December 2008 

Dear Krissy,

Let me start with the warnings for these two machines right from the beginning and then I’ll get to the details:

DON'T USE THESE DEVICES IF:

1. You have acne or blemishes that tend to scar or you get red marks that take awhile to heal. These devices may make acne scarring worse by over heating the epidermis inhibiting skin’s ability to heal.
2. You have acne that tends to be red and inflamed. The heat, in some cases, can make the inflammation worse.
3. If you have more than 10 lesions at a time the Zeno/Thermaclear won't be cost or time efficient and there are better options to consider.

Now, for those of you who haven’t heard of the Thermaclear ($145) or Zeno ($89-$200, depending on which Zeno you choose) both of these devices use heat to combat the bacteria that contributes to acne. They are sold as being best for mild to moderate acne involving individual pimples, not full-blown breakouts all over the face, and certainly not cystic or nodular acne. These devices are truly limited but that won't stop lots of people from giving them a try despite the hefty price tag for what amounts to a simple heat- emitting machine.

Both devices are battery-operated and make similar claims. Of course, both describe themselves as being unique from the other but for all intents and purposes they work the same way. What is different is the cost factor. Each hand held device uses a tip that needs to be discarded and replaced. The Thermaclear device uses a chrome tip that you can use for a year before it needs to be replaced for a cost of $19.95.

With Zeno, the tip provides a fixed number of treatments before it must be replaced (and sets of replacement tips aren't cheap-they range from $19-$25). How many treatments you get depends on which Zeno device you choose. For example, the Zeno Mini offers 45 treatments (that's 45 individual pimple treatments, one pimple is treated by one tip, a single tip does not do a full-face treatments), and the Zeno MD offers 150 treatments (that's a 150 individual blemishes that can be treated). Clearly the Zeno device is the pricier option both initially and long term, and the more acne lesions you have, the more you'll spend.

It is good news that neither company positions their device as a one-stop treatment for mild, intermittent breakouts, but consumers more often then not ignore these details and will try it without using other products to combat acne. (Biore Pore Strips come to mind; no matter how many warnings were on the box, most women I've spoken to over the years had no idea they were there).

Instructions for using both devices are very similar: you wait for the device to charge and when it's ready (indicated by colored lights on either device) you place the treatment tip directly on a blemish and a controlled heat pulse is generated. You have to hold the device on the blemish for 2 ½ minutes and (according to the web site for Zeno) after that "you can clear up a pimple in two hours".

When you place the tip without pressure against a blemish a heat "burst" occurs that happens quickly. There is no risk of “burning” skin when used as directed, but it definitely heats skin. With either device, you must wait several seconds for it to recharge before treating another pimple. Twice a day is the recommended usage and depending on how many pimples you are trying to treat, that can take a lot of time. And this is supposed to be less expensive and faster than seeing a dermatologist or using over-the-counter treatments such as benzoyl peroxide or salicylic acid? Does that sound possible or true to anyone? It certainly doesn't to me and the research doesn’t support that notion either.

One other claim made for Thermaclear that will likely catch the eye of many consumers is that their device is FDA-cleared which, on the surface, conveys some type of special status. It isn’t special or a stamp of approval for acne in the least. All heat-emitting devices such as Thermaclear are classified as Class II laser instruments. Just to keep this in perspective, another example of a Class II laser product is the common laser pointer, like what's used in a classroom or business meeting setting. Doesn't sound too fancy or high-tech now, does it? A Class II light-emitting device does not require a prescription or medical supervision, which is why these devices can be sold without restrictions.

So how does heat possibly affect a pimple? The theory is that the type of heat energy these devices produce when in close contact with a pimple has an oxidizing effect on porphyrins. Porphyrins are naturally occurring substances that are part of a cell's protoplasm (fluid structure). It seems that acne-causing bacteria are able to synthesize and store large amounts of porphyrins. When porphyrins are exposed to heat and light energy, they reach an excited state and a chemical reaction that forms an extra oxygen molecule happens. Similar to how benzoyl peroxide works on acne lesions, the extra oxygen kills acne-causing bacteria, thus reducing the size and severity of a pimple (Sources: Journal of Cosmetic and Laser Therapy, June 2005, pages 63-68; and June 2004, pages 91-95).

What's not as clear (pun intended) is whether or not Thermaclear and Zeno devices have enough power with each pulse of light to significantly impact acne. There are no published, peer-reviewed studies proving either device to be effective (published studies have used other devices available to physicians, not the general public). Instead, each company has done clinical trials whose results are impressive but would you expect anything less? Considering the marketing and cost of either device, the companies certainly aren't going to go on record with clinical trials showing their treatments were average to poor or that they paled in comparison to what doctor-administered light treatments can accomplish.

Even more telling is that none of the clinical trials compared these heat-emitting devices to a sensible anti-acne skin-care routine or spot treating a blemish with salicylic acid or benzoyl peroxide. Perhaps that would have superior results.

The Thermaclear Web site mentions that their clinical trials showed the device can be used with benzoyl peroxide, which is nice, but that still doesn't tell you if the benzoyl peroxide worked or would work better then the Thermaclear. No mention was made of other anti-acne active ingredients such as salicylic acid, glycolic acid, or prescription vitamin A products. All in all, the information about these devices is limited with great- sounding claims and little real scientific evidence in support of the assertions.

As for Zeno, they claim that none of the in-office heat/light-emitting devices used to treat acne have been shown to be as effective as Zeno (namely Thermage or Intense Pulse Light). That's a misleading, absurd claim because thus far a comparison study hasn't been done. Moreover, the minimal research that exists for treating acne with light and heat energy has been about long term results for the entire face, not spot treating when a zit pops up.

If you decide to try either device, I recommend purchasing them from Sephora because they have an excellent return policy should you find Thermaclear or Zeno is not for you. And make no mistake: neither Zeno nor Thermaclear should replace a reliable anti-acne skin care routine or trump the advice given to you by a dermatologist working with you to get your acne under control.

Is there a legitimate reason to invest in these devices and are they really a great adjunct to an anti-acne routine, or are they a waste of money? The quick answer is that both devices may help for their intended purpose, but I would never recommend either as a stand alone treatment, not for efficacy or cost.

Brandith Irwin, MD author of The Surgery-Free Makeover: All You Need to Know for Great Skin and a Younger Face helped with this article.