Acne vulgarisis a distressing, common skin condition that affects millions of individuals in the U.S. Up to 80 percent of the adolescent population, 30 percent of women of child-bearing years, and 3 percent of the middle-aged population are affected by acne. The fact that almost one-third of pre-menopausal women have some degree of acne, many of whom already frequent medical spas for services, makes treating acne a potentially good addition to your menu. Like all medical conditions, the treatment and diagnosis of acne should be directed by a licensed physician. Board-certified plastic surgeon Edward P. Miranda, M.D., director of Pacific Plastic Surgery Group, discusses myriad light-based options when it comes to treating clients with acne.
Conventional Treatment of Acne
The first line of treatment for acne is often with over-the-counter topical preparations, such as benzoyl peroxide, salicylic acid, and other cleansers. Additionally, estheticians have been performing comedone extractions on mild acne for years. However, for the majority of patients with acne, over-the-counter preparations and facials are only temporary fixes. Under medical guidance, derivatives of vitamin A, such as retinoids, are efficacious in reducing acne lesions and preventing recurrence. Oral retinoids, such as isotretinoin, are extremely effective but can be highly toxic and are reserved for patients with severe acne.
While the first solution to help treat patients with acne is primarily medication-based, new advances in adjunctive treatments of acne have provided opportunities for the medical spa industry. Advances in light therapy have proved to be useful in many cases of acne that are either resistant to or in combination with medical therapy. Adjunctive treatments often appeal to those who want to attempt a faster resolution of their acne.
Light Therapy
Historically, it has been noted that acne patients showed improvement when exposed to bright sunlight. It was then assumed that the source of improvement came from ultraviolet (UV) light exposure. Subsequent experience and investigation has shown that UV light alone has no effect on acne. Further research has found that the response of acne to bright light comes from the blue and red segments of the visible light spectrum. This has generated the production of several medical devices for the delivery of blue and red light.
Blue light is efficacious for the treatment of acne, however, its exact mechanism of action remains unclear. Proprionobacterium acnes (P. acnes), a type of bacteria that causes acne, absorbs blue light possibly through its production of porphyrins (highly reactive light molecules), which mediate an anti-inflammatory and/or antibacterial mechanism, thus improving acne lesions. Alternatively, the blue light may bypass P. acnes and reduce inflammation in the keratinocytes (epidermal cells) directly.
The FDA has approved high intensity blue light therapy for the treatment of acne. Studies have shown that high intensity blue light, over a period of eight sessions, can reduce inflammatory lesions by up to two-thirds for two months after therapy. Numerous LED blue light (405 to 420 nm) devices are currently available, some for home use.
Light from the red portion of the visible light spectrum is also absorbed by certain porphyrins that are either naturally present in the skin or are produced by colonizing P. acnes. One difference between shorter wavelength blue light and the longer wavelength red light is the depth of penetration into the skin. Red light can penetrate deeper and potentially affect the sebaceous glands themselves. Red light therapy combined with blue light therapy can significantly reduce the number of inflammatory lesions compared to blue light therapy or benzoyl peroxide therapy alone.
Photodynamic Therapy
The combination of light therapy and topically applied photosensitizers, such as 5-aminolevulinic acid (ALA), has additional efficacies in light-based therapy of acne. A combination of ALA and red light has been shown to reduce oil production and improve acne just three weeks after treatment and lasts for at least 20 weeks. Sebaceous glands also reduce in size by approximately 45 percent.
Blue light PDT has also shown efficacy. After three sessions of high intensity blue light application with pre-treatment ALA, a five-fold reduction in bacterial viability, as measured by culture, was observed.
Medical spas can offer significant help to patients with mild to moderate acne, many of whom are already clients. Acne is a medical disease, and all patients should be offered treatment by a physician experienced in the treatment of acne. Patients with moderate acne should and those with severe and/or cystic acne must see a qualified dermatologist for medical treatment. Despite medication being the mainstay of treatment, adjunctive light-based therapies and chemical peels remain an efficacious and supplemental treatment modality for the physician-supervised medical spa leading to potentially high patient satisfaction.—Edward P. Miranda, M.D.