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ACNE IN INDIA: GUIDELINES FOR MANAGEMENT - IAA CONSENSUS DOCUMENT
Year : 2009  |  Volume : 75  |  Issue : 7  |  Page : 49-50

Physical modalities


members Indian Acne Alliance, India

Correspondence Address:
Raj Kubba
Consultant Dermatologist, Kubba Clinic,10, Aradhana Enclave, Ring Road, New Delhi - 110066
India
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Source of Support: Production and publication of this supplement is made possible by an educational grant from Galderma India Pvt. Ltd., Conflict of Interest: Indian Acne Alliance (IAA) meetings logistics to formulate IAA consensus document DQAcne in India: Guidelines for managementDQ were supported by Galderma India Pvt. Ltd.


PMID: 19282594

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How to cite this article:
Kubba R, Bajaj A K, Thappa D M, Sharma R, Vedamurthy M, Dhar S, Criton S, Fernandez R, Kanwar A J, Khopkar U, Kohli M, Kuriyipe V P, Lahiri K, Madnani N, Parikh D, Pujara S, Rajababu K K, Sacchidanand S, Sharma V K, Thomas J. Physical modalities. Indian J Dermatol Venereol Leprol 2009;75, Suppl S1:49-50

How to cite this URL:
Kubba R, Bajaj A K, Thappa D M, Sharma R, Vedamurthy M, Dhar S, Criton S, Fernandez R, Kanwar A J, Khopkar U, Kohli M, Kuriyipe V P, Lahiri K, Madnani N, Parikh D, Pujara S, Rajababu K K, Sacchidanand S, Sharma V K, Thomas J. Physical modalities. Indian J Dermatol Venereol Leprol [serial online] 2009 [cited 2019 Jun 24];75, Suppl S1:49-50. Available from: http://www.ijdvl.com/text.asp?2009/75/7/49/45485


Lights and lasers have received immense attention in the management of acne in the past five years. They have been discovered to be effective in inflammatory acne through two mechanisms, namely: their biological effects on P. acnes and thermal effects on sebaceous glands. [1] Lasers that emit wavelengths in the visible light spectrum (400-700 nm) take therapeutic advantage of the Q-band absorption peaks (500-700 nm) of porphyrins stored within P. acnes and the subsequent self-destruction of the bacteria.[2] In addition, long-wavelength, near- and mid-infrared lasers cause photothermal damage to the sebaceous glands as a result of a deeper penetration.[3] Conventional UVA and UVB light treatments have little or no acne activity. [1]

Blue-light has the most effective visible wave-length for photoactivation of P. acnes endogenous porphyrin components because the 407-420 nm band has the strongest porphyrin photoexcitation coefficient. [1] Red-light (660 nm) is less effective at activating porphyrins, but it penetrates deeper into the tissue. [1] Red-light, on the other hand, may have anti-inflammatory properties by influencing cytokine release from macrophages that stimulate fibroblast proliferation and the production of growth factors, and by influencing the process of inflammation, healing, and wound repair.[4],[5] Phototherapy with mixed red-blue light may act synergistically, improving both inflammatory and comedonal acne by combining antibacterial and anti-inflammatory actions; however, the differences are not statistically significant. [4],[5]

Photodynamic therapy (PDT): PDT is more effective than lights alone. The rationale is based on the knowledge that aminolevulinic acid (ALA) is preferentially taken up by the pilosebaceous units and metabolized in the heme synthesis pathway to produce a buildup of protoporphyrin IX (PpIX), a potent photosensitizer. [1] Once activated by light, PpIX produces singlet oxygen and free radicals that cause damage to the mitochondria, nuclei, and cell membranes. [1] ALA-PDT can be done with many light sources. ALA is applied on the areas to be treated as a 20% cream. The light sources can be: red-light from a diode laser (635 nm, 25 mW/cm 2 ), pulse excimer dye laser (634 nm, 5 J/cm 2 ), or a broadband halogen source (600-700 nm, 13 J/cm 2 ). [1] ALA-PDT offers a unique way of improving acne by selectively damaging the pilosebaceous units and killing P. acnes . There is little damage to the surrounding skin, and it produces prompt and sustained improvement even in nodular and cystic acne. [6] Side effects of ALA-PDT include discomfort during treatment, transient hyperpigmentation, exfoliative erythema, crust formation, and photosensitivity. [1] The exfoliative erythema and crust formation are typically severe enough to compromise the patient physically and socially for up to two weeks. Another PDT approach is to combine indocyanine green dye (ICG) which is applied topically and combined with a diode laser in a low- or high-power mode to cause photothermal damage to the sebaceous glands.

Lasers that have been tried in acne include: 532-nm KTP, 585-nm and 595-nm pulse dye (PDL), 810-nm and 980-nm Diode, 1064-nm and 1320-nm Nd:YAG, 1450-nm Diode, 1540-nm Erbium-Glass, and Intense Pulse Light (IPL). Some of these lasers, the long-wave, mid-infrared, were developed for facial rejuvenation and have now found place in acne treatment. In particular, 1450-nm Diode seems more popular compared to other laser options. In a pilot study, 14 of 15 patients who had four sittings at three weeks interval with 1450-nm diode laser (18 J/cm 2 ) had a significant and sustained reduction of lesion counts up to six months following the final treatment. [7]

Laser irradiation is known to promote collagen remodeling and this effect has been successfully employed in improving acne scars. [8],[9],[10] Fractional thermolysis (Fraxel laser) is a novel concept in treatment of acne scars and appears to be very promising. [11],[12]

It will be a while before light and laser treatments for acne become viable, cost effective, and popular in India. And when they do, only then we will know how suitable they are for our particular skin types, and how they compare with other available treatment options? The early indications are that they are only moderately effective in inflammatory acne, not at all effective in comedonal acne, and at best improve superficial boxcar scars and ice-pick scars.

 
  References Top

1.Nouri K, Villafradez-Diaz LM. Light/ laser therapy in the treatment of acne vulgaris. J Cosmetic Sci 2005;4:318-20.  Back to cited text no. 1    
2.Cunliffe WJ, Goulden V. Phototherapy and acne vulgaris. Br J Dermatol 2000;142:855-6.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]
3.Lloyd JR, Mirkov M. Selective photothermolysis of the sebaceous glands for acne treatment. Lasers Surg Med 2002;31:115-20.  Back to cited text no. 3  [PUBMED]  
4.Charakida A, Seaton ED, Charakida M, Mouser P, Avgerinos A, Chu AC. Phototherapy in the treatment of acne vulgaris. Am J Clin Dermatol 2004;5:211-6.  Back to cited text no. 4  [PUBMED]  
5.Fien S, Ballard CJ, Nouri K. Multiple modalities to treat acne: A review of lights, lasers, and radiofrequency. Cosmetic Dermatol 2004;17:789-93.  Back to cited text no. 5    
6.Hongcharu W, Taylor CR, Chang Y, Aghassi D, Suthamjariya K, Anderson RR. Topical ALA-photodynamic therapy for the treatment of acne vulgaris. J Invest Dermatol 2000;115:183-92.  Back to cited text no. 6  [PUBMED]  [FULLTEXT]
7.Paithankar D, Ross V, Blair M, Graham B. Acne treatment with a 1450 nm wavelengtrh laser and cryogen spray cooling. Laser Surg Med 2002;31:106-14.  Back to cited text no. 7    
8.Sadick N, Schecter A. A preliminary study of utilization of the 1320-nm Nd:YAG laser for the treatment of acne scarring. Dermatol Surg 2004;30:995-1000.  Back to cited text no. 8    
9.Rogachefsky AS, Hussain M, Goldberg DJ. Atrophic and a mixed pattern of acne scars improved with a 1320-nm Nd:YAG laser. Dermatol Surg 2003;29:904-8.  Back to cited text no. 9  [PUBMED]  [FULLTEXT]
10.Woo SH, Park JH, Kye YC. Resurfacing of different types of facial acne scar with short-pulsed, variable-pulsed, and dual mode Er:YAG laser. Dermatol Surg 2004;30:488-93.  Back to cited text no. 10  [PUBMED]  [FULLTEXT]
11.Hasegawa T, Matsukura T, Mizuno Y, Suga Y, Ogawa H, Ikeda S. Clinical trial of a laser device called fractional photothermolysis system for acne scars. J Dermatol 2006;33:623-7.  Back to cited text no. 11  [PUBMED]  [FULLTEXT]
12.Alster TS, Tanzi EL, Lazarus M. The use of fractional laser photothermolysis for the treatment of atrophic scars. Dermatol Surg 2007;33:295-9.  Back to cited text no. 12  [PUBMED]  [FULLTEXT]




 

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