Medesthetics Special

AR Supplement

Surgical Aesthetics and Acne & Rosacea are special editions of Medesthetics. To see Surgical Aesthetics, go to http://surgicalaestheticsmagazine.epubxp.com

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RESEARCH REVIEW The positive but short-term results achieved with light-based devices in the treatment of acne are fueling research aimed at finetuning these technologies and treatment protocols to offer long-term solutions for patients with moderate-to-severe recalcitrant acne vulgaris. During the 33rd Annual Meeting of the American Society for Laser Medicine and Surgery, researchers from the Wellman Center for Photomedicine (massgeneral.org/wellman) presented three pilot studies that highlight some of the most promising treatments on the horizon. A Sebum-Targeting Wavelength Nanotechnology and Light Building on earlier research conducted by R. Rox Anderson, MD, that identified 1720nm as a wavelength capable of selectively targeting sebum, William Lewis, MD, presented a study using two prototype diode lasers—1700nm and 1720nm—to create selective photothermolysis of the sebaceous glands. The researchers irradiated porcine ear secretions using no cooling, and then stained them with nitro blue tetrazolium chloride staining (NBTC) to detect thermal denaturation. Preliminary findings showed greater selectivity for sebum at 1720nm versus 1700nm—Dr. Lewis postulated that a 1726nm laser might be optimal—and a threshold for consistent thermal denaturation at approximately 40 J/cm2. The researchers called for further studies to defi ne optimal parameters, including pulse duration, fluence and skin cooling. Arielle N.B. Kauvar, MD, presented "Selective photothermolysis of the sebaceous follicle using gold-coated nanoshells for the treatment of acne," a study of 17 subjects (6 male, 11 female). Patients applied a cream containing 150nm silica spheres with gold shells. The spheres are small enough to fall into the hair follicles, but too large to penetrate the epidermis. The cream was massaged in and then wiped clean from the skin, which was then irradiated with an 800nm diode laser. Following treatment, the researchers did a 4mm punch to view damage. There was deep thermal damage to the follicles and sebaceous glands, 60% of the sebaceous glands were either damaged or destroyed with no collateral damage to the epidermis or dermis following one treatment. Acne-Inhibiting PDT Protocol ALA-PDT with high-fluence red light has shown impressive results in reducing acne lesions. Unfortunately, the pain and swelling associated with the treatment make it a poor choice for acne patients, particularly those with facial acne. In an effort to maintain results but reduce pain, Fernanda Sakamoto, MD, and her colleagues performed a randomized, double-blinded control study to compare conventional ALA-PDT to a new inhibitory PDT method (iPDT) that involves irradiating the aminolevulinic acid (ALA) with low-levels of blue light during the incubation period. The researchers found that low-level light exposure during ALA metabolism prevented the accumulation of evaluation of histopathology samples showed a reduction of sebaceous glands and inflammatory acne in areas treated with ALA-PDT and those treated with iPDT. Both methods demonstrated significant improvement in the 18 subjects that finished the study (out of 29 original participants), but the intense pain and immediate inflammatory side effects were reduced in iPDT-treated sites. Delayed side effects were not reduced with the new protocol. 2 July/August 2012 | ACNE & ROSACEA © Thinkstock/Hemera epidermal porphyrins, while allowing for accumulation in deeper tissues, including the sebaceous glands. Blinded

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