The Laser Gap: Why Acne Management in UK Dermatology Needs to Evolve
Acne vulgaris remains one of the most common dermatological conditions worldwide, yet the approaches to its management have changed remarkably little in decades. For all the pharmaceutical advances and endless cycles of skincare trends, the core treatment algorithm still hinges on topical retinoids, oral antibiotics, hormonal modification, and isotretinoin. While these options are often effective, they do not work for everyone and they are not universally well tolerated. Meanwhile, a quiet revolution has been taking place in the energy-based device space: one that many traditional dermatologists have chosen to ignore.
In 2022, the FDA cleared the first 1726 nm laser for the treatment of mild to severe acne. This development marked a significant scientific advance; one grounded in sebaceous gland biology and the principle of selective photothermolysis. For the first time, a device existed that could safely and selectively target sebaceous glands, the core organ involved in acne pathogenesis, without damaging surrounding skin. The laser in question, AviClear, now forms part of the clinical acne pathway at Self London. But despite growing evidence and real-world success, the wider dermatology community has yet to embrace it.
This gap in adoption is not simply about caution or rigour. It reflects a deeper cultural reluctance within dermatology to view lasers as anything more than aesthetic tools. For many clinicians trained in NHS or academic environments, energy-based devices are seen as elective, non-essential, and often conflated with consumer beauty. This perception persists despite growing evidence for their efficacy in multiple domains of medical dermatology from photodamage and scarring to rosacea and now acne. It is a blind spot that undermines the evolution of patient-centred care.
Part of the issue lies in the structure of evidence. Pharmaceutical trials benefit from decades of institutional support, standardised protocols, and regulatory infrastructure. Laser studies, by contrast, are often smaller, industry-sponsored, and published outside the core dermatology journals. This creates a visibility bias: what is seen as “valid” is what is published in familiar places. Devices are viewed with suspicion, particularly when marketed directly to private clinics. Yet the physics underpinning the 1726 nm wavelength is scientifically robust. Sebum, not water, is the primary chromophore at this wavelength, allowing thermal injury to the sebaceous gland without epidermal compromise.
There is also an unspoken gender dynamic at play. Acne in adult women is one of the most under-recognised and under-prioritised presentations in dermatology, and yet it makes up a substantial proportion of private practice. Studies suggest that up to 54% of women over 25 experience acne, with a disproportionately high psychological burden. Many of these women have already exhausted conventional therapies or find themselves excluded from isotretinoin pathways due to concerns about side effects, mental health, or family planning. For this group, a device like AviClear, free of systemic risks, and suitable for all skin types, offers genuine clinical value.
At Self London, we see these patients every day. Some have experienced flares post-isotretinoin. Others have persistent U-zone acne, no obvious hormonal abnormality, and a long history of “trying everything.” They are not always seeking miracles. They are looking for expertise, honesty, and options that align with their lives. For many, AviClear has provided meaningful improvement, not overnight, but over time, and without the cumulative burden of long-term oral treatment.
So why does mainstream dermatology continue to resist? In part, it is institutional inertia. Device medicine is still not routinely taught within dermatology training. Very few NHS departments house lasers capable of acne treatment, and private device ownership remains expensive and under-supported. There is no pharma rep to drop off studies. There is no NICE guidance. And so, lasers remain on the fringe, even when their mechanism is precise, their safety profile favourable, and their real-world impact high.
There is also a performative purism in academic dermatology: a tendency to separate “real” medicine from anything associated with aesthetics. This split is not only outdated, it is often counterproductive. Acne is not simply a cosmetic issue. It affects quality of life, mental health, and long-term skin architecture. And it exists at the crossroads of medical dermatology and cosmetic intervention, particularly in adult women, where scarring and hyperpigmentation often co-exist with active disease. By dismissing devices as peripheral, we fail to recognise their ability to bridge this divide.
The challenge, then, is to rethink our frameworks. Rather than viewing lasers as a last resort or vanity adjunct, we need to consider them as part of a new therapeutic paradigm, one that includes energy-based options alongside oral and topical care. This does not mean abandoning systemic treatments. It means expanding the menu, and designing protocols based on biology, not dogma. It also means acknowledging that remission, not just suppression, is a valid goal. The idea that a three-session laser series might offer lasting benefit without daily medication is not fringe thinking. It is what many patients are asking for.
Importantly, the role of real-world audit cannot be understated. At Self London, our AviClear data reflects a high level of patient adherence, with all patients completing treatment and many opting for maintenance. We have observed early oiliness reduction as a common first marker of improvement, often preceding lesion count decline. We have also seen efficacy across skin tones, including Fitzpatrick types IV and V, something that remains a limitation in many published acne studies. These insights, though observational, are grounded in clinical pattern recognition and informed decision-making. They are the kind of data that shapes true innovation, even in the absence of randomised controlled trials.
The laser revolution in acne is not about replacing dermatology. It is about evolving it. As patient needs shift and systemic therapies face increasing scrutiny, devices like AviClear offer a welcome addition to the therapeutic arsenal. They are not magic, nor universally effective, but they are safe, scientifically rational, and increasingly in demand.
If we continue to dismiss energy-based devices as marketing tools or aesthetic fluff, we risk leaving behind a generation of patients, particularly women, whose acne no longer fits the textbook. As a specialty, dermatology cannot afford to stand still. And as clinicians, we owe it to our patients to think beyond the pill.
