NLite Laser Acne Treatment - The Facts

For many years, lasers have been used with great success to treat skin problems and, through continuous research, new uses are being developed all the time.

Now, following a landmark trial presented at The Royal Society of Medicine under Dr. Tony Chu, the NLite laser has been shown to be an extremely safe and effective new method of acne treatment, without the major side-effects associated with other treatments.

This fact sheet explains the method used and compares it to other treatments currently available.

What Is Acne?

Acne is an inflammatory skin disease which affects the tiny pores which cover the face, arms, back and chest and the oil glands attached to them. It is an extremely common condition which will affect most teenagers and young adults. Acne is commonest in adolescents with a peak in the late teens. Acne may however, appear for the first time in the mid-twenties or even later and persists in a significant number of people into middle age.

Acne can leave scars which are permanent and are easier to prevent than to treat.

What Causes Acne?

It is an abnormal response of the oil glands to normal levels of the male hormone, testosterone, in the blood. Both men and women have testosterone circulating in the blood, but in the acne sufferer, this hormone has a profound effect on the skin. This abnormal response is self limiting and eventually acne does get better without treatment, but there is no way of predicting how long this may take years or even decades! Acne occurs when dead skin cells, near to the pore through which the hairs emerge from the skin, become more 'sticky' and partially block the pore. The oil or sebaceous glands also produce more oil, which gives rise to a generally oily complexion.

The partial blockage in the pore restricts the flow of oil onto the skin surface. This results in solidification of the oil which fills the hair shaft opening forming a blackhead. The black of the blackhead is not due to dirt, but a change in pigment in the blockage in the pore. If the partial blockage becomes complete, the oil builds up around the hair and hair root and  bacteria normally present on the skin multiply behind the plug and release cytokines that cause inflammation, redness, pustules, cysts and even pain. If the inflammation is deep and severe, or if the spot is manipulated or squeezed, the pus can burst deep into the skin rather than onto the surface. This deep-rooted inflammation and infection can result in scarring and cyst formation.

Does Diet Affect Acne?

The simplest answer is no. The myth persists that chocolate and fatty foods make acne worse. In a very small percentage of people, these foods do make their acne worse, but in most people, diet is not important. A good balanced diet is, however, important for general well-being. Acne is not caused by dirt or poor cleanliness. If you have a combination skin, use non-greasy, non-comedogenic moisturizers on the dry areas.

What Other Treatments Are Available For Acne?

• Benzoyl peroxide: this is available over the counter and can be effective in mild acne; however it can irritate the skin and may dry it.

• Azelaic acid and sulpha derivatives are often used for mild acne, or mixed acne, rosacea or seborrhea.

• Prescription antibiotic solutions. They are very effective in mild-to-moderate acne and dry up pustules quickly. These may be combined with benzoyl peroxide in topical formulations.

• Topical vitamin A derivatives: Differin, Retin A and Tazorac come as creams or gels. They are very good for blackheads but often dry and irritate the skin, especially the first few weeks. They help prevent acne and reduce scarring. They should be used with lots of moisturizers, like Cetaphil.

• Antibiotic medication by mouth: this is the usual treatment for moderate-to-severe acne. Many different antibiotics can be used, but the tetracyclines are the most popular, like doxycycline and minocycline. Treatment should last for at least 6 months and, depending on the response, may last for 2 to 3 years. As with all antibiotics, side effects are a possibility.

• Hormone treatments: higher estrogen birth control pills do help acne, but are not without potentially significant side-effects. Ortho-Tricyclen, Alesse and Yasmine can be effective birth control pills for acne.  Spironolactone can be used as a hormone blocking agent by itself or in combination with antibiotics or birth control pills. In rare instances, finasteride, dutasteride or flutamide can be used.

• Oral vitamin A derivatives (eg. Isotretinoin ­, Accutane): these medicines must be prescribed by  Dermatologists, requires registration, regular laboratory studies, including pregnancy tests for women of child bearing age, and monthly, non-refillable prescriptions. They are very powerful anti-acne drugs and with them we can control and even cure the most severe forms of acne. They do have occasionally serious side-effects and we tend to restrict their use to the more severe cases of acne.

Acne can and does scar the skin, sometimes severely. Prevention of most scarring is achievable as long as the treatment is started at an early stage. Once the scars have formed, they are permanent, but can be helped by plastic surgery, chemical peeling, injectable fillers or treatment by NLite laser.

What About the NLite Laser?

Without a doubt, the biggest breakthrough for decades in the treatment of live acne is the NLite laser used by itself or in conjunction with Levulan, a light activated FDA approved compound that binds to oil glands and significantly reduces their function following light activation. This laser was introduced as a collagen building laser, designed for erasing lines and wrinkles and treating the general signs of skin aging. However, it rapidly became apparent to laser users that it was also possible to achieve very good results on pitted acne scarring, as well as lines and wrinkles.

While treating patients with a mixture of pitted scarring, from old breakouts, as well as fresh problem areas, it became obvious that active breakouts improved very rapidly following the laser treatment. Within a short time, it became apparent that many patients were actually controlling their acne by using laser treatment, in conjunction with the correct non-laser treatment regimes.

Since this time, there has been a full clinical trial carried out on the use of this laser for acne. The work has been done by a specialist Acne Dermatologist, Dr Chu of Imperial College Dermatology Department the results of which were presented at The Royal Society of Medicine (January 2003). The trial showed that, over a twelve week period, the number of active lesions dropped dramatically and the activity of these lesions was reduced, even after only one laser treatment. The conclusion of a recent presentation of Dr Chu's work stated that:

'NLite is an effective treatment in Acne vulgaris providing a reduction in both the severity and number of inflammatory lesions.’ (Lancet, 2003)

How Does The NLite Laser Work?

The way in which we think the laser works is threefold: First, the laser light eliminates porphyrins in skin that are needed by the propionabacteria bacteria that cause acne.  Second, the formation  new collagen below and around the spots gives a huge boost to the healing process, causing the spots to disappear with a decreased likelihood of acne scars developing. Third, the light diminishes oil gland output, diminishing the food substrate for the bacteria even more.

The treatment is usually painless and the potential side effects are minimal and very short lived. Certainly, in comparison to the use of Accutane and long term antibiotics, both of which can have side effects, this is a treatment solution that is very well tolerated and much safer.

The treatment is also highly effective in managing occasional flares in patients who are generally in good control. We have patients who will come in to treat break-outs, or single lesions even before they have become fully expressed; the laser will destroy proliferating bacteria even if the lesions are not yet visible on the surface.

What does the treatment involve and how long does a treatment last? The NLite laser pulses are expertly applied in milliseconds over the required areas. The patient may notice a sense of short light flashes as it passes over. Some patients experience a warming glow and tingling sensation. The sensitive lower epidermis level of the skin and surrounding tissue is not affected. There is no need for any anesthetic. Typically a whole face can be treated in perhaps 10 minutes, with smaller areas such as near the eyes, mouth or neck much faster.

Does NLite Work For Acne Scarring?

Yes!  NLite stimulates collagen and with two treatments can reduce acne scars an average of 57% and with three treatments 75% on the face.  It has been equally effective on the chest and back.  It takes several months to see the total reduction in scarring.

Are There Any Side Effects?

World-wide ongoing clinical trials have found treatment with the NLite laser to be remarkably safe. In rare cases there may be some slight swelling and/or reddening, but this, on the few occasions it has happened has gone away very quickly. There is also a minute risk of pigmentation changes within the treated area. A very small minority of patients have had pin-point bruising where the laser has treated, but in every case has gone completely away within a few days. This side effect is very much the exception, but can occur, and patients should not have NLite treatment unless they are fully aware that this and other side effects are a possibility.   Treatment works well for almost all acne patients. Photographs are taken before treatment is started and patients are encouraged to plan on two or three treatments to see the most effective response.  

What Are The Costs Likely To Be?

The cost varies by the area of treatment and number of treatments required.  Full face, chest, arm and back treatments are possible.  The fees will be discussed at the time of your first consultation.

Can The NLite Laser Be Used For Any Other Purpose?

Yes, the NLite laser was specifically designed for the treatment of lines and wrinkles, for which we have been treating patients very successfully since the  Summer of 2001. It can also work on stretch marks, acne scars, facial blood vessels, vascular birth marks and warts.

Is NLite Treatment Safe?

Yes. Twenty years of Pulsed Dye Laser treatments have proven to be safe, with no apparent long-term problems. Treatment is carried out only by Dr. Sabean or a laser certified medical esthetician to ensure safe treatment.

Are There Any Treatment Enhancements To Make It Even More Effective?

Yes.  When Levulan is applied an hour before treatment with NLite, it can effectively treat moderate to severe acne, including cystic acne.  Two to three treatments will reduce acne an average 80-90% for up to two years.  Please see the information under Photodynamic Therapy for more details about treatment.

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