ACNE

Almost everyone experiences acne. If over-the-counter topical agents are ineffective, physicians prescribe antiacne creams, lotions, and/or gels. In a step-wise approach, stubborn cases are normally treated with oral antibiotics and, finally, by isotretinoin. Despite criticisms leveled against traditional antiacne remedies (i.e., drug resistance with antibiotics), creative dermatologists can usually manage acne using the full range of our present-day drug armamentarium. In fact, most dermatologists do not use light in the treatment of acne. However, all dermatologists encounter patients who either have severe acne that is unresponsive to traditional medications or, more commonly, chronic or intermittent acne that resists most therapies. In these circumstances, light therapy represents a viable treatment option, either as a monotherapy or as a complement to drugs. The following groups are especially good candidates for light: (1) the patient who fails oral antibiotic therapy and is unwilling or unable to tolerate isotretinoin; isotretinoin has been associated with suicide, and although no clear causality has been established, a teenager with volatile depression might undergo a trial of light before considering systemic retinoids; (2) the patient failing topical therapy who is unwilling or unable to take oral antibiotics; light may act as a medication-sparing agent in these cases; (3) a pregnant or nursing patient, or a woman actively trying to conceive; (4) patients sensitive to almost all topical remedies, especially topical retinoids; (5) the patient who resists or is noncompliant on at-home daily drug regimens; and (6) adult females with mild to moderate acne for whom a combination of hormonal therapy (i.e., BCP and possibly spironolactone), oral antibiotics, and topical retinoids has proved only partially effective.