Laser Therapies Inappropriate For First-Line Acne Treatment

ANAHEIM, CALIF. — Light-based therapies are heavily promoted as options for treating acne, but issues of cost and convenience should rule them out as a first line of treatment, said experts at a cosmetic dermatology seminar sponsored by the Skin Disease Education Foundation.

The market is filling up with dozens of different lasers claiming to help treat acne with wide-ranging treatment mechanisms and even wider-ranging price tags, said Jerome Garden, M.D., of the department of dermatology at Northwestern University in Chicago.

“I found 26 different products out there all claiming they treat acne, and it's very hard to sort all of these out,” he said.

Most of the claims are backed by some research—infrared laser treatment, for instance, has some strong studies showing shrinkage of the sebaceous glands; blue light and photodynamic therapy (PDT) are gaining recognition for their efficacy; and radiofrequency devices have shown some success.

But for all of the devices and claims, several confounding factors give physicians pause in embracing light-based therapies as a first-line treatment.

First, there is broad inconsistency in the literature. An analysis of acne literature published in the Journal of the American Academy of Dermatology in 2002 underscored the wide-ranging measures used in determining not only outcomes but the very definitions of acne, said James Spencer, M.D., a clinical professor of dermatology at Mount Sinai School of Medicine, New York (J. Am. Acad. Dermatol. 2002;47:231–40).

“There were over 25 methods for assessing acne severity and 19 methods for counting lesions,” he said. “That makes comparing one study to another very difficult.”

With a treatment like PDT, the evidence of efficacy in treating acne is strong, but there is the trade-off of the process being a negative experience for the patient.

“Photochemicals [used in PDT] cause cell membrane damage, and with the process there's pain. The outcome may be positive, but this is not a positive event in the life of the patient,” Dr. Garden said.

When PDT is used to treat something like cancerous lesions, the process is entirely justified, but as a repetitive treatment for acne, it is much more questionable, he said.

“What we have to ask ourselves is this—do we really want this for our patients? And what's the long-term effect? We don't know,” Dr. Garden said. “The approach is new, and at the moment I'm very uncomfortable with this.”

And then there is the cost of light-based therapies, which are far more expensive than a medical option.

“These are highly expensive cash procedures requiring multiple visits to the office,” Dr. Spencer said. “I think light-based therapy for acne represent one more tool in the tool chest, but it's quite unreasonable for it to be the first thing that pops into your head.”

Dr. Garden agreed. “It's tempting to have a nonmedical option for treating acne, and this may have a role for those very selective, noncompliant patients,” he said.

“But when you look at this and ask if it's something that should be a first-line treatment for patients, the answer should be, unequivocally, no,” he asserted. “It's not worth it—not yet.”

The SDEF and this newspaper are wholly owned subsidiaries of Elsevier.

ANAHEIM, CALIF. — Light-based therapies are heavily promoted as options for treating acne, but issues of cost and convenience should rule them out as a first line of treatment, said experts at a cosmetic dermatology seminar sponsored by the Skin Disease Education Foundation.

The market is filling up with dozens of different lasers claiming to help treat acne with wide-ranging treatment mechanisms and even wider-ranging price tags, said Jerome Garden, M.D., of the department of dermatology at Northwestern University in Chicago.

“I found 26 different products out there all claiming they treat acne, and it's very hard to sort all of these out,” he said.

Most of the claims are backed by some research—infrared laser treatment, for instance, has some strong studies showing shrinkage of the sebaceous glands; blue light and photodynamic therapy (PDT) are gaining recognition for their efficacy; and radiofrequency devices have shown some success.

But for all of the devices and claims, several confounding factors give physicians pause in embracing light-based therapies as a first-line treatment.

First, there is broad inconsistency in the literature. An analysis of acne literature published in the Journal of the American Academy of Dermatology in 2002 underscored the wide-ranging measures used in determining not only outcomes but the very definitions of acne, said James Spencer, M.D., a clinical professor of dermatology at Mount Sinai School of Medicine, New York (J. Am. Acad. Dermatol. 2002;47:231–40).

“There were over 25 methods for assessing acne severity and 19 methods for counting lesions,” he said. “That makes comparing one study to another very difficult.”

With a treatment like PDT, the evidence of efficacy in treating acne is strong, but there is the trade-off of the process being a negative experience for the patient.

“Photochemicals [used in PDT] cause cell membrane damage, and with the process there's pain. The outcome may be positive, but this is not a positive event in the life of the patient,” Dr. Garden said.

When PDT is used to treat something like cancerous lesions, the process is entirely justified, but as a repetitive treatment for acne, it is much more questionable, he said.

“What we have to ask ourselves is this—do we really want this for our patients? And what's the long-term effect? We don't know,” Dr. Garden said. “The approach is new, and at the moment I'm very uncomfortable with this.”

And then there is the cost of light-based therapies, which are far more expensive than a medical option.

“These are highly expensive cash procedures requiring multiple visits to the office,” Dr. Spencer said. “I think light-based therapy for acne represent one more tool in the tool chest, but it's quite unreasonable for it to be the first thing that pops into your head.”

Dr. Garden agreed. “It's tempting to have a nonmedical option for treating acne, and this may have a role for those very selective, noncompliant patients,” he said.

“But when you look at this and ask if it's something that should be a first-line treatment for patients, the answer should be, unequivocally, no,” he asserted. “It's not worth it—not yet.”

The SDEF and this newspaper are wholly owned subsidiaries of Elsevier.

ANAHEIM, CALIF. — Light-based therapies are heavily promoted as options for treating acne, but issues of cost and convenience should rule them out as a first line of treatment, said experts at a cosmetic dermatology seminar sponsored by the Skin Disease Education Foundation.

The market is filling up with dozens of different lasers claiming to help treat acne with wide-ranging treatment mechanisms and even wider-ranging price tags, said Jerome Garden, M.D., of the department of dermatology at Northwestern University in Chicago.

“I found 26 different products out there all claiming they treat acne, and it's very hard to sort all of these out,” he said.

Most of the claims are backed by some research—infrared laser treatment, for instance, has some strong studies showing shrinkage of the sebaceous glands; blue light and photodynamic therapy (PDT) are gaining recognition for their efficacy; and radiofrequency devices have shown some success.

But for all of the devices and claims, several confounding factors give physicians pause in embracing light-based therapies as a first-line treatment.

First, there is broad inconsistency in the literature. An analysis of acne literature published in the Journal of the American Academy of Dermatology in 2002 underscored the wide-ranging measures used in determining not only outcomes but the very definitions of acne, said James Spencer, M.D., a clinical professor of dermatology at Mount Sinai School of Medicine, New York (J. Am. Acad. Dermatol. 2002;47:231–40).

“There were over 25 methods for assessing acne severity and 19 methods for counting lesions,” he said. “That makes comparing one study to another very difficult.”

With a treatment like PDT, the evidence of efficacy in treating acne is strong, but there is the trade-off of the process being a negative experience for the patient.

“Photochemicals [used in PDT] cause cell membrane damage, and with the process there's pain. The outcome may be positive, but this is not a positive event in the life of the patient,” Dr. Garden said.

When PDT is used to treat something like cancerous lesions, the process is entirely justified, but as a repetitive treatment for acne, it is much more questionable, he said.

“What we have to ask ourselves is this—do we really want this for our patients? And what's the long-term effect? We don't know,” Dr. Garden said. “The approach is new, and at the moment I'm very uncomfortable with this.”

And then there is the cost of light-based therapies, which are far more expensive than a medical option.

“These are highly expensive cash procedures requiring multiple visits to the office,” Dr. Spencer said. “I think light-based therapy for acne represent one more tool in the tool chest, but it's quite unreasonable for it to be the first thing that pops into your head.”

Dr. Garden agreed. “It's tempting to have a nonmedical option for treating acne, and this may have a role for those very selective, noncompliant patients,” he said.

“But when you look at this and ask if it's something that should be a first-line treatment for patients, the answer should be, unequivocally, no,” he asserted. “It's not worth it—not yet.”

The SDEF and this newspaper are wholly owned subsidiaries of Elsevier.