BBI Contributing Editor
Treating active acne with new light-based devices can generate a profitable new practice revenue stream as opposed to simply prescribing medications. Several systems have been commercialized for this application, and more are expected to emerge this year. These new technologies finally offer physicians an opportunity to participate in the estimated $5 billion acne treatment business, which is currently ruled by the pharmaceutical giants.
ClearLight from Lumenis (Santa Clara, California) is a high-intensity blue light-based system that was developed specifically to treat acne. This system, the first light-based treatment device to be commercialized, was introduced in Europe in 2000. FDA clearance in the U.S. is expected any time. Meanwhile, ClearLight is only sold outside of the U.S.
"More than 500 patients have been treated in leading universities and private clinics," according to Yariv Matzliach, director of marketing for the aesthetic business unit of Lumenis. "Clinical trials have also been conducted by world acne treatment opinion leaders." He said he believes that ClearLight is the only acne phototherapy system that "both treats and prevents acne lesions. The other systems are spot treatments. Even if a certain lesion heals faster, these devices do not destroy bacteria in the other sebaceous glands." He said ClearLight is the only system that photodestructs p. acnes in all facial sebaceous glands and prevents new lesions. "This is the basis for its unique ability to get to 65% reduction in four weeks. The porphyrines in p. acnes are five to 10 times more sensitive to the blue-violet light emitted by ClearLight as compared to green or red light. This provides a significant time/cost benefit ratio."
"We recommend ClearLight acne phototherapy to all our patients with inflammatory acne and to patients with cystic acne who cannot or do not want to receive Accutane," said Yoram Harth, MD, head of the photodynamic therapy unit at Elisha Hospital (Haifa, Israel). "I have experienced a response in more than 80% of treated patients. In patients with papulo pustular acne, we notice a 65% decrease in acne lesions after eight biweekly, 15-minute treatments. A significant decrease in inflammation also has been observed in patients with more severe cystic acne."
Besides ClearLight's "splendid safety profile, we recommend maintenance therapy with mild anti-acne topical medications after completing one month of phototherapy," said Harth, who has been treating active acne with the ClearLight for the past 18 months. "ClearLight is the first choice in more than 70% of our patients," he said. "Ideal candidates are patients with inflammatory acne and less than five deep cysts." The practice economics are also favorable. The patient is assessed by Harth at baseline and at the end of therapy. All the rest of the therapy is performed by a physician assistant.
In December, Radiancy (Orangeburg, New York) received marketing approval in Canada for its new ClearTouch Acne Replacement Kit ($750) used in conjunction with the company's SpaTouch PhotoEpilation System ($14,900). ClearTouch acne therapy employs a combination of filtered green wavelengths of light and heat. When the light-generating handpiece is passed over the affected skin, it penetrates the tissue and targets the acne by shrinking the sebaceous glands and destroying acne-causing bacteria.
"I was initially skeptical about ClearTouch, but I have seen a definite reduction in the red papules," said Christopher Ho, MD, an assistant clinical professor of dermatology at the University of California in Los Angeles. "The light energy or the heat of the device also appears to render a superficial exfoliation. Two to three days after the procedure, patients tend to comment that their skin feels softer. This is especially important to women."
Ho, who has been using ClearTouch therapy since August, generally performs weekly treatments over a period of six to eight weeks. After completion, "there is about a 30% to 40% reduction in the severity of acne," he said. Using ClearTouch also is convenient. "By exchanging the head, which contains a light bulb, you can easily switch from hair removal to acne treatment," Ho noted.
"Because ClearTouch reduces the inflammatory papules, people who wish not to take antibiotic treatment orally may benefit from this treatment," Ho said. "Some patients are against taking systemic medications because of the potential side effects. Plus, conventional systemic medications do not make the skin softer." However, ClearTouch "does not effectively treat commedone acne," he added.
"Active acne is the most common skin condition in the United States. It affects some 17 million people," said Harold Brody, MD, president of the American Society for Dermatologic Surgery (Schaumburg, Illinois). Furthermore, about 85% of people between the ages of 12 and 25 "suffer from some sort of active acne at one time or another," Brody said. Likewise, "the inflammatory changes of acne that are truly socially disabling may occur in as much as 50% of adolescents and may leave scars that are lifelong." Boys have a peak incidence between ages 16 and 19 vs. girls at 14 to 16. However, "boys tend to have the more severe form of acne," Brody said.
Brody, a clinical professor of dermatology at Emory University School of Medicine (Atlanta, Georgia), noted that an increasing number of people in their 20s, 30s and 40s are developing acne from hormonal changes (caused by birth control pills and other drugs) and stress. "Beyond age 23, acne is more prevalent among women," he said. "And in older patients, about 80% of acne cases are female."
All non-pustular phases of acne can be treated effectively with the PhotoGenica V Star pulsed-dye laser ($64,900) from Cynosure (Chelmsford, Massachusetts), according to Henrik Mikkelsen, MD, director of the Dermatologic Skin Clinic (Birkerod, Denmark). "A dominating pustular phase must be treated by conventional therapy before laser treatment," Mikkelsen said. "Primarily, we treat the red popules that can be present for a period of time."
At Mikkelsen's practice, the fluences for facial acne are between 1.8 J/cm2 and 2.4 J/cm2, using a 10-mm spot size with 50% overlapping. But he has not tried combined retinoid therapy. In fact, he prefers to cease retinoid treatments several months before starting laser treatment. "The elements of acne are very sensitive to pulsed-dye laser treatment, even with low treatment fluences. Purpuric reaction is not necessary," he said.
Additionally, "patients appreciate that there is no discoloration after treatment," Mikkelsen said. The PhotoGenica V Star is most likely effective on acne because "P. Acnes — bacteria that cause acne inflammation — are photosensitive to the pulsed-dye wavelength. The laser destroys the surface and ductal acne bacteria. Secondly, the laser improves the erythema caused by acne." Moreover, "patients appreciate the fast improvement of the reduced redness. Often drugs with systemic effect can be avoided."