K Number
K161941
Device Name
Pulsaderm Acne Device
Manufacturer
Date Cleared
2016-10-19

(96 days)

Product Code
Regulation Number
878.4810
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
Pulsaderm Acne Device is intended to emit energy in the red and blue region of the spectrum, specifically indicated to treat mild to moderate acne on the face.
Device Description
The Pulsaderm Acne Device is a device that uses Blue and Red Light Emitting (LED) Diodes to provide LED Light therapy to the skin. A combination of red light and blue light is emitted for the treatment of mild to moderate acne.
More Information

Not Found

No
The device description and performance studies focus solely on the use of LED light therapy for acne treatment. There is no mention of AI, ML, image processing, or any other technology typically associated with AI/ML in medical devices.

Yes.

The device is intended to treat mild to moderate acne, and the performance studies demonstrate a significant decrease in lesion size and redness, indicating a therapeutic effect.

No

The device is intended to treat mild to moderate acne, not diagnose it. It uses LED light therapy to reduce redness and lesion size, which is a therapeutic function rather than a diagnostic one.

No

The device description explicitly states it uses "Blue and Red Light Emitting (LED) Diodes" to provide therapy, indicating it is a hardware device that emits light, not solely software.

Based on the provided information, the Pulsaderm Acne Device is not an IVD (In Vitro Diagnostic).

Here's why:

  • Intended Use: The intended use is to "emit energy in the red and blue region of the spectrum, specifically indicated to treat mild to moderate acne on the face." This describes a therapeutic device that applies energy to the body for treatment, not a device used to examine specimens from the body to provide diagnostic information.
  • Device Description: The description focuses on the mechanism of action (LED light therapy) and the application to the skin. It doesn't mention analyzing biological samples.
  • Lack of IVD Characteristics: The document does not mention any of the typical characteristics of an IVD, such as:
    • Analyzing biological specimens (blood, urine, tissue, etc.)
    • Providing diagnostic information about a disease or condition
    • Using reagents or assays

The Pulsaderm Acne Device falls under the category of a therapeutic device that uses light energy for treatment.

N/A

Intended Use / Indications for Use

Pulsaderm Acne Device is intended to emit energy in the region of the spectrum, specifically indicated to treat mild to moderate acne on the face.

Product codes

OLP

Device Description

The Pulsaderm Acne Device is a device that uses Blue and Red Light Emitting (LED) Diodes to provide LED Light therapy to the skin. A combination of red light and blue light is emitted for the treatment of mild to moderate acne.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

face

Indicated Patient Age Range

13 to 36 years

Intended User / Care Setting

Over-The-Counter Use

Description of the training set, sample size, data source, and annotation protocol

Not Found

Description of the test set, sample size, data source, and annotation protocol

A lay-user study and self-selection study was conducted with Institutional Review Board (IRB) approval and oversight to determine if lay users could read the product labeling and then selfassess if the Pulsaderm acne device would be beneficial for them to use. Study data was collected and demonstrated that the intended users of the device could successfully follow the instructions and use the device as intended. The performance data supplied in this 510(k) demonstrated that 100% of lay users were able to properly self-select themselves using the box labeling and 98% of lay users were able to properly use the device by reading instructions in the user manual without any assistance.

Summary of Performance Studies

A one-week clinical study with IRB approval was conducted with 26 male and female subjects, ranging in age from 13 to 36 years to assess the ability of the Pulsaderm acne device to decrease redness and diminish the size of a facial lesion following 24 hours and one week of use. All subjects underwent a one-week treatment. The subjects used the device for two minutes, three times a day.
Subjects were selected to participate in the evaluation of an acne blemish treatment, which consisted of VISIA digital photography, use of an electronic caliper to measure lesion size, expert clinical grading of facial lesion redness and consumer perception questionnaires.
In summary, the Pulsaderm acne device significantly decreased lesion size and redness when compared to baseline. Treated lesions significantly decreased in size after one week. Patients saw a significant reduction in redness after 24 hours, 48 hours and one week. Subjects had significant reduction in combined lesions (redness and size) after 48 hours and one week.

Key Metrics

Not Found

Predicate Device(s)

K124042, K123999, K081307

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 878.4810 Laser surgical instrument for use in general and plastic surgery and in dermatology.

(a)
Identification. (1) A carbon dioxide laser for use in general surgery and in dermatology is a laser device intended to cut, destroy, or remove tissue by light energy emitted by carbon dioxide.(2) An argon laser for use in dermatology is a laser device intended to destroy or coagulate tissue by light energy emitted by argon.
(b)
Classification. (1) Class II.(2) Class I for special laser gas mixtures used as a lasing medium for this class of lasers. The devices subject to this paragraph (b)(2) are exempt from the premarket notification procedures in subpart E of part 807 of this chapter, subject to the limitations in § 878.9.

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Image /page/0/Picture/1 description: The image shows the logo for the U.S. Department of Health and Human Services. The logo features a stylized caduceus, which is a symbol often associated with medicine and healthcare. The words "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" are arranged in a circular pattern around the caduceus. The logo is simple and recognizable, representing the department's role in promoting health and well-being.

Food and Drug Administration 10903 New Hampshire Avenue Document Control Center - WO66-G609 Silver Spring, MD 20993-0002

October 19, 2016

Nutra Luxe Md, LLC Ms. Gloria Avendano Regulatory Affairs Manager 12801 Commonwealth Dr., Unit 2-6 Fort Myers, Florida 33913

Re: K161941

Trade/Device Name: Pulsaderm Acne Device Regulation Number: 21 CFR 878.4810 Regulation Name: Laser Surgical Instrument for Use In General And Plastic Surgery and In Dermatology Regulatory Class: Class II Product Code: OLP Dated: September 14, 2016 Received: September 15, 2016

Dear Ms. Avendano:

We have reviewed your Section 510(k) premarket notification of intent to market the device referenced above and have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate commerce prior to May 28, 1976, the enactment date of the Medical Device Amendments, or to devices that have been reclassified in accordance with the provisions of the Federal Food. Drug. and Cosmetic Act (Act) that do not require approval of a premarket approval application (PMA). You may, therefore, market the device, subject to the general controls provisions of the Act. The general controls provisions of the Act include requirements for annual registration, listing of devices, good manufacturing practice, labeling, and prohibitions against misbranding and adulteration. Please note: CDRH does not evaluate information related to contract liability warranties. We remind you, however, that device labeling must be truthful and not misleading.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 to 898. In addition, FDA may publish further announcements concerning your device in the Federal Register.

Please be advised that FDA's issuance of a substantial equivalence determination does not mean that FDA has made a determination that your device complies with other requirements of the Act or any Federal statutes and regulations administered by other Federal agencies. You must comply with all the Act's requirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Part 801 and Part 809); medical device reporting (reporting of medical device-related adverse events) (21 CFR 803); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820); and if applicable, the

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electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801 and Part 809), please contact the Division of Industry and Consumer Education at its toll-free number (800) 638-2041 or (301) 796-7100 or at its Internet address

http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR Part 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please go to

http://www.fda.gov/MedicalDevices/Safety/ReportaProblem/default.htm for the CDRH's Office of Surveillance and Biometrics/Division of Postmarket Surveillance.

You may obtain other general information on your responsibilities under the Act from the Division of Industry and Consumer Education at its toll-free number (800) 638-2041 or (301) 796-7100 or at its Internet address

http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm.

Sincerely yours,

Jennifer R. Stevenson -A

For Binita S. Ashar, M.D., M.B.A., F.A.C.S. Director Division of Surgical Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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Indications for Use

510(k) Number (if known) K161941

Device Name Pulsaderm Acne Device

Indications for Use (Describe)

Pulsaderm Acne Device is intended to emit energy in the region of the spectrum, specifically indicated to treat mild to moderate acne on the face.

Type of Use (Select one or both, as applicable)

Prescription Use (Part 21 CFR 801 Subpart D)

|X | Over-The-Counter Use (21 CFR 801 Subpart C)

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Section 5:

510(k) Summary

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510(k) Summary Pulsaderm Acne Device

1. General Information

Submitter: NutraLuxe MD, LLC 12801 Commonwealth Dr. Unit 5 Fort Myers, FL 33913

Contact Person:

Gloria Avendano Regulatory Affairs Manager Nutra Luxe MD 12801 Commonwealth Dr. Unit 5 Fort Myers, FL 33913 Gloria@nutraluxemd.com

Summary Preparation Date: July 12th, 2016

2. Device

Device Name:Pulsaderm Acne Device
Common/Usual Name:Acne Light Therapy System
Classification Name:Over-the-counter powered light based laser for acne
Classification Regulation:21CFR 878.4810
Classification Panel:General and Plastic Surgery
Product Code:OLP

3. Predicate Devices:

Pulsaderm acne device is substantially equivalent to the following predicate devices;

Device510(k) NumberManufacturer
Tanda Mini Skincare SystemK124042Syneron Beauty Inc.
illuMask Acne Light Therapy MaskK123999La Lumiere, LLC
Omnilux Clear-UK081307Photo Therapeutics Inc

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4. Device Description:

The Pulsaderm Acne Device is a device that uses Blue and Red Light Emitting (LED) Diodes to provide LED Light therapy to the skin. A combination of red light and blue light is emitted for the treatment of mild to moderate acne.

5. Intended Use and Indications:

Pulsaderm Acne Device is intended to emit energy in the red and blue region of the spectrum, specifically indicated to treat mild to moderate acne on the face.

6. Technological Characteristics and substantial equivalence:

Pulsaderm Acne Device is substantially equivalent to other LED Light therapy devices currently in commercial distribution. Pulsaderm Acne Device has the same intended use as the predicate devices: Treat mild to moderate acne on the face. Pulsaderm Acne Device is as safe and (commensurate to number of diodes) effective as K124042 (Tanda mini Skin Care). Pulsaderm acne device uses a combination of red and blue light as K123999 (illumask acne light therapy) and K081307 (Omnilux Clear-U). Pulsaderm Acne Device has same treatment schedule as K124042 (Tanda mini Skin Care).

Any differences between the Pulsaderm Acne Device and its predicates does not affect the safety or efficacy of the product. Thus, Pulsaderm Acne Device is substantially equivalent to legally marketed medical devices.

| Device name | Pulsaderm Acne Device | Omnilux Clear-U | Tanda mini skin care
system | Illumask acne light
therapy |
|-----------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------|
| 510(K) | Pending | K081307 | K124042 | K123999 |
| Intended use | Intended to emit
energy in the red and
blue region of the
spectrum, specifically
indicated to treat mild
to moderate acne on
the face | Intended to emit
energy in the red and
blue region of the
spectrum, specifically
indicated to treat mild
to moderate acne on
the face | Indicated to treat
dermatological
conditions. Specifically,
blue light modules are
indicated to treat mild to
moderate inflammatory
acne. | Intended to emit
energy in the red and
blue region of the
spectrum, specifically
indicated to treat mild
to moderate acne on
the face |
| Energy type | Light Emitting diodes
(LED's) | Light Emitting diodes
(LED's) | Light Emitting diodes
(LED's) | Light Emitting diodes
(LED's) |
| OTC | Yes | Yes | Yes | Yes |
| Wavelength
(nm) | Blue light 415 +/-5 nm
Red light 630 +/-5 nm | Blue light 415 nm
Red light 630 nm | Blue light 415 nm | Blue light 445 nm
Red light 630 nm |
| Dose rate | Blue light: 20 mW cm2
Red light 5 mW cm2 | Blue: 40 mW cm2
Red: 70 mW cm² | Blue light 22 mW/ cm² | Blue light 10.44 J/ cm2
Red light 17.91 J/ cm² |
| Treatment
Schedule | 2 Minutes per spot | 20 minutes-whole face | 2 Minutes per spot | 15 minutes- whole face |

Comparison table:

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7. Performance Data:

Performance testing was conducted and confirm compliance to design specifications; similar wavelength, output power, energy type, treatment areas and energy delivery as FDA cleared predicate devices. Pulsaderm Acne Device has been tested and found in conformance with test standards: IEC 60601-1, IEC 60601-1-2, and IEC 62471. Biocompatibility testing to ISO 10993. Pulsaderm Acne Device was designed and developed under a quality management system conforming to ISO 14971.

8. Non clinical-testing

A lay-user study and self-selection study was conducted with Institutional Review Board (IRB) approval and oversight to determine if lay users could read the product labeling and then selfassess if the Pulsaderm acne device would be beneficial for them to use. Study data was collected and demonstrated that the intended users of the device could successfully follow the instructions and use the device as intended. The performance data supplied in this 510(k) demonstrated that 100% of lay users were able to properly self-select themselves using the box labeling and 98% of lay users were able to properly use the device by reading instructions in the user manual without any assistance.

In summary, the conclusion was that an average lay user can read and comprehend correctly the user manual and package labeling.

9. Summarv of Clinical Data

A one-week clinical study with IRB approval was conducted with 26 male and female subjects, ranging in age from 13 to 36 years to assess the ability of the Pulsaderm acne device to decrease redness and diminish the size of a facial lesion following 24 hours and one week of use. All subjects underwent a one-week treatment. The subjects used the device for two minutes, three times a day.

Subiects were selected to participate in the evaluation of an acne blemish treatment, which consisted of VISIA digital photography, use of an electronic caliper to measure lesion size, expert clinical grading of facial lesion redness and consumer perception questionnaires.

In summary, the Pulsaderm acne device significantly decreased lesion size and redness when compared to baseline. Treated lesions significantly decreased in size after one week. Patients saw a significant reduction in redness after 24 hours, 48 hours and one week. Subjects had significant reduction in combined lesions (redness and size) after 48 hours and one week.

10. Conclusion

Based upon the analysis of the performance characteristics, safety characteristics and intended use for the pulsaderm acne device. Nutra Luxe MD, believes that no significant differences exist between this device and the predicates. Therefore, Substantial equivalency is requested.