| DERMATOLOGY | PEER-REVIEW
optimal wavelengths for water-based non-ablative skin remodelling. The 1450 nm diode laser in participants with Fitzpatrick skin types IV to VI was effective54-56
. The
latest generation of the 1320 nm Nd:YAG laser delivers energies ranging between 28–38 J/cm2
with a pulse
duration of 350 μs through a 10 mm spot size hand-piece. Treatments are usually performed every month for a series of at least three sessions57-58
. Twenty patients (skin phototypes I-V) with mild to
moderate atrophic facial acne scars randomly received three successive monthly treatments with a long-pulsed 1320 nm Nd:YAG laser on one facial half and a long-pulsed 1450 nm diode laser on the contralateral facial half. They were evaluated histologically and clinically and showed mild to moderate clinical improvement at 1, 3, 6, and 12 months postoperatively58
.
Conclusion Energy-based treatment options for acne and acne scars can be an alternative to medical modalities for non responders, those who have moderate or severe acne and are concerned about oral medications owing to
References
1. Kim J, Ochoa MT, Krutzik SR, et al. Activation of toll-like receptor 2 in acne triggers inflammatory cytokine responses. J Immunol 2002; 169(3): 1535–41
2. Vowels BR, Yang S, leyden JJ. Induction of proinflammatory cytokines by soluble factor ofPropionibacterium acnes: implications for chronic inflammatory acne. Infect Immunity 1995; 63(8): 3158–65
3. Goodman GJ. The limitations of resurfacing techniques the necessity to combine procedures. Dermatol Surg 1998; 24(6): 687–8
4. Moritz DL. Surgical correction of acne scars. Dermatol Nurs 1992; 4(4): 291–9
5. Mariwalla K, Rohrer TE. Use of lasers and light-based therapies for treatment of acne vulgaris. Lasers Surg Med 2005; 37(5): 333–42
6. Charakida A, Seaton ED, Charakida M, Mouser P, Avgerinos A, Chu AC. Phototherapy in the treatment of acne vulgaris: What is its role? Am J Clin Dermatol 2004; 5(4): 211–6
7. Van Weelden H, de Gruijl FR, van der Putte SC, Toonstra J, van der Leun JC. The carcinogenic risks of modern tanning equipment: is UV-A safer than UV-B? Arch Dermatol Res 1988; 280(5): 300–7
8. Elman M, Lebzelter J. Light therapy in the treatment of acne vulgaris. Dermatol Surg 2004; 30(2 pt 1): 139–46
9. Young S, Bolton P, Dyson M, Harvey W, Diamantopoulos C. Macrophage responsiveness to light therapy. Lasers Surg Med 1989; 9(5): 497–505
10. Jacob CI, Dover JS, Kaminer MS. Acne scarring: a classification system and review of treatment options. J Am Acad Dermatol 2001; 45(1): 109–17
11. Gold MH, Biron JA, Sensing W. Clinical and usability study to determine the safety and efficacy of the Silk’n Blue Device for the treatment of mild to moderate inflammatory acne vulgaris. J Cosmet Laser Ther 2013; 16(3): 108–13
12. Omi T, Bjerring P, Sato S, Kawana S, Hankins RW, Honda M. 420 nm Intense continuous light therapy for acne. J Cosmet Laser Ther 2004; 6(3): 156–62
13. Lee SY, You CE, Park MY. Blue and Red Light Combination LED Phototherapy for Acne Vulgaris in Patients with Skin Phototype IV. Lasers Surg Med 2007; 39(2): 180–8
14. Yilmaz O, Senturk N, Yuksel EP, et al. Evaluation of 532-nm KTP laser treatment efficacy on acne vulgaris with once and twice weekly applications. J Cosmet Laser Ther 2011; 13(6): 303–7
15. Sadick N. An open-label, split-face study comparing the safety and efficacy of levulan kerastick (aminolevulonic acid) plus a 532 nm KTP laser to a 532 nm KTP laser alone for the treatment of moderate facial acne. J Drugs Dermatol 2010; 9(3):229–33
16. Orringer JS, Kang S, Hamilton T, et al. Treatment of acne vulgaris with a pulsed dye laser: A randomized controlled trial. JAMA 2004; 291(23): 2834–9
17. Karsai S, Schmitt L, Raulin C. The pulsed-dye laser as an adjuvant treatment modality in acne vulgaris: a randomized controlled single-blinded trial. Br J Dermatol 2010; 163(2): 395–401
18. Seaton ED, Mouser PE, Charakida A, Alam S, Seldon PM, Chu AC. Investigation of the mechanism of action of nonablative pulsed-dye laser therapy in photorejuvenation and inflammatory acne vulgaris. Br J Dermato 2006; 155(4): 748–55
19. Park KY, Ko EJ, Seo SJ, Hong CK. Comparison of Fractional, Non-ablative, 1550-nm Laser and 595-nm, Pulsed Dye Laser for the Treatment of Facial Erythema Resulting from Acne: A Split-face, Evaluator-blinded, Randomized Pilot Study. J Cosmet Laser Ther. 2013; 16(3): 120–3
20. Avci P, Gupta A, Sadasivam M, et al. Low-level laser (light) therapy (LLLT) in skin: stimulating, healing, restoring. Semin Cutan Med Surg. 2013; 32(1): 41–52
21. Ross EV. Optical treatments for acne. Dermatol Ther 2005; 18(3): 253–66
22. Karsai S, Schmitt L, Raulin C. The pulsed-dye laser as an adjuvant treatment modality in acne vulgaris: a randomized controlled single-blinded trial. Br J Dermatol 2010; 163(2): 395–401
23. Friedman PM, Jih MH, Kimyai-Asadi A, Goldberg LH. Treatment of inflammatory facial acne vulgaris with the 1450-nm diode laser: A pilot study. Dermatol Surg 2004; 30(2 Pt 1): 147–51
24. Darné S, Hiscutt EL, Seukeran DC. Evaluation of the clinical efficacy of the 1450 nm laser in acne vulgaris: a randomized split-face, investigator-blinded clinical trial. Br J Dermatol 2011; 165(6): 1256–62
25. Boineau D, Angel S, Auffret N, Dahan S, Mordon S. Treatment of active acne with an erbium glass (1.54 micron) laser. Lasers Surg Med 2004; 16:S55
26. Isarría MJ, Cornejo P, Muñoz E, Royo de la Torre J, Moraga JM. Evaluation of clinical improvement in acne scars and active acne in patients treated with the 1540-nm non-ablative fractional laser. J Drugs Dermatol 2011; 10(8): 907–12
27. Babilas P, Schreml S, Szeimies RM, Landthaler M. Intense pulsed light (IPL): A review. Lasers Surg Med 2010; 42(2): 93–10
28. Kawana S, Tachihara R, Kato T, Omi T. Effect of smooth pulsed light at 400 to 700 and 870 to 1200 nm for acne vulgaris in Asian skin Dermatol Surg 2010; 36(1): 52–7
29. Ianosi S, Neagoe D, Calbureanu M, et al. Investigator-blind, placebo-controlled, randomized comparative study on combined vacuum and intense pulsedlight versus intense pulsed light devices in both comedonal and papulopustular acne. J Cosmet Laser Ther 2013;
15(5): 248–54
30. Taylor M, Porter R, Gonzalez M. Intense pulsed light may improve inflammatory acne through TNF- down-regulation. J Cosmet Laser Ther 2013; 16(2): 96–103
31. Ali MM, Porter RM, Gonzalez ML. Intense pulsed light enhances transforming growth factor beta1/Smad3 signaling in acne-prone skin. J Cosmet Dermatol 2013; 12(3): 195–203
32. Prieto VG, Zhang PS, Sadick NS. Evaluation of pulsed light and radiofrequency combined for the treatment of acne vulgaris with histologic analysis of facial skin biopsies. J Cosmet Laser Ther 2005; 7(2): 63–8
33. Ruiz-Esparza J, Gomez JB. Nonablative radiofrequency for active acne vulgaris: The use of deep dermal heat in the treatment of moderate to severe active acne vulgaris (thermotherapy): A report of 22 patients. Dermatol Surg 2003; 29(4): 333–9
34. Hongcharu W, Taylor CR, Chang Y, Aghassi D, Suthamjariya K, Anderson RR. Topical ALA-photodynamic therapy for the treatment of acne vulgaris. J Invest Dermatol 2000; 115(2): 183–92
35. Riddle CC, Terrell SN, Menser MB, Aires DJ, Schweiger ES. A review of photodynamic therapy (PDT) for the treatment of acne vulgaris. J Drugs Dermatol 2009; 8(11): 1010–9
36. Ma L, Xiang LH, Yu B, et al. Low-dose topical 5-aminolevulinic acid photodynamic therapy in the treatment of different severity of acne vulgaris. Photodiagnosis Photodyn Ther 2013; 10(4): 583–90
37. Alster TS. Cutaneous resurfacing with CO2 and erbium: YAG lasers: preoperative, intraoperative, and postoperative considerations. Plast Reconstr Surg 1999; 103(2): 619–32
38. Walia S, Alster TS. Prolonged clinical and histologic effects from CO2 laser resurfacing of atrophic acne scars. Dermatol Surg 1999; 25(12): 926–30
39. Tanzi EL, Alster TS. Comparison of a 1,450-nm diode laser and a 1,320-nm Nd:YAG laser in the treatment of atrophic facial scars: a prospective clinical and histologic study. Dermatol Surg 2004; 30(2 Pt 1): 152–7
40. Alster TS. Cutaneous resurfacing with CO2 and Erbium:YAG lasers; preoperative, intraoperative, and postoperative considerations. Plast Reconstr Surg 1999; 103(2): 619–32
41. Walia S, Alster TS. Prolonged clinical and histologic effects from CO2 laser resurfacing of atrophic acne scars. Dermatol Surg 1999; 25(12): 926–30
42. Ross E, Naseef G, Skrobal M, et al. In vivo dermal collagen shrinkage and remodeling following CO2 laser resurfacing. Lasers Surg Med 1996; 18: 38
43. Qian H, Lu Z, Ding H, et al. Treatment of acne scarring with fractional CO2 laser. J Cosmet
Laser Ther 2012; 14(4): 162–5
44. Asilian A, Salimi E, Faghihi G, et al. Comparison of Q-Switched 1064-nm Nd: YAG laser and fractional CO2 laser efficacies on improvement of atrophic facial acne scar. J Res Med Sci. 2011 Sep; 16(9): 1189–95
45. Mohammed G. Randomized clinical trial of CO2 laser pinpoint irradiation technique with/ without needling for ice pick acne scars. J Cosmet Laser Ther 2013; 15(3): 177–82
46. Schweiger ES, Sundick L. Focal Acne Scar Treatment (FAST), a new approach to atrophic acne scars: a case series. J Drugs Dermatol. 2013 Oct; 12(10): 1163–7
47. Wang B, Wu Y, Luo YJ, et al. Combination of intense pulsed light and fractional CO2 laser treatments for patients with acne with inflammatory and scarring lesions. Clin Exp Dermatol. 2013; 38(4): 344–51
48. Kaufmann R, Hibst R. Pulsed erbium:YAG laser ablation in cutaneous surgery. Lasers Surg Med 1996; 19(3): 324–30
49. Walsh JT Jr, Deutsch TF. Er:YAG laser ablation of tissue: Measurement of ablation rates. Lasers Surg Med 1989; 9(4): 327–37
50. Sapijaszko MJ, Zachary CB. Er:YAG laser skin resurfacing. Dermatol Clin 2002; 20(1): 87–96
51. Trelles MA, Mordon S, Benitez V, et al. Er:YAG laser resurfacing using combined ablation and coagulation modes. Dermatol Surg 2001; 27 (8): 727–34
52. Alster TS, LuptonJR. Erbium:YAG cutaneous laser resurfacing. Dermatol Clin 2001; 19(3): 453–66
53. Tanzi EL, Lupton JR, Alster TS. Review of lasers in dermatology: four decades of progress. J Am Acad Dermato 2003; 49 (1): 1–31
54. Alster TS, Tanzi EL. Benign manifestations of photodamage: laser and light source treatment. In: Goldberg DB (ed) Photodamaged Skin. New York: Marcel DekkerInc, 2004. 115–43
55. Semchyshyn N, Prodanovic E, Varade R. Treating acne scars in patients with Fitzpatrick skin types IV to VI using the 1450-nm diode laser. Cutis 2013; 92(1): 49–53
56. Hardaway CA, Ross EV. Non-ablative laser skin remodeling. Dermatol Clin 2002; 20 (1): 97–111
57. Kelly KM, Nelson JS, Lask GP, Geronemus RG, Bernstein LJ. Cryogen spray cooling in combination with nonablative laser treatment of facial rhytides. Arch Dermatol 1999; 135(6): 691–4
58. Tanzi EL, Alster TS. Comparison of a 1450 nm diode laser and a 1320 nm Nd: YAG laser in the treatment of atrophic facial scars:a prospective clinical and histologic study. Dermatol Surg 2004; 30(2 Pt 1): 152–7
prime-journal.com | July/August 2014 Key points
There are many energy based modalities for treating acne and acne scars
Early treatment of inflammatory acne is imperative to prevent scar formation
No modality can
guarantee 100% healing of scars
potential adverse effects, or be used in combination with a topical medication. Devices targeting P. acnes, causing selective damage to the sebaceous gland and decrease sebum production are short-lived and require continued follow-up treatments; but result in long-term acne clearance. The results after treatment of acne scars will disappoint patients who desire dramatic improvement in a short period of time. The goal of any treatment in acne scars is not total cure or perfection; rather it is making scars less visible. Selection of appropriate technique requires that patient factors as well as the risks and benefits of the procedure be weighed.
Declaration of interest None
29
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