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BLU-U PHOTODYNAMIC THERAPY FOR ACNE
Timothy J. Mickel, M.D., F.A.C.S.
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Just about all of us at some point in our lives have had to deal with the inconvenience, the embarrassment and the anxiety of unwanted acne. Even its scientific name - acne vulgaris - sounds like something no proper lady or gentleman would ever wear out of the house. This article will review the newest weapon in the arsenal against acne - blue light photodynamic therapy with levulan .
Acne affects about 80% of adolescents, but it is not limited to young people as some 25 million adults are also affected. In fact, if you put all these people end to end they would stretch around the world twice at the equator! And this is only Americans with acne. It is rampant in the rest of the world too. Most adult acne patients are women, and I can tell you from first hand experience that hell hath no fury like a grown up woman with zits.
Contrary to urban legend, acne is not caused by chocolate, cola drinks or greasy food. The two major players in the development of inflammatory acne are sebum , produced by sebaceous glands in the skin, and bacteria , specifically propionibacterium acnes . When a sebaceous gland colonized by p. acnes becomes obstructed, a pimple happens.
Consequently, acne treatment has centered on a combination of unblocking the sebaceous gland (e.g., with exfoliants), killing the offending bacteria with either topical or systemic antibiotics and shutting down the sebaceous glands with drugs like accutane. None of these methods are perfect. Approximately 40% of p. acnes bacteria are resistant to commonly used antibiotics such as tetracycline, clindamycin and erythromycin. Topicals take a long time to work, can be irritating and are problematic in difficult to reach places like the back. Of course, these modalities are only as good as the long-term commitment and compliance of the patient. If you forget to rub on your cream or take your tetracycline, it won't work. On the other hand, accutane, which shuts down the sebaceous glands, can be very effective in severe, resistant acne, and the beneficial effect can last for a year or more after treatment. However, it has a long list of serious side effects and must be given under the strict monitoring of a Dermatologist.
The search for a minimally invasive, effective acne treatment, that is relatively painless, could be easily and consistently administered in the office to insure patient compliance, and has minimal side effects lead to the development of blue light photodynamic therapy (PDT). The favorable effect of sunlight on acne has been well known for many years by everyone who owns a bathing suit. Recently, science geeks discovered that the reason for this is that the blue portion of the sunlight spectrum reacts with a substance naturally occurring in the p. acnes bacteria to produce toxic free radicals that kill the bacteria and improve the acne. Logically, exposure to pure blue light without the rest of the sunlight spectrum would be even more effective, and would not have the harmful effects of ultraviolet radiation.
Furthermore, different science geeks discovered that if you paint aminolevulanic acid (ALA, brand name LEVULAN)) on the skin prior to blue light exposure the same mechanism of action is intensified and you not only kill the bacteria but you also shut down the sebaceous glands, delivering a one two punch to acne. This gross over-simplification of some very elegant biochemistry is the basis for blue light photodynamic therapy with levulan.
Treatment begins with a light microdermabrasion or an acetone facial scrub to exfoliate. Levulan is then applied to the area and allowed to incubate for 30 - 60 minutes. The patient then sits under a blue light for 15 - 30 minutes before going home. Three to five treatments two weeks apart are generally required. Early clinical results from around the country show 60-80% resolution of acne with the results lasting six months to a year. Roughly 20% of patients are non-responders. Pain has varied from none at all to mild stinging and burning from the levulan . Side effects are minimal and usually limited to mild redness and peeling over the first day or two. The main limitation of treatment is that patients must avoid excessive sun exposure for 48 hrs until the levulan is inactive. We recommend that they stay indoors as much as possible for the first 24hrs, and use SPF 45 sunscreen and a broad-brimmed hat the second 24hrs. Failure to do this will result in a significant sunburn.
Blue light PDT with levulan may well revolutionize the treatment of acne. Call Angela or Natalie at Mickel Plastic Surgery, 388-2050, to find out more. During the month of December, mention this article and receive four treatments for the price of three. We look forward to helping you feel better about your skin.
