While conventional treatment for acne in the form of topical products and oral medications may be the solution for some acne sufferers, there are still a sizeable number of victims who do not achieve satisfactory recovery from them. Light and laser based therapies however are major breakthroughs in the battle against acne. Not only do they target sending active acne into remission, they too improve the appearance of resultant acne scars as well. Owing to the fact that these modalities of treatment are deemed to be considerably safe (as they are not invasive) and also have substantial effectiveness, light and laser therapies are gradually becoming quite literally the light at the end of the tunnel for many.
In this article, a few examples of light based therapies and how they aid in the treatment of acne will be touched upon. Although the exact mechanism of action of this therapy is not fully understood, proposed theories on how they work revolve around the usage of light and photosensitisers (molecules that absorb and subsequently are activated by light) as well as the resultant oxidative stress from photosensitisers. These are three important components of light based therapies to bear in mind as we think about how this therapy works to tackle acne.
Broad-spectrum continuous-wave visible light sources (blue light, red light):
Propionibacterium acnes (P.acnes) bacteria, the main bacteria associated with the development of acne produces porphyrins. These porphyrins best absorb light at the wavelength of 410nm. This is within the absorption spectrum of blue and red light. As such, blue and red light therapy are believed to be absorbed by the porphyrins of this acne perpetrating bacteria. Subsequently, the porphyrins become activated and thus produce free oxygen radicals which will ultimately kill P. acnes. Although red light does not activate the porphyrins as well as blue light, it penetrates more deeply into the skin and hence is efficacious as well. With a reduction in the amount of acne causing bacteria in the skin, this effectively decreases the occurrence of breakouts.
IPL, PDL, KTP lasers and Infrared lasers are proposed to work through the inhibition of P. acnes and cause thermal injury to the sebaceous glands on the skin and thus decrease sebum production. When sebum production decreases, this also helps to lower the likelihood of the pilosebaceous units of our skin getting clogged by dirt, dead skin cells and P. acnes; a combination which triggers the development of pimples. Additionally, these lasers also have the effect of causing facial hair to become thinner and once more has the effect of reducing clogging in the pores of our face.
Apart from minimising the conditions that support acne formation, these light based therapies have considerable effectiveness in reducing post-inflammatory redness which is an important aspect of acne scar treatment. The presence of redness of the acne scar accentuates its presence. By targeting oxyhemoglobin which is present within the vascular structures in the skin, successful treatment of acne scar erythema can be achieved.
Photodynamic therapy (PDT):
PDT is a combination of light based and medicinal therapy. It uses medicine in the form of aminolevulinic acid (ALA) or methyl aminolevulinic acid (MAL) which is applied to the skin prior to the shining of the light source. With such a combination, acne is cleared up more effectively than if light was to be used alone. ALA and MAL are photosensitisers. It is postulated that they are preferentially taken up by the pilosebaceous units of the skin and are meant to result in targeted killing off of P. acnes bacteria and also help to reduce the size and activity of sebaceous glands. This way, PDT addresses the issues of pilosebaceous unit clogging and also helps to decrease the inflammation within acne lesions. Additionally, it is also useful in treating the redness of post-inflammatory acne scars. The type of light source utilised in this procedure is decided upon by the dermatologist and it can range from blue/red light to IPL to even non-pulsed broad spectrum light sources; depending on what the medical professional deems to be the most beneficial for the patient’s current state. Some studies however have found that blue light when combined with LA or MLA do not produce significantly better results than if blue light were to be used alone. It is to be noted as well, that this form of light based therapy is associated with the highest number of side effects such as crusting of the skin and even dyspigmentation.
Photopneumatic therapy is considered to be one of the more recent light based therapies available in the market. It makes use of broadband pulsed light which has antibacterial and anti-inflammatory properties as well as a gentle suction pressure delivered through the photopneumatic treatment tip which aids in removing sebum from the face.
Safety issues of these light based therapies:
In general, light based therapies are considerably safe and are associated with very minor side effects such as redness and swelling which will resolve spontaneously after a few hours. However, other more major side effects that may occur include burns, blisters and even changes of skin colour. These are thankfully rare and can be prevented by going to relevant medical professionals and also listening to the doctor’s instructions of not exposing the treated area to sunlight for 48 hours et cetera.
Efficacy of these light based therapies:
Although this modality of treatment is promising, it is also crucial to bear in mind that results will vary from patient to patient and that one requires a series of treatments before satisfactory results can be achieved. As the cause of acne if multi-factorial, rarely can a single treatment modality clear acne. More often than not, a combination of treatments are adopted to achieve synergy in the tackling of acne.
Other forms of treatment available for acne and its scars:
Other viable alternatives to light based therapy include chemical peels. Chemical peels which use glycolic acid or salicylic acid are the most effective for patients who primarily suffer from comedonal acne. Apart from this, oral medications can be considered as well. Oral medications can come in the form of hormonal pills, antibiotics and even isotretinoin for more severe acne. Additionally, a good skincare routine which incorporates topical treatment with anti-bacterial and anti-inflammatory ingredients is vital as well. Diet arguably plays a role in the development of acne as well. Although it is still a highly debated topic, food such as dairy products and sugar are hypothesised to increase the occurrence of acne.
Light based therapies are an attractive treatment option and may very well be the solution for one’s refractory acne and acne scars. However there still remains the absence of an agreement with regards to an optimal treatment protocol. Details such as the best type of light source and its dosage, how the treatment is delivered and also the optimal treatment interval et cetera have not been addressed. It is thus imperative for more studies to be done in order for these loose ends to be tied up. Additionally, there are limited studies conducted comparing the efficacy of light-based treatments with conventional acne therapies. This is an important question to be answered as light based therapies are very expensive and a proper cost analysis needs to be conducted.
Hence, while the role of light based therapy in the treatment of acne is promising, continued research is still necessary to further establish and clarify its part to play in tackling acne! Finally, a discussion with a medical professional to decide which combination of treatment options will be the most beneficial for your current state is important as well.