| ACNE TREATMENT | PEER-REVIEW vulgaris is Propionobacterium acnes (P. acnes). This
clinically presents as inflammatory acne vulgaris lesions, namely papules, pustules, and cysts 2
. In dermatology, there are a number of very good
‘traditional’ medicines to treat those individuals suffering from acne vulgaris. Medicines are and will remain the gold standard for acne vulgaris therapy 2
. These include
the topical and systemic antibiotics, the topical benzoyl peroxide medicines, the topical salicylic acid derivatives, and the variety of topical sulfa preparations seen on the market. Over the past few years, combination topical therapies have become very popular among clinicians as they are used synergistically to achieve acne vulgaris clearance. The most popular topical acne vulgaris combinations include the benzoyl peroxide/ erythromycin or clindamycin drugs, and the retinoid/ benzoyl peroxide topicals. Topical (alone) and systemic retinoids round out the medical armamentarium for those suffering from acne vulgaris. Despite the advances in acne therapies, drawbacks to
each group of medicines exist. Some of the topical medications are irritating to the skin and may cause clothes to stain, namely the retinoids and benzoyl peroxides. Furthermore, many topical therapies are slow to achieve an acceptable onset of action, with some requiring a number of months to become successful. This, at times, is frustrating to both the patient and the treating physician. Systemic antibiotics, the mainstay for inflammatory acne for many years, have seen reports of up to 40% drug resistance to the commonly used systemic therapies — these include the tetracyclines, the erythromycins, and the sulfa derivatives 1,3
. One report has even suggested that the
long-term use of systemic antibiotics in women may be associated with a higher incidence of breast cancer 4
, In dermatology, there are a number
of very good ‘traditional’ medicines to treat those individuals suffering from acne vulgaris. Medicines are and will remain the gold standard for acne vulgaris therapy.
and another suggests that the long-term use of antibiotics may make some people prone to an increased risk of infection, especially pulmonary2 Isotretinoin, also a common systemic therapy used by
.
dermatologists for recalcitrant cystic acne vulgaris, can be associated with significant morbidity, including teratogenicity if one becomes pregnant while taking the drug 5
. In the United States, the iPLEDGE programme,
although useful to hopefully prevent many of the untoward effects, requires the administering physician’s office to fill out forms and document more information than ever before. Therefore, many clinicians and patients are looking
for other therapies which will either help their medical therapy work better, or are looking for an alternative
Table 1 Devices available
to treat acne vulgaris BLU–U®
Dusa Pharmaceuticals Isolaz®
Palomar Medical M22™
Solta Medical Aclera™
Lumenis
BBL™ Sciton
Palomar Medical StarLux© 2 1.5 1 0.5 0 300
350 400 450 500 550 Wavelength
600 650 IPL
form of therapy using lasers and light sources, all of which are fairly routine for many other indications. Medical devices to treat inflammatory acne vulgaris are commonly divided into two distinct forms, based on their mechanisms of action. The first are those devices that destroy the P. acnes bacteria preferentially, and the second are those with a mechanism of action that focuses on destruction of the sebaceous gland leading to elimination of the acne vulgaris lesion. There are many reviews in the medical literature for all of these devices, and the reader should read the relevant articles and visit the product websites for further descriptions, as well as considering the medical literature that supports their use. This article will focus predominantly on blue light therapy for the destruction of the P. acnes bacteria and acne vulgaris clearance based on the available medical literature.
Light therapy for acne vulgaris Exposure to natural and artificial ultraviolet (UV) light has been reported to be successful in treating those suffering from acne vulgaris for a number of years 6
. The
exact mechanism for the response of the acne lesions to UV light is not fully understood, but felt to be partly owing to the destruction of the P. acnes bacteria in the sebaceous unit, in what can be described as a photodynamic therapy (PDT) mechanism of action. This natural endogenous PDT reaction works well in the treatment of acne vulgaris; however, the damaging effects of UV light with regard to the potential for photoageing and the development of skin cancers limits its regular use in today’s medical environment. The photodynamic reaction seen in the destruction of
the P. acnes bacteria involves the natural production of porphyrins, seen during the growth of the P. acnes at the inflammatory phase of the acne cycle. The porphyrins produced are principally Protoporphyrin IX (PpIX) and
prime-journal.com | May/June 2013 ❚ 21 700 2.5 Figure 1 PpIX Absorption Spectrum
PpIX absorption in vivo (mouse skin) BLUE
KTP PDL RED
Absorption
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76