1. Photopneumatic (PPx) Pore-Cleansing Acne
Treatment™: A Breakthrough Treatment Option
for Non-Responders to Acne Therapies
AVA T. SHAMBAN, MD
Laser Institute for Dermatology and European Skin Care, Santa Monica, CA
BACKGROUND: Acne is a common skin OBJECTIVE: To determine the efficacy,
disease for which multiple treatment response and side effects on patients treated with
modalities including oral medication, Photopneumatic Pore-Cleansing Acne Therapy.
topicals and lasers have been used with RESULT: Non-responders to oral medications,
varying degrees of success. Lasers and light topicals and lasers demonstrated greater than 75%
sources have been less than effective as improvement after 4 treatments. Immediate
treatment options for a multitude of reasons visible improvement defined as a reduction in
including painfulness of procedures; often as erythema and the flattening of the lesion was
many as 11 treatments required; treatments observed 24-48 hours post treatment. Patients
at weekly intervals making compliance reported the treatment as being painless. Global
difficult; and the risk of side effects improvements in skin texture including a
including burning. Photopneumatic Pore- reduction of pore size were noted.
Cleansing- Acne-Treatment™ is a CONCLUSIONS: Photopneumatic™ Pore-
revolutionary combination of pneumatic Cleansing-Acne-Treatment™ is a painless, and
energy and broadband light. This novel effective therapy for treating a broad range of
therapy offers painless treatments that are acne. It offers a new treatment option for
effective, quick and require no pre-treatment traditional non-responders to acne therapies.
with anesthetics or gels. Additional benefits include subjective changes in
the improvement of skin texture.
ACNE is perhaps the most common of skin reminder of the condition. Acne is commonly
disease; 85% of people between the ages of described as a disease of pilosebaceous units
12 and 24 suffer from acne while 20% of all (PSUs). PSUs consist of a sebaceous gland
adults suffer from active acne. While most connected to a follicle that contains a fine (vellus)
commonly manifesting in individuals in hair. While PSUs are found all over the body,
their teens and 20s, acne often affects those they occur most densely on the face, upper back,
in their 30s, 40s and even sometimes and chest. Sebum normally empties onto the
beyond. While the absolute number of acne skin’s surface through the follicular duct,
sufferers globally is staggering, only a small commonly called a “pore.” The defective
11% of people with acne seek medical help.1 keratinization of the follicular duct results in
Acne has few boundaries and occurs on the abnormally adherent epithelial cells that plug the
face, neck, upper arms, chest, back and duct with sebum, dead epithelial cells.
shoulders. While acne usually clears up over
time, its presence can cause severe When the follicular debris pushes to the surface
psychological and emotional trauma to of the skin, the result is what we commonly call
sufferers during outbreaks.2 Untreated acne “blackheads.” Follicular debris that remains right
can cause permanent scarring -an unwanted below the opening of the pore results in what we
permanent commonly call “whiteheads.” Some
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2. comedones develop into inflammatory Photopneumatic treatments use the PPx™
lesions, papules, pustules, nodules and cysts. System (Aesthera Corporation, Pleasanton, CA)
which comprises of a base platform, a treatment
While there are a very wide variety of hand piece and multiple specialized treatment tips
treatment options available to patients who in a wide range of sizes designed to contour with
suffer from acne, there is no cure for the the areas being treated.
disease. Treatment options span the entire
range from retinoids, topical and oral Negative pressure lifts the sebaceous gland
antibiotics, over-the-counter topical peeling bringing it closer to the skin’s surface. When
agents and lasers. While retinoids and vacuum is applied, the elevated sebaceous gland
antibiotics have been successfully used in is inverted and opened up, emptying its contents.
the treatment of acne, they are commonly Acne causing bacteria, sebum and other
contraindicated for pregnancy and are impurities including dead skin cells are ejected
associated with side effects such as onto the surface of the skin where they can be
photosensitivity, redness and extreme dry easily wiped away.
skin and itchiness.
The abovementioned treatment options
require long periods of continuous use and
do not physically alter the sebaceous gland.
Lasers and light sources have been less than
effective as treatment options for acne
sufferers.
The majority of laser treatments are very
painful. Many patients do not return for
follow up visits after the initial treatment
due to the extreme discomfort associated
with treatments. Lasers and light sources
often require as many as 11 treatment
sessions.
Several commonly used lasers or light
Aesthera™ PPx™ System with IntelliTip™
sources require weekly treatments making
compliance extremely difficult for teenagers One of the greatest ancillary benefits of PPx Acne
and adults. High powered lasers are also treatments is the result of vacuum activation that
associated with a high risk of side effects deep cleanses pores by ejecting congested sebum
including the potential for burns. to “jump start” the process of eliminating
p.acnes.3
The Mechanism of Photopneumatic
Pore-Cleansing Acne Treatment™ Description of Clinical Study and
Overview of Methods
Photopneumatic (PPx) Pore-Cleansing
Acne- Treatment™ has revolutionized laser
13 patients male and female between 18 and 37
treatments of acne. Photopneumatic Therapy
years of age were recruited via word of mouth
is the world’s first advanced acne therapy
advertising from the patient base of a private
that harnesses the dual power of pneumatics
clinic. 11 patients (Skin types I – V) completed
with the proven therapeutic qualities of
all four treatments. 64% (7 / 11) of patients
selected filtered broadband light to
enrolled had previously been non-responders to
painlessly treat the broadest types of acne.
multiple other modalities for
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3. the treatment of acne (including oral Discussion
medications, topicals and lasers). All
recruited patients currently suffered from 11 patients (Skin types I – V) completed all four
acne. treatments. As is demonstrated in Figure 1, all
patients continued to experience lesion reduction
Patients who had been on any acne after final treatment through the second month of
medication (topical or oral) or laser / light follow up. 64% (7/11) of patients who were
based therapy for 3 months prior to the start traditional non-responders to multiple treatment
of the study were automatically excluded. modalities experienced greater than 75%
Photographs were taken at baseline. reduction in lesions at 2nd month follow up. 4/4
Inflammatory, pustular and comedonal of patients who had experienced other treatment
lesions were counted by the treating modalities had 88% clearance at second follow
physician or RN. Skin was cleaned with up. 100% of patients described the treatment as
warm water to soften the lesion prior to being painless. Subjective evaluation by
treatment. Each patient received 4 physicians and patients observed an improvement
treatments at weekly intervals. No topical in skin texture specifically a reduction in pore
anesthesia or treatment gels were applied size and an improvement in skin texture and tone.
prior to treatment.
Patients and physicians both observed clearance
Clinical photographs and lesion counts were of post-inflammatory sequelae of acne, including
taken for evaluation purposes prior to each hyperpigmentation and prolonged erythema for
treatment and at follow up. Aside from this, an additional cosmetic benefit. Figure 2 shows
clinic staff kept records of other clinical photographs of a patients before and after 4
observations including erythema, purpura, treatments.
and comfort level of treatment. Evaluations
of improvement were recorded after every There were no unexpected adverse events
treatment. Follow up was conducted at 1 recorded during the course of the study. One
month, 2 months and 3 months post final patient experienced transient petechiae which
treatments. Photographs were taken at resolved within 72 hours of treatment. No
follow up, lesion counts were performed and hyperpigmentation, hypopigmentation, scarring
patient evaluations were noted. Blinded or purpura was noted in any patient treated.
reviewers independently assessed
improvement based on clinical photographs.
%Reduction in Lesion Counts
100
90
80
% Reduction
70 N R
on esponders
60 who Responded
50
40 Others
30
20
10
0
After 1st Tx After 2nd After 3rd Tx After 4th Tx 1 month F/U 2 month F/U
Tx
Treatments & Follow Up
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4. Fig 1: Percentage Reduction in Lesion Counts
Before 1 month after 4th Treatment Pores Are Cleansed
Figure 2: Clinical Photographs
Conclusion treatment, specifically a reduction in redness and
a flattening of lesions. Erythema associated with
A clinical study using Photopneumatic™ inflammation also resolved providing patients
(PPx) Pore-Cleansing Acne Treatment™ with an additional cosmetic benefit. Patients
demonstrated a significant improvement in uniformly described the treatment as being
acne lesions in those patients who were painless and compliance rates were very high for
previous non-responders to a wide range of all study patients. Patients and treating physicians
acne treatments including oral medications, noted a vast improvement in skin texture, most
topicals and lasers. The study also significantly a reduction in pore size and a
demonstrated improvement in acne lesions reduction in oiliness of the skin. No significant
on those patients who had received other side effects were reported. Photopneumatic™
forms of treatment but had been dissatisfied Therapy’s (PPx) unique mechanism results in
with outcomes. Patients noted an immediate effectively improving acne lesions in those
improvement in lesions 24 - 48 hours post patients who have been previous non responders.
Reference
1
Acne Resource Center Online.
2
Kellet, S.C and Gawkroger, D.J., “The Psychological and Emotional Impact of Acne and the Effect of Treatment with Isotretinoin.”
British Journal of Dermatology, 140 (1999), 273 – 282.
3
Anderson B and Narurkar V "Efficacy and safety of a novel device for acne vulgaris" Lasers In Surgery And Medicine, 18(Supp):
35, 2006
Aesthera and its logo, Photopneumatic, PPx and IntelliTip are trademarks of Aesthera Corporation, www.aesthera.com
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