Light and heat control of acne

Among the various proposed therapies for the treatment of acne is gaining momentum that uses a particular wavelength of light along with heat. And the results look positive 

Acne and 'inflammation of the units' pilo-sebaceous some areas of the body, particularly the face, which is the most' frequently in adolescence and with increased incidence in male subjects. Acneiche injuries are the result of the interaction between ipercheratinizzazione follicular sebum production and presence of bacteria in the follicular canal. The process begins acneico, by interaction between sebum and bacteria, with the formation of microcomedone, step more 'low-expression acneiche. 

On this particular condition fits the intense activity increased due seborrhoea 'function of the sebaceous glands, and the greater number' of sebum produced is converted by bacteria through the production of lipase, fatty acid. Oil and fatty acids cause a sterile inflammatory reaction of UNITA 'pilo-sebaceous who, through of ipercheratinization of keratinocytes which are the leading follicle, it creates a bottleneck, visible with a black or a white dot, depending on whether or not there is an outside outlet. The walls of the follicle at this point can break disseminating content in the dermis and causing the appearance of papules, pustules and / or nodules, and from a more 'mild to a more' severe. Inflammation and 'much more' violent and the more 'the immune response to P. Acne, Propionibacterium granulosum to, at Stafilococcus epidermidis, the Malassetia furfur. 

Acne skin anaerobic bacteria are slow growing, generally are unable to multiply in follicles in which the speed 'of secretion of sebum and' high because 'their products are disposed of by the flow of sebum, where, however, the follicle is clogged, it becomes a closed culture system in which bacteria and terminal products may not be removed, and the accumulation to toxic levels, damaging the wall of the follicle generating the inflammatory response. Although 'the pathophysiology of acne has virtually no more' secrets, it remains a very common disease and often highly debilitating for the life of the subject report that's and' affection in the most's needs related to modern styles life pushing patients to seek new solutions that are fast and secure efficiency. The medical therapy of acne can 'be topical and / or systemic, the first relies mainly antibiotics, alpha hydroxyacids and retinoids, systemic therapy instead of using antibiotics and isotretinoin. Patient can 'be useful to intervene with the application of chemical peeling with AHA.

The limits of medical treatment, but's are many, both those of a topical or systemic ones, because the former often give rise to awareness and redness, while the latter often leading to the development of antibiotic resistance with possible phenomena intolerance and / or annoying side effects. An alternative solution 'now represented by the light through the use of pulsed power and heat (LHE). The technology used is based on a lamp that emits a non-coherent light, with wavelengths between 430 and 1100 nm, with a width of 35 ms, a maximum fluence of 9 J/cm2 per pulse and with a spot of 22_55 mm . 

Treatment is aimed directly to the cause of acne acting on molecules synthesized in large quantities' from P. Acnes, that's the porphyrins: these make the bacteria sensitive to light. When the porphyrin and 'exposed to visible light it becomes chemically active and reaches an excited state resulting in the formation of singlet oxygen that binds to cell membranes and destroys the P. Acnes and the sebaceous gland cells. Like any other photochemical reaction efficiency of the procedure and 'related to the concentration of porphyrins and of photons, the temperature at which the photochemical reaction, and the wavelength used.

In particular, and 'useful to keep in mind that: 

- A source of pulsed light (PW) and 'more' efficient than a continuous light wave (CW), because 'the Court provides 10,000 times more' photons that the source of continuous waves. 

- The effect of the reaction described by the Arrhenius to an increase in temperature of 10 ° C leads to a doubling of the effect of a chemical reaction, also the increase in skin temperature of 10 º C for a short time, 35 msec, does not entail any negative effect on health of the patient. 

- Light blue and 'theoretically the most' effective wavelength visible for most of the endogenous porphyrins P. Acnes, because 'the band between 407 - 420 nm and' the range of wavelengths that can cover the whole of the absorption spectrum of porphyrins. 

But the blue light has a low depth 'penetration into the skin. In contrast, the red light and 'less effective for fotoeccitare the porphyrins, but penetrates more' deeply into the fabric. In addition, the red light compared to blue light can 'properties also have' anti-inflammatory for the influence of cytokines released by macrophages. 

But one of the main limitations of light therapy for acne and 'the fact that the photons must penetrate nell'epidermide before it can reach the depth' required for the activation of porphyrins. The depth 'to reach for the follicles on the face and' of about 3 mm. The calculation of depth 'in the penetration of light showed that the blue light in the range of 400-430 nm penetrates the skin to the depth' of 0.25 mm. 

So 'even if the coefficient of excitation of porphyrins in the band and' very high this light is not's preferential treatment of acne. In contrast to the phototherapy lights green and red lights, used to treat of acne, presents a good degree of penetration of photons in the follicles of the face and neck (at least 3 mm), even if it offers a coefficient of excitation of most porphyrins 'bottom of that available from a combination of light blue and red. Consequently, the combined use of light to green and red light and energy, through a patented technology which LHE, can 'be supported by increases in temperature in order to double the capacity' of reaction to produce oxygen porphyrins can destroy P. Acne, without that increase in temperature, for a time of 35 msec, would have any adverse effects for the patient. 

LHE also uses a dual path for the energy of light and heat, allowing for greater control of temperature is reached on the skin, eliminating the need for 'cooling and reducing any side effects. The LHE is used in patients with acne in various stages and of varying extension for a period of 8 weeks and have every biweekly meetings during the session is a first step on all the affected areas, interspersed with 10 min. pause after which there is a second step. From the second week are the first obvious improvements: decrease the degree of inflammation of injuries and slight decrease in the number of injuries. 

In our experience, at the end of treatment almost all the lesions have disappeared, while the remaining, now no longer 'in the active phase encounter in the weeks following resolution. The results remain for a long time, even in the follow up on in the months following treatment, during which the patient does not follow any medical support. The lesions tend to recur and there is no 'always a progressive improvement of the acneico.

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