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    1,450-nm laser treats facial acne rapidly

    Inflammatory counts reduced after only one to three sessions, even in stubborn cases

    Dr. Friedman
    Washington - The recently concluded American Academy of Dermatology conference witnessed the first published report documenting the safety and efficacy of the Smoothbeam laser treatment for inflammatory facial acne. Building on previous research that showed the 1,450-nm diode laser to be effective for treating inflammatory acne on the back, a team of researchers led by Paul M. Friedman, M.D., showed the same type of laser to be safe and effective for treating facial acne vulgaris.

    "The most exciting finding was that we found a marked reduction in inflammatory facial acne counts after only one to three treatment sessions with the laser, even in patients who had been refractory to traditional topical or systemic therapies," Dr. Friedman said. He is clinical assistant professor at the University of Texas, Houston, School of Medicine. "There are certainly other light-based devices that are being approved for acne," he said, "but the advantage of the Smoothbeam is that the treatment, as well as the number of sessions required, is shorter than you probably see with other light-based devices. We found this to be a major advance in the clinical treatment of facial acne vulgaris with an excellent safety profile."

    Clearing of inflammatory papules and pustules is evident (right) after four treatments with the 1450-nm diode laser. (Photos courtesy of Paul M. Friedman, M.D.)
    He said the laser's ability to selectively damage sebaceous glands may account for patients' rapid response. In the study, 19 patients with active inflammatory facial acne vulgaris whose ages ranged from15 to 44 years were treated with the laser at four- to six-week intervals. Researchers used no control group because their trial was designed to examine safety and efficacy (and because previous researchers had used one). Patients were allowed to continue using previous medications, which included topical agents and oral antibiotics, during the study.

    For patients who requested anesthesia, doctors applied topical lidocaine 5 percent (LMX-5; Ferndale Laboratories, Ferndale, Mich.) under occlusion one hour before performing laser treatments. They gave all patients nonoverlapping single pulses of a 1,450-nm diode laser (Smoothbeam; Candela Corp., Wayland, Mass.) equipped with a cooling device. Treatment fluences ranged from 11 to 14 J/cm2, with a spot size of 6 mm. Applications of moisturizing cream and sunscreen immediately followed treatments.

    Dr. Alster
    For analysis purposes, patients were divided into mild, moderate, and severe categories based on pre-treatment lesion counts. After treatment, Dr. Friedman said, "we felt that the moderate to severe groups did best, but there was a trend toward a decreased lesion count in the mild group." The mild group failed to reach statistical significance given the small sample size. Overall, patients' mean lesion count decreased 37 percent after one treatment, 58 percent after two, and 83 percent after three.

    The study's results appear consistent with what dermatologists are finding in the field. "In my practice," said Tina S. Alster, M.D., "using the Smoothbeam laser for acne delivers two procedures for the price of one, meaning that not only is it helpful for inflammatory acne, but it also reduces the risk of scarring and improves scars that are there as a consequence of previous acne." Dr. Alster, director of the Washington Institute of Dermatologic Laser Surgery and clinical professor of dermatology at Georgetown University Medical Center, presented her work using the same laser for atrophic acne scars at the AAD annual meeting as well.

    Patient's right cheek was 100 percent cleared of lesions after three laser treatments.
    "Pilot studies are limited due to the fact that they include small numbers of patients," she added. "For a start, however, Dr. Friedman's study is very good and shows that the Smoothbeam does at least as much, if not more, than do other acne systems."

    According to Neil Sadick, M.D., clinical professor of dermatology at Cornell University, "the longer-wavelength lasers, infrared lasers, Electro-Optical Synergy [ELOS] technology, and radiofrequency devices all can cause temporary shrinkage of sebaceous glands, decrease in organism counts, and decrease in inflammation." However, he said the study would have been stronger if researchers had found a more specific way to measure results than basic lesion counts. "Also," Dr. Sadick said, "it would have been nice to do one or two biopsies to confirm that they're doing some damage to the sebaceous glands."

    A 39-percent decrease in active lesions was observed after two laser treatments.
    At press time, Dr. Friedman and his colleagues had launched a study to determine optimal treatment parameters and duration of sustained improvement of facial acne vulgaris treated with the 1,450-nm diode laser. Candela is sponsoring this study. However, doctors received no financial support from the company for the first study. Dr. Sadick is a research investigator for Syneron (Toronto, Canada) and Thermage (Hayward, Calif.).

    For more information

    Friedman PM, Jih MH, Kimyai-Asadi A, Goldberg LH. Treatment of inflammatory facial acne vulgaris with the 1450-nm diode laser: a pilot study. Dermatol Surg 2004;30:147-51.

    Paithankar DY, Ross EV, Saleh BA, Blair MA, Graham BS. Acne treatment with a 1,450-nm wavelength laser and cryogen spray cooling. Lasers Surg Med 2002;31:206-14.

    Lloyd JR, Mirkov M. Selective photothermolysis of the sebaceous glands for acne treatment. Lasers Surg Med 2002;31:115-20.

    Tanzi EL, Alster TS. Comparison of a 1450-nm diode laser and a 1320-nm Nd:YAG laser in the treatment of atrophic facial scars: a prospective clinical and histologic study. Dermatol Surg 2004;30:152-7.

    John Jesitus
    John Jesitus is a medical writer based in Westminster, CO.

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