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Dovepress Photodynamic therapy in dermatology Table 1 (Continued) Reference N Type of trial; study population/type Split-face Controlled; mild-to- moderate acne on the back Controlled; mild-to- moderate acne Randomized; mild-to- moderate inflammatory acne Randomized; mild-to- moderate acne Light source (dose); incubation time 20% ALA-PDT + red light (630±63 nm, 30 mw/cm2, 18 J/cm2) versus placebo; 4 hours 20% ALA-PDT versus red light (635 nm, 25 mw/cm2, 10 J/cm2); 3 hours 20% ALA-PDT versus blue light (417±5 nm, 10 mw/cm2, 3.6 J/cm2) only; 15 minutes 20% ALA-PDT + red light versus light alone (550–570 nm, 150 J/cm2) versus placebo; 3 hours Blue light (415 nm) versus mixed blue and red light (415 nm and 660 nm) versus 5% benzoyl peroxide versus cool white light; 15 minutes Session number (interval); follow-up Once; 6 months 3× (1 week); 3 weeks 2×; 2 weeks Randomized to 1× versus 4× (1 week); 20 weeks Daily × (12 weeks); 8 weeks Results Inflammatory lesion reduction: 41.9% ALA-PDT, 15.4% placebo. Reductions in noninflammatory lesions were not statistically significant. Reduction in inflammatory acne lesions after second treatment at ALA-PDT site but not other sites or treatments. Inflammatory lesion reduction: 68% ALA- PDT, 40% blue light. ALA-PDT 4 sessions . ALA-PDT 1 session . red light alone . placebo. Histology: sebaceous glands smaller after ALA-PDT. Mixed blue-red . other treatments. At 8 weeks: 76% improvement in inflammatory lesions with blue-red light, greater than blue light and benzoyl peroxide (% not reported); 58% improvement in comedones with blue- red light (not significant). Hong and Lee184 2005 8 Pollock 10 et al101 2004 Goldman 22 and Boyce185 2003 Hongcharu 22 et al99 2000 Papageorgiu et al186 2000 107 Abbreviations: I, inflammatory; NI, noninflammatory; IL, intralesional; PDT, photodynamic therapy; ALA, aminolevulinic acid; MAL, methyl aminolevulinate; IPL, intense pulsed light; LPDL, long-pulsed dye laser; LeD, light-emitting diode; IR, infrared; KTP, potassium titanyl phosphate. MAL-PDT in acne MAL-PDT followed by red light has been well documented in the literature. One split-face study (n=30) used MAL with a 3-hour occlusion followed by red light, and showed a statistically significant median reduction in inflammatory lesion count at 12 weeks (54%) when compared with pla- cebo (20%; 95% confidence interval 8%–50%).105 Another study (n=21) compared the use of MAL-PDT with the same regimen (3-hour occlusion and red light) versus placebo, and reported a median 68% reduction (P=0.0023) of inflam- matory lesions upon clinical examination at 12 weeks post treatment. However, there was no significant difference in noninflammatory lesions.106 Interestingly, one study (n=16) concluded that a diluted concentration of 4% MAL resulted in similar efficacy (average 66% reduction for inflamma- tory lesions) with reduced side effects (most commonly, pain), and this formulation may be a more cost-effective strategy.107 Other photosensitizers Other topical photosensitizers, which have been studied less extensively, include indocyanine green (or methylene blue) and indole-3-acetic acid.32,33,108–113 Indole-3-acetic acid in particular may have an important role in clinical practice, primarily because patients receiving indole-3-acetic acid Clinical, Cosmetic and Investigational Dermatology 2014:7 for acne experience less pain. It also has promising practical aspects, requiring shorter incubation times whilst producing equivalent efficacy (Table 2). Rosacea Rosacea, sometimes termed “adult acne”, although similar in appearance to acne, has a different pathophysiology. Common current treatments include topical metronidazole, topical azelaic acid, oral tetracyclines, and most recently, topical alpha-2 adrenergic agonists. Recent evidence sug- gests that rosacea may represent an altered immune reactivity to the microbes of the skin.114 The use of ALA-PDT in rosacea is primarily anecdotal, with few randomized controlled studies published thus far. MAL-PDT with red light has been shown to improve the appearance of rosacea, in particular papulopustular lesions when compared with the erythematotelangiectatic types.115 One small, prospective study (n=4) demonstrated increased efficacy using PDT with long-pulsed dye laser (LPDL) versus LPDL alone in the treatment of inflammatory papulopustular rosacea.116 However, in a controlled study, the long-term benefit of MAL-PDT with LPDL compared with LPDL alone demonstrated no difference.116 This study does not rule out the possibility that other light sources may work in combination with ALA to treat rosacea effectively. submit your manuscript | www.dovepress.com Dovepress 153PDF Image | applications of photodynamic therapy dermatology
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