Light Treatment for Active Acne (Laser, IPL, LED, PDT) Information

To many teenagers afflicted with this skin problem, acne is a four letter word!

While it is estimated that more than 80 percent of the world's population is affected by acne in various forms at some point during their life, there is still no cure.

It can cause considerable emotional stress, affecting self esteem and social lives, and occasionally lead to life long scarring of the skin.

Until recently, a combination of topical preparations and oral medications, including antibiotics, has been used almost exclusively with varying degrees of success to combat acne. In 2003 several laser and light-based technologies had been shown to improve mild to moderate acne in a few treatment sessions, and with no known systemic side effects.

If you are considering a light based treatment for improving acne, the following information will give you a basic understanding of the procedure. It can't answer all your questions, since a lot depends on the individual patient and the practitioner involved. Please ask a practitioner about anything you don't understand.

Acne is a chronic inflammatory disease of the sebaceous hair follicles. Each follicle contains a tiny hair and multiple sebaceous glands.

Under normal circumstances, sebum, the oily substance made by the sebaceous glands, travels up the hair follicle and out to the skin's surface. Acne vulgaris is caused by an excessive amount of oil production by the skin, blockage of the openings to the oil producing glands (resulting in tiny blackheads) and also due to a bacterium, Propionibacterium acnes (P. acnes) which causes inflammation in the blocked glands. These three factors seem to work together in order to produce the red and yellow spots so characteristic of acne.

Occasionally these spots can develop into large cysts (so called nodular or cystic acne) which often results in scarring.

Although a bacterium is involved, acne cannot be caught from other people.

Acne develops on those areas of the skin where sebaceous glands are most numerous: the face, scalp, neck, chest, back, and upper arms and shoulders.

Acne is sometimes confused with Rosacea, which is a rash which looks like acne but on a red background. It is a skin disease that tends to be more common in the over 40s.

The commonest form, Acne vulgaris, typically begins in adolescence, although onset in the twenties or thirties is common, and it can range from the occasional flare-up of pimples or spots that do not require any treatments to severe cases that can cause scarring and psychological problems.

If one looks very closely at the facial skin of teenagers, up to 90% have some form of blackheads or mild spots.

Moderately severe acne, i.e. with lots of inflamed spots on the face and upper trunk, affect around 5% of teenagers.

Acne usually starts around the age of 12 to 13 in girls and slightly later in boys.

There is some evidence to suggest that acne is more common amongst some families, suggesting that genetic factors are important.

Occasionally acne affects babies (so called infantile acne), and chemical or drug induced acne can affect anyone. Certain cosmetics, or oral and topical steroids can also result in an outbreak of acne.

For more information about different types of acne, please visit Acnenet.

Treatments are aimed at either unblocking blocked pores, killing the bacteria (P.acnes) or reducing the production of sebum. This can be done in a variety of different ways.

Mild cases are often self –treated with over the counter topical creams and gels (containing products such as benzoyl peroxide or salicylic acid). Some teenagers and women will visit beauty salons who may use various creams in conjunction with chemical peels or even microdermabrasion to help reduce the appearance of spots.

For more persistent or severe problems, the advice of a general practitioner may be sought.

Treatments prescribed may use a combination of topical and oral medications - including antibiotics, azeleic acid and topical retinoids – with varying degrees of success.

Occasionally hormonal treatment using cyproterone acetate, or a particular oral contraceptive pill may be prescribed by a doctor for certain women.

For the most difficult cases, a referral to a dermatologist may result in treatment with Roaccutane (isotretinoin - an oral vitamin A derivative that reduces the production of sebum by the sebaceous glands).

There is no “cure” for acne. Whilst many of the above treatments are effective, none of these treatments help all patients and they all have their own side effects profile. For some treatments, especially oral retinoids, these can be serious. [Read our blog: Popular acne prescription treatment isotretinoin linked to serious bowel injuries, but is it really to blame?]

In addition, some dermatologists are becoming increasingly concerned about the levels of resistance being displayed by the P. acnes bacterium to some of the commonly used antibiotics.

Many acne sufferers recognise that small amounts of sun exposure may initially improve the appearance of acne, and as the skin darkens, blemishes may be less noticeable. However, prolonged exposure promotes more rapid exfoliation of dead skin cells, so you’re more likely to get clogged pores. In addition, acne’s unsightly souvenirs, post-inflammatory hyperpigmentation and macules, will actually get darker if you spend time in the sun.

Over time, sun damages the skin and increases the likelihood that your acne will leave scars as well as increase your chances of getting some form of skin cancer.

In 2003 clinical trials allowed a number of machines utilising light for the treatment of active acne to receive FDA (Food and Drugs Administration) approval in the US – allowing the companies to promote their device for the treatment of this skin disease.

There are two main approaches which are being used and evaluated clinically:

1) The use of light to kill bacteria

The first of these approaches targets the bacteria that produces the inflammation associated with acne - Propionobacterium Acnes, or P. acnes.

Porphyrins are naturally occurring molecules that reside alongside the P.Acne bacteria in the infected pore. Porphyrins are photosensitive and light of certain colours can cause the release of oxygen from this molecule which destroys the anaerobic P.acnes bacteria. (It is thought that this is how natural sunlight also helps to improve acne).

2) The use of light to reduce the production of sebum

Another way to treat acne using laser technology is to damage the sebaceous (oil) glands in the skin by a thermal or heat effect.

Skin samples taken immediately after treatment with certain types of lasers show heat-induced changes of the sebaceous glands, reducing the amount of oil produced.

The laser emits a wavelength of light that is strongly absorbed by water within the skin. This generates heat in and around the sebaceous glands. By creating a mild thermal injury just below the skin’s surface, a laser can alter the structure and function of the sebaceous gland, leading to prolonged acne clearance.

Photodynamic Therapy (PDT)

Photodynamic therapy using a cream called aminolevulinic acid (ALA) has been approved by the Food and Drug Administration (FDA) to treat actinic keratosis, an early potential sign of skin cancer.

In the process of laser PDT for the treatment of acne, aminolevulenic acid or ALA, is applied to the skin.

This is absorbed preferentially by certain structures in the skin, such as hair follicles, oil glands, bacteria, or rapidly growing cells. Illumination with a high-intensity light (red light) or laser/IPL causes a reaction in the skin, resulting in destruction of the targeted tissue.

Photodynamic therapy seems to improve acne by decreasing the bacteria on the skin and by shrinking the oil-producing sebaceous glands.

What are Lasers?
A Laser is a high-energy beam of light that can transfer its energy into specific areas of the skin’s tissue to treat skin problems. These beams of light are produced in one wavelength or colour at a time, and can vary in terms of their strength and the type of tissue that they can target.
Some lasers work by killing the bacteria, and others help to reduce the production of sebum from the sebaceous glands in the skin.

What is Intense Pulsed Light (IPL)?
Intense Pulsed Light systems, although technically not lasers, use flashes of light that work in a similar way to lasers.

Their main affect appears to be antibacterial.

What is Light, Heat Energy (LHE)?
This is another treatment which you may hear mentioned. This also works by carefully controlled bursts of low-level light and heat that can help to destroy the P. acnes bacteria.

What are Light Emitting Diodes (LED)?
These can produce blue light that helps to destroy the P. acnes bacteria, and red light that can be used for Photodynamic Therapy (described above).

Additional investigational studies are ongoing with combination laser/Radiofrequency (electrical energy) systems.

Depending on the area of skin and type of light system used, different treatment procedures may be recommended for you by your practitioner.

Your first discussion with a practitioner should clearly set out your expectations. These should be matched by the likely improvement predicted by your practitioner for the system that they use. He or she should be able to prescribe the most appropriate type of light treatment for you.

A medical history should be taken to ensure that there are no reasons why you shouldn’t have the treatment. You would also normally be asked to sign a consent form at this time which means that you have understood the potential benefits and risks associated with the procedure recommended.

Photographs may also be taken by the practitioner for a "before and after" comparison at a later date.

Treatment procedure

This procedure generally requires no special pre-treatment care.

You will be required to wear eye protectors for all laser and IPL machines.

Depending upon the type of system used, you may experience a slight stinging sensation in the area treated during the procedure. The treatment will take 15 to 30 minutes for IPL/lasers depending on the area treated (i.e. backs will take longer than the face).

Treatments using LED or blue light will normally take the same amount of time, and require you to expose your skin continuously to the light for the duration of treatment.

Repeat procedures

This really does vary, depending on the system used.

LED or blue light treatments, for example, may require twice weekly treatments for several weeks.

Some specific laser systems claim prolonged improvement of acne lesions after just two treatment sessions.

Most patients will be able to return to work immediately following the procedure.

It is very important that you follow carefully the advice of your practitioner following any type of light treatment to help make the treatment as successful as possible and to reduce the risk of complications afterwards.

Post-treatment advice may include:

• not exposing the area treated to the sun without a sunscreen for at least 2 weeks to reduce the risk of pigmentation or change in skin colour. A high factor sun block should be used daily to protect the skin;
• contacting your practitioner immediately if you notice any signs of infection or pigment changes.

It is highly unlikely that anyone considering light based treatment to improve their acne would be able to access this free of charge on the National Health Service at this point in time.

Private prices for acne treatment using light vary depending upon the light source used, and your particular treatment requirements.

Costs can be in the £75 - £300 range per treatment session.

Depending on the type of equipment used, there may be no pain at all, or occasionally some mild stinging or burning may be noticed during the procedure, and the area treated may feel hot for 15 minutes or so after treatment.

Most patients will experience skin redness which will fade over the next hour or so and can be covered with light make up.

Some systems appear to be free of any other side effects, whilst others can cause post - treatment complications that may include blistering of the skin at the treatment site which can very rarely lead to mild scarring and changes in skin colour or pigment.

You need to discuss, in detail, the potential for these risks with the particular system that your practitioner is using.

Patients generally not suitable for any form of light treatment are those who have a history of keloid scarring (overgrowth of scar tissue), an active herpes infection (cold sores) or other skin infections such as impetigo at the site to be treated.

You would also not be suitable if you have a history of sensitivity to light that may cause your skin to develop a rash or any other reaction.

Patients who have used isotretinoin in the last year would also not be suitable candidates.

Darker skin, or recently tanned skin, may be not be suitable for treatment by certain types of machine. Your practitioner will advise you about this if you have a darker complexion.

Generally, light systems for skin improvement are used by trained doctors, surgeons or nurses.

The use of aminolevulenic acid or ALA for PDT treatments is a prescription only treatment so should be prescribed and performed by a doctor or independent nurse prescriber.

For more information about practitioner training, qualifications and relevant medical organisations please view the information contained within the Legislation section of the Consulting Room.

If you are worried about your acne, discuss it with your General Practitioner. If it is really severe, he/she may refer you on to see a dermatologist.

If you have been prescribed a treatment for your acne (whether a cream, lotion or tablet) remember that all of the treatments only work by preventing new spots and that all treatments have to be tried for at least four months before you decide whether they are helping.

Dabbing on a cream or lotion to existing spots when and if they appear is a waste of time.
Your acne treatment needs to be applied on a daily basis for a long time in order to exert its beneficial effects.

If you are concerned about poor results or side effects achieved with current treatment, you may want to explore the option of light based procedures.

The use of light technology alone or combined with PDT can offer clearance rates averaging between 50% and 90%.

The results seem to be comparable to oral antibiotics, but with the apparently reduced potential for systemic side effects.

Many private clinics and beauty salons are being persuaded to buy these systems and market them for acne.

Some machines may even find their way into the National Health Service.

In addition, various home use devices are available and marketed direct to the public in the UK as systems to use for the treatment of acne.

Advertising messages of clearance rates, treatment times, numbers of procedures required, doctor led or beautician initiated procedures and overall treatment costs will need to be carefully evaluated in order to clearly identify the benefits of purchasing this form of treatment.

Please note that results of non-surgical treatments vary enormously, depending upon both the patient and the skill of the individual practitioner.

We currently do not have any before and after images for light treatment of active acne.