I admit it. I spent the wonder years of my youth back in the '70s beneath a sunlamp at the dermatologist's office struggling to gain control over my acne. Did the sunlamp do much for me? Hard to say. It's a jump in medical awareness and memory from teen to dermatologist. My gut instinct tells me no; but who's to say the acne wouldn't have been worse sans sunlamp?

Now, many years later, the FDA has approved a new form of acne light therapy called ClearLight; an enhanced form of visible blue light for the treatment of mild to moderate inflammatory acne.

An Illuminating Experience

An estimated 20 million people have acne at any one moment in time. Those who make their way to a dermatologist often credit summer's natural sunlight as helpful in reducing the severity of their acne. Studies indeed support the benefits of sunlight in acne therapy. But with concerns of UV induced skin cancer (not to mention wrinkles), indiscriminate use of medical ultraviolet phototherapy is not the treatment de jour.

Pimple Production Pathology

To better understand how light is helpful in acne therapy, here is a simple review of how acne forms.

Acne is a problem with keratinization. In other words, the cells that line the sebaceous glands (which open out onto the skin through the pores we see on the surface) are too sticky and literally plug the opening of the gland rather than easily exfoliating themselves onto the surface.

Despite the presence of this plug, the sebaceous glands continue to secrete sebum, a natural skin lubricant which when present in excess makes our skin look shiny and feel oily.

The bacteria that live on our skin, Proprionibaterium acnes (P. acnes), thrive in this environment. Lack of air and lots of sebum nourish the bacteria, allowing them to flourish. Too many P. acnes contribute to the inflammation within the gland.

Ultimately, a combination of persistent plugging, excessive oil build-up (envision an expanding water balloon) and inflammation produced by bacterial over growth causes the gland to rupture. On the surface, this is seen as an inflamed acne papule or cyst.

Acne Blues?

P. acnes bacterium produce a natural metabolic byproduct called porphyrins. Porphyrins are light sensitive and as it turns out, exquisitely sensitive to narrow band visible blue light. When porphyrins are exposed to this light (or to a lesser extent, natural sunlight which contains less concentrated blue light), a chemical reaction occurs that is toxic to the P. acnes. Kill the P. acnes, improve the acne. P. acnes literally self-destruct as a result of its own metabolic process.

The process, referred to as Acne PhotoClearing (APC) utilizes a high intensity, enhanced narrow band beam of visible blue light to help destroy P. acnes and clear acne. The machine, known as ClearLight (manufactured by CureLight and licensed by Lumenis for sale in the U.S.), is not a laser, but a specialized halide lamp, illuminating the skin with therapeutic blue visible light.

BLUE FAQs

What types of acne will ClearLight clear?

The FDA has approved ClearLight for the treatment of mild to moderate inflammatory acne. This translates small red inflammatory papules and pustules (whiteheads). ClearLight is unlikely to help resolve blackheads or cysts, minimize pore visibility, or reduce oiliness.

Not all cases of acne are driven by flourishing bacteria, so APC is not going to be 100% effective.

How clear will I get?

Eighty percent of acne patients treated with ClearLight in a multi-center study experienced improvement. In this study performed by Shalita, et. Al and published in Clinical Application Notes ( Vol. 9 No.1), the level of improvement was just over 60% reduction of inflammatory acne lesions at the completion of the 8 treatments.

Who should consider Acne PhotoClearing treatment?

Anyone unable to tolerate oral treatment; has sensitive skin easily irritated by acne topicals; finds compliance difficult and has mild to moderate inflammatory acne may want to consider this form of therapy. With an estimated 40% acne antibiotic resistance, APC is an option for systemic drug-free therapy.

ClearLight may be used on any area of the body.

Is this an acne cure?

No. ClearLight helps improve acne or clear the acne. Remission typically lasts between 4-8 months. Assuming one is not using acne products to help keep the acne clear, repeat series of ClearLight may be required for maintenance clearing.

Will ClearLight help my oiliness?

It is unlikely that ClearLight will address oiliness concerns. According to Lumenis, it is fine to continue your glycolic acid, salicylic acid and Vitamin A products. Using a sebum removing cleanser such as MD Formulations Facial Cleansing Gel for Oily and Very Oily Skin, Peter Thomas Roth Beta Hydroxy Acid 2% Acne Wash or 3LAB Perfect Cleansing Foam.

Daily glycolic acid treatments including MD Formulations Glycare Acne Gel to help reduce oiliness or target fine lines and blemishes are also fine to use.

Oil absorbing agents like DERMAdoctor Tease Zone Oil Control Gel, OC Eight Professional Mattifying Gel helps to keep skin matte and will not increase light sensitivity. Stick with oil-free foundations and wear a very light sunscreen such as DERMAdoctor Body Guard Exquisitely Light SPF 30 For Face & Body. Oil absorbing masques can help boost oil reduction. Try DERMAdoctor Ain't Misbehavin' Intensive Skin-Correcting Sulfur Acne Mask with Phytosphingosine or B. Kamins Diatomamus Earth Masque for Oily or Combination Skin a few nights a week.

When will I see a difference?

Plan on 2-3 treatments before improvement is seen. Lack of any improvement at this point may indicate that P. acnes is primarily to blame for this case of acne and future treatments may not be helpful.

Can I take my acne medications?

Visible light can cause photosensitizing reactions. Oral medications that increase the risk of sunburn should be avoided throughout the 4 week series of treatments. This includes tetracycline, minocycline, doxycycline and Accutane for acne therapy. Other prescription medications may be photosensitizers. Make sure to inform your dermatologist about all of your prescription medications.

Are there any limitations to topical treatments that can be used during treatment?

I spoke with the ClearLight product manager and was assured it is fine to remain on topical acne therapy including those that have UV photosensitization. This inlcudes Vitamin A based products (including retinol, tretinoin and Tazarotene) as well as glycolic and salicylic acid.

How long can I expect to stay clear?

While this will vary by patient as well as changes in a patient's lifestyle, stresses, etc., remission is expected to last anywhere from 4-8 months.

What is a treatment like?

ClearLight is a painless system. Ten to fifteen minutes are spent under the light for a full face treatment.

What are the risks?

There is no down time, no residual redness, scarring or burning. There have been no reports of skin discoloration due to the light itself (remember that resolving acne may leave some PIH-post inflammatory hyperpigmentation).

Can the ClearLight be used while I am pregnant or nursing?

ClearLight was not tested on pregnant women. Therefore it is not recommended for pregnant women. However, there is no contraindication for nursing women. When in doubt, discuss this with your physician.

What if I have a light sensitive problem like lupus, porphyria or PMLE?

Patients with light sensitive medical conditions should consider other acne treatment alternatives.

How does ClearLight differ from using a sunlamp?

Sunlamps produce a much wider range of visible light throughout the blue and red spectrums. Some may even have small amounts of UVB. ClearLight is strictly a narrow band blue enhanced visible blue light targeting porphyrins produced by P. acnes.

What are the costs?

Costs are going to vary across the country, but expect to pay anywhere from $50.00 to $100.00 per treatment. A complete course of treatments consists of two 10 minutes sessions weekly over the course of 4 weeks The full cost of these 8 sessions essentially ranges from $400.00 to $800.00. At this time, most medical insurance plans do not cover the cost of treatments. Check with your plan and your dermatologist for payment specifics.

Am I Blue?

Acne PhotoClearing is an exciting new option for acne treatment, but it is not a panacea. ClearLight isn't going to eradicate blackheads, reduce pore visibility, eliminate oiliness or attack most acne cysts. So don't throw out all of your acne products just yet.

There are going to be patients who require potentially photosensitizing medications, whether acne, high blood pressure, etc. Until withstanding the test of time, I would discourage APC for anyone unable or unwilling to give these up during the 4 week treatment process.

ClearLight treatment isn't cheap and for now, it is unlikely that most medical insurances will pay for treatment. And most dermatologists are not going to be able to add yet another 50K+ piece of equipment to the office inventory. This makes finding a dermatologist who possesses the light a challenge, at least for now.

In some ways, ClearLight makes what is old, new again. Gone are the 60's where teens sat beneath a sunlamp, only to be replaced by teens sitting under more effective APC blue light illumination. I envision ClearLight as a new tool available for dermatologists to treat difficult acne cases, those with sensitive skin or maybe those with delicate stomachs, unable to tolerate other treatments.

Thank you for taking the time to read my article. I hope you have found it informative.

Audrey Kunin, M.D.

(Any topic discussed in this article is not intended as medical advice. If you have a medical concern, please check with your doctor.)

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