PracticalDermatology

Despite advances in treating acne in recent years, patient compliance remains an issue with many existing therapies. Energy-based devices play a growing role in getting patients clear and treating acne scars, according to Cosmetic Surgery Forum faculty members.

“More and more, patients sidestep antibiotics or isotretinoin and instead want to try a non-pill option for treatment,” says Nashville dermatologist Michael Gold, MD. “Acne and scar therapy with energy-based devices has changed the paradigm for our patients.”

Energy-based devices speed the treatment response in almost every instance, which is important for acne patients who don’t want to wait the typical eight to 12 weeks to get clear, he says. “We have found them useful from a monotherapy point of view, but they can also be used successfully in combination with our medical treatments.”

From blue light to IPL and beyond

Early on, Dr. Gold favored blue light therapy with the Blu-U device by Dusa Pharmaceuticals. “This device still has some play,” Dr. Gold says. “We recommend that our patients receive blue light two times per week for four weeks or once per week for six weeks, and we treat for up to 20 minutes per session,” he says. “This treatment is usually well tolerated and has shown to be effective in all grades of acne severity.”

Intense pulsed light (IPL) also has an important role in treating acne, including inflammatory acne lesions. “The broad band light source and some of the more sophisticated IPLs have specific cut-off filters in the 400nm range that effectively target the porphyrins in the bacteria associated with the acne lesions,” Dr. Gold explains. “Several sessions with these devices have shown very nice results.” Treatments are given at one-month intervals in most cases, he says.

Dr. Gold’s go-to devices in this category include the M22 Stellar (Lumenis), the Lumecca (InMode), and the BBL (Sciton).

Vascular lasers also perform well for inflammatory acne, he says. “We use the pulsed-dye laser (V Beam, Candela) as well as the AdvaTX (AdvaLight),” Dr. Gold says. “Clinical studies with both have shown improvements in active acne.”

AdvaTX is a multi-wavelength device at 589nm and 1319nm, so it can also target acne scarring. Dr. Gold treats patients once a month with this device.

He is also a fan of the short-pulsed 1064nm Aerolase Neo. “This laser is virtually painless, which is important as we are usually treating a younger patient population, and pain is not something that we want them to experience,” he says. “We also find that in this era of the pandemic, doing treatments that are touchless is also important and that is the case with the Neo.”

Patients are treated every other week with Neo, and on average, four to six treatments are needed to achieve the desired results. “The Neo has proven to be one of the most effective treatments for our acne population.”

Jill Waibel, MD, Medical Director and Owner of Miami Dermatology and Laser Institute in Florida, agrees that there have been tremendous strides in treating acne with laser and light-based technology.

One new player, Sebacia, uses selective photothermolysis for the treatment of inflammatory acne by targeting select sebaceous glands with gold nanoparticles. These particles are massaged into the skin for 10 minutes and then activated with a Diode 755nm alexandrite or 1064nm laser. Patients typically receive two to three treatments spread one week apart. After three treatments, Dr. Waibel saw in her patients a 63 percent reduction in inflammatory acne after two months and an 85 percent reduction after 12 months, according to a CSF blog post.

In addition, a 1720nm laser from Accure is pending FDA approval, says Dr. Waibel, who was an investigator for the device. “Natural sebum had absorption peaks near 1210nm, 1728nm, 1760nm, 2306nm and 2346nm,” she says. “The laser-induced heating of the sebum was found to be approximately twice that of water at 1710nm and 1720nm, and approximately one and a half times higher in human sebaceous glands compared to water.”

Scar wars

For acne scars, Dr. Gold’s go-to devices include microneedling pens such as the SkinPen (Crown Aesthetics), the Collagen P.I.N. (Induction Therapies), and the StrataPen (Strata Skin Sciences). “They are all useful for acne scars and have shown very promising results after a series of treatments, usually four to six,” he says. “The RF microneedling devices, such as the original eMatrix (Candela) and now the VivaMD (Venus Concepts) allow us to use the power of radiofrequency to enhance our treatments.” Dr. Gold recommends that patients receive up to three treatments at monthly intervals. “We use the RF microneedling for those wanting the quickest results, but who can also afford more downtime, and these devices can also give us a nice outcome for those with active acne and scarring.” His go-to devices for this indication include the Morpheus8 (InMode) and the Intensif (EndyMed).

Save the dates: Cosmetic Surgery Forum 2021 will be held December 1-4 in Nashville. Visit CosmeticSurgeryForum.com