Photopneumatic Technology Used in Combination with Profusion Therapy for the Treatment of Acne

Background: Topical and oral medications, such as retinoids, benzoyl peroxide, antibiotics, and isotretinoin, have been the standard of care for the treatment of mild-to-moderate acne for the last several decades. More recently, a number of pubHshed studies on optical treatments, such as ultraviolet light, visible (blue) light, and intense pulsed Hght systems, have also shown clinical improvement in the appearance of acne. Specifically, photopneumatic technology, which utilizes gentle pneumatic energy (vacuum) to draw the target tissue into the treatment tip and then deHver broadband pulsed Hght to the dermal targets, has demonstrated marked improvement in the appearance of acne lesions and side effects associated with acne. Objective: To demonstrate the safety and efficacy of using a combination treatment of the photopneumatic system and profusion therapy using three currently marketed topical agents for the treatment of mild-to-moderate acne on the face and/or body, including neck, chest, or back. Methods: A prospective, multicenter, dinical trial of 41 individuals with mild-to-moderate acne was performed. Patients received up to four treatments at 1- to 2-week intervals with the photopneumatic system and profusion therapy with three separate topical agents. Study investigators and subjects evaluated dinical efficacy at 1-month and 3-month follow-up visits. Results: At three months, a 69-percent reduction was noted in inflamed acne lesions and a 41-percent reduction in noninflamed acne lesions was noted by physician assessment. Additionally, at this same time point, subjects reported moderate-to-marked (26-75%) improvement in acne lesions. Eighty-one percent of subjects (22/27) were either satisfied or very satisfied with treatment outcome. There were no adverse events caused by malfunction of the device, and no serious adverse events or deaths. Conclusion: The results, as well as the reported patient satisfaction and safety, suggest that the treatment of acne with the photopneumatic system in combination with profusion using currently available topical acne agents demonstrated significant treatment results.Acne vulgaris is a common skin disease that affects more than 85 percent of adolescents and often continues into adulthood.1 Laser and Hght-based devices traditionally target the sebaceous glands, which are part of the pilosebaceous unit, the site of acne and commensal organisms, such as Propionibacterium acnes. P. acnes live on the fatty acids in the sebaceous glands and proHferate when the infundibulum of the pilosebaceous unit becomes blocked with sebum and sheds cells, immune reactions and inflammation occur, and, as a result, acne vulgaris develops.2 Ultraviolet Hght and visible (blue) Hght kill the bacterium and/or sebaceous cells through activated mechanisms of endogenous porphyrins and in turn cause a reduction in acne lesions.3,4Intense pulsed light (IPL) systems have also been used for the treatment of acne on all skin types in the medical specialties of dermatology and plastic surgery. One of the more recent pulsed Hght combination treatments that has been cleared by the United States Food and Drug Administration (FDA) for the treatment of comedonal and pustular acne, in addition to inflammatory acne (including acne vulgaris), utilizes photopneumatic technology (Isolaz®, Solta Medical Inc., Hayward, California), which consists of a gentle pneumatic energy (vacuum) to draw the target tissue into the treatment tip and then deHvers broadband pulsed Hght (400–1200nm) to the dermal targets. The vacuum technique causes elevation of the sebaceous gland and other dermal structures toward the epidermal surface, where the pore is opened and the sebaceous contents are mechanically removed. The sebaceous gland is then treated with broadband light, followed by the release of the treatment area. This mechanism has been supported by histological evidence that this therapy mechanically removes comedo contents from the infundibulum, and ultrastructural evidence has shown that the P. acnes bacteria and the pilosebaceous unit are thermally injured after treatment.4,5 The profusion tip used in combination with this photopneumatic system is subsequently used on the treatment areas to assist in deHvery and profusion of therapeutic topicals to the cleansed sebaceous gland while the skin is again gently stretched via vacuum technology.5The objective of this prospective, multi-center study was to evaluate the safety and efficacy of using the photopneumatic device followed by profusion using three different commercially available topical agents for the treatment of mild-to-moderate acne.