CARLSBAD, Calif. — Lasers and energy-based treatments alone or in combination with medical therapy may improve outcomes for patients with moderate to severe acne, according to Arielle Kauvar, MD.
At the annual Controversies and Conversations in Laser and Cosmetic Surgery symposium, Kauvar, director of New York Laser & Skin Care, New York, highlighted several reasons why using lasers for acne is beneficial. “First, we know that topical treatment alone is often ineffective, and antibiotic treatment does not address the cause of acne and can alter the skin and gut microbiome,” she said. “Isotretinoin is highly effective, but there is a growing reluctance to use it. Lasers and energy devices are effective in treating acne and may also treat post-inflammatory hyperpigmentation and associated scarring.”
The pathogenesis of acne is multifactorial, he continued, including a disruption of sebaceous gland activity, with overproduction and alteration of sebum and abnormal follicular keratinization. Acne also causes skin microbiome imbalance, local inflammation, and activation of both innate and adaptive immunity.
“Many studies point to the fact that inflammation and activation of the immune system may actually be the primary event” of acne formation, said Kauvar, who is also a clinical professor of dermatology at New York University in New York. “This persistent immune activation is also associated with scarring,” he noted. “So are we off target in terms of trying to kill the sebaceous glands? Should we be focusing on anti-inflammatory approaches?”
AviClear became the first 1726 nm laser approved by the US Food and Drug Administration (FDA) for the treatment of mild to severe acne vulgaris in 2022, followed a few months later by the FDA clearance of another 1726 nm laser, the Accure Acne Laser System in November 2022. These lasers cause selective photothermolysis of sebaceous glands, but according to Kauvar, “access to these devices is somewhat limited right now.”
What is available includes its go-to device, the pulsed dye laser (PDL), which has been widely studied and demonstrated in a systematic review and meta-analysis of studies to be effective for acne. PDL “targets skin blood vessels by facilitating inflammation, upregulates TGF-beta, and inhibits CD4+ T cell-mediated inflammation,” he said. “It can also treat PIH [post-inflammatory hyperpigmentation] and may be helpful in preventing scarring.”
In an abstract presented at The American Society for Laser Medicine and Surgery (ASLMS) 2024 Annual Meeting, Kauvar and colleagues conducted a real-world study of PDL therapy in 15 adult women with intractable acne who were maintained on their regimen . Their average age was 27 years and they had skin types II-IV. underwent four monthly PDL treatments with follow-up at 1 and 3 months. At each visit, the researchers took digital photographs and measured inflammatory acne lesions, non-inflammatory acne lesions, and post-inflammatory pigmented lesions (PIPA).
The primary outcomes of interest were investigator global assessment (IGA) scores at the 1- and 3-month follow-up visits. Kauvar and colleagues observed a significant improvement in IGA scores at the 1- and 3-month follow-up visits (P < 0.05), with a mean reduction of 1.8 and 1.6 points on the acne severity scale, respectively, from a baseline score of 3.4. At the 3-month follow-up visits, the number of inflammatory and non-inflammatory lesions was significantly reduced (P < .05) and 61% of study participants showed a decrease in PIPA score. No side effects occurred.
Kauvar disclosed that she has done research for Candela, Lumenis and Sofwave and is a consultant to Acclaro.
