Rosacea

LOS CABOS, MEXICO — Dr. Mitchel P. Goldman doesn't accept insurance and says he believes that his cash-only acne patients get more for their money with one to three photodynamic therapy sessions than they do with years of prescriptions for medications, he said at the annual meeting of the Noah Worcester Dermatological Society.

Although he says he knows it sounds heretical—"and maybe you'll strip me of my derm boards"—he has been using the photosensitizing agent 5-aminolevulinic acid (ALA) followed by exposure to a blue-light laser for nearly 4 years and he thinks that there is nothing better for acne. "As soon as insurance companies wake up and realize it's a hell of a lot cheaper to do this than prescribe Accutane—they'll cover it," said Dr. Goldman, a dermatologist in private practice in La Jolla, Calif.

In the meantime, his patients pay $500-$600 for a treatment session that consists of a salicylic acid prep, microdermabrasion of the affected area, a scrub with acetone, 1-hour exposure to ALA (Levulan Kerastik, DUSA Pharmaceuticals), and 10–15 minutes' exposure to a blue light that is approved for the treatment of acne (BLU-U Photodynamic Therapy Illuminator, DUSA Pharmaceuticals Inc.), as well as long-pulse dye laser to individual acne lesions.

He said that he sees at least a 30% improvement in inflammatory acne after each treatment, spaced about 4 weeks apart. He has never done more than three treatments on a patient and he has never seen a patient's acne rebound, even years after a final treatment.

"Have I done controlled studies? No," he admitted. "It definitely lasts a long time."

Dr. Goldman explained that he is reassured by animal data, which show that exposure to photodynamic therapy (PDT) actually reduced, and did not increase, the risk of skin cancer ("Photodynamic Therapy" [London: Elsevier, 2005], pp. 53–64).

He says he has biopsied patients and seen a 90% decrease in the size of sebaceous glands after PDT.

He's read the studies that show that ALA-PDT kills bacteria and appears to normalize follicular shedding, and has participated in a study comparing blue light therapy with topical 1% clindamycin solution for inflammatory acne, in which lesions were reduced 34% after blue light therapy, compared with 14% with clindamycin (J. Drugs Dermatol. 2005;4:64–70).

"This is something the pharmaceutical companies do not want us to investigate, because they're going to lose a few billion dollars in acne treatment," he said.

Dr. Goldman disclosed that he has served as a consultant to DUSA Pharmaceuticals, the manufacturer of Levulan Kerastik (ALA) and the BLU-U light source.

LOS CABOS, MEXICO — Dr. Mitchel P. Goldman doesn't accept insurance and says he believes that his cash-only acne patients get more for their money with one to three photodynamic therapy sessions than they do with years of prescriptions for medications, he said at the annual meeting of the Noah Worcester Dermatological Society.

Although he says he knows it sounds heretical—"and maybe you'll strip me of my derm boards"—he has been using the photosensitizing agent 5-aminolevulinic acid (ALA) followed by exposure to a blue-light laser for nearly 4 years and he thinks that there is nothing better for acne. "As soon as insurance companies wake up and realize it's a hell of a lot cheaper to do this than prescribe Accutane—they'll cover it," said Dr. Goldman, a dermatologist in private practice in La Jolla, Calif.

In the meantime, his patients pay $500-$600 for a treatment session that consists of a salicylic acid prep, microdermabrasion of the affected area, a scrub with acetone, 1-hour exposure to ALA (Levulan Kerastik, DUSA Pharmaceuticals), and 10–15 minutes' exposure to a blue light that is approved for the treatment of acne (BLU-U Photodynamic Therapy Illuminator, DUSA Pharmaceuticals Inc.), as well as long-pulse dye laser to individual acne lesions.

He said that he sees at least a 30% improvement in inflammatory acne after each treatment, spaced about 4 weeks apart. He has never done more than three treatments on a patient and he has never seen a patient's acne rebound, even years after a final treatment.

"Have I done controlled studies? No," he admitted. "It definitely lasts a long time."

Dr. Goldman explained that he is reassured by animal data, which show that exposure to photodynamic therapy (PDT) actually reduced, and did not increase, the risk of skin cancer ("Photodynamic Therapy" [London: Elsevier, 2005], pp. 53–64).

He says he has biopsied patients and seen a 90% decrease in the size of sebaceous glands after PDT.

He's read the studies that show that ALA-PDT kills bacteria and appears to normalize follicular shedding, and has participated in a study comparing blue light therapy with topical 1% clindamycin solution for inflammatory acne, in which lesions were reduced 34% after blue light therapy, compared with 14% with clindamycin (J. Drugs Dermatol. 2005;4:64–70).

"This is something the pharmaceutical companies do not want us to investigate, because they're going to lose a few billion dollars in acne treatment," he said.

Dr. Goldman disclosed that he has served as a consultant to DUSA Pharmaceuticals, the manufacturer of Levulan Kerastik (ALA) and the BLU-U light source.

LOS CABOS, MEXICO — Dr. Mitchel P. Goldman doesn't accept insurance and says he believes that his cash-only acne patients get more for their money with one to three photodynamic therapy sessions than they do with years of prescriptions for medications, he said at the annual meeting of the Noah Worcester Dermatological Society.

Although he says he knows it sounds heretical—"and maybe you'll strip me of my derm boards"—he has been using the photosensitizing agent 5-aminolevulinic acid (ALA) followed by exposure to a blue-light laser for nearly 4 years and he thinks that there is nothing better for acne. "As soon as insurance companies wake up and realize it's a hell of a lot cheaper to do this than prescribe Accutane—they'll cover it," said Dr. Goldman, a dermatologist in private practice in La Jolla, Calif.

In the meantime, his patients pay $500-$600 for a treatment session that consists of a salicylic acid prep, microdermabrasion of the affected area, a scrub with acetone, 1-hour exposure to ALA (Levulan Kerastik, DUSA Pharmaceuticals), and 10–15 minutes' exposure to a blue light that is approved for the treatment of acne (BLU-U Photodynamic Therapy Illuminator, DUSA Pharmaceuticals Inc.), as well as long-pulse dye laser to individual acne lesions.

He said that he sees at least a 30% improvement in inflammatory acne after each treatment, spaced about 4 weeks apart. He has never done more than three treatments on a patient and he has never seen a patient's acne rebound, even years after a final treatment.

"Have I done controlled studies? No," he admitted. "It definitely lasts a long time."

Dr. Goldman explained that he is reassured by animal data, which show that exposure to photodynamic therapy (PDT) actually reduced, and did not increase, the risk of skin cancer ("Photodynamic Therapy" [London: Elsevier, 2005], pp. 53–64).

He says he has biopsied patients and seen a 90% decrease in the size of sebaceous glands after PDT.

He's read the studies that show that ALA-PDT kills bacteria and appears to normalize follicular shedding, and has participated in a study comparing blue light therapy with topical 1% clindamycin solution for inflammatory acne, in which lesions were reduced 34% after blue light therapy, compared with 14% with clindamycin (J. Drugs Dermatol. 2005;4:64–70).

"This is something the pharmaceutical companies do not want us to investigate, because they're going to lose a few billion dollars in acne treatment," he said.

Dr. Goldman disclosed that he has served as a consultant to DUSA Pharmaceuticals, the manufacturer of Levulan Kerastik (ALA) and the BLU-U light source.

ATLANTA — A new device that combines pulsed light and radiofrequency energy is proving highly effective for the treatment of acne vulgaris, Dr. Neil Sadick reported at the joint annual meeting of the American Society for Dermatologic Surgery and the American College of Mohs Micrographic Surgery and Cutaneous Oncology.

In 32 patients with moderate acne who were treated twice a week for 4 weeks, the combined use of optical and conducted bipolar radiofrequency energy reduced the average lesion count by 47%. Of patients surveyed, 59% rated overall improvement as good, 32% rated it as very good, and 4.5% rated it as excellent. Another 4.5% had mild or no improvement, said Dr. Sadick, clinical professor of dermatology at Cornell University, New York.

Biopsies were performed on four of the patients prior to treatment, 1 week after the initial treatment, and 1 month after the initial treatment. Compared with the baseline biopsy, the last biopsy showed a lower percentage of follicles with perifolliculitis (58% vs. 33%, respectively) and a reduction in the size of sebaceous glands (0.092 mm

The patients were treated using the Aurora AC device (Syneron Inc., Richmond Hill, Ont.). Those with Fitzpatrick skin types I-IV were treated with pulsed light of 8–10 J/cm

The combined use of optical energy and conducted bipolar radiofrequency current affects Propionibacterium acnes directly by photochemical activation of porphyrins, and by selective hyperthemia of the sebaceous glands. The radiofrequency energy supplements the optical energy and raises the temperature of the sebaceous glands, severely damaging the bacteria, Dr. Sadick explained.

Dr. Sadick is a research consultant for Syneron Inc.

Patient is shown at baseline and after 1 month of twice weekly treatments. Photos courtesy Dr. Neil Sadick

ATLANTA — A new device that combines pulsed light and radiofrequency energy is proving highly effective for the treatment of acne vulgaris, Dr. Neil Sadick reported at the joint annual meeting of the American Society for Dermatologic Surgery and the American College of Mohs Micrographic Surgery and Cutaneous Oncology.

In 32 patients with moderate acne who were treated twice a week for 4 weeks, the combined use of optical and conducted bipolar radiofrequency energy reduced the average lesion count by 47%. Of patients surveyed, 59% rated overall improvement as good, 32% rated it as very good, and 4.5% rated it as excellent. Another 4.5% had mild or no improvement, said Dr. Sadick, clinical professor of dermatology at Cornell University, New York.

Biopsies were performed on four of the patients prior to treatment, 1 week after the initial treatment, and 1 month after the initial treatment. Compared with the baseline biopsy, the last biopsy showed a lower percentage of follicles with perifolliculitis (58% vs. 33%, respectively) and a reduction in the size of sebaceous glands (0.092 mm

The patients were treated using the Aurora AC device (Syneron Inc., Richmond Hill, Ont.). Those with Fitzpatrick skin types I-IV were treated with pulsed light of 8–10 J/cm

The combined use of optical energy and conducted bipolar radiofrequency current affects Propionibacterium acnes directly by photochemical activation of porphyrins, and by selective hyperthemia of the sebaceous glands. The radiofrequency energy supplements the optical energy and raises the temperature of the sebaceous glands, severely damaging the bacteria, Dr. Sadick explained.

Dr. Sadick is a research consultant for Syneron Inc.

Patient is shown at baseline and after 1 month of twice weekly treatments. Photos courtesy Dr. Neil Sadick

ATLANTA — A new device that combines pulsed light and radiofrequency energy is proving highly effective for the treatment of acne vulgaris, Dr. Neil Sadick reported at the joint annual meeting of the American Society for Dermatologic Surgery and the American College of Mohs Micrographic Surgery and Cutaneous Oncology.

In 32 patients with moderate acne who were treated twice a week for 4 weeks, the combined use of optical and conducted bipolar radiofrequency energy reduced the average lesion count by 47%. Of patients surveyed, 59% rated overall improvement as good, 32% rated it as very good, and 4.5% rated it as excellent. Another 4.5% had mild or no improvement, said Dr. Sadick, clinical professor of dermatology at Cornell University, New York.

Biopsies were performed on four of the patients prior to treatment, 1 week after the initial treatment, and 1 month after the initial treatment. Compared with the baseline biopsy, the last biopsy showed a lower percentage of follicles with perifolliculitis (58% vs. 33%, respectively) and a reduction in the size of sebaceous glands (0.092 mm

The patients were treated using the Aurora AC device (Syneron Inc., Richmond Hill, Ont.). Those with Fitzpatrick skin types I-IV were treated with pulsed light of 8–10 J/cm

The combined use of optical energy and conducted bipolar radiofrequency current affects Propionibacterium acnes directly by photochemical activation of porphyrins, and by selective hyperthemia of the sebaceous glands. The radiofrequency energy supplements the optical energy and raises the temperature of the sebaceous glands, severely damaging the bacteria, Dr. Sadick explained.

Dr. Sadick is a research consultant for Syneron Inc.

Patient is shown at baseline and after 1 month of twice weekly treatments. Photos courtesy Dr. Neil Sadick

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 dermatologists 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 dermatologists 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 far 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," he 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 represents 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."

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 dermatologists 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 dermatologists 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 far 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," he 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 represents 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."

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 dermatologists 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 dermatologists 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 far 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," he 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 represents 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."

SDEF and this newspaper are wholly owned subsidiaries of Elsevier.

LAKE BUENA VISTA, FLA. — Plasma skin resurfacing reduces acne scars and fine lines while minimizing downtime and adverse events, according to data presented at the annual meeting of the American Society for Laser Medicine and Surgery.

"Plasma skin regeneration provides an effective long-term facial rejuvenation for acne scarring and fine lines," said M. Potter, M.D., of RAFT Institute of Plastic Surgery in London.

The plasma device works by passing ultrahigh energy through nitrogen gas, generating plasma used to treat scars and lines with short pulses.

In this study, Dr. Potter treated a total of 11 patients (10 women)—3 for acne scars, 7 for fine lines, and 1 patient for both. The treatment was performed under anesthesia. Energy varied between 1 and 4 J.

All patients were assessed at 10 days and 3 and 6 months post treatment. "A precise measure of skin irregularity was recorded using silicon molds. … Wrinkle depth was assessed using a light microscope technique to give an accurate measurement," Dr. Potter said.

In patients with fine lines, the mean pretreatment wrinkle depth was 0.25 mm. At 10 days, there was a mean improvement in wrinkle depth of 39%. At 6 months, mean improvement was 24%. "Acne is always difficult to treat, but these patients had an improvement of 35% at 10 days and 23% at 6 months," Dr. Potter said.

LAKE BUENA VISTA, FLA. — Plasma skin resurfacing reduces acne scars and fine lines while minimizing downtime and adverse events, according to data presented at the annual meeting of the American Society for Laser Medicine and Surgery.

"Plasma skin regeneration provides an effective long-term facial rejuvenation for acne scarring and fine lines," said M. Potter, M.D., of RAFT Institute of Plastic Surgery in London.

The plasma device works by passing ultrahigh energy through nitrogen gas, generating plasma used to treat scars and lines with short pulses.

In this study, Dr. Potter treated a total of 11 patients (10 women)—3 for acne scars, 7 for fine lines, and 1 patient for both. The treatment was performed under anesthesia. Energy varied between 1 and 4 J.

All patients were assessed at 10 days and 3 and 6 months post treatment. "A precise measure of skin irregularity was recorded using silicon molds. … Wrinkle depth was assessed using a light microscope technique to give an accurate measurement," Dr. Potter said.

In patients with fine lines, the mean pretreatment wrinkle depth was 0.25 mm. At 10 days, there was a mean improvement in wrinkle depth of 39%. At 6 months, mean improvement was 24%. "Acne is always difficult to treat, but these patients had an improvement of 35% at 10 days and 23% at 6 months," Dr. Potter said.

LAKE BUENA VISTA, FLA. — Plasma skin resurfacing reduces acne scars and fine lines while minimizing downtime and adverse events, according to data presented at the annual meeting of the American Society for Laser Medicine and Surgery.

"Plasma skin regeneration provides an effective long-term facial rejuvenation for acne scarring and fine lines," said M. Potter, M.D., of RAFT Institute of Plastic Surgery in London.

The plasma device works by passing ultrahigh energy through nitrogen gas, generating plasma used to treat scars and lines with short pulses.

In this study, Dr. Potter treated a total of 11 patients (10 women)—3 for acne scars, 7 for fine lines, and 1 patient for both. The treatment was performed under anesthesia. Energy varied between 1 and 4 J.

All patients were assessed at 10 days and 3 and 6 months post treatment. "A precise measure of skin irregularity was recorded using silicon molds. … Wrinkle depth was assessed using a light microscope technique to give an accurate measurement," Dr. Potter said.

In patients with fine lines, the mean pretreatment wrinkle depth was 0.25 mm. At 10 days, there was a mean improvement in wrinkle depth of 39%. At 6 months, mean improvement was 24%. "Acne is always difficult to treat, but these patients had an improvement of 35% at 10 days and 23% at 6 months," Dr. Potter said.

LAKE BUENA VISTA, FLA. — Treatment with an erbium:glass laser can safely reduce moderate to severe acne lesions by as much as 80% up to 1 year after therapy, according to the results of two studies presented at the annual meeting of the American Society for Laser Medicine and Surgery.

In the first study, 18 patients (15 women) had a baseline total of 275 lesions—77 comedones, 173 pustules and papules, and 25 nodules, said Sylvie Angel, M.D., of the Cabinet de Dermatologie in Paris. At 12 months' follow-up, only 20% of the baseline lesions remained (55 total lesions—24 comedones, 28 pustules and papules, and 3 nodules). At 6 months' follow-up, there were 87 total lesions—32 comedones, 52 pustules and papules, and 3 nodules.

"All patients observed that their skin was less prone to oiliness and reported quicker healing when new lesions appeared after the treatments," she said.

All the patients had acne—severity greater than 2 on the Burton scale—on the back (10 patients) or face (8 patients). All the patients had received standard acne therapies but were not satisfied by the results. Antibiotic and Accutane (isotretinoin) treatments were stopped 6 and 12 months, respectively, prior to this study. No other therapies were used during the study.

Dr. Angel and her colleagues used a 1,540-nm erbium:glass laser (Aramis, Quantel Medical) in combination with contact cooling set at 5° C. The protocol involved four pulses at 10 J/cm

On average, the patients rated pain during treatments at 1.4, based on a scale of 1-4. There were no adverse events, except for some transient edema and erythema.

Dr. Angel and her colleagues say they believe that the laser induces a thermal injury in the upper- to mid-dermis. Penetration depth has been shown to range between 200 and 900 μm—sebaceous gland depth. Contact cooling protects the dermis from thermal injury.

She suggested future studies be designed to find the ideal number of treatments.

In the second study, 15 patients with moderate to severe inflammatory acne of the face—grade 3 or higher on the Burton scale—were treated with an erbium:glass laser (Aramis, Quantel Medical), which has a 4-mm spot size and 3.3-ms pulse duration. Contact cooling was also used. Quantel Medical provided equipment and funding for the study.

"The treatment worked well for all types of inflammatory lesions," said Melissa A. Bogle, M.D., a practicing dermatologist in Chestnut Hill, Mass. As the treatment course progressed, patients had a steady decline in the total number of lesions. At 6 months, only 20% of the baseline lesions remained. There was essentially no change in sebum production, even though the patients reported that their skin felt less oily.

The patients were treated four times at 2-week intervals. The protocol consisted of first treating the active lesions using bursts of six pulses (10 J/cm

At the 6-month follow-up, improvement was more than 80%, as subjectively determined by the investigator. Patients felt their acne had improved by 70%.

Patients rated treatment on average at 2.25 on a scale of 1-4. Dr. Bogle noted that there was some minimal erythema that resolved in 5-10 minutes.

"I think the most exciting thing about it is that it's a relatively painless device," Dr. Bogle said.

A patient with inflammatory acne is shown prior to treatment with an erbium:glass laser.

The same patient is shown 1 month after receiving four laser treatments at 2-week intervals. Photos courtesy Dr. Melissa A. Bogle

LAKE BUENA VISTA, FLA. — Treatment with an erbium:glass laser can safely reduce moderate to severe acne lesions by as much as 80% up to 1 year after therapy, according to the results of two studies presented at the annual meeting of the American Society for Laser Medicine and Surgery.

In the first study, 18 patients (15 women) had a baseline total of 275 lesions—77 comedones, 173 pustules and papules, and 25 nodules, said Sylvie Angel, M.D., of the Cabinet de Dermatologie in Paris. At 12 months' follow-up, only 20% of the baseline lesions remained (55 total lesions—24 comedones, 28 pustules and papules, and 3 nodules). At 6 months' follow-up, there were 87 total lesions—32 comedones, 52 pustules and papules, and 3 nodules.

"All patients observed that their skin was less prone to oiliness and reported quicker healing when new lesions appeared after the treatments," she said.

All the patients had acne—severity greater than 2 on the Burton scale—on the back (10 patients) or face (8 patients). All the patients had received standard acne therapies but were not satisfied by the results. Antibiotic and Accutane (isotretinoin) treatments were stopped 6 and 12 months, respectively, prior to this study. No other therapies were used during the study.

Dr. Angel and her colleagues used a 1,540-nm erbium:glass laser (Aramis, Quantel Medical) in combination with contact cooling set at 5° C. The protocol involved four pulses at 10 J/cm

On average, the patients rated pain during treatments at 1.4, based on a scale of 1-4. There were no adverse events, except for some transient edema and erythema.

Dr. Angel and her colleagues say they believe that the laser induces a thermal injury in the upper- to mid-dermis. Penetration depth has been shown to range between 200 and 900 μm—sebaceous gland depth. Contact cooling protects the dermis from thermal injury.

She suggested future studies be designed to find the ideal number of treatments.

In the second study, 15 patients with moderate to severe inflammatory acne of the face—grade 3 or higher on the Burton scale—were treated with an erbium:glass laser (Aramis, Quantel Medical), which has a 4-mm spot size and 3.3-ms pulse duration. Contact cooling was also used. Quantel Medical provided equipment and funding for the study.

"The treatment worked well for all types of inflammatory lesions," said Melissa A. Bogle, M.D., a practicing dermatologist in Chestnut Hill, Mass. As the treatment course progressed, patients had a steady decline in the total number of lesions. At 6 months, only 20% of the baseline lesions remained. There was essentially no change in sebum production, even though the patients reported that their skin felt less oily.

The patients were treated four times at 2-week intervals. The protocol consisted of first treating the active lesions using bursts of six pulses (10 J/cm

At the 6-month follow-up, improvement was more than 80%, as subjectively determined by the investigator. Patients felt their acne had improved by 70%.

Patients rated treatment on average at 2.25 on a scale of 1-4. Dr. Bogle noted that there was some minimal erythema that resolved in 5-10 minutes.

"I think the most exciting thing about it is that it's a relatively painless device," Dr. Bogle said.

A patient with inflammatory acne is shown prior to treatment with an erbium:glass laser.

The same patient is shown 1 month after receiving four laser treatments at 2-week intervals. Photos courtesy Dr. Melissa A. Bogle

LAKE BUENA VISTA, FLA. — Treatment with an erbium:glass laser can safely reduce moderate to severe acne lesions by as much as 80% up to 1 year after therapy, according to the results of two studies presented at the annual meeting of the American Society for Laser Medicine and Surgery.

In the first study, 18 patients (15 women) had a baseline total of 275 lesions—77 comedones, 173 pustules and papules, and 25 nodules, said Sylvie Angel, M.D., of the Cabinet de Dermatologie in Paris. At 12 months' follow-up, only 20% of the baseline lesions remained (55 total lesions—24 comedones, 28 pustules and papules, and 3 nodules). At 6 months' follow-up, there were 87 total lesions—32 comedones, 52 pustules and papules, and 3 nodules.

"All patients observed that their skin was less prone to oiliness and reported quicker healing when new lesions appeared after the treatments," she said.

All the patients had acne—severity greater than 2 on the Burton scale—on the back (10 patients) or face (8 patients). All the patients had received standard acne therapies but were not satisfied by the results. Antibiotic and Accutane (isotretinoin) treatments were stopped 6 and 12 months, respectively, prior to this study. No other therapies were used during the study.

Dr. Angel and her colleagues used a 1,540-nm erbium:glass laser (Aramis, Quantel Medical) in combination with contact cooling set at 5° C. The protocol involved four pulses at 10 J/cm

On average, the patients rated pain during treatments at 1.4, based on a scale of 1-4. There were no adverse events, except for some transient edema and erythema.

Dr. Angel and her colleagues say they believe that the laser induces a thermal injury in the upper- to mid-dermis. Penetration depth has been shown to range between 200 and 900 μm—sebaceous gland depth. Contact cooling protects the dermis from thermal injury.

She suggested future studies be designed to find the ideal number of treatments.

In the second study, 15 patients with moderate to severe inflammatory acne of the face—grade 3 or higher on the Burton scale—were treated with an erbium:glass laser (Aramis, Quantel Medical), which has a 4-mm spot size and 3.3-ms pulse duration. Contact cooling was also used. Quantel Medical provided equipment and funding for the study.

"The treatment worked well for all types of inflammatory lesions," said Melissa A. Bogle, M.D., a practicing dermatologist in Chestnut Hill, Mass. As the treatment course progressed, patients had a steady decline in the total number of lesions. At 6 months, only 20% of the baseline lesions remained. There was essentially no change in sebum production, even though the patients reported that their skin felt less oily.

The patients were treated four times at 2-week intervals. The protocol consisted of first treating the active lesions using bursts of six pulses (10 J/cm

At the 6-month follow-up, improvement was more than 80%, as subjectively determined by the investigator. Patients felt their acne had improved by 70%.

Patients rated treatment on average at 2.25 on a scale of 1-4. Dr. Bogle noted that there was some minimal erythema that resolved in 5-10 minutes.

"I think the most exciting thing about it is that it's a relatively painless device," Dr. Bogle said.

A patient with inflammatory acne is shown prior to treatment with an erbium:glass laser.

The same patient is shown 1 month after receiving four laser treatments at 2-week intervals. Photos courtesy Dr. Melissa A. Bogle

NEW ORLEANS — Nonablative laser therapy for acne doesn't kill Propionibacterium acnes or decrease sebum production but instead appears to work by inducing a rapid and dramatic increase in transforming growth factor beta, Edward Seaton, M.D., and colleagues said in a poster presented at the annual meeting of the American Academy of Dermatology.

"TGF-β is very important anti-inflammatory cytokine that plays a pivotal role in decreasing inflammation and is the first stimulus of neocollagenesis," Dr. Seaton of Hammersmith Hospital, London, said in an interview. "This is the first time a biologic explanation of lasers' effect on acne has been proposed."

Dr. Seaton used nonablative laser therapy on the foreheads of 19 subjects with mild to moderate acne who had received no previous treatment. He took before and after measurements of P. acnes colony count, sebum production, and several cytokines and receptors: interleukin-1 (comedogenic), interleukin-1 receptor antagonist (anticomedogenic), interleukin-10 (anti-inflammatory), tumor necrosis factor (proinflammatory), TGF-βanti-inflammatory), and melanocortin-1 receptor (expressed in healthy sebaceous glands).

Each subject received one session of nonablative laser therapy (wavelength 585 nm, pulse duration 350 msec, 2 J/cm2, spot diameter 7 mm). Cytokine levels were obtained from 4-mm punch biopsies from the buttocks before laser treatment and 3 and 24 hours post treatment.

After 24 hours, there was no decrease in the number of P. acnes colonies on the treated area; in fact, there was a non-statistically significant increase in the number of colonies. There was no significant decrease in the sebum excretion rate at 2, 4, 8, or 24 weeks post treatment.

After 24 hours, there was a fivefold increase in TGF-β but no significant changes in any other cytokine or receptor levels. The TGF-β levels had increased slightly, but nonsignificantly, by 3 hours post therapy.

In addition to inhibiting the inflammatory response, Dr. Seaton said, TGF-βstimulates collagen, proteoglycan, fibronectin, and integrin production and inhibits matrix metalloproteinase-induced collagen degradation. Thus, the benefits of nonablative laser therapy in acne seem similar to those it exerts for photorejuvenation.

"They induce collagen remodeling at the ultrastructural level and increase collagen production," he said. "The molecular mechanism of this is unclear, but it is thought to be secondary to nonlethal dermal wounding."

NEW ORLEANS — Nonablative laser therapy for acne doesn't kill Propionibacterium acnes or decrease sebum production but instead appears to work by inducing a rapid and dramatic increase in transforming growth factor beta, Edward Seaton, M.D., and colleagues said in a poster presented at the annual meeting of the American Academy of Dermatology.

"TGF-β is very important anti-inflammatory cytokine that plays a pivotal role in decreasing inflammation and is the first stimulus of neocollagenesis," Dr. Seaton of Hammersmith Hospital, London, said in an interview. "This is the first time a biologic explanation of lasers' effect on acne has been proposed."

Dr. Seaton used nonablative laser therapy on the foreheads of 19 subjects with mild to moderate acne who had received no previous treatment. He took before and after measurements of P. acnes colony count, sebum production, and several cytokines and receptors: interleukin-1 (comedogenic), interleukin-1 receptor antagonist (anticomedogenic), interleukin-10 (anti-inflammatory), tumor necrosis factor (proinflammatory), TGF-βanti-inflammatory), and melanocortin-1 receptor (expressed in healthy sebaceous glands).

Each subject received one session of nonablative laser therapy (wavelength 585 nm, pulse duration 350 msec, 2 J/cm2, spot diameter 7 mm). Cytokine levels were obtained from 4-mm punch biopsies from the buttocks before laser treatment and 3 and 24 hours post treatment.

After 24 hours, there was no decrease in the number of P. acnes colonies on the treated area; in fact, there was a non-statistically significant increase in the number of colonies. There was no significant decrease in the sebum excretion rate at 2, 4, 8, or 24 weeks post treatment.

After 24 hours, there was a fivefold increase in TGF-β but no significant changes in any other cytokine or receptor levels. The TGF-β levels had increased slightly, but nonsignificantly, by 3 hours post therapy.

In addition to inhibiting the inflammatory response, Dr. Seaton said, TGF-βstimulates collagen, proteoglycan, fibronectin, and integrin production and inhibits matrix metalloproteinase-induced collagen degradation. Thus, the benefits of nonablative laser therapy in acne seem similar to those it exerts for photorejuvenation.

"They induce collagen remodeling at the ultrastructural level and increase collagen production," he said. "The molecular mechanism of this is unclear, but it is thought to be secondary to nonlethal dermal wounding."

NEW ORLEANS — Nonablative laser therapy for acne doesn't kill Propionibacterium acnes or decrease sebum production but instead appears to work by inducing a rapid and dramatic increase in transforming growth factor beta, Edward Seaton, M.D., and colleagues said in a poster presented at the annual meeting of the American Academy of Dermatology.

"TGF-β is very important anti-inflammatory cytokine that plays a pivotal role in decreasing inflammation and is the first stimulus of neocollagenesis," Dr. Seaton of Hammersmith Hospital, London, said in an interview. "This is the first time a biologic explanation of lasers' effect on acne has been proposed."

Dr. Seaton used nonablative laser therapy on the foreheads of 19 subjects with mild to moderate acne who had received no previous treatment. He took before and after measurements of P. acnes colony count, sebum production, and several cytokines and receptors: interleukin-1 (comedogenic), interleukin-1 receptor antagonist (anticomedogenic), interleukin-10 (anti-inflammatory), tumor necrosis factor (proinflammatory), TGF-βanti-inflammatory), and melanocortin-1 receptor (expressed in healthy sebaceous glands).

Each subject received one session of nonablative laser therapy (wavelength 585 nm, pulse duration 350 msec, 2 J/cm2, spot diameter 7 mm). Cytokine levels were obtained from 4-mm punch biopsies from the buttocks before laser treatment and 3 and 24 hours post treatment.

After 24 hours, there was no decrease in the number of P. acnes colonies on the treated area; in fact, there was a non-statistically significant increase in the number of colonies. There was no significant decrease in the sebum excretion rate at 2, 4, 8, or 24 weeks post treatment.

After 24 hours, there was a fivefold increase in TGF-β but no significant changes in any other cytokine or receptor levels. The TGF-β levels had increased slightly, but nonsignificantly, by 3 hours post therapy.

In addition to inhibiting the inflammatory response, Dr. Seaton said, TGF-βstimulates collagen, proteoglycan, fibronectin, and integrin production and inhibits matrix metalloproteinase-induced collagen degradation. Thus, the benefits of nonablative laser therapy in acne seem similar to those it exerts for photorejuvenation.

"They induce collagen remodeling at the ultrastructural level and increase collagen production," he said. "The molecular mechanism of this is unclear, but it is thought to be secondary to nonlethal dermal wounding."

NEWPORT BEACH, CALIF. — Light therapy with a photosensitizing agent is an effective treatment for acne vulgaris and provides an important alternative to other approaches, Dore Gilbert, M.D., said at a meeting sponsored by the Foundation for Facial Plastic Surgery.

Though treatment with retin-A compounds is the front-line option for most dermatologists who have patients with sebaceous acne, this is another way to see visible improvement—and to satisfy patients, said Dr. Gilbert, who practices in Newport Beach, Calif. "It is not a cure, but we do see a long-term deterrence of the condition."

Current drug therapies for acne have side effects, and some adolescents cannot tolerate them, he observed. However, there are no such concerns with light therapy. By adding levulinic acid to the regimen, "you get a much quicker response and better skin texture changes," he said. The effect on the sebaceous gland is fairly well documented: Light activation in the presence of a photosensitizing agent diminishes the sebaceous product inside the pustule and kills the bacteria thriving in it. Shrinkage occurs quickly, Dr. Gilbert said.

The term photodynamic therapy was coined a century ago by German scientists who observed that targeted light benefited certain skin conditions, including acne. Only a few decades ago, it was not unusual to see adolescents with serious involvement who suffered periodic sunburns, thanks to popular home treatments with a UV lamp. Now, with the addition of photosensitizing compounds to activate certain target cells, the administration of light is proving much safer than, and just as effective as, some topical treatments, Dr. Gilbert said at the meeting, which was also sponsored by Medical Education Resources.

He has treated patients with the combination of a photosensitizer and both blue light and intense pulsed-light therapy. Significant clearance with a few treatments, sometimes only one, is achieved about 75% of the time in patients with cystic or superpustular acne, he said. About 50% of his patients have had a quantifiable decrease in pore size.

The photosensitizing compound needs to be activated by wavelengths with good penetration of the skin, he advised. Any wavelength in the range of 415–640 nm seems to work well. Moreover, any type of light source will work in this wavelength zone. Dr. Gilbert said he has relied mostly on blue light and intense pulsed-light lasers. In some cases, a combination of these two is substantially better than either alone, he noted.

Dr. Gilbert recommends using a facial scrub with acetone followed by application of the photosensitizer, which can be left on for at least an hour prior to light treatment. The chemical photosensitizing compound should be one that metabolizes well over a 60-minute waiting period. This should give it significant intracellular photodynamic properties with the introduction of light. The process should result "in rapidly dividing target cells and have a short time between administration of compound and accumulation in the target cells," he said.

"One downside to phototherapy is that for 3–4 days there is redness and scaling," he pointed out. "That can be tough for kids in school." He tries to schedule these patients so that their recovery time does not coincide with school days.

NEWPORT BEACH, CALIF. — Light therapy with a photosensitizing agent is an effective treatment for acne vulgaris and provides an important alternative to other approaches, Dore Gilbert, M.D., said at a meeting sponsored by the Foundation for Facial Plastic Surgery.

Though treatment with retin-A compounds is the front-line option for most dermatologists who have patients with sebaceous acne, this is another way to see visible improvement—and to satisfy patients, said Dr. Gilbert, who practices in Newport Beach, Calif. "It is not a cure, but we do see a long-term deterrence of the condition."

Current drug therapies for acne have side effects, and some adolescents cannot tolerate them, he observed. However, there are no such concerns with light therapy. By adding levulinic acid to the regimen, "you get a much quicker response and better skin texture changes," he said. The effect on the sebaceous gland is fairly well documented: Light activation in the presence of a photosensitizing agent diminishes the sebaceous product inside the pustule and kills the bacteria thriving in it. Shrinkage occurs quickly, Dr. Gilbert said.

The term photodynamic therapy was coined a century ago by German scientists who observed that targeted light benefited certain skin conditions, including acne. Only a few decades ago, it was not unusual to see adolescents with serious involvement who suffered periodic sunburns, thanks to popular home treatments with a UV lamp. Now, with the addition of photosensitizing compounds to activate certain target cells, the administration of light is proving much safer than, and just as effective as, some topical treatments, Dr. Gilbert said at the meeting, which was also sponsored by Medical Education Resources.

He has treated patients with the combination of a photosensitizer and both blue light and intense pulsed-light therapy. Significant clearance with a few treatments, sometimes only one, is achieved about 75% of the time in patients with cystic or superpustular acne, he said. About 50% of his patients have had a quantifiable decrease in pore size.

The photosensitizing compound needs to be activated by wavelengths with good penetration of the skin, he advised. Any wavelength in the range of 415–640 nm seems to work well. Moreover, any type of light source will work in this wavelength zone. Dr. Gilbert said he has relied mostly on blue light and intense pulsed-light lasers. In some cases, a combination of these two is substantially better than either alone, he noted.

Dr. Gilbert recommends using a facial scrub with acetone followed by application of the photosensitizer, which can be left on for at least an hour prior to light treatment. The chemical photosensitizing compound should be one that metabolizes well over a 60-minute waiting period. This should give it significant intracellular photodynamic properties with the introduction of light. The process should result "in rapidly dividing target cells and have a short time between administration of compound and accumulation in the target cells," he said.

"One downside to phototherapy is that for 3–4 days there is redness and scaling," he pointed out. "That can be tough for kids in school." He tries to schedule these patients so that their recovery time does not coincide with school days.

NEWPORT BEACH, CALIF. — Light therapy with a photosensitizing agent is an effective treatment for acne vulgaris and provides an important alternative to other approaches, Dore Gilbert, M.D., said at a meeting sponsored by the Foundation for Facial Plastic Surgery.

Though treatment with retin-A compounds is the front-line option for most dermatologists who have patients with sebaceous acne, this is another way to see visible improvement—and to satisfy patients, said Dr. Gilbert, who practices in Newport Beach, Calif. "It is not a cure, but we do see a long-term deterrence of the condition."

Current drug therapies for acne have side effects, and some adolescents cannot tolerate them, he observed. However, there are no such concerns with light therapy. By adding levulinic acid to the regimen, "you get a much quicker response and better skin texture changes," he said. The effect on the sebaceous gland is fairly well documented: Light activation in the presence of a photosensitizing agent diminishes the sebaceous product inside the pustule and kills the bacteria thriving in it. Shrinkage occurs quickly, Dr. Gilbert said.

The term photodynamic therapy was coined a century ago by German scientists who observed that targeted light benefited certain skin conditions, including acne. Only a few decades ago, it was not unusual to see adolescents with serious involvement who suffered periodic sunburns, thanks to popular home treatments with a UV lamp. Now, with the addition of photosensitizing compounds to activate certain target cells, the administration of light is proving much safer than, and just as effective as, some topical treatments, Dr. Gilbert said at the meeting, which was also sponsored by Medical Education Resources.

He has treated patients with the combination of a photosensitizer and both blue light and intense pulsed-light therapy. Significant clearance with a few treatments, sometimes only one, is achieved about 75% of the time in patients with cystic or superpustular acne, he said. About 50% of his patients have had a quantifiable decrease in pore size.

The photosensitizing compound needs to be activated by wavelengths with good penetration of the skin, he advised. Any wavelength in the range of 415–640 nm seems to work well. Moreover, any type of light source will work in this wavelength zone. Dr. Gilbert said he has relied mostly on blue light and intense pulsed-light lasers. In some cases, a combination of these two is substantially better than either alone, he noted.

Dr. Gilbert recommends using a facial scrub with acetone followed by application of the photosensitizer, which can be left on for at least an hour prior to light treatment. The chemical photosensitizing compound should be one that metabolizes well over a 60-minute waiting period. This should give it significant intracellular photodynamic properties with the introduction of light. The process should result "in rapidly dividing target cells and have a short time between administration of compound and accumulation in the target cells," he said.

"One downside to phototherapy is that for 3–4 days there is redness and scaling," he pointed out. "That can be tough for kids in school." He tries to schedule these patients so that their recovery time does not coincide with school days.