Procedural Treatments for Acne Vulgaris

Abstract

Earlier procedural therapies were adjunctive to medical therapy, such as intralesional steroids, chemical peels, and microdermabrasion. Newer methods include radiofrequency, light or laser, and photodynamic therapy that represent treatment alternatives for systemic medications. Still early in their development, these new procedures provide an important, novel set of options for the treatment of acne. The most developed and studied therapies are blue or blue/red light combinations, 1,450-nm diode laser, and photodynamic therapy with 5-aminolevulinic acid or indocyanine green. Review of the literature of more up-to-date physical procedures provides a starting point for physicians seeking to treat their acne patients safely and effectively with these new methods.

New insights into the management of acne: An update from the Global Alliance to Improve Outcomes in Acne Group

“…Light may also have anti-inflammatory properties via action on inflammatory cytokines. [138][139][140][141] Reduction of P acnes. As part of its normal metabolism, P acnes produces light-sensitive porphyrin compounds (protoporphyrin, uroporphyrin, and coproporphyrin III).…”

Recent Advances in Acne Pathogenesis: Implications for Therapy

“…High temperatures are thought to kill bacteria and shrink sebaceous glands. While preliminary studies show promise, the study samples were small [84][85][86][87]. More recently, fractional radiofrequency treatment with insulated microneedles targeting the middermis has shown promise in treating inflammatory acne lesions [86].…”

Thermotherapy in dermatologic infections

“…In 1939, Karp et al 71 mixed solid CO 2 (dry ice), acetone, and precipitated sulfur and applied it to acne lesions and then the entire face for 20 minutes. 72 Treated patients initially experienced erythema and edema, followed by exfoliation. In a later 1951 report by Dobes, 83 a similar CO 2 mixture was applied to 120 patients weekly for three to 24 treatments, and patients with papulopustular or cystic acne appeared to benefit the most from treatment.…”

“…70 The application of solid CO 2 (dry ice) mixtures directly to the skin for the treatment of acne have largely been abandoned by dermatologists given the risks associated with use and the plethora of safer treatments available. 71,72 BACTERIAL INFECTIONS Key point d Thermotherapy (hyperthermia) may be a useful adjunct in dealing with MRSA infection and acne Staphylococcal and streptococcal infections S aureus and Group A streptococcus (Streptococcus pyogenes) are the major causes of skin infections in immunocompetent patients. S aureus is commonly implicated as the etiologic agent in skin and soft tissue infections, including furunculosis, carbuncles, and abscesses.…”