With More Adults Getting Acne, New Treatment Uses Light

Researchers are working on better ways to treat acne by harnessing the healing properties of light.
Acne is the most common skin condition in the U.S., affecting 40 million to 50 million people at any one time. A growing number of adults report suffering from it, according to the American Academy of Dermatology, and the reasons aren't clear. Adults may be more aware of their acne, which leads them to seek treatment, or certain products may aggravate the condition, dermatologists say. In a study of 1,013 people, 15% of women and 7% of men over 50 reported having acne.
Light, administered alone or with pharmaceuticals, offers fresh options to acne patients for whom existing treatments often are either too powerful or not powerful enough. There is no hard evidence that ultraviolet light, which is blocked by most sunscreens, is beneficial for acne, or that recent increased use of sunscreen has led to higher incidence of adult acne.

Options, Old and New

With adults making up a growing portion of acne sufferers, pricey therapies that make use of a skin cream and light have come to the fore.

• Antibiotics: Widely used. The whole-body 'systemic' treatment helps kill bacteria and reduce inflammation.
• Topical treatments: Widely used. Some help kill bacteria and others reduce oil.
• Isotretinoin: A powerful systemic treatment known to kill all forms of acne but can have severe side effects.
• Combination treatments: Widely used. Therapies are primarily combinations of topical treatments that work in tandem to target different aspects of acne. Several combinations exist, and ongoing research is actively looking into others.
• Lasers: Lasers work directly on acne through methods such as targeting the water in cells and prompting the body to produce new, smoother collagen. A variety of lasers of different wavelengths are on the market.
• Light therapy: Known as photodynamic therapy, the treatment uses a cream containing an amino acid that targets acne. It is activated by light of a certain wavelength to kill cells. One type of photodynamic therapy exists on the market for acne; others are in development.
• Virus: Very early-stage research at the University of California Los Angeles and the University of Pittsburgh is investigating whether a virus that naturally infects the bacterium that causes acne can be harnessed to control and kill acne bacteria once it gets inside.

Sources: American Academy of Dermatology; Elma Baron, Case Western Reserve University; David Pariser, Eastern Virginia Medical College; Graham Hatfull, University of Pittsburgh

Common acne treatments include topical creams and oral medications, such as antibiotics and isotretinoin, known in the U.S. by its brand name Accutane. Some patients, though, don't respond to existing treatments or experience negative side effects. Some don't like the idea of taking drugs that affect the whole body in order to treat the skin.
For these patients, scientists are trying to develop better options. In a procedure known as photodynamic treatment, which has been studied for years, certain pharmaceutical ingredients that are sensitive to light can kill acne when turned on by specific light wavelengths. It hasn't yet been approved by the Food and Drug Administration as an acne treatment, though it has been approved for other skin conditions.
Other research is focused on figuring out new or better combinations of existing treatments. Early-stage research, at the University of California Los Angeles and the University of Pittsburgh, is looking into attacking acne through novel action mechanisms, such as harnessing viruses that naturally infect the acne-causing bacterium, which is known as Propionibacterium acnes.
The common term "acne" refers to several types of blemishes which may be caused by abnormalities in the functioning of the skin, the human body's largest organ. Common problems include overactive oil glands, bacteria growth within follicles and pores and problems with the keratinization process, where cells are normally sloughed off the skin, pushed out of the hair follicle and replaced by new cells. Severe acne tends also to involve inflammation, which can lead to scarring and painful pustules.
Generally, people who have mild acne can be treated with topical treatments, and those with moderate acne through a combination of topical and systemic treatments such as isotretinoin, says David Pariser, dermatology professor at Eastern Virginia Medical School in Norfolk and principal investigator of clinical trials with Oslo-based specialty drug maker Photocure, which is developing a photodynamic treatment for moderate-to-severe acne.
Isotretinoin is a powerful drug known to work on all forms of acne. It may cause potentially severe side effects, like depression, inflammatory bowel disease and birth defects. More common side effects include dry skin, dry eyes and abnormal results of lab tests such as those of liver function.
"There's a real therapeutic need for a treatment that can be used to treat moderate-to-severe acne that doesn't involve Accutane," Dr. Pariser says.
Light is used to treat medical conditions including seasonal affective disorder—a cyclical depression often tied to low sunlight—as well as skin, eye and gastrointestinal conditions. Photodynamic acne treatments appeal to patients because they are topical and don't involve introducing medicine to the entire body.
More than 10 years ago, researchers at Massachusetts General Hospital in Boston and other centers discovered the compound aminolevulinic acid, or ALA, is a photosensitizer, meaning it is activated by certain wavelengths of light. ALA-based compounds are approved in the U.S. as a treatment for actinic keratosis, a precancerous skin condition, but not for acne. Although several light and laser therapies have FDA approval as medical devices to treat acne, no true photodynamic acne therapy, combining photosensitizer and light, has been approved.

Photocure ASA

An acne treatment from Photocure, of Oslo, involves using this lamp to administer light wavelengths to skin treated with 'photosensitizer' cream.

Some doctors, though, already use ALA-based compounds as "off label" acne treatments. Cream containing ALA is applied to a patient's skin and taken up by hair follicles and oil glands. Then the patient is exposed to particular light wavelengths. The resulting photochemical reaction destroys the skin cells that have absorbed the ALA, including specialized cells that produce oil.
The trick is to make sure ALA is taken up only by the targeted cells—those that are causing the acne—and not by surrounding cells, such as nerve cells. When nerve cells take up the ALA and are destroyed, the result is pain, Dr. Pariser says.
Off-label photodynamic acne treatments are legal and rely on a doctor's judgment. "In practice we use kind of what's available and what's practical," says Elma Baron, dermatology professor at Case Western Reserve University, Cleveland, who is currently running a clinical trial of photodynamic therapy to treat a type of skin cancer. She isn't involved with Photocure.
Prof. Baron says photodynamic therapy appears to reduce her patients' lesions. But research is limited in terms of which wavelength works best, which dosages and frequencies patients need and how long the effects last.
Photocure is working on a more effective photosensitizer using an amino-acid derivative of ALA called Visonac. And it is studying what light wavelength best activates the compound. The drug attacks acne through multiple avenues as it is taken up by the P. acnes bacterium and oil glands, Dr. Pariser says.
In a recent midstage clinical trial, patients got either Visonac activated with light or a red-light treatment alone. Visonac was similar to the red-light treatment in reducing noninflammatory acne, but it was significantly better at reducing inflammatory lesions, according to the trial data. Some patients reported temporary mild pain during the course of the treatment, but no major adverse events have been reported, says Kathleen Deardorff, chief operating officer of Photocure.
Because the therapy doesn't use ultraviolet light, neither cancer nor wrinkles appear to be an issue. However, it is necessary to adjust the dose and exposure to make sure nerve cells don't take up the ALA. (Light in the form of lasers, often combined with other treatments, also may help with treatment of acne and acne scars. Results can be variable.)
The effects of the therapy appear to sustain themselves for about six weeks after the last dose, according to the data. Photocure plans late-stage clinical testing to monitor patients up to 12 months after treatment and intends to file for U.S. regulatory approval to treat moderate-to-severe acne. Most patients wouldn't need this type of photodynamic therapy, Dr. Pariser says.
Patients typically pay for light and laser acne treatments out of pocket, and prices can be hefty—more than $200 a session, says Joshua Fox, a dermatologist at Advanced Dermatology PC, who offers treatment at 10 locations in the New York City area. Most people getting laser treatments get four to seven sessions, he says.

A version of this article appeared February 26, 2013, on page D1 in the U.S. edition of The Wall Street Journal, with the headline: With More Adults Getting Acne, New Treatment Uses Light.

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