms of therapies there may be pain associated with the treatment, but the degree varies from patient to patient depending on the individual's threshold. Topical anesthetic creams are used to minimize the discomfort. Mild erythema and edema can occur following each treatment, but these subside within minutes to a few hours. Depending upon the intensity of treatments or combination of lasers used in the treatment there may be moderate erythema and edema, which may peak 1-2 days after treatment but usually disappears a couple of days later.

It is very important to somehow balance patient expectations with the reality of treatment results. Patients who are seeking acne or acne scars removal may require multiple treatments but the overall results with nonablative lasers may be very satisfactory in the long run. This is because the cumulative effects of nonablative therapies are less dramatic and take longer to surface.

After nonablative treatment, little if any post treatment care is required. Patients should refrain from active sun exposure for a few days thereafter and should also use sun-blockers for added protection.

Multiple factors determine which type of nonablative laser will be used in a given patient. The patientís skin type, the characteristics of the acne lesions and scars on the skin, whether the patient has a tendency to keloid, these are some of the factors that will help determine the best treatment strategy.

Some of the most commonly used non-ablative lasers, light and IPL technologies used to treat acne are:

The diode lasers - The diode lasers can be helpful in the treatment of acne and acne scars and they also have multi-application capabilities such as hair removal, broken capillaries, leg veins, etc. Some of these lasers are Nd:Yags.

A few of the lasers used for the treatment of acne and acne scars are the Sciton, SmoothBeam, VeriLite, Gemini, Aura-i Laser system, Aramis Erbium Glass Acne Treatment, Alma, Radiency, Luminis, to name just a few.

Pulsed Dye lasers - nonablative lasers used to treat certain forms of acne and acne scars, and because they are also multifunctional, they can be used to treat other skin conditions such as spider veins, telangiectasia, broken capillaries, birthmarks, red scars, fine lines, and helps to remodel collagen.

A few of the Pulse dye lasers are: the V-Beam, Alexandrite, GentleLase and Cool Pulse.

IPL - It stands for Intense Pulsed Light, they are considered non-ablative and they use a beam of high intensity light, but it is not a laser, but it works in similar ways. IPL treatment can be used for the treatment of acne, alone or in combination with other cosmetic modalities. This technique is meant for those with sun-damaged skin and pigmentary (brown spots) changes, enlarged pores and it may be used in skin tightening programs in combination with lasers or radiofrequency procedures. They are also useful in hair removal, and in the treatment of superficial vascular changes of the skin.

Some of the IPL machines are: EpiLight, PhotoDerm, Quantum, and many others.

Fraxel - This relatively new laser devise treats a fraction of the skinís surface at a time, causing microscopic injuries that promote increases in collagen formation and cellular repair. It is used to treat acne and acne scars. Because it functions also as an ablative laser, it is useful in the treatment of wrinkles and for skin resurfacing procedures. It has also been used in the treatment of brown spots, melasma and other pigmentary changes of the skin.

Light Therapies - Some of these systems have been FDA-approved for the treatment of mild to moderate inflammatory acne (red papules and pustules)

These lamp-like devices, use an intense 407-420 nm wavelength, high-intensity, bluish light to destroy the bacteria that causes acne without damaging the surrounding tissue or skin. Exposing the skin to a low-intensity blue light source is believed to destroy P. acnes by activating the bacteria-fighting militia called porphyrins. The porphyrins start a chemical reaction that produces peroxide, which destroys the bacteria. This painless procedure is usually done through a series of sessions, each lasting about 15 minutes. P. acnes multiplies rapidly, however, so ongoing treatment is necessary for best results. Side effects of blue light therapy include pigment changes, swelling in the treated areas and dryness.

Photodynamic Therapy (PDT) - Photodynamic therapy involves the application of special medicines (5-aminolevulinic acid (ALA) and methylaminolevulinate (MAL) to the skin followed by exposure to a light source to activate the medicine. These substances are believed to make the cells light sensitive. There are practically no risks involved, and results are seen immediately after one treatment. Photodynamic therapy is helpful for removing precancerous spots, acne, fine lines, and irregular pigmentation.

For the treatment of acne, preferential targeting of sebaceous glands and Propionibacterium acnes, the bacteria involved as a cause of acne are believed to be the main mechanisms involved. Because P acnes has been shown to naturally accumulate porphyrins, blue or red light alone can also have a direct therapeutic photodynamic effect on the bacteria. The exact mechanisms involved in ALA PDT for the treatment of photoaging are not well known, but increased collagen synthesis has been demonstrated following ALA PDT. Patients receiving this treatment undergo a two-step process. First, a solution of 5-aminolevulinic acid (ALA) is applied to the skin to be treated. ALA is a medication that increases sensitivity to light. When used to treat acne, the ALA is kept on the skin for a period of time ranging from 15 to 60 minutes. The length of time depends on the severity of the acne. The second step involves removing the ALA and treating the skin with light therapy. PDT is also being used in patients with actinic keratosis with good results. Since ALA makes the skin more light sensitive, patients are instructed to use sun protection for 48 hours after treatment. Many patients require a multi-targeted approach. Acne develops when one or more of the following occurs: excess sebum production, rapid production of P. acnes, skin cells shed too quickly blocking the pores, and release of inflammatory substances. For treatment to work it must interfere with what is causing the acne. This is why the acne treatment prescribed by a dermatologist often requires patients to use more than one medication. Since some of the laser and light therapies target only one cause, a patientís acne may not resolve. For example, blue-light therapy targets only P. acnes, so acne will resolve only when this is the sole cause. If other factors are present, blue-light therapy will not clear the acne. The same can be said for many of the other lasers and treatments used today. That is the reason why more and more physicians are using multiple lasers and treatments in the overall strategy to treat acne.

Radiofrequency Technology

Thermage is an FDA approved laser therapy procedure. It works by heating the fluid (water) in the sebaceous glands. When the sebaceous glands are gently heated up using the laser light, it results in an injury to the gland, causing the gland to be less active. When being treated with Thermage, most acne sufferers notice an immediate improvement in their appearance, specifically the reduction of acne. Thermage also has another benefit, it can also reduce any scar tissue that you have due to acne. For acne sufferers that have stubborn types of acne, it can be extremely effective. While side effects are usually mild, some patients can experience swelling and slight erythema. Usually this goes away in less than a few hours, or at most a day.

How are the skin laser treatments performed?

At the time of your first consultation the doctor or nurse will inform you on what to expect from the laser acne treatment.

He/she will explain other treatment alternatives available to you, the procedure, its risks and limitations.

Test patches may be performed to determine how your skin will respond to the laser. This is done to increase safety. Once you are ready for the treatment, the area to be treated will be cleaned and an anesthetic cream will be applied to minimize discomfort, if you request it.

During the procedure you may feel a slight stinging sensation with each pulse of the laser. Many lasers are equipped with cooling system devices to decrease skin temperature, providing an additional mild anesthetic effect and to minimize the possibility of burns from the laser heat.

How long do these treatments take?

The treatment time depends on the size of the area to be treated, and the particular laser and technique used. A small area may take only five minutes, while a larger area like the back may take up to one hour.

Initial treatments typically require weekly or bi-weekly sessions, for up to 6 to 8 weeks, again depending of what kind of laser is used in your specific case and how severe the condition is.

Your physician will inform you in greater detail about your specific treatment.

Can acne laser treatments be combined with other treatments?

New research shows that laser acne skin treatments can often be combined with other topical treatments or other procedures with very beneficial results. Your doctor prescribes these topical medications and their use may be instrumental in the proper application of your acne laser treatment. Always make sure to understand the procedure being done ahead of time so you are prepared for what happens next.

Where are the treatments performed?

Laser acne treatments are usually performed in a doctorís office or medical spas.

Is there pain associated with the treatments?

Some discomfort may occur during the treatment in the form of burning or a stinging sensation, and varies from individual to individual. An anesthetic cream can be applied to the skin prior to treatment to minimize pain.

What can I expect after the treatment?

After the procedure the area may be red or swollen, as if mildly sunburned. Your doctor may prescribe a topical cream to soothe the skin. Occasionally, the skin in the treated area becomes slightly crusty, but this reaction should fade within a few days.

Your physician will provide you with more complete after-care instructions.