BBI Contributing Editor

The way many dermatologists treat acne is gradually shifting from an emphasis on pharmaceutical medications to light-based therapies. Fueling this new paradigm is a combination of significant developments in systemic therapy, startling research on the attitudes of acne patients, peer-reviewed clinical research on new laser-based treatments and the integration of these devices into routine clinical use.

Another powerful factor influencing a change in acne treatment standards are the negative side effects and contraindications associated with Accutane. Well-documented side effects include birth defects and depression. As a result, many dermatologists have ceased prescribing this powerful drug in the wake of a series of FDA warnings and Accutane-related suicides. The FDA also has taken measures to block Accutane prescriptions via the Internet.

One laser well positioned to capitalize on the growing trend of light-based therapies to treat acne is the Smoothbeam from Candela (Wayland, Massachusetts). Smoothbeam is a 1450 nm diode laser that thermally alters the sebaceous glands at the sites where acne lesions occur. This laser received the first and only existing FDA clearance for laser treatment of acne in October 2002.

"Smoothbeam is an excellent laser that's very effective in treating inflammatory acne on the face and in other body locations like the back," said Jason Lupton, MD, a dermatologist in private group practice in San Diego, California. "Typically, after only one session, patients have a marked reduction in the number of inflammatory papules, although we recommend one to three sessions." In addition, "the laser is very well tolerated and there is minimal downtime, without much pain. It is a relatively quick and easy procedure to perform."

Lupton also has had good results using the Smoothbeam to treat patients with sebaceous hyperplasia. "These common waxy, yellow papules respond well to laser treatment," he said. "As with inflammatory acne, significant improvement occurs in one session." He primarily uses the Smoothbeam on patients who are either resistant to other forms of therapy or unable to undergo treatment with Accutane or systemic antibiotics because of contraindications. "People with severe inflammatory acne tend to be strongly motivated to undergo any form of treatment that can be of benefit," Lupton said.

Nisan Pilest, MD, a dermatologist in private practice in Irvine, California, has had so much success treating acne with the Smoothbeam that he rarely prescribes Accutane anymore. "I can basically alter the oil glands with the laser," he said. In contrast, "Accutane has a lot of side effects, such as attitude changes, dry eye and hair loss." Patients also must undergo monthly blood tests when taking Accutane to monitor cholesterol and triglyceride levels. Furthermore, "there is the issue of compliance," Pilest said. "And there is a serious danger of birth defects if a female patient on Accutane should become pregnant."

His regimen for active acne with Smoothbeam is four to six sessions, spaced two weeks apart. "I can also improve acne scarring during the same visit because the laser stimulates collagen production," Pilest noted. The laser "works wonders for treating acne on the back and chest. You can actually dry those lesions in one or two sessions. Smoothbeam has no side effects whatsoever."

E. Victor Ross, MD, the lead clinical investigator in the original study of Smoothbeam for acne used to obtain FDA clearance, uses Smoothbeam to treat both facial and back acne. In his original study of patients' backs, there was a stunning 98% clearance of acne lesions for at least six months after the fourth and final treatment. Side effects were minimal and transient. Ross continues to follow the original patient population to determine how much longer remission is beyond the original six-month post-treatment assessment.

Last summer, Candela contracted with Health Advances (Weston, Massachusetts), a healthcare consulting firm specializing in the commercialization of new medical technologies, to conduct an online survey of more than 200 parents of teenagers with acne who were being treated by physicians across the country. The purpose was to assess their satisfaction level with current acne therapies. The reported satisfaction levels were less than anticipated, especially by the physicians treating these patients. "The majority of respondents felt their teens improved less than 50% with current treatment (oral and topical therapies, but excluding Accutane)," said Amy Siegel, research manager at Health Advances. "About 60% of teens also experienced at least one side effect."

The Health Advances study also sought to assess the willingness of acne patients to self-pay for a laser procedure, given the abundance of acne treatments available that are covered by insurance. Although treating acne with Smoothbeam is an out-of-pocket expense for patients, "we found that about one-third of families were willing to pay approximately $1,000 for four sessions with the laser," reported Siegel. "And over 20% were willing to pay up to $1,500 for a course of treatments."