INTRODUCTION:

Acne is a chronic skin disease generated in the pilosebaceous units. The association of thick skin and hyperseborrhea generates comedones which are non inflammatory lesions because of the follicular plugging. The comedone is the precursor of other acne lesions. It can become infected by the cutibacterium acnes, whose cell wall and biological byproducts are chemoattractant and proinflammatory (1) generating papules and pustules which are inflammatory lesions. Inflammation increases the possibility of scarring and post inflammatory hyperpigmentation. Acne affects primarily the face, neck, chest and the back. These lesions can generate physical and mental anguish on the patients driving them to seek effective treatment. Controlling inflammation is mandatory in order to reduce acne sequelae. Multiple treatment options have been used to target one or more of acne´s pathogenic elements. These include topical preparations with topical antibiotics and retinoids, oral antibiotics like minocycline or tetracycline, and oral isotretinoin, which may be needed for long periods of time and is related to side effects like cheilitis, dry skin, nose bleeds, secondary infection, temporary worsening of lesions, photosensitivity, and increased serum lipids (2).

The use of lasers and optical treatments to treat acne is an increasing practice because of their minimal complications and limited number treatments required. Blue light, blue–red light and infrared radiation were more successful, particularly those using multiple treatments (3).

Treatments with the 1450-nm diode laser, 585- and 595-nm pulsed dye lasers (PDLs), near infrared diode lasers, 1320-nm Nd:YAG laser, 532-nm potassium titanyl phosphate laser, 1064-nm long-pulsed Nd:YAG laser, 1540 nm Erbium (Er):Glass Laser, and the 1550-nm Er:Glass fractional laser are among the most common lasers used to treat acne and acne scarring (4).

Here we report three cases of 1064-nm Q-switched laser treatments in conjunction with 660nm Q-switched laser for successful treatment for inflammatory acne on the face and back. The 1064-nm wavelength has affinity for water heating the dermis, and has also affinity for oxyhemoglobin in the near infrared spectrum (800-1100 nm) (5). The therapeutic effect on acne lesions is believed to be mediated by the selective photothermolysis of vessels and and the up regulation of TGF Beta, the reduction of interleukin-8 (IL-8), Toll-like receptors-2 (TLR-2), and the thermal destruction of sebaceous glands (6). The 660 nm wavelength may have anti-inflammatory properties by influencing the release of cytokines from macrophages (7).

CASE PRESENTAION:

Case 1

A 25-year-old Latin male (Phototype 3) with a 5 year history of acne vulgaris presented with inflammatory - papulopustular acne. In the past, he was unable to tolerate isotretinoin due to significant side effects. On presentation, the patient had erythematous papules and pustules on his cheeks, forehead, temples and chin. He had rolling and boxcar atrophic scars associated and were distributed bilaterally along the cheeks from prior acne lesions (Pic. 1). Prior treatments included the following: topical clindamycin, tetracycline, and isotretinoin for two months. He was on topical benzoyl peroxide for 1 month prior to procedure to decrease Cutibacterium acnes. As part of this protocol, he was pretreated with 1064 nm ND YAG Q-switched laser (Pastelle-Wontech) using a 7 mm spot with the Zoom handpiece, acne toning mode, 2.5 J/cm2 , frequency 8 Hz on the chin, cheeks, forehead, and perioral area where active inflammatory lesions were present. Red 660 nm laser handpiece (Pastelle-Wontech) was then applied directly and punctually 2 shots per inflammatory lesions with 0.3 J/cm2, spot 3mm frequency 2Hz. At the end of the session, the patient exhibited mild erythema and swelling of the face. Pictures were taken the next day of the first treatment showing reduction of erythema and reduction of the number of inflammatory lesions. (Pic. 1) Three treatments were performed every two weeks. One month after the last session the patient had its follow-up, showing significant improvement in the number of inflammatory lesions and the appearance of atrophic acne scars. This patient presented a reduction of 94.7% in the number of inflammatory lesions (38 to 2 lesions). Given marked resolution in acne inflammatory lesions the patient continued with topical treatment with benzoyl peroxide and tretinoin. He is now 6 months with this treatment without relapsing. After the last control, the patient reported a to be very satisfied when asked with a 5-point satisfaction scale.