'Jury Out' on Using Special Laser for Acne

Despite Earlier Promise as a Low-Risk Treatment, NLite Laser May Be Ineffective

From the WebMD Archives

June 15, 2004 -- Despite early promises, a new study shows no benefit in treating acne with a non-ablative laser that has long been used to remove wrinkles, scars, and other skin lesions.

"I can't say we were surprised one way or the other, but we are certainly disappointed," says researcher Jeffrey S. Orringer, MD, director of Cosmetic Dermatology and Laser Center at the University of Michigan Health System in Ann Arbor. "We certainly hoped this was a convenient, low-risk way to treat what is a very common disease."

But after treating facial acne on 40 teenagers with the NLite pulsed dye laser, Orringer says that there isn't enough evidence to recommend the device as an alternative to traditional medications for America's most common skin condition. It is currently used by at least 200 dermatologists in the U.S. to treat acne and other skin conditions. The non-ablative nature of the laser means it does not cause harm to the epidermis -- the upper layer of skin -- like the ablative carbon dioxide laser for skin resurfacing.

"Essentially, we found zero benefit from this laser," Orringer tells WebMD. "Our results were about as negative as you can find."

Benefits Shows in Previous Study

His study, published in this week's Journal of the American Medical Association, follows another well-publicized trial last year that showed a single 15-minute treatment with the laser improved overall acne severity in 31 patients by about 50% -- and the improvement lasted up to three months.

But in that study by British researchers and published in The Lancet, patients were either treated with the NLite or with a sham laser. In Orringer's study, one half of each patient's face was treated with NLite either once or twice, and the other half got no treatment. His patients were also tracked for three months.

"The fact that we had a split-face study design made our findings so interesting," Orringer says. "We definitely saw some patients improve, but it was bilaterally, so there is no reason to think that the untreated side of their face reaped any benefit from laser. We also saw some patients' acne get worse following the treatment, and we can't blame that on the laser, either. The bottom line is that more research is needed before this laser can be recommended to the public for the treatment of acne."

The NLite laser is believed to destroy the bacteria that cause acne while also stimulating collagen development. Its fast-pulsed laser heats small blood vessels, allowing them to open and release healing "mediators" that remove acne redness, says Robert Trow, PhD, president of USA Photonics in Nanuet, N.Y., which manufactures the NLite, first approved for use in the U.S. four years ago to remove wrinkles and scars.


Improvement Seen by Others

"The many clinics around the world that regularly use the NLite and other lasers for the treatment of inflammatory acne vulgaris would seem to disagree with this latest study," Trow tells WebMD. "The doctors and patients who use it tell us that it works."

Elizabeth K. Hale, MD, a laser surgeon and assistant professor of dermatology at New York University School of Medicine who was not involved in either study, agrees with Orringer that "the jury is still out" on using NLite as the "go-to" acne therapy.

"It's too early to determine if the laser will become standard treatment for acne," she tells WebMD. "But I have used it on several patients and have definitely seen some benefit -- especially in patients that have a type of acne that leaves red spots from previous lesions. Some of my patients who were completely unresponsive to standard treatments have responded very well to this laser."

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SOURCES: Orringer, J. Journal of the American Medical Association, June 16, 2004; vol 291: pp 2834-2839. Seaton, E. The Lancet, Oct. 25, 2003; vol 362: pp 1347-1352. Jeffrey S. Orringer, MD, clinical assistant professor of dermatology, University of Michigan School of Medicine; director, Cosmetic Surgery and Laser Center, University of Michigan Health System, Ann Arbor, Mich. Robert Trow, PhD, president, USA Photonics, Nanuet, N.Y. Elizabeth K. Hale, MD, assistant professor, dermatology, New York University School of Medicine, New York City.
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