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Dovepress Table 3 Comparative studies of PDT light sources in photorejuvenation/photoaging Photodynamic therapy in dermatology Results Photorejuvenation did not seem to improve with increasing IPL fluence levels. ALA-IPL . IPL: global score: 50% ALA-IPL, 12.5% IPL only. Fine lines: 70.8% ALA-IPL, 33.3% IPL only. Coarse wrinkles: 50% ALA-IPL, 12.5% IPL only. No significant difference with respect to mottled pigmentation and skin roughness. Significant improvement of signs of skin aging, equal on both sides (ALA-IPL and IPL alone). However, 75% of patients found ALA-IPL more effective than IPL alone. ALA-IPL (530–750 nm) versus ALA-IPL (400–720 nm): significant reduction of perioral and periorbital wrinkles on both sides. Pigmentation, erythema, and telangiectasias better with IPL (530–750 nm). Moderate improvement in fine lines, tactile roughness, and skin tightness in both groups, greater improvement in 3-hour group. Greater improvement in pretreatment + MAL-PDT rather than pretreatment only (not significant). ALA-IPL . IPL alone. Crow’s feet: 55% ALA-IPL, 29.5% IPL alone. Tactile skin roughness: 55% ALA-PDT-IPL, 29.5% IPL alone. Mottled hyperpigmentation: 60.3% . 37.2% IPL alone. Telangiectasias: 84.6% ALA-PDT- IPL, 53.8% IPL alone. ALA-IPL . IPL alone. Photoaging scale: 80% ALA-IPL, 45% IPL alone. Hyperpigmentation: 85% ALA-IPL, 20% IPL alone. Fine lines: 60% ALA-IPL, 25% IPL alone. Higher clinical global improvement scores (by photography) 5-ALA + IPL . IPL alone. Reference Haddad et al190 2011 Xi et al191 2011 Kosaka et al192 2010 Bjerring et al193 2009 Ruiz-Rodriquez et al165 2008 Ruiz-Rodriquez et al194 2007 Gold et al169 2006 Dover et al195 2005 Alster et al196 2005 n 24 24 16 37 10 4 13 20 10 Type of study Comparative Split-face, prospective, controlled Split-face Split-face, prospective, randomized Split-face, randomized, prospective Split-face Split-face, prospective Split-face, prospective, randomized Split-face Light sources (light doses); incubation times 20% ALA-IPL (20, 25, 40, and 50 J/cm2) versus IPL only; 2 hours 5% and 10% ALA, IPL (560 nm or 590 nm, 14–20 J/cm2, 3.5–4 msec, double or triple pulses); 1 hour 5% ALA + IPL (500–670 nm and 870–1,400 nm, 23–30 J/cm2, 20 msec, single pulses); 2 hours 0.5% liposome-encapsulated ALA-IPL (530–750 nm, rejuvenation filter, 6–7 J/cm2, double pulses of 2.5 msec) versus ALA-IPL (400–720 nm, 3.5 J/cm2, 30 msec) 16% MAL-PDT + red light; 1 hour versus 3 hours Fraxel® SR laser pretreatment then MAL-PDT + red light versus pretreatment only; 3 hours 20% ALA-IPL versus IPL (550–570 nm, 34 J/cm2) alone; 30–60 minutes 20% 5-ALA + IPL versus IPL (515–1,200 nm, 23–28 J/cm2) alone; 30–60 minutes 5-ALA-IPL versus IPL alone (560 nm); 1 hour Session number (interval); follow-up Once; 8 weeks 3× (4 weeks); 2 months 3× (4 weeks); 3 months 3× (3 weeks); 3 months 3×; 2 months 2 Fraxel SR laser (3 weeks) then once MAL-PDT; 12 weeks 3× (1 month); 3 months 3 split face × (3 weeks) then 2× IPL only (3 week); 1 month 2× (4 weeks); 6 months Note: Fraxel® (formerly Fraxel SR750, Reliant Technologies Inc, Palo Alto, CA, USA). Abbreviations: PDT, photodynamic therapy; ALA, aminolevulinic acid; MAL, methyl aminolevulinate; IPL, intense pulsed light. less than 2 mm in height. There was a 95% (19/20) recur- rence rate at 9-month follow-up.174 Furthermore, another study (n=21) showed improvement in post-surgical scar appearance, which directly correlated with the number of ALA/MAL-PDT sessions.175 PDT represents a promis- ing, noninvasive treatment, but more definitive studies are required to elicit its role and the regimen required in the treatment of cicatrix. Concluding remarks PDT is a mainstay of treatment for actinic keratoses and superficial nonmelanoma skin cancers, and has been Clinical, Cosmetic and Investigational Dermatology 2014:7 demonstrated to be an increasingly popular option for acne. With the advent of nanoemulsions and patch-ALA, recent advances have focused on improved vehicles and delivery. Improving standardization of ALA delivery and decreas- ing pain during the treatment are advances that will further popularize this modality. PDT is more frequently utilized in Europe as compared with the US. This discrepancy likely reflects the poor reimbursement rates for PDT in the US. Well controlled studies are needed to demonstrate the efficacy of PDT in order to justify its use, and hopefully convince insurance companies that this viable treatment option with a low side effect profile and high cosmetic outcome is worth submit your manuscript | www.dovepress.com Dovepress 157PDF Image | applications of photodynamic therapy dermatology
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