Photodynamic photorejuvenation of the face with a combination of microneedling, red light, and broadband pulsed light

Abstract

BackgroundHigh efficacy and safety, coupled with in‐office, short contact protocols have made photodynamic therapy (PDT) with aminolevulenic acid (ALA) for the treatment of actinic keratoses a mainstay option over the last decade. Clinical improvement in photoaged skin has also been reported to accompany PDT treatments. The study objective was to maximize epidermal penetration and subsequent activation of ALA for the treatment of photodamaged facial skin, utilizing a microneedle roller prior to incubation and combined irradiation with red light and broadband pulsed light in a single treatment.Materials and MethodsA full‐face treatment of 21 patients was performed with 630 nm light and broadband pulsed light after multiple passes with a microneedle roller and 1‐hour ALA incubation. The primary endpoint was clinical improvement, scored during two separate live assessments by three physicians blinded to previous scores, using a 5‐point standardized photoaging scale. The secondary endpoint was evaluation of patient satisfaction based on a quartile scale comparing baseline to 6‐month post‐treatment photography.ResultsStatistically significant improvement was seen in the global photoaging scores, as well as sub‐components of the scale (fine lines, mottled pigmentation, sallowness, tactile roughness, and telangiectasias) at 3 months as compared with baseline live assessment, and at 6‐month live assessment compared with the 3 months. In addition, 90% of patients judged clinical improvement to be greater than 50% at 6 months compared to baseline photography.ConclusionUse of a microneedle roller to “pre‐treat” prior to application of ALA appears to be well tolerated and allows for even absorption and perhaps deeper penetration of ALA following a defined incubation period. Use of red light and broadband pulsed light allowed for deeper activation of ALA, potentially accounting for marked clinical improvement in photoaging. Lasers Surg. Med. 42:150–159, 2010. © 2010 Wiley‐Liss, Inc.

Skin needling as a treatment for acne scarring: An up-to-date review of the literature

“…Fine needles puncture the skin, resulting in increased dermal elastin and collagen, collagen remodeling, and thickening of the epidermis and dermis (Aust et al, 2008a, Aust et al, 2010a, Aust et al, 2010b, Aust et al, 2011, Fabbrocini et al, 2011a, Fernandes, 2005, Fernandes and Signorini, 2008, Kim et al, 2011, Park et al, 2012, Schwarz and Laaff, 2011). Additionally, skin needling creates small channels, which increase the absorption of topically applied preparations (Badran et al, 2009, Kalluri et al, 2011), a property which has been used in various dermatological treatments (Bencini et al, 2012, Budamakuntla et al, 2013, Clementoni et al, 2010, Fabbrocini et al, 2011b, Fabbrocini et al, 2014a, Kang et al, 2008, Torezan et al, 2013, Yoon et al, 2008, Yoon et al, 2010). …”

Treating cutaneous squamous cell carcinoma using 5-aminolevulinic acid polylactic-co-glycolic acid nanoparticle-mediated photodynamic therapy in a mouse model

“…Topical PDT is becoming an established treatment for actinic keratosis, Bowen's disease, and superficial basal cell carcinoma. [11][12][13] ALA is a prodrug of porphyrins and widely used in topical PDT around the world. [14][15][16] However, the insufficient local bioavailability can limit the effectiveness of ALA-PDT.…”

Current Evidence and Applications of Photodynamic Therapy in Dermatology

“…[161][162][163] Deep wrinkling and mottled hyperpigmentation have not been reported to change following treatment.…”