New treatment using gold may offer solution for acne sufferers
A new treatment which combines gold micro-particles with laser, may offer a solution for acne. The treatment is being trialled at London Dermatology Centre by Dr Sunil Chopra and Balsam Alabassi.
Gold has been used for centuries to treat different medical conditions because of its unique properties as a noble metal. It is now being utilised for the first time in the skin as part of a new treatment being trialled for acne. The protocol which uses gold micro-particles and laser is being trialled in the UK by Dr Sunil Chopra and Balsam Alabassi at the London Dermatology Centre. The clinic was approached because of Dr Chopra’s expertise and background in clinical research and the equipment he has which has the ability to measure various skin parameters. They are one of 30 centres worldwide taking part in the phase IV trials for Sebacia, a topical formulation of gold microparticles which are delivered into the skin and then heated using a diode laser. They are aiming to treat 25 patients at their clinic as part of the trial and have been working with the treatment for two months now.
Dr Chopra explains, “The principle behind it is quite simple. The gold particles are absolutely tiny microparticles so when you place them on the skin they go down into the sebaceous glands almost immediately. Once the gold particles have sunk into the sebaceous glands you heat them up with a diode laser – we are using the LightSheer but you can use an Nd:YAG laser (1064nm). That heat basically frazzles the oil producing glands. The inflamed oil producing glands will preferentially pick up more of the gold particles, so they will be affected more. By heating up the sebaceous gland you stop its activity and get rid of the acne.”
The Sebacia product comes in a vial that must be kept in the fridge. The liquid is black rather than gold because of its light-absorbing properties, but contains microscopic particles of gold. The first step is to deliver the gold nano-particles into the skin. A whole vial of the serum is spread across the entire face. Penetration is improved by massaging the product in with a special electric massager for before applying the laser energy. Before applying the laser, the excess must be wiped off the surface of the skin with wet gauze as excess particles on surface can cause burns during laser exposure. The whole procedure takes about 30 minutes.
Once in the skin the microparticles act as a chromophore. Alabassi explains, “The idea is to create a chromophore, because the sebaceous glands don’t have them, unlike hair. We want to target the oil secreting gland in order to eliminate the habitat that the bacteria can grow in. By creating a contrast using a physical chromophore we allow the laser to be able to do its job and target the gland selectively.” The laser is then applied across the entire face with a 10% overlap spot-to-spot. The laser energy interacts with the microparticles creating localised tissue heating. This selective photothermal effect heats the follicle and sebaceous gland to reduce oil output. Like any treatment with laser, the procedure can be uncomfortable for some patients but discomfort can be minimised with skin cooling and no anesthesia is required.
After treatment, there may be some swelling and initially the acne can look worse for some patients. Dr Chopra comments, “You do get an inflammatory reaction where the acne looks worse and the face is swollen for about two or three days but then it all settles down. This may actually be a good sign that the treatment is working. Patients are able to return to work or school on the same day as their treatment.” Three treatments are performed in total – one a week for three weeks. “You need the full three treatments”, Dr Chopra says. “So far, we have noticed after one treatment you don’t get that much improvement, so you need the full three treatments.”
The ideal patient for treatment with this protocol is those with moderate to moderately severe acne with a Fitzpatrick skin type of I-III. Dr Chopra sees it as a good alternative for those with this type of acne who don’t want to go onto Roaccutane. “There is a particular group of patients who have tried antibiotics but then the acne comes back as soon as they stop taking them”, he says. “After that your main option is Roaccutane but many patients don’t want to go onto that. “The advantage of this treatment is that you don’t have to take any drugs or get any of the side effects associated with them. It is just three treatments spaced one week apart.” Although they have not seen any adverse events so far with the treatment there are patients who are not suitable. Safety and effectiveness have not been shown in those under the age of 16 or over the age of 35; women who are pregnant or breast feeding; those with known photosensitivity; non-facial acne and skin types IV and higher. The treatment is also not indicated for severe acne and Dr Chopra also says he would not treat if someone has a secondary skin condition in the treatment area such as rosacea or psoriasis or a tattoo in the treatment area.
The trial is still ongoing but the initial results look promising, according to Dr Chopra. He says, “The treatment looks really promising. The studies have assessed patients at three months and nine months so we only currently have data up to nine months. They showed a 50% decrease in lesion count after three months.” Anecdotally Dr Chopra also believes the treatment could improve acne scarring as well and is keen to do further research to provide evidence of this. He says, “We don’t know yet but I believe that if you are heating the skin up at quite a deep level, like we are here, you are going to get a rejuvenation and anti-scarring effect as well. We are measuring the number of scars as a separate side study and suspect we are going to see not only a lowering of the acne but the scarring as well.”
The London Dermatology Centre is still recruiting patients for the study. Contact 0207 467 3720 or london-dermatology-centre.co.uk