Comparison of Stacked Pulses versus Double‐Pass Treatments of Facial Acne with a 1,450‐nm Laser

• Published in: Dermatologic surgery 2007-05, Vol.33 (5), p.552-559
• Main Authors: UEBELHOER, NATHAN S., BOGLE, MELISSA A., DOVER, JEFFREY S., ARNDT, KENNETH A., ROHRER, THOMAS E.
• Format: Article
• Language: English
• Subjects: Acne Vulgaris - pathology; Acne Vulgaris - radiotherapy; Adult; Biological and medical sciences; Dermatology; Facial Dermatoses - pathology; Facial Dermatoses - radiotherapy; Female; Humans; Low-Level Light Therapy - methods; Male; Medical sciences; Severity of Illness Index; Skin involvement in other diseases. Miscellaneous. General aspects; Skin plastic surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Treatment Outcome
• ISSN: 1076-0512; 1524-4725
• DOI: 10.1111/j.1524-4725.2007.33113.x

BACKGROUND Although effective as a monotherapy for the treatment of inflammatory acne, the 1,450‐nm diode laser is associated with considerable pain at higher fluences. MATERIALS AND METHODS Eleven subjects were treated with a 1,450‐nm diode laser in a split‐face bilateral paired acne study. One‐half of the face received a single‐pass consisting of stacked double pulses. The other side received a double‐pass treatment of single pulses. Settings were 11 J/cm2 or lower as tolerated with appropriate dynamic cooling device (range 25–35). RESULTS The mean pain rating was 5.33 on a 0 to 10 scale on the stacked–pulse treatment side and 5.12 on the double‐pass side. Blinded reduction in mean acne lesion counts were 57.6% and 49.8% reduction, respectively. An overall acne scar improvement was seen in 83% of subjects with acne scarring. Transient hyperpigmentation occurred in two patients on the stacked pulse side and completely resolved without sequelae. CONCLUSIONS The pulsed 1,450‐nm diode laser can be used at lower fluences that elicit less discomfort yet effectively improve inflammatory acne. Stacking pulses appears to render a slightly higher efficacy than the multipass technique. Single‐pulse, multiple‐pass treatments may have a lower risk of cryogen‐induced transient hyperpigmentation compared to standard high fluence techniques.