Acne vulgaris is one of the most common skin conditions and usually result in scarring and disfigurement. Oral retinoids, oral antibiotics, topical retinoids, topical antibiotics, and keratolytic are commonly used to treat acne, but such treatment options have many well-known risks, complications, and limitations. Recently, several laser therapies using various wavelengths have been evaluated for the treatment of acne vulgaris. Acne is the most common skin disorder. It is based on an interaction of seborrhea, follicular hyperkeratinization, increased proliferation of Propionibacterium acnes and inflammatory processes. The pulsed dye laser is one such promising treatment option. The laser produces light of 585- and 595-nm wavelengths, which mainly oxyhemoglobin absorbs, and is mainly used to treat vascular lesions, such as port-wine stains, but the laser has also been reported to be effective at treating inflammatory acne vulgaris. The mechanism of laser therapy is unknown, but it has been proposed to occur secondary to damage of Propionibacterium acnes of the sebaceous gland. The long-pulse neodymium-doped yttrium aluminum garnet (Nd:YAG) laser emits light of 1,064-nm wavelength, which deeply penetrates the dermis and causes diffuse heating of dermal tissues without damaging the epidermis. The main chromophores of this laser system are water, melanin, and hemoglobin.
Nd:YAG lasers have been reported to treat acne scars and rhytids effectively and to promote photorejuvenation, but the effects of Nd-YAG lasers on inflammatory and noninflammatory lesions of acne vulgaris have not been evaluated. Laser- and light-based therapies are now regarded as alternative treatments for acne, and many encouraging results have been reported for blue and red light and infrared laser therapies. Furthermore, these therapies have the advantages of reducing existing acne scars and improving skin texture and are free of complications, such as teratogenic effects and antibiotic resistance. Several studies have been conducted on the use of PDL in acne therapy. Seaton and colleagues10 found a 53% reduction in total lesion counts in PDLtreated patients, and 9% in controls and 49% and 10% reductions in inflammatory lesion count in PDL-treated patients and controls, respectively. Because the main chromophore of the laser is oxyhemoglobin, selective photothermolysis of the dilated vascular components of acne inflammatory lesions is possible. Moreover, by delivering coherent yellow light, porphyrins in P. acnes are activated, and these have phototoxic effects. Furthermore, some reports have been issued on infrared lasers (1,450 nm and 1,540 nm) and a 595nm Laser. Some research reported an 84% reduction in mean acne lesion count using a 595-nm PDL and a 1,450- nm diode laser in combination, but the comparative effectiveness of treatments using a 1,064-nm Nd: YAG laser and a 585/1,064-nm laser have not yet been explored in acne. Other study showed that the Laser and combined 585/1,064-nm laser techniques are highly effective in treating inflammatory and noninflammatory acne lesions. Furthermore, these treatments were also found to improve acne scars and rejuvenate skin. Inflammatory acne lesions were reduced on PDL- and 585/1,064-nm laser–treated sides by 86% and 89%, respectively, and noninflammatory acne lesions by 69% and 64%. Furthermore, these treatment effects were sustained 12 weeks after treatment start (8 weeks after final treatment). Overall, inflammatory acne lesions showed greater and more rapid improvements than noninflammatory lesions for both treatments. Furthermore, acne severity findings followed the same pattern of improvement. In the present study, thee e 585/1,064-nm laser was found to be significantly better than PDL at reducing noninflammatory acne lesion counts eight weeks after treatment start and nonsignificantly better at treating inflammatory acne lesions. Orringer and colleagues17 concluded that infrared laser therapy might improve comedonal acne. Moreover, the 1,064-nm Nd:YAG laser is a near-infrared unit and thus may penetrate the deep dermis and selectively deliver energy to the dermal layer, which contains the sebaceous glands. As a result, sebum production is probably reduced, and noninflammatory acne lesions improved. Alternatively, the normalization of keratinization within pilosebaceous units might improve acne. Furthermore, combined 585-nm PDL and 1,064-nm Nd:YAG laser treatment may act synergistically on acne by targeting different skin components, although the precise mechanisms involved have not been determined. Although acne lesions were significantly improved by 585/1,064-nm treatment from the second week, patient subjective scores significantly increased only from the fourth week. Enrolled patients might have hoped that acne lesions would be much reduced after one treatment session. At two weeks (just before the second treatment sessions), noninflammatory lesions counts were still at 70% of their original values, although inflammatory lesions had been reduced to less than 40% of their original counts. Also, at the final visits, although acne lesions had improved continuously, the VAS score was slightly lower than at the eighth week, indicating that patients expected a greater decrease in acne lesions at the twelfth week.
This shows that laser treatment is an effective alternative to the traditional acne treatments special in patients suffering from serious side effects. The important part to educate the patient that multiple treatment is required along with maintenance treatment. In conclusion and combined 585/1,064-nm laser treatment were found to be effective at treating inflammatory and noninflammatory acne lesions, although the 585/1,064-nm laser was found to be significantly better other treatments at treating noninflammatory acne. Further research is required to identify optimal treatment parameters and synergistic action mechanism. Also, the long-term treatment results of combined 585/1,064-nm laser treatment are needed to exclude the possibility of improvement of acne by other factors, because the follow-up period was short.
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