Light and Laser Treatments for Active Acne

Blue Light Phototherapy

Light and Laser (L&L) Treatments use high-intensity light sources to treat active acne and ameliorate acne symptoms. Most of Light and Laser treatments are fairly non-invasive and can be combined with Pharmaceutical, Naturopathic and OTC acne treatments to create comprehensive acne treatment regimens.

Many L&L Treatments can improve acne symptoms, but the effects are often temporary. For many patients, treatments must be repeated on a regular basis to achieve the maximum benefit. These treatments also tend to be more expensive than many of the common Pharmaceutical treatments that are available. Nonetheless, Light and Laser treatments are excellent options for most people, especially when used in combination with other types of treatments. Below is our complete guide to the Light and Laser Treatments available for Active Acne.

Blue Light Phototherapy

LED Blue Light PhototherapyBlue 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 porphyrin that produces free radicals when exposed to high intensity blue light. Blue Light Phototherapy works by causing porphyrin to produce enough free radicals to damage and kill P. acnes bacteria.

Blue Light Phototherapy is a safe, non-invasive treatmtent that complements most other acne treatments. Our discussion about Blue Light Phototherapy and acne can be found here.

Diode Lasers

Diode Laser Acne TreatmentDiode Lasers are becoming a popular 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 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 Naturopathic Acne Treatments. Our discussion about Diode Lasers and acne can be found here.

Intense Pulsed Light (IPL)

Intense Pulsed Light (IPL) Treatment of NeckIntense Pulsed Light (IPL) therapy uses short bursts of high intensity light to treat a variety of skin conditions. IPL is most commonly used for photo-rejuvenation procedures and to treat mild skin discolorations caused by hyper-pigmentation. Intense Pulsed Light (IPL) therapy is also occasionally used to treat active acne symptoms and certain types of mild acne scars.

Although IPL is not a common treatment for active acne, several research studies have reported positive results that suggest IPL might be an effective acne treatment. IPL can be used commonly as part of Photodynamic Therapy (PDT), which uses a topical photo-sensitizer to increase the effectiveness of the treatment. Overall, clinical research studies have found that IPL alone was partially effective at improving acne symptoms. Very few patients experienced dramatic improvement of their acne symptoms in response to IPL treatment. However, the research does suggest that IPL can be partially helpful, and IPL may be a valuable addition to comprehensive acne treatment regimens. Our discussion about IPL and acne can be found here.

KTP Lasers

KTP Laser TreatmentsKTP Lasers are commonly used for minimally invasive ablation and coagulation treatments. KTP lasers have also been used to treat rosacea, spider veins, hyper-pigmented spots and acne, although it is an uncommon acne treatment.  KTP Lasers are occassionaly used for Photodynamic Therapy (PDT) of active acne.

Low power KTP Lasers can theoretically be used for the treatment of active acne. In these application, KTP lasers can be used as a form of light therapy and/or Photodynamic Therapy (PDT) to directly target acne-causing Propionibacterium acnes bacteria living in follicles. The green light generated by KTP lasers can activate molecules in P. acnes bacteria called porphyrins. Activation of the bacterial porphyrin releases free radical molecules, which can kill the bacteria. Although green light is less effective at activating porphyrins then Blue Light Phototherapy, it is able to penetrate more deeply into the skin tissue. Our discussion about KTP Lasers and acne can be found here.

Photodynamic Therapy (PDT)

Photodynamic Therapy (PDT) Acne TreatmentPhotodynamic Therapy (PDT) is the generic name for a class of treatments that use specialized medications called photosensitizers to increase the effectiveness of a light-based treatment. PDT is used treat certain types of skin problems, including acne and some forms of cancer.

Numerous clinical research studies have reported that Photodynamic therapy (PDT) can decrease bacterial levels in the skin and help improve acne symptoms. PDT appears to be more effective for treating inflammatory acne lesions (Acne Types: 2-4) than non-inflammatory acne lesions (Acne Types: 1-2). PDT has also been reported to be more effective at improving acne symptoms than Blue Light Phototherapy or IPL alone. Our discussion about Photodynamic Therapy (PDT) and acne can be found here.

Ultraviolet Light (UV) and Tanning

UV Light Tanning BedUltraviolet (UV) light is electromagnetic radiation with wavelengths that are just shorter than visible light. UV light is most commonly found in sunlight and artificial UV sources, such as tanning beds and blacklights.
Exposure to ultraviolet light, particularly UV-B, can cause sunburns and trigger the production of the pigment melanin in a process commonly known as “tanning”.

Exposure to UV light causes significant changes in the affected skin tissue, and these changes can impact acne symptoms. Many people strongly believe that tanning improves their complexion. While there is certainly some truth to this, the scientific research indicates that exposure to UV Light, tanning and sunburns are a mixed bag when it comes to acne.
Overall, the research is inconclusive (and occasionally contradictory) regarding the relationship between UV Light exposure and acne. Our discussion about UV Light, Tanning and acne can be found here.

Ultraviolet Light (UV) and Tanning

UV Light Tanning Bed

Ultraviolet (UV) light is electromagnetic radiation with wavelengths that are just shorter than visible light. Although humans can’t see UV light, many other animals can. UV light is most commonly found in sunlight and artificial UV sources, such as tanning beds and blacklights. UV light is classified into 3 general groups based on wavelength:

  • UV-A (315-400 nm) – e.g. blacklights
  • UV-B (285-315 nm) – e.g. tanning beds
  • UV-C (100-285 nm) – e.g. germicidal UV light systems

UV Light and Skin

Color Spectrum of Sunlight as a Rainbow
Color Spectrum of Sunlight as a Rainbow

Sunlight contains a full spectrum of colors, including the UV spectrum. However, much of the shorter wavelength electromagnetic radiation in sunlight is absorbed by the atmosphere and does not reach the earth’s surface. As a result only low levels of UV-B, and minute levels of UV-C reach the earth’s surface. UV-B and UV-C light are both capable of causing damage to DNA and the collagen matrix that supports the skin. Because of this, excessive exposure to sunlight and/or tanning booths can accelerate aging of the skin and may increase the risk of skin cancer.

Sun Tanning on Beach
Sun Tanning on Beach

Exposure to ultraviolet light, particularly UV-B, can cause sunburns and trigger the production of the pigment melanin in a process commonly known as “tanning”. Exposure to UV light is important for the natural production of vitamin D in the skin. UV-B and UV-C light can directly damage DNA, which can cause genetic mutations. Strong UV-C light is toxic to bacteria and UV-C systems are commonly used to sterilize air or surfaces. Blacklights (UV-A) do not cause genetic mutations and do not pose a health risk.

UV Light, Sunlight, Tanning and Acne.

Effect of UV Exposure on Sebum Production
Effect of UV Exposure on Sebum Production

Exposure to UV light causes significant changes in the affected skin tissue, and these changes can impact acne symptoms. Many people strongly believe that tanning improves their complexion. While there is certainly some truth to this, the scientific research indicates that exposure to UV Light, tanning and sunburns are a mixed bag when it comes to acne.

Positive Effects of UV Light on Acne

  • A tan (or a sunburn) can even out skin complexion, decreasing the appearance of acne.
  • UV Light is toxic to the bacteria that cause acne, although it is unclear whether UV Light penetrates the skin deeply enough to have much benefit in this respect. Longer wavelength UV light (UV-A) can excite the porphyrins in Propionibacterium acnes bacteria, killing the bacteria in the same way as Blue Light Phototherapy.
  • The increase in skin temperature during an acute sunburn may make sebum less viscous (less sticky), aiding in clearance of sebum plugs.
  • Exposure to UV Light has been observed to modulate immune responses in the skin. One of these changes may be an inhibition or depletion of certain types of white blood cells called Mast Cells and Langerhans Cells, which are involved in immune activation and inflammation. Depletion of these cells could potentially result in short term improvements in acne by decreasing inflammatory responses in the skin.

Negative Effects of UV Light on Acne

  • Some research studies have reported that UV Light can change some non-comedogenic molecules into comedogenic molecules, which may worsen acne symptoms for some individuals.
  • Excessive exposure to UV Light can accelerate skin aging and increase the risk of skin cancer.

Overall, the research is inconclusive (and occasionally contradictory) regarding the relationship between UV Light exposure and acne. The specific effects of UV Light vary greatly between people with different skin tones. In addition the intensity and duration of the exposure to UV Light is very important. Our bodies have adapted over millions of years to respond to UV exposure by increasing melanin (skin pigment) production and upregulating many cellular DNA repair systems. Exposure to small doses of UV light can stimulate these processes, but large doses of UV Light (which cause significant sunburns) can overwhelm the body’s natural defenses and may cause permanent damage.

How and Where is UV Light Therapy Administered?

Tanning Bed at Tanning Salon
Tanning Bed at Tanning Salon

The most common source of UV light exposure is the sun. The second most common source are the UV bulbs used for tanning. Tanning beds usually employ fluorescent bulbs that emit UV-A and UV-B light. Ultraviolet light therapy is also administered in many dermatology clinics, primarily for the treatment of psoriasis and eczema. For these treatments, a specialized source of UV-B light (310-315 nm) is commonly used.

The cost of UV Light therapy varies from free (the sun) up to ~$100 per treatment (dermatologist). The cost of a tanning session (the most common source) often ranges between $5 and $25 per session. There are no established guidelines on the amount of exposure or treatment frequency for treating acne.

UV Light Images

References

Enhancement of comedogenic substances by ultraviolet radiation. Mills, et al. 2006.
Changes of comedonal cytokines and sebum secretion after UV irradiation in acne patients. Suh, et al. 2002.
Epidermal Langerhans Cell Depletion After Artificial Ultraviolet B Irradiation of Human Skin In Vivo: Apoptosis Versus Migration. Kolgen, et al. 2002.
Bivalent Effect of UV Light on Human Skin Mast Cells Low-Level Mediator Release at Baseline but Potent Suppression Upon Mast Cell Triggering. Guhl, et al. 2005.
Ultraviolet phototherapy and photochemotherapy of acne vulgaris. Mills, et al. 1978.
Pathophysiology of premature skin aging induced by ultraviolet light. Fisher, et al. 1997.
Photoinactivation of Propionibacterium acnes by near-ultraviolet light. Kjeldstad, et al. 1984.
A systematic review of the evidence for ‘myths and misconceptions’ in acne management: diet, face-washing and sunlight. Magin, et al. 2004.

KTP Lasers

KTP Laser Treatments

KTP lasers are commonly used for minimally invasive ablation and coagulation treatments. KTP lasers have also been used to treat rosacea, spider veins, hyper-pigmented spots and acne, although it is an uncommon acne treatment. When used for the treatment of acne scars, lower-power KTP lasers that are non-ablative or partially ablative are most commonly used. KTP Lasers are also occassionaly used for Photodynamic Therapy (PDT) of active acne.

How does KTP laser treatment work?

KTP Laser Treatment
KTP Laser Treatment

KTP lasers are modified Nd:YAG lasers that produce a laser beams with a wavelength near 532 nm (green). In a KTP laser, an Nd:YAG laser beam (infra-red) is used to illuminate a crystal of potassium titanyl phosphate (KTP), to generate another laser (green).

The green light produced by the KTP laser is readily absorbed by skin pigments (eg. melanin) and blood (eg. oxyhemoglobin). This selectivity, allows KTP lasers to efficiently targeting of pigmented lesions and spider veins.

KTP Lasers and the treatment of active acne and acne scars.

KTP Laser Treatment of Active Acne B and After Image
KTP Laser Treatment of Active Acne B and After Image

KTP Lasers are occassionally used to treat minor skin discoloration associated with acne scars (eg. hyper-pigmented and erythematous acne scars). KTP Lasers are generally ineffective treatments for most types of acne scarring. For the treatment of moderate to severe acne scars, laser resurfacing technologies that use CO2, Er:YAG and Nd:YAG Lasers are the most common platforms.

Low power KTP Lasers can theoretically be used for the treatment of active acne. In these application, KTP lasers can be used as a form of light therapy and/or Photodynamic Therapy (PDT) to directly target acne-causing Propionibacterium acnes bacteria living in follicles.  The green light generated by KTP lasers can activate molecules in P. acnes bacteria called porphyrins. Activation of the bacterial porphyrin releases free radical molecules, which can kill the bacteria. This mechanism of action i is the same as that for Blue Light Phototherapy acne treatment. Although green light is less effective at activating porphyrins then blue light, it is able to penetrate more deeply into the skin tissue.

Chart of Efficacy of KTP Laser Treatment for Inflammatory Acne
Chart of Efficacy of KTP Laser Treatment for Inflammatory Acne

Blue Light Therapy is more popular than KTP Lasers for the treatment of active acne because it has less risk and a lower cost. KTP lasers are not used to treat active acne by most dermatologists. However, there have been scientific research studies that have reported KTP lasers are moderately effective at improving acne symptoms, with results similar to blue light therapy. The published research indicates that KTP laser treatment does lead to a moderate decrease in the number and severity of acne lesions. In addition, KTP lasers also apparently lead to a moderate decrease in the sebum production in treated areas, although the mechanism is not understood and those results need to be independently validated.

How and where is KTP Laser treatment administered?

KTP Laser Treatment of Vericose Veins
KTP Laser Treatment of Vericose Veins

KTP Laser treatment of active acne and acne scars is generally administered in hospitals, dermatology offices and cosmetic surgery clinics. Because misuse of this and other laser systems can cause significant and permanent injuries, it is important that KTP laser treatment is administered by trained professionals in the appropriate environment.
Costs for KTP Laser treatment vary widely depending on the specific type of treatment. For skin based treatments, the cost of KTP laser treatment is similar to other laser based treatments. For facial applications, KTP laser treatment can easily exceed $500 per session. The number of sessions is generally limited to less than three.

Popular KTP Laser Systems

Aura, DioLite, VariLite

KTP Laser Images

References

Nonablative Phototherapy for Acne Vulgaris Using the KTP 532 nm Laser. Baugh, et al. 2005.
Effects of 532 nm KTP Laser Exposure on Acne and Sebaceous Glands. Bowes, et al. 2003.
Use of the KTP Laser in the Treatment of Rosacea and Solar Lentigines. Bassichis, et al. 2004.
KTP Laser Removal of Hyperpigmented Spots @ Realself.com

Diode Lasers

Diode Laser Acne Treatment

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.

How do Diode Lasers work?

Diode Laser Treatment Selectively Damages Sebaceous Glands (Paithankar)
Diode Laser Treatment Selectively Damages Sebaceous Glands (Paithankar)

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.

Diode Laser Treatment Selectively Targets Subcutaneous Tissue (Paithankar)
Diode Laser Treatment Selectively Targets Subcutaneous Tissue (Paithankar)

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.

Diode Lasers and Acne Treatment

Diode Laser Treatment of Acne 3 (Jih)
Diode Laser Treatment of Acne 3 (Jih)

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 Naturopathic Acne 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.

Graph of Decrease in Inflammatory Acne After Diode Laser Treatment (Jih)
Graph of Decrease in Inflammatory Acne After Diode Laser Treatment (Jih)

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.

Diode Laser Treatment of Acne 1 (Jih)
Diode Laser Treatment of Acne 1 (Jih)

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.

How and Where are Diode Laser Treatment administered?

Smoothbeam Diode Laser Treatment
Smoothbeam Diode Laser Treatment

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.

Individual diode laser treatments of facial acne usually cost between $200 and $400 dollars. Generally speaking, a treatment plan includes 3 separate sessions about a month or two apart. Some practitioners may recommend a yearly or bi-annual maintenance session.

Popular Diode Laser Systems

Acure, Lightsheer, Smoothbeam, Velas.

Diode Laser Acne Treatment Images

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
Diode Lasers @ Wikipedia

Photodynamic Therapy (PDT)

Photodynamic Therapy (PDT) Acne Treatment

Photodynamic Therapy (PDT) is the generic name for a class of treatments that use specialized medications called photosensitizers to increase the effectiveness of a light-based treatment. PDT is used treat certain types of skin problems, including acne and some forms of cancer.

How Does Photodynamic Therapy (PDT) Work?

Decrease in Propionibacterium acnes bacteria in follicles after PDT treatment (Hongcharu)
Decrease in Propionibacterium acnes bacteria in follicles after PDT treatment (Hongcharu)

Photodynamic Therapy (PDT) involves topical application of a photosensitizer followed by exposure to a specialized, high-intensity light source. The photosensitizer causes certain kinds of cells to produce large amounts of light-absorbing molecules called porphyrins. The photosensitizing agent helps target the treatment to the appropriate cells. The acne-causing Propionibacterium acnes (P. acnes) bacterium produces a unique porphyrin molecule that absorbs light in the blue spectrum (~415 nm). When this porphyrin molecule absorbs blue light, it produces free radical molecules that can kill the bacteria.

Aminolevulinic Acid (ALA) Molecule
Aminolevulinic Acid (ALA) Molecule

Aminolevulinic Acid (ALA) is the most common photosensitizer for PDT-based acne treatments. But three other photosensitizers are also occasionally used: MAL (methyl aminolevulinate), LA (levulinic acid) and IAA (Indole-3-Acetic Acid). MAL is generally used with red light sources and is more commonly used against cancer than acne.

Photodynamic Therapy Mechanism of Action (Sandberg)
Photodynamic Therapy Mechanism of Action (Sandberg)

The photosensitizers used in PDT acne treatments are designed to increase the production of porphyrin. which helps improve the anti-bacterial capability of Blue Light Phototherapy and IPL. ALA and LA are starting compounds in the biosynthesis of porphyrin. Topical administration of these medications prior to therapy increases the amount of porphyrin in the P. acnes bacteria that are growing in the skin and follicles. After topical treatment with photosensitizers, the patient is then treated with Blue Light Phototherapy, Intense Pulsed Light (IPL), KTP or Pulsed Dye Lasers. These Light and Laser Treatments cause the porphyrin to release toxic free radicals that kill the P. acnes bacteria. The increased levels of porphyrin generate elevated levels of anti-bacterial reactive oxygen molecules (free radicals) during treatment, which kills more bacteria than light therapy alone.

Is Photodynamic Therapy (PDT) an Effective Acne Treatment?

Effect of PDT on Non-Inflammatory and Inflammatory Acne Lesions (Weigell)
Effect of PDT on Non-Inflammatory and Inflammatory Acne Lesions (Weigell)

Numerous clinical research studies have reported that Photodynamic therapy (PDT) can decrease bacterial levels in the skin and help improve acne symptoms. PDT appears to be more effective for treating inflammatory acne lesions (Acne Types: 2-4) than non-inflammatory acne lesions (Acne Types: 1-2). PDT has also been reported to be more effective at improving acne symptoms than Blue Light Phototherapy or IPL alone. However, PDT rarely results in complete resolution of acne symptoms. It is important to keep in mind that PDT, like most light therapies, provides only temporary benefit and treatment must be repeated regularly to achieve and maintain significant improvements.

ALA-PDT vs MAL-PDT Acne Treatment Before and After
ALA-PDT vs MAL-PDT Acne Treatment Before and After

PDT a popular technique for many dermatologists, but it has received mixed reviews from acne patients. Because PDT requires the careful application of a photosensitizer and controlled light exposure, effective PDT for acne can become quite expensive and time consuming. There are also potential risks associated with the photosensitizers themselves, such as allergic reactions, hypersensitivity to sunlight, redness and inflammation. In summary, while PDT can be an effective acne treatment, many people prefer frequent Blue Light Phototherapy over PDT because of the decreased risk of side effects.

Photodynamic Therapy Targets and Damages the Sebaceous Glands (Hongcharu)
Photodynamic Therapy Targets and Damages the Sebaceous Glands (Hongcharu)

In addition to killing acne-causing bacteria, PDT has been shown to damage the sebaceous glands and temporarily decrease sebum production. Because of these effects, PDT can be a very useful treatment for patients with inflammatory acne that also have sebaceous hyperplasia or excessively oily skin. The effect of a PDT treatment regimen on sebaceous gland activity and sebum production appears to be semi-permanent. PDT may be a viable alternative to oral retinoids (eg. Accutane) in some patients, such as pregnant women.

Some dermatologists advocate using ALA-PDT to treat sebaceous hyperplasia (enlarged sebaceous glands) and other conditions. However, PDT is not highly targeted and the treatment can cause some collateral skin damage. For patients with small areas of affected skin, Pulsed Dye Laser (PDL) systems may be more effective for targeting hyper-active sebaceous glands.

How and Where is Photodynamic Therapy (PDT) Administered?

PDT Acne Treatment Before and After 1 (Itoh)
PDT Acne Treatment Before and After 1 (Itoh)

Because Levulan (ALA) and the other photosensitizers are prescription medications, PDT is generally available only in specialized dermatology or cosmetic surgery clinics. This is also necessary because the treatment has a high risk of side effects if applied improperly.

Generally, PDT costs between $100 and $400 per session. Most dermatologists recommend at least four sessions. But keep in mind that the results are rarely permanent and continued control over acne symptoms will likely require continued treatment. So generally speaking, a PDT starter package of four treatments will cost in the vicinity of $1000.

Photodynamic Therapy Images

References

A Comparative Study of Topical 5-Aminolevulinic Acid Incubation Times in Photodynamic Therapy with Intense Pulsed Light for the Treatment of Inflammatory Acne. Oh, et al. 2009.
A comparison of intense pulsed light, combination radiofrequency and intense pulsed light, and blue light in photodynamic therapy for acne vulgaris. Taub, et al. 2007.
The use of a novel intense pulsed light and heat source and ALA-PDT in the treatment of moderate to severe inflammatory acne vulgaris. Gold, et al. 2000.
Treatment of Inflammatory Facial Acne Vulgaris with Intense Pulsed Light and Short Contact of Topical 5-Aminolevulinic Acid: A Pilot Study. ROJANAMATIN, et al. 2006.
Effectiveness of Photodynamic Therapy with Topical 5-Aminolevulinic Acid and Intense Pulsed Light versus Intense Pulsed Light Alone in the Treatment of Acne Vulgaris: Comparative Study. Arianee, et al. 2005.
A comparative study of intense pulsed light alone and its combination with photodynamic therapy for the treatment of facial acne in Asian skin. Yeung, et al. 2007.
Photodynamic therapy of acne vulgaris with topical δ‐aminolaevulinic acid and incoherent light in Japanese patients. Itoh, et al. 2001.
Photodynamic therapy of acne vulgaris using 5-aminolevulinic acid versus methyl aminolevulinate. Wiegell, et al. 2006.
Photodynamic therapy for acne vulgaris with topical 5-aminolevulinic acid. Itoh, et al. 2000.
Photodynamic therapy of acne vulgaris using methyl aminolaevulinate: a blinded, randomized, controlled trial. Wiegell, et al. 2006.
Photodynamic Therapy of Acne. Sandberg, et al. 2001.
Topical ALA-photodynamic therapy for the treatment of acne vulgaris. Hongcharu, et al. 2001.
Photodynamic therapy for acne vulgaris: a pilot study of the dose-response and mechanism of action. Hörfelt, et al. 2007.
Topical aminolaevulinic acid‐photodynamic therapy for the treatment of acne vulgaris: a study of clinical efficacy and mechanism of action. Pollock, et al. 2004.
In vivo porphyrin production by P. acnes in untreated acne patients and its modulation by acne treatment. Borelli, et al. 2006.

Intense Pulsed Light (IPL)

Intense Pulsed Light (IPL) Therapy

Intense Pulsed Light (IPL) therapy uses short bursts of high intensity light to treat a variety of skin conditions. It is most commonly used for photo-rejuvenation procedures and to treat mild skin discolorations caused by hyper-pigmentation. Intense Pulsed Light (IPL) therapy is also occasionally used to treat active acne symptoms and certain types of mild acne scars.

How Does Intense Pulsed Light (IPL) Therapy Work?

Intense Pulsed Light (IPL) Treatment of Neck
Intense Pulsed Light (IPL) Treatment of Neck

Intense Pulsed Light (IPL) systems are one of the most commonly administered forms of light therapy for dermatology applications. IPL systems are designed to administer many rapid, high intensity pulses of light.  The rapid pulsing prevents thermal damage to the skin and minimizes discomfort of the patient.

The light produced by IPL treatment is absorbed more by pigmented tissue than non-pigmented tissue causing thermal damage to pigmented cells. Because hair and hair follicles generally have a higher density of melanin (pigment), IPL can be used to damage those structures. IPL is a common procedure for treating areas of hyper-pigmented skin (eg. melasma).

IPL treatments generally use a broad spectrum and non-coherent light source, much like standard white light. In many cases a special optical filter is used that limits the light to a specific range of wavelengths (colors). One of the most common IPL filters is designed to limit the light to orange and red wavelengths.

IPL Therapy, Active Acne and Acne Scars

IPL Treatment of Active Acne Before and After 2 (Rojanamatin)
IPL Treatment of Active Acne Before and After 2 (Rojanamatin)

IPL is not a common treatment for active acne or acne scars. IPL can be used to improve the appearance of hyper-pigmented acne scars, but other laser systems (eg. C02, Nd:YAG, Er:YAG) are much more effective treatments for acne scars. Although IPL is not regularly used as a treatment for active acne, several research studies have reported positive results that suggest IPL might be an effective acne treatment.

IPL vs PDL Treatment of Active Acne Summary of Results (Choi)
IPL vs PDL Treatment of Active Acne Summary of Results (Choi)

IPL has been tested as a treatment for active acne symptoms. For the treatment of active acne, IPL is commonly used as the light source for Photodynamic Therapy (PDT), which uses a topical photo-sensitizer to increase the effectiveness of the treatment. Several clinical research studies have been conducted to evaluate the efficacy of IPL as an active acne treatment. Overall, these studies have found that IPL alone was partially effective at improving acne symptoms. Very few patients experienced dramatic improvement of their acne symptoms in response to IPL treatment. However, the research does suggest that IPL can be partially helpful, and IPL may be a valuable addition to comprehensive acne treatment regimens.

How and Where is IPL Therapy Administered?

IPL vs PDL Treatment of Active Acne Before and After (Choi)
IPL vs PDL Treatment of Active Acne Before and After (Choi)

IPL is usually administered in a spa or clinical environment. IPL is a non-ablative treatment with a good safety record. The incidence of serious complications and side effects is lower for IPL than with more invasive types of laser treatment. Therefore, IPL can be safely administered in many settings.

There are numerous types of IPL treatment systems, each with its own advantages and disadvantages. Some IPL systems include special filter sets to control the wavelengths of light being used, while others include automated cooling systems to prevent damage to the outer surface of the skin during treatment. Because of the variability in the treatment itself, there is a wide range of efficacy with IPL procedures.

There is a substantial range in prices for IPL treatment. This often reflects the particular type of treatment, IPL system being used, area being treated and other factors. In general, IPL treatments range between $100 and $1500. Treatment of simple hyper-pigmentation (e.g. small sunspots) is an example of a a procedure that you might find at the low end of the cost spectrum, while full facial photo-rejuvenation or large scale hair removal treatments tend to run at higher costs. The cost of IPL and IPL-based Photodynamic Therapy (PDT) acne treatments can also vary significantly, but are often in the mid cost range ($300-$600).

https://youtu.be/BB3TYWDAdqg?t=23

Common Intense Pulsed Light (IPL) Systems

AccelaWave, Chromolite, IPL Quantum SR, LimeLight, StarLux.

Intense Pulsed Light (IPL) Images

References

The use of a novel intense pulsed light and heat source and ALA-PDT in the treatment of moderate to severe inflammatory acne vulgaris. Gold, et al. 2000.
Treatment of Inflammatory Facial Acne Vulgaris with Intense Pulsed Light and Short Contact of Topical 5-Aminolevulinic Acid: A Pilot Study. ROJANAMATIN, et al. 2006.
Effectiveness of Photodynamic Therapy with Topical 5-Aminolevulinic Acid and Intense Pulsed Light versus Intense Pulsed Light Alone in the Treatment of Acne Vulgaris: Comparative Study. Arianee, et al. 2005.
A comparative study of intense pulsed light alone and its combination with photodynamic therapy for the treatment of facial acne in Asian skin. Yeung, et al. 2007.
Treatment of Facial Acne Papules and Pustules in Korean Patients Using an Intense Pulsed Light Device Equipped with a 530‐to 750‐nm Filter. Chang, et al. 2007.
A comparison of intense pulsed light, combination radiofrequency and intense pulsed light, and blue light in photodynamic therapy for acne vulgaris. Taub, et al. 2007.
Treatment of hypertrophic scars and keloids using intense pulsed light (IPL). Erol, et al. 2008.
Intense pulsed light (IPL): a review. Babilas, et al. 2010.
Intense pulsed light vs. pulsed‐dye laser in the treatment of facial acne: a randomized split‐face trial. Choi, et al. 2010.
A Comparative Study of Topical 5-Aminolevulinic Acid Incubation Times in Photodynamic Therapy with Intense Pulsed Light for the Treatment of Inflammatory Acne. Oh, et al. 2009.

Blue Light Phototherapy

LED 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.

How Does Blue Light Phototherapy Work?

UV Fluorescence of Propionibacterium acnes Bacteria in Nose Pores
UV Fluorescence of Propionibacterium acnes Bacteria in Nose Pores

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).

Is Blue Light Phototherapy an Effective Treatment for Acne?

Comparison of Blue Light Phototherapy and Benzoyl Peroxide Treatment of Acne (Papageorgiou)
Comparison of Blue Light Phototherapy and Benzoyl Peroxide Treatment of Acne (Papageorgiou)

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.

Frequency of Side Effects with Blue Light Phototherapy or Benzoyl Peroxide (Papageorgiou)
Frequency of Side Effects with Blue Light Phototherapy or Benzoyl Peroxide (Papageorgiou)

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.

Blue Light, Porphyrin Activation and P acnes Bacteria
Blue Light, Porphyrin Activation and P acnes Bacteria

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.

How and Where is Blue Light Photherapy Administered?

Blue Light PhototherapyBlue 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.

Propionibacterium acnes Porphyrin Blue Light Spectrum Absorption Peak
Propionibacterium acnes Porphyrin Blue Light Spectrum Absorption Peak

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 Photherapy 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.

Blue MD Trophy Skin (tm) Blue Light Phototherapy System for Home Use
Blue MD Trophy Skin ™ Blue Light Phototherapy System for Home Use

Small handheld Blue Light Phototherapy systems for home use can be purchased on the internet for as little as $20. However, these small systems are unlikely to be effective. Blue Light Phototherapy systems capable of producing the intensity of light required for therapeutic efficacy generally cost more than $200. Costs for Blue Light Phototherapy in a clinical or spa setting are generally between $50 and $150 per session.

Blue Light Phototherapy Images

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.