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Laser Treatment of Acne: Still Waiting

Inflammatory acne lesions did not seem to respond to laser treatment.

Results of several uncontrolled trials suggest that various lasers and light sources improve acne. Unfortunately, the placebo effect is strong in acne treatment, making controlled studies essential. In this randomized, controlled, split-face clinical trial, 46 patients underwent three treatments, 3 weeks apart, to half the face with a near-infrared laser (CoolTouch II; 1320-nm wavelength). The entire face was pretreated with lidocaine 4% topical anesthetic cream. Participants stopped all acne therapy for 1 month before treatment. Patients were examined at 7 and 14 weeks; 37 had at least one follow-up visit, and 30 patients completed the study. Assessment included lesion counts, global acne severity score rating of photographs, and patient self-assessment.

The change in the number of open comedones relative to baseline was significantly different on the treated and untreated sides (a 27% reduction on the treated side vs. a 12% increase on the untreated side). The sides also differed significantly in mean cyst counts (which remained at the low baseline level of 0.22 on the treated side but increased on the untreated side from 0.27 to 0.70). There were no between-side differences in the number of papules or pustules, and the number of lesions seemed to increase and decrease without any obvious correlation with treatment. Three independent dermatologist observers examined patient photographs, noting only a slight overall improvement in acne severity on the treated skin compared to the untreated skin. Treatment was at least moderately painful in 74% of patients. Sebutape measurement revealed no difference in sebum production. In patient assessments, 43% reported at least moderate acne improvement and 53% reported less oiliness on the treated side. Laser treatment was preferred by 57% of those who had used oral acne treatments and 73% of those who had used topical treatments. A small number of transient local reactions occurred, including two cases of hyperpigmentation and two cases of focal blisters.

Comment: The 1320-nm laser seems to be of minimal, if any, clinical use for treating acne. Many patients preferred the convenience of lasers to other therapies, but that percentage could drop precipitously when patients are faced with the cost of paying for laser treatment. The 1450-nm wavelength that has been used most often for acne treatment is better absorbed by the sebaceous glands than the 1320-nm wavelength, making the 1320-nm laser less likely to be effective. Changing the treatment parameters and increasing the number of treatments could improve results. At this point, however, traditional, nonlaser acne therapies remain the treatments of choice.

— George J. Hruza, MD

Published in Journal Watch Dermatology April 6, 2007

Citation(s):

Orringer JS et al. A randomized, controlled, split-face clinical trial of 1320-nm Nd:YAG laser therapy in the treatment of acne vulgaris. J Am Acad Dermatol 2007 Mar; 56:432-8.

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