New Acne-Specific Lasers Are Not Identical

ORLANDO, Florida — Two lasers developed specifically to target the sebaceous gland were cleared by the US Food and Drug Administration (FDA) for the treatment of acne vulgaris in 2022, but it is unclear whether there are meaningful clinical differences between them.

The good news has been the relatively high rates of efficacy reported with both devices, but Fernanda H. Sakamoto, MD, PhD, Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, in describing their differences, indicated that they are not necessarily interchangeable.

The devices “use the same wavelengths, but they actually employ two different strategies,” reported Sakamoto, who hypothesized in 2012 that laser light targeted at the sebaceous gland would likely be an effective therapy for acne. She listed 1760 nm at that time as a potential therapeutic wavelength for this purpose, and the introduction of the two devices have validated this hypothesis.

Now, 3 years after two 1760-nm lasers have become available for the treatment of acne, Sakamoto provided an update on their utility and relative roles in a symposium on therapeutic lasers at the American Academy of Dermatology 2025 Annual Meeting. 

Two 1760-nm Lasers Introduced Almost Simultaneously

AviClear (manufactured by Cutera), the first of the sebaceous gland-specific lasers, was introduced a few months before the second, Accure (manufactured by Accure). According to Sakamoto, the studies that led to FDA clearance demonstrated rates of acne treatment efficacy that were at least comparable with those of other options but often with far more durable responses.

These effects are consistent with the expectation that photothermolysis of the sebaceous gland would prevent or reduce sebum production, which is a substrate of Cutibacterium acnes, the inflammation-inducing bacterium considered to be among one of the most common causes of acne vulgaris.

While the wavelength of the laser energy of the two devices is the same, there are multiple distinctions that have the potential to affect efficacy or safety. AviClear features diode delivery of energy in pulse modes and cooling delivered by a sapphire plate in contact with the skin. Accure employs fiber delivery of energy monitored continuously. Once the target temperature is reached, the device provides cool air that blows on the skin. 

At the surface of the skin, AviClear has a single spot size of 3.0 mm but with a seven-spot hexagonal array creating a 10-mm cumulative spot. Accure provides a spot size of 4.7 mm. Treatment depths range from 200 to 750 microns with AviClear and from 450 to 1750 microns with Accure. The greater depth of the Accure device is related to its larger spot size, according to Sakamoto.

Clinical Significance of Differences Not Yet Shown

However, the clinical significance of the relative differences in spot size or depth of penetration is unclear. Sakamoto listed several other technical differences between these devices but cautioned that they have never been compared head-to-head for clinical endpoints or even surrogate endpoints, such as reduction of sebum.

Both have shown similar effects across skin types, with little or no damage to tissue surrounding the sebaceous gland, according to Sakamoto.

Empirically, the AviClear laser generally appears to be “a little bit faster” for completing a treatment session and might be associated with less pain, she said. Conversely, the continuous air cooling provided by the Accure device is a potential advantage because the cooling plate of the AviClear device begins to warm once placed.

Yet, neither these nor other differences can be verified as clinically meaningful in the absence of direct comparisons, Sakamoto noted. More studies are underway and planned, but she said that published research remains relatively limited for both devices.

In separate 12-week placebo-controlled studies, acne clearance rates have been impressive, according to data cited by Sakamoto. In one of the studies conducted with AviClear, clearance rates reached 89%. In another with Accure, the rate was 78%, but she called these “very similar” in the context of cross-trial comparisons that do not account for baseline severity or other variables.

“But what is really interesting is that both devices have shown very prolonged remission of acne” after treatment is completed, Sakamoto said. In one study, 80% of patients remained in remission after 35 months of follow-up. In another, the remission rate was 50% after 24 months of follow-up.

Likening these sustained acne responses to other skin conditions (such as unwanted hair growth) with prolonged benefit after laser treatment, Sakamoto suggested that acne therapy with lasers targeting the sebaceous gland might prove to be a new benchmark in efficacy.

“This is a new era where we have laser treatments that perhaps will give some sort of cure” in the best responders, said Sakamoto, noting that clearance rates are generally in the vicinity of 40%-60% with pharmacologic agents, and duration of the beneficial effects is shorter.

Other types of lasers delivering energy at different wavelengths as well as other forms of light, including daylight, have been associated with benefit against acne, but the selectivity of the 1760-nm devices appears to explain an added degree of efficacy, she said.

For the treatment of acne, “you should not abandon the older types of lasers,” said Sakamoto, who explained that nonselective devices still have a role in the adjuvant setting when used with selective devices or in combination with anti-acne drugs.

In the absence of head-to-head trials, definitive statements about the relative value of selective 1760-nm lasers are elusive, but Sakamoto said, “I think we will know a lot more as clinicians get more experience.”

Devices Probably Not Interchangeable

Two dermatologists experienced with these targeted lasers agreed with both of the key points made by Sakamoto: These devices are probably not interchangeable, but this has not yet been established with objective evidence. 

In separate remarks, all three experts suggested that regardless of performance on clinical endpoints, such as acne clearance and duration overall, the devices might still differ by acne location or on practical points, such as ease of use. 

“While they share the same wavelength, the technologies differ in ways that could impact clinical outcomes, especially in areas like truncal acne where gland depth varies,” Julie de la Cruz, MD, the first author of a 2024 review article on treatment of acne with 1726-nm lasers, told Medscape Medical News. 

In her own experience, “AviClear seems more user-friendly with fewer consumables, while Accure involves more setup and patient-specific components,” said de la Cruz, who was in training at Rush University, Chicago, at the time the article was written and is now affiliated with Miami Dermatology & Laser Institute in Miami.

She said that she is “looking forward to seeing more data” and agreed that a direct comparison would be valuable.

Macrene Alexiades, MD, PhD, who practices in New York City and is a ssociate clinical professor of dermatology, Yale University School of Medicine, New Haven, Connecticut, was the lead investigator for an AviClear trial including 104 patients with facial acne, published in 2023. She argued that the quality of the data for the two devices is not yet equivalent, although she expects them to perform similarly if a head-to-head comparison is performed.

“While technical comparisons between the devices may reveal differences, I would be surprised to see substantial disparity in clinical efficacy — though comprehensive published clinical trial data on Accure are still forthcoming,” she told Medscape Medical News.

In an early single center open-label 2023 trial of 17 patients aged 18-36 years with acne, Alexiades noted, AviClear demonstrated statistically significant reductions in inflammatory lesion counts — 52% within 1 month and 97% at 24 months posttreatment. In her larger, nonrandomized, open-label study of 104 patients with moderate to severe facial acne (skin types II-VI), treated with three monthly sessions with AviClear, results were evaluated using the Investigator’s Global Assessment (IGA) scale.

At 26 weeks follow-up, the proportion of patients whose skin was clear (IGA score, 0) or almost clear (IGA score, 1) went from 0% at baseline to 11.4% and 30.4% respectively. At that time, the proportion of patients who had an IGA score of 2 (mild) was 41.8% compared with 1.1% at baseline; 16.5% had an IGA score of 3 (moderate) compared with 77.5% at baseline; and none had an IGA score of 4 (severe) compared with 21.3% at baseline. 

Lesion clearance rates are informative, “but IGA scores reflecting clear or nearly clear skin at long-term follow-up are more clinically meaningful for both dermatologists and patients,” she noted. 

In her clinical practice, AviClear has delivered “consistently excellent outcomes,” Alexiades said. “Typically, 3-4 monthly sessions are followed by an optional booster around 6 months, with few patients needing additional treatments thereafter. Aesthetic benefits, including scar improvement, have also been notable and reproducible,” she added.

Sakamoto reported financial relationships with Avava, Beiersdorf, Blossom Innovations, Cytrellis Biosystems, Follica, Lightwater Biosciences, R2 Dermatology, Seventh Sense BioSystems, Sofregen Medical, and Accure Medical. De la Cruz reported financial relationships with Evereden, MJH Life Sciences, and Oasis Pharmaceuticals. Alexiades was the lead investigator for the AviClear study published in 2023 but reported no current potential conflicts of interest.