Lasers and acne, Do they work to clear acne?
Lasers and acne, Do they work to clear acne?
What is it?
Laser therapy aims to prevent run-of-the-mill "zits" (papules and pustules), and appears to be less effective with non-inflammatory acne (whiteheads and blackheads) and severe lesions (cysts and nodules).1 Lasers, much like at-home light devices, work on the premise of exciting compounds called porphyrins, which live inside acne bacteria.2 When the lasers excite the porphyrins, the porphyrins damage the bacteria wall, effectively killing the bacteria.3
Less acne bacteria should help reduce symptoms of acne. Laser treatment
may also reduce sebum (skin oil) levels. Laser treatment requires trips
to the doctor's office, and costs $200-$500 per treatment. Doctors
usually recommend three treatments, about a month apart, though some
doctors recommend more treatments, and sometimes more frequently. The
kinds of lasers that doctors use on acne patients include Diode, Pulsed
Dye, Fractional, KTP, InfraRed, Potassium Titanyl Phosphate, Nd:YAG,
IPL, Glass, and Pulsed Light and Heat Energy (LHE), as well as a new
"vacuum" laser called Isolaz.4-5 Doctors sometimes apply a
photosensitizer such as aminolevulinic acid (ALA) or
methylaminolevulinate (MAL) prior to laser treatment. Photosensitizers
makes the skin more sensitive to light, and may help produce more
porphyrins within bacteria.1,6-7
Does it work?
Several studies attempting to gauge laser effectiveness exist. However, these studies are almost all small cohort (just a few people), sometimes lack split face design (compare one side of the face to the other), tend to lack long follow up (so it's hard to tell if results last), and often employ no controls. Still, almost all of the studies show at least some improvement in acne symptoms. Consensus amongst researchers is that results are temporary since colonies of acne bacteria grow back quickly. Results are also incomplete, meaning lasers alone usually do not completely clear acne.9 The studies show anywhere from 36% clearance to 83%.2,10-19
Side effects
Some patients experience pain or discomfort
during treatment. Depending upon the laser used, patients report varying
levels of redness after treatment as well as some inflammation and skin
peeling and sometimes blistering and/or crusting. ALA treatment may
cause skin darkening and/or folliculitis (inflammation of hair
follicles), and requires absolute avoidance of sunlight for 30 hours
after treatment to minimize such effects.12
Bottom line
At this time, it's hard to say whether lasers
are worth the time and effort, and if so, which lasers are best. A
systematic review of the 19 avaialable controlled studies on lasers and
acne, published in The Journal of the European Academy of Dermatology and Venereology,
concluded "...most of the studies were of suboptimal methodological
quality...we conclude that optical treatments with lasers...possess the
potential to improve inflammatory acne on a short-term basis...optical
treatments for acne today are not included among first-line treatments."13
Since insurance rarely if ever covers such procedures, patients need to
weigh the cost/benefit ratio. Both proper topical treatment with The Acne.org Regimen, as well as isotretinoin (Accutane) for people with severe acne, can provide more predictable, consistent, and complete clearing.
The Holy Grail
When you delve deeply into literature on
lasers and acne, you find one study where researchers combined long
duration ALA exposure with intense laser therapy.20 Results
from this study points toward potential long term damage to sebaceous
(oil) glands. Since acne cannot exist without sebaceous glands, this
research is intriguing. Unfortunately, most patients in these trials
experienced skin darkening and/or folliculitis. Still, this is an area
well worth further investigation.
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