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The Treatment of Acne V ulgaris using a
Novel, Synchronous Intense Pulsed Blue
Light and RadioFrequency Energy system
Lisa M. Kellett, M.D. and R. Stephen Mulholland, M.D.
Toronto, Ontario, Canada
ABSTRACT
form of cleansers, creams, gels, lotions and masks. These consist of salicylic acid, vitamin improvements in lasers that have enabled their A/tretinoin, benzoyl peroxide and antibiotic use in the treatment of skin diseases. For the formulations. In addition, oral antibiotics and most part these have concentrated on non- oral Isotretinoin (Accutane) are also used in the treatment of moderate acne. On average, the rhytides, pigmented lesions, vascular lesions effectiveness of topical or oral medications is technology have resulted in the development of multiple lasers and light sources that are associated with traditional therapies including skin irritation, erythema, chelitis, dry eyes, diseases including Acne Vulgaris (acne). We describe the introduction of a novel dual impressive results in preliminary studies to abnormalities, hypersensitivity reactions, fetal affect the natural course of acne. The evidence to substantiate this is not only a resolution in photosensitivity, irreversible night blindness, the number of papules that were present at the start of treatment, but also a decrease in the formation of new papules. In addition, this technology is fast, has minimal adverse effects acne now go beyond traditional topical and and is associated with zero recovery time.
oral therapies into the realm of lasers, lightsources and radiofrequency. Some of these new INTRODUCTION
light based therapies are 410-415 nm passive Acne has been estimated to affect over 90% of the human population at some point in their porphyrins associated with P.acnes. The result is a destruction of P.acnes. These lasers claim to multifactorial: a disorder of keratinization of have an 80% response rate with a 60% decrease in development of papules at 4 weeks and a o v e rg rowth of Propionibacterium acnes 70% decrease at 6 weeks. The long wavelength laser systems in the long pulsed YAG spectrum overproduction of oil. Multiple treatments are act directly upon the pilosebaceous glands.
available including topical treatments in the hand piece consists of an Aurora head withcontact cooling and containing an Intense PulsedOptical crystal of short, blue light wavelength,between two bipolar, conducted radiofrequencyelectrodes. It is important during treatment thatoptimal contact is made with the skin to deliverthe RF energy and, to deliver the availablefluences of the optical energy safely. The contactcooling handpiece reduces the risk of thermalinjuries to the skin with the short wavelength oflight emitted. Similarly, “arcing” is possible with Figure1.
the radio frequency current, which can also Close-up view of the pulsed blue light optical guide (440-600nm) and bi-polar RF electrodes. Treatment treatment protocol targets sub clinical sebaceous glands with high bacterial loads and results insebaceous gland atrophy. Inflammatory papules Pulsed Optical Energy (POE)
and pustules are treated with a second or thirdpulse, in a non-stacked fashion. The pulsed and Radio Frequency
nature of the device allows a greater depth of penetration than passive “blue light” systems, consists of a combination of Pulsed Optical thus delivering the blue light to greater depths E n e rgy (POE), short wavelength blue light systems, similar to IPL™ (intense pulsed light) Each pulse emits a train of 10, 10ms pulses of and Radio Frequency (RF). The treatments were pulsed light with wavelengths between 440nm performed using the Aurora™ (Syneron Inc.), to 600nm. The inter-pulse delay between each of which has an intense pulsed blue light optical these pulses is 10ms. The RF pulse is a constant head and RF treatment head (Fig. 1). This dual
200 ms pulse duration. The fluences from the system acts on porphyrins through the short short wavelength pulsed light head range from 2-10 J/cm2 and the RF up to 20 J/cm3. The 600nm), while the RF is theorized to cause protocol calls for two treatments/week over 6 sebaceous gland atrophy. This synergistic optical weeks for a total of 12 treatments. Treatment is energy profile and radio frequency is effective in initiated at low POE and RF, then increased t reating two key factors involved in the based upon skin type and response, weekly.
pathophysiology of acne vulgaris; P.acnes andoil/sebum production. The short wavelength, Indications and Contraindications
blue pulsed light flash lamp targets porphyrins therapy include acne vulgaris grades 1-4 (i.e.
pilosebaceous unit. The P.O.E. stimulates the Clearlight™ or other acne programs, skin types 1-6, and patients in whom systemic antibiotics or unstable. The result is destruction of P.Acnes in Accutane are contraindicated. Contraindications the pilosebaceous unit. The RF energy causes include unrealistic expectations, Accutane use within 3 months of treatment, photosensitization sebaceous gland and a subsequent decrease in disorders, collagen vascular diseases (such as As a result of targeting both P. Acnes and the Dermatomyositis, Rheumatoid Arthritis and efficacious acne therapy than a passive, non- pulsed blue light source i.e. the Clearlight™ or a Similar to the FotoFacial RF™, the entire long pulsed YAG system targeting only the face is treated using the Fotofacial overlap technique. A test spot is done in front of each earto ensure a good endpoint and should Treatment Protocol
demonstrate slight erythema. The tre a t m e n t The treatment protocol is to treat the entire may result in minimal to moderate discomfort.
face, not just active papules or pustules. The This can be eliminated with the use of a topical anesthetic cream applied 30 minutes prior to Adverse Effects
t reatment. The duration of treatment is 30 With the exception of transient erythema, no minutes and can be delegated to a laser nurse.
adverse effects were noted. Patients were able to Active papules and pustules are treated with a return to normal activities immediately with no t reatment, there should be very mild,generalized erythema. In regions of the skin that Conclusions
are more pigmented or over active papules and On the basis of our initial series of acne pustules, more erythema might be pre s e n t .
patients treated with synchronous pulsed optical Erythema usually lasts 30-90 minutes however, blue light and radiofrequency energy, we have 1. A series of synchronous, Intense Pulse Optical Maintenance treatment
appears to provide significant reduction in responsive to a number of factors including active acneiform papules and pustules.
hormones, stress and the environment. Becauseof this, unlike other skin lesions, which are 2. The intense pulsed optical, direct contact and t reated with lasers and resolve, acne is not RF energy synergy appears to be effective on curable but can be controlled. Part of this control in our study was to develop a maintenance more advanced nodular cystic acne vulgaris treatment program, which prolongs the benefits of the original treatment course. This program 3. Long term acne flares appear diminished in a Preliminary Study and Results
4. The treatments are very well tolerated and An initial study using a split face comparison have very acceptable, negligible side effect resulted in a 100% response rate. A reduction of new papules of 70-80% was seen after 6 weeks
and maintenance treatment was found to
decrease the frequency and severity of outbreaks
by 50% (Fig. 2)
Figure 2
Before treatment
After 12 treatments, showing approximately
70% clearance of P. Acne.

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