laser treatment for acne vulgaris

Last edited 02/2020 and last reviewed 08/2021

There is evidence regarding the effectiveness of laser treatment in acne (although the patient numbers in the trials is relatively small):

• a trial involving 27 patients with acne on both sides of the upper back (1)
  • one side was randomised to four treatments with a 1450nm diode laser plus cryogen spray, and the other side to the cryogen spray only
  • the number of spots fell on the laser-treated side after the first treatment (by 63% vs. a 2% rise, p<0.01)
    • also 14 of 15 patients completing a 24-week follow-up had no acne lesions on that side
  • three patients developed transient hyperpigmentation on the laser-treated side
• a trial involving 41 patients with mild-to-moderate facial inflammatory acne, participants were randomised to a single treatment with a low-level 585nm pulsed-dye laser or a sham treatment (a disconnected laser handpiece moved across the face in an identical manner) (2)
  • at the 12-week follow-up
    • the mean acne grade had fallen more in the laser-treated patients (by 50% vs. 2% in the sham-treatment group, p=0.007)
      • there was a greater fall in both the overall number of acne lesions (by 53% vs. 9%, p=0.023) and the number of inflamed lesions (by 49% vs. 10%, p=0.024) in the laser treated group
  • note that another randomised controlled trial, involving 40 patients with facial acne, found no significant difference between the side of the face treated with pulsed-dye laser and the untreated side at 12 weeks with regard to falls in the numbers of papules, pustules or comedones (3)

Note also that visible light in the blue range can destroy Propionibacterium acnes (a key organism in the pathogenesis of acne) and so has been used in an attempt to reduce acne severity and there is evidence regarding the effectiveness of this therapy in a randomised study (4) (again the number of patients is relatively small).

• lasers primarily work by targeting the P.acnes in the sebaceous glands. Laser treatment may be indicated for post-acne scarring (6):
  • atrophic scars - development of ablative lasers combined with appropriate surgical techniques has led to a significant improvement in the way that certain atrophic scars can be treated
  • hypertrophic/keloid scars - pulsed dye laser, which can reduce the redness of scars and flatten them. This procedure is only possible through specialised hospital departments

Reference:

1. Paithankar DY et al. Acne treatment with a 1,450 nm wavelength laser and cryogen spray cooling. Lasers Surg Med 2002; 31: 106-14.
2. Seaton ED et al. Pulsed-dye laser treatment for inflammatory acne vulgaris: randomised controlled trial. Lancet 2003; 362: 1347-52.
3. Orringer JS et al. Treatment of acne vulgaris with a pulsed dye laser: a randomized controlled trial. JAMA 2004; 291: 2834-9.
4. Elman M et al. The effective treatment of acne vulgaris by a high-intensity, narrow band 405-420 nm light source. J Cosmet Laser Ther 2003; 5: 111-6.
5. Drug and Therapeutics Bulletin (2004); 42(10): 73-77
6. Primary Care Dermatological Society.Acne: acne vulgaris (accessed 6/2/2020)