Photopneumatic therapy: Vacuum-assisted pulsed light device delivers safe, efficient acne treatment
Patients with acne that is unresponsive to traditional therapies were enrolled in a multicenter study evaluating photopneumatic therapy with a vacuum-assisted pulsed light device (Isolaz, Aesthera). The treatment was easy to deliver and well-tolerated.
The clinical trial enrolled 15 patients who were treated once weekly for up to four sessions.
All patients continued on existing traditional acne treatment during the study, although patients on retinoids were excluded.
Responses were evaluated based on review of stereotactic photographs that were obtained immediately pre- and post-treatment at each session, and again at one month following the last treatment.
Ten patients completed the post-treatment follow-up.
Analyses of data from the last available visit showed all 15 patients benefited with improvement in acne lesion counts. Marked improvement was usually evident after three weeks.
Overall, 11 patients (73 percent) achieved 50 percent to 100 percent clearance of comedonal lesions (open and closed), and 12 subjects (80 percent) achieved 50 to 100 percent clearance of inflammatory lesions (papules, pustules, nodules).
Patient satisfaction was also assessed as an outcome measure and was found to be very high.
Using a global scale of acne severity, five patients (33 percent) indicated they were very satisfied, and nine patients (60 percent) were extremely satisfied. The remaining patient was moderately satisfied.
"This device-based treatment involves sessions that are relatively short and painless, and it results in rapid clearing of facial acne after only a few weeks.
"These very favorable features account for the high patient satisfaction noted in this study, and it is an excellent complement to traditional medical acne therapies," Dr. Munavalli tells Dermatology Times.
Patients who were included in the study had Fitzpatrick skin types I to IV and were selected for inclusion based on a history of responding inadequately to multiple previous treatments.
The photopneumatic therapy was delivered with a multi-pass regimen involving three to five full-face passes applied during a 20- to 30-minute session.
Power and vacuum were varied for each patient, depending on skin type and tolerability, and the cutoff filter for the broadband light device also varied (550 nm or 580 nm) according to patient skin type.
Mechanisms of action
Dr. Munavalli says the rapid and marked improvement associated with the photopneumatic therapy is thought to reflect its multimodal mechanisms of action.
He says the heat and vacuum suction are thought to reduce follicular plugging and the sebaceous load, as well as sebaceous gland activity and inflammation.
In addition, the light and heat can induce activation of endogenous porphyrins leading to a decrease in colonization by Propionibacterium acnes.
Suction-induced stretching of the skin may also reduce the concentration of competing cromophores that is thought to be a factor limiting the effectiveness of traditional intense pulsed light treatment.
The potential for the photopneumatic therapy to act via these multiple pathways is also consistent with other clinical observations made during the study.
In addition to experiencing reductions in total lesion counts, patients reported improvements in the number, interval and severity of breakouts.
Furthermore, while the reduction in lesion counts became most noticeable after three treatments, many patients reported a decrease in oil production beginning after the first treatment.
"Also consistent with the idea that photopneumatic therapy has a direct effect on sebaceous gland activity was the finding that female patients with hormonal/menstrual cycle-sensitive acne noted less severe flaring at successive cycles after starting the study," Dr. Munavalli says.