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Laser Damage to Glands Reduces Acne Lesions
Special Report: LASERS
The Leading News Magazine for Dermatologists
1/1/2004
Dermatology Times
Atlanta- Selective dermal heating targeting the sebaceous glands causes a significant reduction in acne lesions, according to Mark A. Blair, M.D., a third-year dermatology resident at the Naval Medical Center, San Diego.
Dr. Blair and his colleagues conducted a small study of selective dermal heating using the 1450-nm Smoothbeam laser (Candela) and its cryogen-cooling device. The investigators performed four treatments at three to four-week intervals on the backs of 27 male volunteers with mild to moderate acne lesions and skin types II through IV.
The treatment consisted of intermittent bursts of laser, averaging 16 to 18J/cm2, between 40 msec of cryogen cooling spray. Each of the treated areas had a diameter of 6cm. A control area was treated only with the cooling device.
Fifteen patients had completed the study by the time results were presented here at the annual meeting of the American Society of Laser Medicine and Surgery. Several patients had to leave the study because they were deployed to Afghanistan or other locations, Dr. Blair said. Final results are expected to be available on about 20 patients.
"At the end of the study, there were no lesions in the 15 patients," Dr. Blair said. "The baseline was six or seven lesions in that square that we treated."
The number of lesions was counted preoperatively, before each treatment, and at six and 12 weeks after the final treatment. A statistically significant decrease in lesions was observed at the follow-up visits. At the six-week point, the average lesion count at the treatment sites decreased from 5.43 to 0.43 (p=0.00013).
"At the control site, the average lesion count measured at the same interval changed from 3 to 3.86, which was not statistically significant. By the end of the follow-up period, the number of lesions at the control site had actually increased," Dr. Blair said.
"Occasionally the control site would decrease just a little bit or increase just a little bit,
depending on the follow up. That was because of the deployments," he said. "Some people would meet certain follow-up dates and some people wouldn't, so there's a little discrepancy as far as those numbers. But overall, from those 15 patients that finished, their mean lesion count on the control site actually went up."
Improvement, Side Effects Present
"On the treatment side there was a moderate to very significant improvement all the way to the end. There were zero lesions by the end of the study."
The only acute side effect in any of the patients was erythema, which lasted five to twelve hours. A few patients also experienced edema. Hyper pigmentation occurred at the treatment sites in two patients with Type IV skin; however, the problem was largely resolved within six to nine weeks.
In a patient satisfaction survey following treatment, all patients said they would be willing to have their entire back treated rather than just a small section, despite classifying the pain as mild to moderate.
Dr. Blair and the other dermatologists at the Naval Medical Center, along with sources at Candela, came up with the experimental therapy in a roundabout way.
“Our approach to treatment, like many discoveries, was serendipitous,” Dr. Blair said. The laser was being studied for the treatment of periorbital wrinkles, and researchers analyzing the histology of biopsy results noticed thermal damage in the sebaceous glands. Since acne is the result of excessive production of sebum, they decided to launch a new study investigating the laser and its cooling device in acne treatment.
“We started off with this study not knowing if it would help,” Dr. Blair said, “We didn’t know how much damage to the sebaceous glands was actually happening, or whether it would be enough to decrease sebum production.”
Epidermis Left Intact by Device
The mechanism of action led them to believe the technique might be successful. “The epidermis is left intact by the cooling device during the treatment,” Dr. Blair said. “The heating of the dermis leads to the thermal alterations of the sebaceous glands. We were hoping, as a consequence, that lesions would be reduced.”
The depth of heating is 100nm to 300nm, where most of the sebaceous glands are found. “The magical thing for the 1450nm laser is not necessarily what it’s heating but where,” Dr. Blair said. “It heats the dermis down to a point where most of the sebaceous glands reside. The heating damages the sebaceous glands in that zone.”
"Histological examination revealed mild necrosis to the duct epithelium and sebocytes of the sebaceous glands. The glands are damaged but not destroyed, which is preferable since destruction could lead to side effects such as dryness and eczema," Dr. Blair said.
"Dermatologists at the Naval Medical Center have begun a study of selective dermal heating with the 1450nm laser as a form of therapy for facial acne lesions," Dr. Blair said. If the results are as strong as they were in the back study, it will lead to FDA approval of the laser for this purpose. “A lot of people are going to be excited about this,” he said. 
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