Acne treatment without medication
Phototherapy is one of the most safe, effective and non-invasive methods for the treatment of acne without medication.
Phototherapy can be applied painlessly and without side effects even during summer months with lots of sunshine.
Many studies as well as clinical practice have proved the effectiveness of photodynamic therapy on the pathogenetic mechanisms of acne. It is It’s suitable mainly for patients who do not want or who cannot or are not allowed to receive medication, regardless of the severity of the acne and the skin complexion:
- women who are or want to become pregnant
- people who cannot be treated with oral medications
- individuals who cannot tolerate dryness of the lips or eyes
- someone with various liver and renal diseases,
- children and adolescents in order to avoid oral medication,
- someone who exercise intensely or athletes
- blood donors, patients with dyslipidemia or suffer from inflammatory bowel disease
- people who suffer from depression or who often have nose bleeding
There are only advantages with Phototherapy:
- safe and effective acne therapy without medication
- harmless without medication
- suitable for application all year round, even during periods with lots of sunshine
- success rates comparable to those of traditional treatment methods with oral medication without their side effects
- cost effective as a treatment strategy as compared to the need for repetitive treatments
- beneficial effect of light on acne with antiaging properties
- personalised treatment for adolescents and adults
- imminent return to daily activities and external environment using the appropriate sun protection products
How Phototherapy works
Phototherapy uses pure, visible, invigorating light spectrum (blue and red), which is responsible for the presence of life on the planet as well as the development of healthy organisms.
To achieve clinical effect and destroy the bacteria, the light focuses on the affected tissue to manage the Propionibacterium acnes (P. acne) and inflammation.
Blue and red light combine antibacterial and anti-inflammatory properties which constitute photodynamic therapy effective and safe for the treatment of acne.
More specifically, the blue light (415nm wavelength) improves the severity of acne as it is absorbed by the porphyrins offering significant advantages:
- the production of singlet oxygen (¹O2) and other free radicals within acnes inside P. acne resulting in its destruction
- the activation of the organism’s defensive leukocytes
The red light (633nm wavelength) has antibacterial, healing and soothing properties. Despite the fact that is less effective towards the porphyrins activation it can approach the sebaceous glands which are located deeper, succeeding in the:
- stimulation of immunoregulatory mechanisms.
- minimisation of the production of pro-inflammatory cytokines.
- anti-inflammatory activity.
Photodynamic therapy treatment protocols are individualised, depending on the needs of each person’s skin and organism. In certain cases, a combination of various treatment methods may be applied to effectively manage acne. In addition, in our clinics, patients are advised on a personal level regarding ways to carefully maintain continuous care of acne-prone skin which is essential on a daily basis. A monitoring program is also created planned in order to maintain the result of treatment.
Maximising the action of Phototherapy
In cases of persistent acne, phototherapy therapy is combined with the local application of a specific photosensitizer (photodynamic therapy, PDT) which maximises the effectiveness of light on acne lesions.
Photosensitiser is a photosensitive substance which is taken up by the epithelial cells and it is metabolised through porphyrins. In phototherapy therapy, only certain photosensitisers are used for the treatment of skin disorders. The most common are aminolaevulinic acid (ALA) and methyl aminolevulinic acid (MAL).
The ideal photosensitizer is:
- minimally toxic.
- taken up faster by the targeted tissue as compared to the normal tissue.
- rapidly eliminated by the normal tissue.
- activated at wavelengths that penetrate the target tissue.
- capable of producing large amounts of cytotoxic product.
The effectiveness of the photosensitiser agent depends partly on how deeply and how selectively the agent penetrates the skin. When light is exposed to the skin three basic stages occur:
- light is reflected from the surface of the skin
- light is scattered by the skin after penetrating it
- light is absorbed by the structures within the skin
Reflected light can be used for diagnostic purposes. However, it does not have a direct clinical effect. Scattered light also has no clinical effect. The absorbed light is the only light that can lead to a clinical effect.
The absorption of light and its effects on the tissue are related to several factors like:
- wavelengths of light
- energy of light
- chromophores of light
For any therapeutic effect to occur, the light must reach the targeted tissue, be absorbed by it and have enough energy to cause the desired response. The longer the wavelength, the deeper the light penetrates the tissue. Thus, the appropriate wavelength and dosage of light delivered depends on the depth of the target and on how well it is absorbed by the photosensitiser.
Topical treatments are applied in the entire affected area and not just on the acne lesions. In most cases, long-term treatment is required. In many patients, the topical treatment can be effective as a maintenance treatment after achieving the initial control of acne onset in combination with oral medication if it is possible.
- Topical Retinoids
Topical retinoids are considered especially effective as they:
- reduce comedones and inhibit the development of new lesions.
- have significant anti-inflammatory action.
- inhibit the activity of leukocytes, the release of pro-inflammatory cytokines and other mediators, as well as other factors which are involved in immunomodulation.
- help other active agents in penetrating the skin.
Topic retinoids should be used for in every patient with acne and constitute the main choice during maintenance treatment.
Irritation that occurs can be minimised through the use of retinoids every other night or moisturizing. Also, they are especially useful for patients with a dark skin complexion as they manage to minimise the level of post-inflammatory hyperpigmentation.
- Tretoin was the first retinoid formulation used for acne, mostly known in cream form, as there was less irritating than gels and liquids. Usually, it takes up to 8-12 weeks of treatment before improvement. Night application is required.
- Adapalene, another retinoid-like compound, is similar in efficacy to lower concentrations of tretoin because it is light and stable. It may be applied either in the morning or the evening.
- Tazatorene is comparatively strong in its action but it can cause irritation. It should be applied once at night or every other night, and as it belongs in the category X regarding safety during pregnancy, contra septic advice should be provided.
- Benzol peroxide
Benzoyl peroxide has a potent antibacterial effect. Its concomitant use with antibiotics deteriorates the P. Acnes resistance, even if only given for short periods of time like 2 to 7 days. Despite the fact that it is mostly effective in inflammatory acne, studies have shown that it can be comedolytic too. Treatment is applied once or twice a day or every other day. Allergic contact dermatitis will rarely develop.
- Topical Antibacterial
There are several formulations of topical clindamycin and erythromycin, which are well tolerated and effective in mild and moderate inflammatory acne. Despite the fact, that they are safe during pregnancy, they are not recommended due to their high resistance to antibiotics. Topical antibiotics combined with benzol peroxide can deteriorate the situation.
- Sulfur, sodium sulfamethazine and resorcin
Although benzoyl peroxide, retinoids, and topical antibiotics have largely supplanted these older medications, sulfur, resorcin, and salicylic acid preparations are still useful and moderately helpful if the newer medications are not tolerated. Sulfacetamide–sulfur combination products are mildly effective in both acne and rosacea. The latter should be avoided in patients with known hypersensitivity to sulfonamides.
- Azelaic acid
This dicarboxylic acid is remarkably free from adverse actions and has mild efficacy in both inflammatory and comedonal acne. It may help to lighten post-inflammatory hyperpigmentation.
- Combined Topical Treatment
Several products are available which combine antibiotics and benzoyl peroxide or retinoids. In general, these medications increase adherence, as they require less frequent application and they may also limit irritation compared with the cumulative topical application of each product separately. However, they are likely to cause skin irritation as compared to the exclusive use of a single product.
Chemical peels are a therapeutic option without the use of a LASER to exfoliate the skin’s surface.
They help accelerate the process of the comedones’ elimination through their transfer on the skin’s surface. This process lasts between 2 and 7 weeks.
Chemical peelings can cause epidermolysis of the granular layer which depends on the PH and the concentration of the product used. The specific effect results to an amelioration of the elasticity of the stratum corneum (the outermost layer of the skin, consisting of keratinised cells) since:
- new cells are produced
- the production of collagen at the upper part of the dermis is activated
For chemical peeling, glycolic acid or salicylic acid are primarily used. Several studies which were conducted in patients with acne in order to compare chemical peeling with salicylic acid to glycolic acid, demonstrated that both agents were effective in achieving superficial epidermolysis, leading to improvement of various acne types. It should be mentioned, that with chemical peeling is it of utmost importance for patients to use sunscreen and avoid prolonged sun exposure.
- Chemical peeling with glycolic acid
Glycolic acid is an α-hydroxy acid and the component of many formulations for acne that are intended either for home use or for application by a dermatologist at different concentrations. The goal of chemical peeling with glycolic acid is to penetrate into the granular skin layer, which is achieved 2 to 10 minutes after the application of the product.
Chemical peeling with glycolic acid is effective in comedonal acne, while treatment is well tolerated by patients.
- Chemical peeling with salicylic acid
Salicylic acid is a component of a large number of over-the-counter formulations for acne. It is a lipophilic β-hydroxy acid that acts against comedones.
Salicylic acid can:
- slow cell apoptosis inside hair follicles, preventing pore clogging.
- cause exfoliation of the stratum corneum through the reduction of keratinocytes cohesion.
Chemical peels with salicylic acid are applied using a similar procedure as for glycolic acid. However, salicylic acid is a volatile compound, leaving no active agent 4 minutes after local application.
Microdermabrasion involves removing the outer layer of the epidermis using a device to smooth the skin. This device, applies aluminum microcrystals onto the skin, which are simultaneously re-absorbed by the double pump, or skin dermabrasion is performed with a diamond head. Microdermabrasion effectiveness has been demonstrated by several studies while its effectiveness as a preliminary treatment prior to the application of phototherapy.
Sebaceous glands, P. Acnes and inflammation are the main target of LASER acne treatment.
Activating the mechanism for the effect on sebaceous glands, P. acnes and inflammation is the main target of LASER acne treatment. LASER devices can help reducing or minimising acne by one of the following two mechanisms:
- LASER devices that emit shorter wavelengths, such as 532 nm, 585 nm and 595 nm Pulsed-Dye LASERS are absorbed by the porphyrins that are present in P. acnes, causing thermal destruction, which results in bacterial degradation.
- LASER devices that emit longer wavelength, such as diode laser at 1450 nm focus on reducing the size of sebaceous glands, as they penetrate deeper in the skin. The minimisation of sebaceous glands leads to subsequent improvement of acne.
- KTP LASER (532nm)
The KTP vascular LASER has been used for the treatment of telangiectasia and rosacea and has been demonstrated to be effective for the treatment of acne as it causes selective photothermolysis of blood vessels and photodynamic effect on the P. acnes and/or sebaceous glands.
- Pulsed Dye LASER (585nm και 595nm)
Pulsed Dye LASER has been used mainly for the selective photothermolysis of vascular disorders, as well as other inflammatory disorders such as psoriasis and telangiectatic rosacea. Since Pulsed Dye LASER has the ability to stimulate dermal remodeling and collagen production are for the treatment of hypertrophic scars and acne scars while they can also be applied for the minimisation of inflammatory acne. Pulsed Dye LASER do not affect the P. acnes colonisation rate or sebum production. It acts locally and has anti-inflammatory properties.
- Diode LASER (1450nm)
Treatment of acne vulgaris with the infrared 1450-nm diode laser and a dynamic cooling device has been shown to safely and effectively reduce inflammatory acne lesions of the face. As far as their mechanism of action is concerned, diode lasers target water on the upper part of the dermis, reshape the underlying collagen and improve facial wrinkles. Their positive effect on acne treatment seems to be affected by the thermal destruction of sebaceous glands, leading to a temporary discontinuation of sebum production.
Other methods of Acne Treatment
Local surgical treatment helps in bringing about a quick resolution of the comedones. This procedure does not lead to scarring. Comedone extraction may be a particularly painful process and that is why application of an anaesthetic cream may help in reducing pain. Among the limitation of this method is that in some cases comedones may not be fully removed, while there is the possibility of causing damage to other tissues.