Acne is the result of obstructed sebaceous follicles, and is characterized by comedones, nodules and eruptions of papules, pustules, and nodulocystic lesions. Lesions are found in areas with the greatest concentration of sebaceous glands, including the face, neck, and upper part of the trunk. Causal factors for acne include androgen-mediated sebaceous gland hyperplasia and excess sebum production; abnormal follicular keratinization, which results in plugging of the follicles and comedo formation; proliferation of propionibacterium acnes (P. acnes); and inflammation resulting from the chemoattractant and proinflammatory byproducts of P. acnes. Genetic factors, environment, and stress also contribute to the development and severity of acne. Acne can result in permanent scarring in severe cases.
Therapy is directed at the cause of active acne. First-line therapy consists of pharmacologic treatment, including contraceptive hormone therapy, oral and topical retinoid treatment, and oral and topical antibiotics. Other therapies that have been proposed for acne treatment include cryotherapy/cryosurgery, chemical exfoliation, including epidermal chemical peels, and laser and light therapies.
A number of laser and focused light devices have received marketing clearance for the treatment of acne via the U.S. Food and Drug Administration’s (FDA’s) 510(k) process. These include lasers that emit light at 1320 nm (Candela Smoothbeam™ and CoolTouch®); intense pulsed light systems, which emit light in the range of 590 to 1200 nm (Radiancy ClearTouch™, MED flash II and Ellipse I2PL); and lasers or high-intensity light devices, which emit violet or blue (around 414 nm) and red (around 633 nm) light (Aura-i™, CLEARLight™ and Dermillume). The specific indications for these devices vary. Indications include, but are not limited to, treatment of back acne, facial acne, mild to moderate inflammatory acne, and atrophic acne scars. A thermal device (ThermaClear™), marketed for the treatment of individual acne pimples in persons with mild to moderate inflammatory acne, is marketed for home use.
The following may be considered MEDICALLY NECESSARY AND APPROPRIATE for treatment of active acne that is resistant to pharmacologic treatments:
The following treatments for active acne are considered EXPERIMENTAL/INVESTIGATIVE due to the lack of clinical evidence demonstrating their impact on improved health outcomes:
Treatment for acne scarring and other cosmetic effects of acne is considered COSMETIC including, but not limited to, the following treatments:
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Acknowledgements:
CPT® codes copyright American Medical Association® 2023. All rights reserved.
CDT codes copyright American Dental Association® 2023. All rights reserved.
