[Lecture of the month] HELIOS II In Acne Cocktail Management

Lecturer/Dr. Dhananjay Chavan

Hello, I am Dr. Dhananjay Chavan from India. It is my great pleasure to give this lecture in front of Korean doctors. The topic of today’s talk is ‘HELIOS II In Acne Cocktail Management’.

I used Helios II in acne treatment. As readers would already know, psychological and physical factors play a major role in treatment of acne. Early treatment, therefore, is very important. Combination therapy is also needed as acne has complicated pathophysiology. This can help cure the condition, prevent complications, minimize downtime and maximize the effect. The doctor and patient have to work together to speed up the treatment process.

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Treatments that combine benzoyl peroxide, clindamycin, and sunblock include glycolic peel and salicylic acid, etc. Here, you can also combine comedon extraction and Q-switched Nd:YAG 1064nm laser. I administered oral combination of isotretinoin and azithromycin. I divided patients into three groups and performed treatments every 2 weeks for 2-3 months. I continued follow-up to adjust isotretinoin. External treatments included combination of glycolic peel, comedon extraction, and laser. From second or third visits, I used Helios II. For medication, I maintained a low dose. Isotretinoin was maintained for 3 months for psychotherapy and I prescribed it for additional 3-4 weeks. I also performed surgical treatments when needed.

Glycolic peel was also tried and when the outcome was good, medication was discontinued. I prescribed 0.2~0.4mg/kg for the first 4-5 weeks and increased the dose as needed during the next 4 months. I also use laser. Caution should be given to blood vessels and sebaceous gland and combination therapy should be carried out. Especially, when capillaries or pigment are the target, special caution is needed to avoid complications.

Thermal effect promoted collagenesis and reduced sebaceous glands. The Q-switched 1064nm Nd:YAG laser brought satisfactory results in the mouth and eye areas. I found that it could also be used in active acne. The Nd:YAG laser is not indicated for acne but applying carbon lotion can improve outcome of acne treatment.

Q-switched 1064nm Nd:YAG laser has two modes; Quasi-long pulse and Q-switched pulse. The 1064nm laser has different absorbance of carbon, leading to biological effects which can be beneficial in acne treatment. The absorbed carbon infiltrates into follicles. The 1064nm laser has stronger absorbance of carbon than melanin.

The treatment can be carried out as following. Use low fluence in the first pass. Thsi does not cause any damage to the epidermis, dermis or sebaceous glands. The thermal damage controls acne activity as well as provide a biological remedy for causal bacteria. Skin elasticity and acne scar were also improved.

The second pass was given at 5ns. Here, the upper epidermis was partially removed. The clogged follicles were cleared and this provided very good exfoliation. Helios II treatment can begin 1-2 weeks after acne therapy. In some patients I wait for a month after initiating medication.

After 1 month, acne lesions are drastically reduced and it is easy to see the effect of laser on scars. Also, laser therapy is effective in inflammatory acne, erythema, and acne excoria. Continuing therapy for 2-3 months helps eradicate acne bacteria and reduce scars.