Latest / The Science of Skin / Acne Treatment with Lasers & Energy-Based Devices: The Skincare Algorithm
Transcript
- 0:00SPEAKER_01: The views presented in this podcast are based on clinicians' points of view and experience from clinical practice.
- 0:05SPEAKER_01: This episode is brought to you by Skin Suiticals, the number one medical aesthetic skincare brand worldwide, and the leader in antioxidant science.
- 0:14SPEAKER_01: To learn more, visit www.skinseuticals.com.
- 0:26SPEAKER_02: Hello and welcome to the Science of Skin Podcast.
- 0:29SPEAKER_02: My name is Dr.
- 0:30SPEAKER_02: Ted Lane.
- 0:30SPEAKER_02: I'm a board-certified dermatologist practicing in Austin, Texas.
- 0:34SPEAKER_02: But today we're in Paris, France.
- 0:36SPEAKER_02: We're here for the Skin Alliance Conference sponsored by L'Oreal, and today's episode is actually sponsored by Skin Picals.
- 0:44SPEAKER_02: I am extremely excited to have an international guest as well.
- 0:48SPEAKER_02: This is Dr.
- 0:49SPEAKER_02: Zhang from China.
- 0:50SPEAKER_02: How are you?
- 0:51SPEAKER_00: Fine.
- 0:52SPEAKER_00: Uh hello.
- 0:53SPEAKER_00: Hello.
- 0:54SPEAKER_00: And I'm Dr.
- 0:54SPEAKER_00: Zhang from Hua Shan Hospital, Fudan University, Shanghai.
- 0:59SPEAKER_02: Great.
- 0:59SPEAKER_02: So Dr.
- 0:59SPEAKER_02: Zhang is a professor of dermatology.
- 1:01SPEAKER_02: He specializes in cosmetic dermatology, pigmentary disorders, as well as acne, which is really going to be the focus of today's episode.
- 1:10SPEAKER_02: He runs many, many clinical trials, but in addition to that, and your patient work and your teaching, you also run a lab, a wet lab for translational work, especially in pigmentary disorders, right?
- 1:23SPEAKER_02: Exactly.
- 1:24SPEAKER_02: Amazing.
- 1:25SPEAKER_02: So he's a very, very busy man, and we're thankful that you're spending some time with us today.
- 1:30SPEAKER_02: So today, guys, we're going to talk about a paper that was published in February 2026.
- 1:37SPEAKER_02: And Dr.
- 1:38SPEAKER_02: Zhang and I were both involved in this, so we both have a lot of knowledge.
- 1:41SPEAKER_02: And it is a kind of a consensus statement on a practical algorithm for acne treatment, integrated skincare, and energy-based devices.
- 1:50SPEAKER_02: So what kind of skincare should you use if you decide to treat acne with an energy-based device?
- 1:55SPEAKER_02: But we even have non-energy-based devices in here as well, right?
- 1:59SPEAKER_02: Yeah.
- 2:00SPEAKER_02: If you decide to treat it with an energy-based device, which is becoming more and more popular, what skincare should you use?
- 2:06SPEAKER_02: And that was that was our goal.
- 2:08SPEAKER_02: That was the task that we took on with this practical algorithm.
- 2:12SPEAKER_02: Again, published February 2026 in JDD, if you'd like to look it up.
- 2:16SPEAKER_02: Jill Weibel is the first author.
- 2:19SPEAKER_02: And so let's let's kind of dive into this.
- 2:22SPEAKER_02: So acne is something that you and I treat on a daily basis, right, Dr.
- 2:27SPEAKER_02: Zhang?
- 2:27SPEAKER_02: And how do you decide if you're going to use only prescription therapies or if you'd like to start using, you know, energy-based devices or mechanical devices to help you?
- 2:37SPEAKER_00: Yes, acne is so popular.
- 2:39SPEAKER_00: We see hundreds of acne every week.
- 2:43SPEAKER_00: So I think for certainly we use prescription for some most of cases, but in some of the cases, actually many cases, prescription might not solve all the questions.
- 2:58SPEAKER_00: Then we need to think about how to treat these patients more highly h more efficiently in addition to prescription.
- 3:08SPEAKER_00: In that perspective, energy-based device might play an important role because we now use quite many devices which could help us to control the lesions, to help us to prevent a lot of side effects of the prescription and also could avoid some sequelae, which is very popular.
- 3:34SPEAKER_02: Yeah, I completely agree.
- 3:36SPEAKER_02: And I think the the goal for any acne patient is to get them to clear, right?
- 3:41SPEAKER_02: That should be the goal of all dermatology professionals, is we need to get our patients to clear.
- 3:47SPEAKER_02: So an IgA of zero, because we know from psychosocial data that's been published over the last decade or so, that even an IGA of almost clear affects the patient's quality of life.
- 3:59SPEAKER_02: It has a negative impact on the dermatology life quality index, the DLQI.
- 4:04SPEAKER_02: And so if our goal as healthcare professionals is to improve the quality of life for our patients, that means, based on the data, that we need to get our patients to clear.
- 4:13SPEAKER_02: And we have the tools, as Dr.
- 4:15SPEAKER_02: Zhang was just talking about, to do so.
- 4:18SPEAKER_02: And it may be an incorporation of multiple different technologies or treatment options, including skincare plus prescription, plus energy-based device, all of it, plus lifestyle modification, plus diet modification, right?
- 4:35SPEAKER_02: We know about all that.
- 4:37SPEAKER_02: So it really, acne is such a complex disorder.
- 4:40SPEAKER_02: We haven't solved it, but we certainly can get our patients to clear with the treatments that we have available to us, and that's our goal.
- 4:48SPEAKER_02: And I think with that in mind, we developed this practical algorithm.
- 4:51SPEAKER_02: And I, you know, at the core of this algorithm, which again was looking at the skin care to be used alongside EBDs for acne, it seemed like we always turned to, you know, besides the cleansers and moisturizers, which are very important, we'll go back to that.
- 5:05SPEAKER_02: But I think that one of the products that we always turn back to was an antioxidant, which may be surprising to people, right?
- 5:11SPEAKER_02: But Dr.
- 5:12SPEAKER_02: Zhang, why would an antioxidant be so important for acne patients?
- 5:15SPEAKER_00: Yes, because actually when you look at the mechanism or pathogenesis of the acne also and also their sequelite, oxidative stress might play an important role.
- 5:27SPEAKER_00: And we see a lot of uh ROS, which is called reactive oxidation species work accumulated in the lesions, and this will lead to a severe inflammation, which could promote this leftover, which causes scars or other sequeli happen.
- 5:48SPEAKER_00: That's why we need to control the inflammation or we should clear up the uh ROS as much as possible as soon as possible.
- 5:57SPEAKER_00: That's why we need antioxidants when treating acne.
- 6:01SPEAKER_02: I think that explanation was spot on, right?
- 6:04SPEAKER_02: We know that inflammation, just like if we talk about longevity, inflammation is the enemy, right?
- 6:08SPEAKER_02: We're always trying to solve for inflammation.
- 6:11SPEAKER_02: And if we think about those lesions, there's data again that I'm gonna point to that those lesions, which are the most common lesions that lead to scarring, are actually post-inflammatory erythema lesions.
- 6:24SPEAKER_02: It's the red marks that are left behind.
- 6:27SPEAKER_02: Something like 70% of acne scars result from PIE and not necessarily straight from an active papule or pustule, which is surprising to some people.
- 6:37SPEAKER_02: Now, the other surprising thing, and we're gonna get back to the reactive oxygen species, but the other surprising thing is that not all scars are permanent, which kind of blows your mind a little bit when you think about it, because when you think of scarring, you think of a permanent mark left behind.
- 6:53SPEAKER_02: But a third of scars, I put that in a bit of quotes, are actually transient.
- 6:58SPEAKER_02: They go away.
- 6:59SPEAKER_02: Which is nice, because you know, if a third go away, that helps us quite a bit to reduce the number of scars if they do it spontaneously.
- 7:06SPEAKER_02: But that means two-thirds don't.
- 7:07SPEAKER_02: And we and that's why it's so important to use the right acne products before, during, and after acne.
- 7:15SPEAKER_02: Because you obviously we need to do our best to prevent acne, we need to do our best to treat acne, to reduce the inflammation, to your point.
- 7:23SPEAKER_02: And then if unfortunately an acne lesion does develop, and once it's resolved, we have to continue treating so that we resolve the inflammation as much as we can to prevent scarring, to your point.
- 7:36SPEAKER_02: Okay.
- 7:37SPEAKER_02: So the product that we talk about the most is one that's it's an antioxidant formula that's really targeted to the acne patient.
- 7:46SPEAKER_02: Okay, let's go through that quickly, Dr.
- 7:48SPEAKER_02: Zhang.
- 7:49SPEAKER_02: Okay.
- 7:49SPEAKER_02: So that's the silamarin CF, okay?
- 7:52SPEAKER_02: Yes.
- 7:52SPEAKER_02: So silamarin, right?
- 7:54SPEAKER_02: It's a milk thistle extract.
- 7:56SPEAKER_02: Uh, very interesting antioxidants.
- 7:58SPEAKER_02: It's been around for a long time, right?
- 8:00SPEAKER_00: Yes, I think it's it has been found for a long time.
- 8:06SPEAKER_00: Now I'm not sure how long it has been applied to treat acne, but certainly it's we know that we now know that it plays an important role and it could help to reduce the inflammation, to help to relieve the lesions and also avoid the side effect and also the leftover disequili.
- 8:25SPEAKER_02: Yeah.
- 8:26SPEAKER_02: You know, if we are thinking about it's silamarin, right?
- 8:29SPEAKER_02: And then let me get back.
- 8:30SPEAKER_02: My ADD is kicking in.
- 8:32SPEAKER_02: So after silimarin, we've got vitamin C.
- 8:34SPEAKER_02: Yes.
- 8:35SPEAKER_00: Okay, another potent antioxidant.
- 8:37SPEAKER_00: Yes.
- 8:37SPEAKER_00: It is very important antioxidant in a lot of aspects, in a lot of conditions, we can use vitamin C.
- 8:44SPEAKER_02: And that's pure aloscorbic acid, as as Sheldon Pinnell found and is in the CE ferulic, for example.
- 8:50SPEAKER_02: That's the best-selling antioxidant in the world.
- 8:53SPEAKER_02: Uh, and then we have ferulic acid.
- 8:55SPEAKER_02: Yeah.
- 8:56SPEAKER_02: Also an interesting ingredient.
- 8:57SPEAKER_02: It helps to turbocharge the vitamin C, is the way I think of it.
- 9:01SPEAKER_02: It acts as kind of a lift of vitamin C's antioxidant abilities.
- 9:06SPEAKER_02: Exactly.
- 9:07SPEAKER_02: Okay.
- 9:07SPEAKER_02: All right.
- 9:08SPEAKER_02: So silomarin CF is a solution used once a day.
- 9:11SPEAKER_02: Most people would use this in the morning actually, and and uh before sunscreen.
- 9:16SPEAKER_02: And let's let's also talk about because we include sunscreen in here.
- 9:20SPEAKER_02: Yeah.
- 9:20SPEAKER_02: And yes, it's important when you're going out to prevent sun damage, but for patients with acne in particular, sunscreen's an integral part of their regimen, right, Dr.
- 9:30SPEAKER_02: Zhang?
- 9:30SPEAKER_00: Yeah, I think in this algorithm, I think pre-treatment, post-treatment, we always suggest the sunscreen because you know overexposure of sunlight, uh, even LD light could uh lead to a lot of um bad things which could trigger the onset and even the worsening of the lesion itself and also a lot of uh sequili such as PIE and PIH.
- 9:58SPEAKER_02: Yeah.
- 9:59SPEAKER_02: Very interesting.
- 10:00SPEAKER_02: So we know that the sebum of acne itself is inflammatory.
- 10:04SPEAKER_02: Okay, so it's not like someone who produces a lot of oil is just moisturizing their skin and it's a good thing.
- 10:11SPEAKER_02: Unfortunately, that oil being produced has inflammatory properties.
- 10:15SPEAKER_02: But the other problem with all that oil, it's full of lipid.
- 10:19SPEAKER_02: And when lipid is exposed to sun, there is a process called lipid peroxidation, which leads to a lot of reactive oxygen species formation, right?
- 10:30SPEAKER_02: And ROS leads to an imbalance in the redox homeostasis.
- 10:36SPEAKER_02: We overload the skin's own ability to deal with these horrible reactive oxygen species, which are just grabbing electrons left and right, and it leads to lots of damage.
- 10:47SPEAKER_00: It also leads to the think the damage of the skin barrier.
- 10:50SPEAKER_02: Yeah, that's exactly right.
- 10:52SPEAKER_02: And then we have a barrier issue which is integral to acne as well.
- 10:56SPEAKER_02: And so that's why sunscreen, guys, is so important.
- 10:59SPEAKER_02: Broad spectrum, and thankfully, in the United States, we have BEMPT now, finally.
- 11:04SPEAKER_02: Uh, of course, outside the United States, much better sunscreens.
- 11:08SPEAKER_02: But um, you know, thankfully we have BEMPT as one of the newer sunscreen ingredients, although it has a 20-year history outside of the United States, it's a very safe.
- 11:16SPEAKER_01: This episode is brought to you by Skin Suiticals, the number one medical aesthetic skincare brand worldwide, and the leader in antioxidant science.
- 11:24SPEAKER_01: To learn more, visit www.skinseuticals.com.
- 11:28SPEAKER_02: Now let's talk about moisturizers, though.
- 11:31SPEAKER_02: Okay.
- 11:31SPEAKER_02: Uh as you mentioned the barrier.
- 11:33SPEAKER_02: Can you can you dive a little deeper into that?
- 11:36SPEAKER_00: Yes, beforehand, we don't think actually we don't know whether there is a skin barrier dysfunction in acne, but later when we look at literatures, a lot of reports that showed that acne patients might suffer from skin barrier dysfunction.
- 11:51SPEAKER_00: On one hand, these lesions, these inflammation could damage the skin barrier to make the barrier very vulnerable to exposure of sunshine or other pollutions, PM2.5, a lot of things.
- 12:06SPEAKER_00: On the other hand, a lot of treatment could worsen the skin barrier dysfunction like isotractinoid or retinoid, even some vitamin A.
- 12:16SPEAKER_00: That's why we need the to protect and to keep a healthy skin barrier for our acne patients, especially before and after the treatment.
- 12:28SPEAKER_02: I think you again said exactly what I was thinking, which was not only is there an inherent barrier issue in our acne patients, which makes moisturizing so important.
- 12:38SPEAKER_02: We unfortunately prescribe ingredients that further impair the barrier, whether it's a retinoid, whether it's a benzoyl peroxide, for example, um alpha hydroxy acid, beta hydroxy acids, they all impair the barrier.
- 12:52SPEAKER_02: And so when you are already kind of deficient in your barrier, when it's a defective barrier and you're doing more to make it less effective as a true barrier, it's so important to provide the ingredients that help to support the barrier, the ceramides, for example, cholesterol, ceramides, free fatty acids, all of that's important in a moisturizer.
- 13:13SPEAKER_02: And yet there's so much more technology behind moisturizers.
- 13:16SPEAKER_02: That's outside the scope of today's episode.
- 13:18SPEAKER_02: But very important just to remember a very good sunscreen and a very good moisturizer, antioxidants as well.
- 13:25SPEAKER_02: Let's talk quickly about cleansers.
- 13:27SPEAKER_02: What cleansers do you normally recommend?
- 13:29SPEAKER_00: Yeah, cleansers are extremely important for acne patients because usually our patients have to use quite many times of cleansers, but sometimes they do it in the wrong way.
- 13:39SPEAKER_00: So cleanser needs to be gentle, needs to be used gently.
- 13:44SPEAKER_00: It's the uh with without fragrance and should be non-comidogenic.
- 13:52SPEAKER_00: Yes.
- 13:53SPEAKER_00: Because these some of the ingredients could play a bad role in the acne.
- 14:00SPEAKER_00: So we need to pay attention to the cleanser.
- 14:03SPEAKER_00: It's very important to the acne patients, even when we are using energy-based device together.
- 14:10unknown: Dr.
- 14:10SPEAKER_02: Zhang, there's there's a common theme on social media where we see patients double cleansing.
- 14:17SPEAKER_02: They would use an oil-based cleanser, for example, first, and then maybe a gentle cleanser or not so gentle cleanser afterwards.
- 14:24SPEAKER_02: I personally find that quite ridiculous.
- 14:26SPEAKER_02: I I don't understand, especially with the cleansing technology that we have available and the wonderful surfactant technology.
- 14:33SPEAKER_02: I don't quite understand double cleansing at all.
- 14:35SPEAKER_02: Um, but what are your thoughts?
- 14:38SPEAKER_00: I totally agree with you that we usually would suggest our acne patients not wash the face for too many times and just pay attention to the ingredient of your cleanse, as I have mentioned.
- 14:55SPEAKER_00: You need to look at it.
- 14:56SPEAKER_02: Yeah.
- 14:57SPEAKER_02: We're preaching here, okay?
- 14:59SPEAKER_02: Because it's really important when you have an impaired barrier already, that if you overcleanse, if you use too many surfactants, you're going to affect the barrier.
- 15:09SPEAKER_02: And again, that just sets you up for more and more acne, probably more severe acne, and it just makes it so much more difficult for us to get the skin to clear, which is the goal.
- 15:20SPEAKER_02: Okay?
- 15:20SPEAKER_02: So that's why integrated skincare, that's why focusing on the right products, ingredients, and formulations is so important and integral to treatment success, and why we're spending so much time on it, uh, because it it really does help you when you are using either energy-based devices or prescriptions plus energy-based devices.
- 15:40SPEAKER_02: Yeah.
- 15:41SPEAKER_02: Yeah, which is what you said you do quite a bit.
- 15:43SPEAKER_02: Let's talk about the kind of tech technologies that you incorporate in your clinic, Dr.
- 15:49SPEAKER_02: Zheng.
- 15:49SPEAKER_02: Okay?
- 15:50SPEAKER_00: Yeah, for acne patients and also for their sequili, we we use quite many different categories of devices.
- 15:59SPEAKER_00: For example, the red light, blue light, the IPL is very commonly used to treat the acne lesions, to reduce the lesions at the early stage.
- 16:11SPEAKER_00: For example, the photodynamic treatment, which is uh usually used to uh to treat some relatively strong and severe cases, it's quite effective and successful together with the proper skincare products.
- 16:29SPEAKER_00: And we also have mechanical devices that which is very popular for like microneedling, microdermigration, and also radio frequency.
- 16:39SPEAKER_00: These techniques and devices can also help to reduce or to help to remove some of the lesions.
- 16:48SPEAKER_00: Larst, I think, also the most popular, is uh quite many um laser lasers, for example, uh fractional laser, which is very popularly used to treat scars.
- 17:03SPEAKER_00: And also we have like pulse eye lasers to treat relatively like with some blood validation or like telling gelactasia, these red pimpes.
- 17:16SPEAKER_00: So we have quite many alternatives.
- 17:19SPEAKER_00: I think a good doctor is good at choosing the right EBD devices together with the products to make 100%, even over 100% effect on the patient.
- 17:31SPEAKER_02: And and just to just to highlight Dr.
- 17:33SPEAKER_02: Zhang's expertise, he has access to 40 lasers in his clinic, okay?
- 17:38SPEAKER_02: And so he really does choose the laser based on the presentation that the patient has in the clinic versus using one laser for everybody.
- 17:47SPEAKER_02: He doesn't need to do that.
- 17:48SPEAKER_02: He has multiple technologies.
- 17:49SPEAKER_02: Now, many of us are not like that.
- 17:51SPEAKER_02: We don't have 40 lasers in our clinic, but we do rely on PDT, for example, which I know would be off-label in the United States, but certainly we have data to show that it's highly effective for our uh acne patients.
- 18:05SPEAKER_02: We also may have an IPL or a broadband, which can also be effective.
- 18:09SPEAKER_02: And many of us also have fractionated laser, which we use for the uh the scarring that can occur because of acne, right?
- 18:18SPEAKER_02: So although we may not have as much as Dr.
- 18:21SPEAKER_02: Zhang has on at his fingertips, we certainly have, or in your area, most likely somebody has access to these lasers, which can be incredibly effective.
- 18:31SPEAKER_02: Um, as we mentioned, uh mild cleanser, sunscreen, antioxidant.
- 18:37SPEAKER_02: We we recommended those for every type of procedure, uh whether it was PDT or fractional.
- 18:44SPEAKER_02: It didn't matter.
- 18:45SPEAKER_02: We recommended those for everybody.
- 18:46SPEAKER_02: But then what about retinoids, right?
- 18:48SPEAKER_02: Because retinoids are such a foundational treatment for our acne patients.
- 18:53SPEAKER_02: What did we say in terms of stopping retinoids before any of these?
- 18:57SPEAKER_02: Or what is your normal use of retinoids and how do you counsel patients?
- 19:01SPEAKER_00: So we do have a discussion when we are doing this algorithm.
- 19:06SPEAKER_00: Yeah.
- 19:07SPEAKER_00: Because as you have mentioned, that retinoid is a foundation of the acne treatment.
- 19:13SPEAKER_00: So we usually, most of the patients are using retinoid, no matter they choose to do a procedure or not.
- 19:21SPEAKER_00: But when we are going to give them energy-based device treatment, usually we would think to stop for a short while, but not so many, to make sure the skin barrier is in a very healthy condition, together with some skincare products to maintain a good skin barrier.
- 19:43SPEAKER_00: And after one or two weeks, probably we can restart the retinol use.
- 19:48SPEAKER_02: Yeah.
- 19:48SPEAKER_02: And and we said that we said that it was time for us to stop that we stopped the retinoid two weeks before, specifically for, I believe, energy-based devices, anything where where we were using kind of photosensitizing, photosensitizing ingredients could be an issue.
- 20:02SPEAKER_02: So energy-based devices, IPL in particular, but we didn't say that for our fractionated lasers, right?
- 20:08SPEAKER_02: I think we we said that patients continue using up till the reason.
- 20:10SPEAKER_00: Yes, in a certain patient who are using a certain treatment, we probably will suggest.
- 20:19SPEAKER_00: I think in the algorithm we quite we make it clear in a very certain um procedure part we can stop for a short while, but in the other cases we just it will not interrupt the normal prescription for retinoid.
- 20:34SPEAKER_02: Yeah.
- 20:35SPEAKER_02: So so please, uh, if you have any other questions, take a look at this practical algorithm for the use of skincare alongside energy-based devices.
- 20:42SPEAKER_02: Again, February 2026 in JDD.
- 20:45SPEAKER_02: The first author is Jill Weibel.
- 20:47SPEAKER_02: Uh, we have an international group, obviously, of experts who came together to put this together and we worked quite hard on it.
- 20:53SPEAKER_02: So um hopefully you'll find it uh effective and helpful in your practice.
- 20:58SPEAKER_02: Uh again, thank you so much for listening.
- 21:00SPEAKER_02: My name is Dr.
- 21:01SPEAKER_02: Ted Lane.
- 21:02SPEAKER_02: I'm a board certified dermatologist in in Texas.
- 21:04SPEAKER_02: I have Dr.
- 21:05SPEAKER_02: Zhang with me, who is also a board-certified dermatologist in China and a true leader uh in acne treatment and uh development of treatments and understanding the disease process as well.
- 21:18SPEAKER_02: So very exciting to have such an international expert with us on this podcast.
- 21:22SPEAKER_02: Please, if you like the podcast, give us a five-star rating.
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- 21:29SPEAKER_02: So please tell your colleagues and friends about the Science of Skin podcast.
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- 21:34SPEAKER_02: If you have any questions about today's episode, you please drop us an email, inquiry at scienceofskinsummit.com.
- 21:40SPEAKER_02: That's inquiry at science of skinsummit.com.
- 21:43SPEAKER_02: Patty and I very soon will be uh hosting a new podcast episode where we'll go through all these questions and make sure they're answered.
- 21:51SPEAKER_02: And also if you have any ideas for future episodes, let us know.
- 21:54SPEAKER_02: We we'd love to hear from you.
- 21:56SPEAKER_02: Uh in the meantime, uh hope everyone's doing well.
- 21:59SPEAKER_02: Certainly much cooler than we have here in Paris, where we have the Parisian heat dome, and it's well over 100 degrees or over 40 degrees centigrade.
- 22:07SPEAKER_02: Um, and so not super fun in Paris today, unfortunately.
- 22:10SPEAKER_02: But uh I hope you are enjoying your day.
- 22:13SPEAKER_02: Thank you so much for listening.
- 22:14SPEAKER_00: Thank you.
- 22:25SPEAKER_01: This episode is brought to you by Skin Suiticals, the number one medical aesthetic skincare brand worldwide, and the leader in antioxidant designs.
- 22:34SPEAKER_01: To learn more, visit www.skinseuticals.com.