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Enlisting laser technology to battle acne

New therapies strike at the oil glands under the skin without harming the top layer.

May 26, 2003|Shari Roan | Times Staff Writer

Having struggled with acne for more than a decade, Aaron Goldberg had tried everything from antibiotics and prescription skin creams to Accutane, pills that often clear stubborn acne but carry many side effects.

When his acne gradually returned about a year after finishing a course of Accutane, Goldberg, a 24-year-old law student, thought he had run out of options. He was wrong.

Lasers and light therapies are now being used for acne, marking the first significant advance in treating the condition since Accutane became available in 1982. One laser, called Smoothbeam, was approved by the Food and Drug Administration last October for treating acne. Other lasers, as well as radio-frequency treatments, are also being investigated for acne.

The idea, experts say, is to damage the oil-producing sebaceous glands without harming the top layer of the skin.

Like other new skin rejuvenation procedures, the Smoothbeam technique uses a cryogen spray to cool the surface of the skin while a particular wavelength of laser energy is directed to the sebaceous glands in the epidermis. Accutane is the only other acne treatment that targets the sebaceous glands. Most focus on the top layer of the skin or the bacteria that cause acne.

"I never in a million years thought I'd say laser with the word acne," says Dr. James Leyden, emeritus professor of dermatology at the University of Pennsylvania School of Medicine who has studied the new device. "Laser therapy is kind of what Accutane does pharmacologically. The doses of heat will wipe out the sebaceous glands and will make acne better."

Goldberg says the acne on his face and back cleared up after two Smoothbeam treatments.

"I had pretty much tried everything, so I'm very happy," he says.

Because of the discomfort and cost involved, lasers seem to be best suited for people who have tried most other acne remedies, including Accutane, or who don't want to use Accutane. Accutane carries the risk of side effects, such as liver problems, and patients almost universally complain that the drug causes severe dry eyes and lips.

"There are people with acne who just don't do great with whatever we throw at them," says Dr. Steven Weiss, an assistant clinical professor of dermatology at UCLA Medical Center who has treated patients with the laser for about a year. "This is another alternative."

The Smoothbeam laser is also being used to treat acne scars because the wavelength delivered by the device also produces a mild injury to the dermis that can cause the growth of new collagen and smooth the skin.

Weiss says he usually recommends about four Smoothbeam treatments along with standard acne therapy, such as topical creams or antibiotics. Laser therapy for acne is so new, doctors can't say how long the skin will stay clear. Studies suggest it works for at least six months.

The FDA approved Smoothbeam for acne on the back and chest. Doctors are using it on the face as well, although facial treatments tend to be more painful. According to Leyden, the laser may not work as well on facial acne because the dose required to damage sebaceous glands may be too high to withstand, even with the anesthetic that is applied to the skin. "The problem on the face is that doses that are well tolerated are too low," he says. "The doses that are effective most people don't want any part of. The face is much more sensitive than the back."

High doses of laser energy can lead to minor burns if the doctor isn't careful, Weiss adds.

Some patients may also be dissuaded from laser acne treatments because insurance doesn't yet cover the therapy. Smoothbeam therapy costs about $1,500 for four treatments.

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