Pulsed Dye Lasers (PDL)

Pulsed Dye Laser Treatment and Acne

Pulsed Dye Lasers (PDL) are occasionally used for the treatment of both active acne symptoms and acne scars. Although they can be used for multiple applications, Pulsed Dye Lasers are not usually not the first-choice of treatment for either active acne or acne scars.

On average, Pulsed Dye Laser treatment of acne and acne scars is reviewed as poor to moderate by patients after treatment. It is likely that PDLs are popular because they are a relatively inexpensive, versatile and common platform – but not because they are an effective for active acne or acne scars.

Pulsed Dye Lasers and Active Acne

There are a handful of clinical research studies that found Pulsed Dye Lasers may be effective for treating active acne infections. There are also a few studies that found PDLs were not effective treatments for active acne. This disagreement is likely because there are several different kinds of PDLs, and the treatments being researched are not all the same for every study.

Research studies on the use of PDL systems for the treatment of active acne for acne found that optimum results required at least four treatments. In addition, PDL-based treatment of active acne usually only provides temporary relief, and acne symptoms eventually return.

Pulsed Dye Lasers can be used as part of Photodynamic Therapy (PDT), which is a treatment that targets sebaceous glands and acne-causing P. acnes bacteria. Photodynamic Therapy works better with adjustable PDLs that are capable of producing a laser with a wavelength near 415 nm (ultraviolet), instead of the more common 595 nm (green/yellow). However, PDLs are rarely used for PDT because there are easier-to-use (and less expensive) light sources available for this treatment.

Pulsed Dye Lasers can also be used to directly kill acne-causing bacteria. The acne-causing Propionibacterium acnes bacterium produces a special molecule called porphyrin. When porphyrin is exposed to high intensity light at a wavelength around 420 nm (ultraviolet/blue) it generates free radical molecules which can kill the bacterium. This process is called Blue Light Phototherapy. Pulsed Dye Lasers are available that can generate high intensity light in this spectrum. However, other high-intensity sources of blue light (eg. LEDs) are substantially less expensive than PDL and are generally used for this type of acne treatment.

PDLs are also being studied as a way to selectively ablate the sebaceous gland, which then inhibits sebum production and reduces acne symptoms. While the research indicates using PDLs is a a viable approach, there are alternative lasers (eg. Diode Lasers) with longer wavelengths that are better suited for this application.

Pulsed Dye Lasers and Active Scars

The most popular dermatology application for Pulsed Dye Lasers is for the removal of birthmarks and other hyper-pigmented marks on the skin. Low-power Pulsed Dye lasers are also used to improve the appearance of wrinkles by stimulating regrowth of the tissue immediately underneath the skin.

Pulsed Dye Lasers can be used for two ablative and non-ablative treatments. Ablative treatments (ablative means to be removed or vaporized at very high temperature) utilize longer laser pulses and/or high light intensity to thermally damage or destroy the target tissue. Certain molecules, like oxyhemoglobin (found in red blood cells), preferentially absorb energy from Pulsed Dye Lasers. This feature makes Pulsed Dye Lasers a viable treatment for spider veins, erythematous acne scars and other skin discolorations caused by damaged or dilated blood vessels.

Both ablative and non-ablative PDL treatments are available for treating acne scars. Pulsed Dye Lasers are generally only used for the treatment of mild acne scars. Improvements in acne scars following PDL treatment are usually modest and superficial. The Pulsed Dye Laser platform is not well suited to correct severe acne scarring. This is because most PDL systems do not penetrate deeply enough into the skin tissue to correct significant acne scar damage.

How Do Pulsed Dye Lasers Work

Dye Lasers get their name from the fact that they use a specialized liquid dye suspension, instead of a crystal, as the source of the laser beam. Pulsed Dye Lasers (PDLs) are designed to deliver short bursts of light that last only a fraction of a second. Many Pulsed Dye Lasers can be adjusted (tuned) to create lasers of several different wavelengths (colors). For dermatology purposes, Pulsed Dye Lasers that produce laser beams at ~495 nm (green/yellow) are the most common.

Popular Pulsed dye laser (PDL) Systems

C-Beam, Cobra, Cynergy, Navigator, N-Lite, PhotoGenica, Regenlite, Vbeam.

References

Laser Treatment of Acne Vulgaris. Jih, et al. 2007.
Investigation of the Mechanism of Action of Nonablative Pulsed Dye Laser Therapy in Photorejuvenation and Inflammatory Acne Vulgaris. Seaton, et al. 2006.
Treatment of Acne Vulgaris With a Pulsed Dye Laser: A Randomized Controlled Trial. Orringer, et al. 2004.
Improvement of Facial Acne Scars by the 585 nm Flashlamp-Pumped Pulsed Dye Laser. Alster, et al. 1996.
Comparison of a 585-nm pulsed dye laser and a 1064-nm Nd:YAG laser for the treatment of acne scars: A randomized split-face clinical study. Lee, et al. 2008.

Diode Lasers

Diode Lasers are quickly becoming the preferred laser treatment for inflammatory acne. Diode Lasers are used to selectively target and damage the sebaceous glands, reducing sebaceous hyperplasia, sebum secretion and acne symptoms. Diode Lasers are also commonly used in hair removal and scar treatment applications.

The long wavelength of Diode Lasers is capable of penetrating deeply enough into the cutaneous tissue (skin) to reach the sebaceous glands. The energy from the laser beam is then absorbed by the tissue, which causes thermal damage. This damage can often cause a reduction in the size and activity of a sebaceous gland.

The use of diode lasers to treat inflammatory acne is a relatively new procedure. However, there are an increasing number of studies that indicate that diode laser treatment can be an effective treatment for inflammatory acne. Diode Lasers can be used in combination with many other Pharmaceutical and NaturopathicAcne Treatments. Diode Lasers (and other Light and Laser Acne Treatments) are also excellent options for women who are pregnant because there is no risk of exposing the fetus to medications.

Because Diode Laser treatment can target the sebaceous glands themselves, it is one of the few Light and Laser acne treatments that can offer the promise of providing long-term acne relief. Diode Laser treatment has a semi-permanent effect on the treated sebaceous glands and can lead to long-term reduction of sebum production in the treated region.

Because hyper-active sebaceous glands and the overproduction of sebum directly contribute to the development of acne symptoms, Diode Laser treatment can significantly improve symptoms for many acne patients. Several scientific research studies have reported that Diode Laser treatment can provide-long term improvement in acne symptoms for many patients.

Diode Lasers are also occasionally used for the treatment of acne scars. They have been reported to be somewhat effective as an acne scar treatment, although other modalities, such as Er:YAG and C02 lasers are more popular for this application.

Diode Lasers use semiconductors as the light source, similar to light emitting diodes (LEDs). There are several different kinds of Diode Lasers. Diode lasers are used in common technology products such as laser pointers and CD/DVD players. The most common Diode Lasers used for the treatment of acne produce a beam of laser light with a wavelength near 1450 nm.

Like other forms of laser therapy, diode laser treatment is almost exclusively provided in a dermatology clinic or hospital environment. Diode Lasers only improve acne symptoms in the areas of the skin that are treated. Therefore, Diode Lasers can be cost effective for patients with small, defined areas that are affected by acne. But the cost can be much higher for individuals with large regions of skin that require treatment.

Popular Diode Laser Systems

Acure, Lightsheer, Smoothbeam, Velas.

References

Use of Lasers and Light-Based Therapies for Treatment of Acne Vulgaris. Mariwalla, et al. 2005.
Acne Treatment With a 1,450 nm Wavelength Laser and Cryogen Spray Cooling. Paithankar, et al. 2002.
Sebaceous Hyperplasia Treated With a 1450-nm Diode Laser. No, et al. 2004.
The 1,450-nm Diode Laser Reduces Sebum Production in Facial Skin: A Possible Mode of Action of Its Effectiveness for the Treatment of Acne Vulgaris. Perez-Maldonado, et al. 2007. 
The 1450-nm diode laser for facial inflammatory acne vulgaris: Dose-response and 12-month follow-up study. Jih, et al. 2006.
Treatment of Inflammatory Facial Acne Vulgaris with the 1450-nm Diode Laser: A Pilot Study. Friedman, et al. 2004.
Smoothbeam Patient Reviews @ Realself

Blue Light Phototherapy

Blue Light Phototherapy is a treatment for acne that uses high intensity blue light (~415 nm) to directly kill acne-causing Propionibacterium acnes bacteria that are growing in the skin.

P. acnes bacteria produce a molecule called Coproporphyrin III that produces free radicals when exposed to high intensity blue light. Blue Light Phototherapy works by causing Coproporphyrin III to produce enough free radicals to damage and kill P. acnes bacteria. P. acnes bacteria fluoresce when exposed to high intensity blue light, which can be observed with the help of special photographic filters (see attached image).

Multiple clinical research studies have reported that Blue Light Phototherapy can temporarily reduce the number of acne-causing P. acnes bacteria that are growing within hair follicles. This reduction can significantly improve acne symptoms in many patients. However, the effect of Blue Light Photherapy is temporary, so treatment must be repeated on a regular basis.
Blue Light Phototherapy is non-invasive and generally has few side effects. Blue Light Phototherapy complements many other types of acne treatments and can be a helpful component of a comprehensive acne treatment plan.

In some cases, the skin of patients is treated with a sensitizing agent prior to Blue Light Phototherapy. This sensitizing agent (eg. ALA or MAL) causes P. acnes bacteria to increase their production of Porphyrins, thus making them more sensitive to treatment. The combination of Blue Light Phototherapy and a sensitizing agent is called Photodynamic Therapy (PDT). In addition to acne, Photodynamic Therapy is also used to treat certain types of skin cancer.

Blue Light Phototherapy is primarily available in dermatology clinics that have a focus on acne. It may also be available at some spas and wellness centers. Blue Light Phototherapy systems can also be purchased for home use. The effects of Blue Light Phototherapy are temporary and achieving the maximum therapeutic benefit requires regular treatments.

There are many home use Blue Light systems available for purchase on the internet. However, it should be noted that almost all of the acne research studies that reported positive results were using high-intensity Blue Light Phototherapy systems. Many of the small, inexpensive Blue Light products that are sold on the internet are unlikely to produce enough of blue light (in the correct spectrum) to be effective for the treatment of acne. Most home use Blue Light Phototherapy systems use LEDs as the light source.

References

Light-emitting diode 415 nm in the treatment of inflammatory acne: An open-label, multicentric, pilot investigation. Tremblay, et al. 2006.
An open study to determine the efficacy of blue light in the treatment of mild to moderate acne. Morton, et al. 2005.
Clinical Efficacy of Self-applied Blue Light Therapy for Mild-to-Moderate Facial Acne. Gold, et al. 2009.
Phototherapy with blue (415 nm) and red (660 nm) light in the treatment of acne vulgaris. PAPAGEORGIOU, et al. 1999.
Blue and Red Light Combination LED Phototherapy for Acne Vulgaris in Patients with Skin Phototype IV. Lee, et al. 2006.
Laser and other light therapies for the treatment of acne vulgaris: systematic review. Hamilton, et al. 2008.
Blue light phototherapy in the treatment of acne. Tzung, et al. 2004.
Acne phototherapy with a high-intensity, enhanced, narrow-band, blue light source: an open study and in vitro investigation. Kawada, et al. 2002.
The effective treatment of acne vulgaris by a high-intensity, narrow band 405-420 nm light source. Elman, et al. 2003.
Eradication of Propionibacterium acnes by its endogenic porphyrins after illumination with high intensity blue light. Ashkenazi, et al. 2003.