Shedding Light on Devices for Acne: Update from Emmy Graber, MD

There are energy-based devices approved for the treatment of acne plus others with promising data. But there is some confusion about what works and what doesn't. AARS Treasurer Emmy Graber, MD provides an overview of findings from a recent study.

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Transcript

This transcript has not been edited for content or accuracy.

This is hot topics from the American Acne and Rosacea Society.
Energy-based devices are increasingly recognized for their potential to treat acne, but there is a wide range of device types, and a lack of consensus regarding treatment parameters. In a review article recently published in Lasers in Medical Science, Jean-Pierre and colleagues attempted to assess emerging and existing energy-based devices that have been used in acne. AARS Treasurer, Dermatologist, Dr. Emmy Graber, practices at the Dermatology Institute of Boston, and has been involved in research on lasers for acne.
She was not involved in the recent publication, but she spoke with us about the review's findings. And helped shed some, ahem, light on the role for devices in acne care now and in the future. 

Dr. Emmy Graber:
This was a review study looking at laser and light-based devices to treat acne. There have been a number of laser and light-based devices looked at for studying acne over the years. And this article attempted to capture some of the strongest and best studies in the literature, and write a review as to how they worked for acne.
We're always looking for something new for acne. Despite all of our therapeutic modalities, there's not one treatment that's perfect for all of our patients, and patients have different unique needs. Some patients are particularly looking to do something other than a pharmaceutical, or other than an over-the-counter medication. And so it's nice to know about these options so that we can educate our patients about what lasers or lights might be suitable for them. This study looked at different light sources such as blue light, red light, intense pulse light. Looked at pulse dye laser.
It looked at some of the infrared lasers. And of note in this study, they did a review of the 1726 nanometer laser devices, which are relatively newcomers to the market, just in the last few years. And the authors did note that of the evidence that we have available, the largest studies are done with these devices. There's no one device that really is the gold standard yet for treating acne. There are many devices that have been used. Some of the lasers and lights, as the authors concluded, are really limited by their depth of penetration, such as blue light. While it does a great job at killing cutobacterium acne, it's really limited by its depth of penetration into the skin. It may not be reaching all the way down into the sebaceous gland where a lot of the C acne is located. Some of the laser and light devices are really limited by their side effects, such as pain.
We know that some of the older infrared wavelengths, such as the 1320 nanometer devices, really were just uncomfortable for patients requiring multiple treatments. The authors also concluded that in most of the studies, they were really limited by a lack of follow-up time. Such that many of these acne patients were only studied maybe for a week or two after the laser light treatment was concluded. Whereas really, with acne studies, our patients are looking for duration that's much longer, or maybe even permanent. So the authors really concluded that more studies are needed. And I thoroughly agree with that. I think we need to look at these lasers and light-based devices more deeply. We need to do larger studies. We need to have a longer follow-up period for these studies. And we need to better define if there are certain populations of acne patients that may do best with these lasers.
A lot of these studies, by their nature, looked at adults. But it would be nice to know whether, perhaps some of these lasers and lights are better suited for our adolescent population. Or maybe they are better for adults. Are they better for males or for females? These are interesting things that would really help us as clinicians to know, so that we can appropriately counsel our patients when they're inquiring about laser and light-based options for their acne.
So this review article dealt only with lasers and light-based devices that are primarily found in physicians' offices. There are a lot of lasers and, well, I should say, not lasers, but light-based devices that patients can buy over-the-counter for use at home to treat their acne. And while some of these are red lights or blue lights, and that is addressed in the article, they may be of lower, lower power, lower fluence.
This article really only addressed studies that were done on devices that are available in physician's offices. And it would be really nice to know more about these at-home devices that our patients may be purchasing over-the-counter, and using on their acne to know if they have any therapeutic benefit at all. This article does give us some implications for patient care in treating acne. Even if you are a dermatologist that doesn't use lasers, doesn't use light-based devices, you're going to have patients, they're going to ask you, "Hey, could I use a laser to treat my acne?"
And it's good to give them some of the evidence that is presented in this article. Now, we know that there is evidence that some of these devices may help some patients, but we really don't know how long they're going to keep their skin clear, or their skin better. So this study, it does give us some basis for counseling patients, and that is helpful for our day-to-day activities as dermatologists. I think in addition to having more studies that look at a longer follow-up period, and look at different populations of acne patients, it would be nice to have some studies that are head-to-head studies comparing some of these devices. Perhaps comparing the newer 1726 nanometer lasers to some of our older devices, and seeing which one is better in head-to-head.Speaker 1:

Host:

Thank you for joining us for Hot Topics from the American Acne and Rosacea Society.
Special thanks to Dr. Graber for sharing her insights. The AARS Hot Topics Podcast is produced for the American Acne and Rosacea Society by physician resources. The Hot Topics Podcast is a complement to the Semi-Monthly Hot Topics newsletter. The Hot Topics Newsletter is an AARS member benefit delivered to your email inbox.
Get information at acneandrosacea.org. And why don't you plan to come interact with AARS in real life at our annual Scientific symposium to be held May 7th in San Diego? More details and free registration are also on the AARS website.