Procedural Treatments for Acne Vulgaris

BACKGROUND: Simple procedural treatments such as comedone extraction and intralesional steroids have been utilized for many years as adjunctive therapy for acne. In the past 5 years, new technologies and procedures have become available that present new options for the treatment of acne. OBJECTIVES: The objective was to review, summarize, and evaluate the key studies of procedural therapies for the treatment of acne as well as place them in perspective with current clinical practice. METHODS: Studies selected for evaluation had at least 10 patients and clear statements of purpose, acne severity, patient selection, follow-up evaluations, previous and concurrent medications, treatment parameters, methods for evaluating results, and adverse effects. All studies were complete and published (in English) in peer-reviewed journals. RESULTS AND CONCLUSIONS: 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.