The acne gold PTT suits and the acne it is not recommended for

Among the people who come in for acne, two cases often get compared. One person's face turns shiny easily on an ordinary day and inflamed acne recurs over a wide area. The other has little oil or rather dry skin, yet deep spots come up along the chin and jawline before every period.

Both are acne, but the one I would point toward gold PTT is the first. The place gold PTT aims at is the oil gland.

Following the steps of the treatment shows how it works. A solution holding very small gold particles is applied to the skin and pushed down into the pores. Then a laser at a wavelength the gold absorbs well is fired, and the gold particles take in the light and give off heat.

The gold gathers close to the oil glands, so the heat gathers there too. As the glands work less, oil output drops and the inflamed acne that kept recurring comes up less.

It does not aim only at the oil glands. Raising the heat to a certain level also helps the dermis make collagen, in a direction similar to radiofrequency lifting stimulating collagen with heat. As the laser passes it also burns off fine facial hair.

Clearing that fine hair helps acne treatment quite a bit. So for people with a lot of fine facial hair I often suggest mixing in gold PTT.

When the whole face looks shiny in the mirror and inflamed acne recurs over a wide area, gold PTT is what comes to mind first. The skin makes plenty of oil to begin with, so a treatment that shrinks the oil glands carries straight through to the result.

The nose is another place I look at often. People whose nose is shiny with wide pores and recurring inflamed acne tend to be satisfied with gold PTT. When sebaceous hyperplasia, where the gland itself has grown and bumps up, is mixed in, gold PTT is also used as a way to shrink the glands.

• The whole face turns shiny easily on an ordinary day
• Inflamed acne recurs over a wide area, not in one or two spots
• The nose is shiny with wide pores
• A lot of fine hair on the face

Some people have little oil or rather dry skin most of the time, yet deep spots come up on the chin and jawline only just before a period. Hormonal change raises oil and inflammation in that window alone.

Treating that skin with something that strongly suppresses the oil glands can leave dryness and tightness after the session that are uncomfortable. So for these people I keep medication as the base and suggest Potenza alongside it. Potenza works less on shrinking the glands and more on calming recurring inflammation and helping damaged dermis recover, which fits this skin better.

If a bump left on the nose is firm and reddish, I suspect a hypertrophic scar before sebaceous hyperplasia. Scar tissue has thickened after repeated inflammation, so reducing oil does not flatten it. Then the plan moves to steroid injections that soften the hardened tissue, or to Potenza.

There was a middle-school patient whose mother, who has many acne scars herself, was worried her son would be left with as many. He had had laser treatment several times at another clinic without seeing much difference.

Looking at his face, red marks (PIE) and brown marks (PIH) were mixed together. We did three sessions of Potenza together with three sessions of gold PTT, and he improved visibly.

The two treatments do different jobs. Potenza puts radiofrequency into the dermis, helps recovery where repeated inflammation did damage, and takes on the marks and scars. Gold PTT shrinks the oil glands so that fewer new spots come up. If new inflammation keeps coming, treating the marks only leaves new marks on top, so the two are used together.

People who are oily to begin with and also get deep spots before every period likewise have both treatments combined, depending on the state of the skin.

A Korean study treated 12 Asian patients with moderate or worse acne three times, 1 to 2 weeks apart, after applying gold nanoparticles (Dermatol Ther 2021, PMID 33631028). Papules, pustules and comedones all went down, and physician assessment showed an average improvement of more than half. Biopsies showed fewer inflammatory cells, and there were no serious side effects. It was, however, a preliminary study of 12 people without a control group.

In a study at three European centres, 28 patients had gold particles and laser once a week, three times (Lasers Surg Med 2019, PMID 31090089). At 12 weeks, 19 of the 25 analysed (76%) had their acne lesions reduced by 40% or more. Pain averaged 4 out of 10, and redness and swelling around the pores after treatment were common but did not last. This study also had no control group.

Both studies treated three sessions as one course and measured the effect weeks later. Expecting a change straight after one session can lead to disappointment. These are small studies, so it is hard to expect the same numbers for everyone. If you are travelling for treatment, plan the three sessions and the weeks after them, not a single visit.