Thermomechanical Ablation‐Assisted Photodynamic Therapy for the Treatment of Acne Vulgaris. A Retrospective Chart Review of 30 Patients

Abstract

Background and Objectives Acne vulgaris, a chronic inflammatory disease, affects more than 90% of teenagers. The first‐line treatments for acne vulgaris are topical and oral medications, mainly antibiotics and retinoids. However, antibiotic resistance of Propionibacterium acnes, contraindications, partial response, significant adverse effects, or recurrence creates demand for novel treatment options in acne. Aminolevulinic acid (ALA) photodynamic therapy (PDT) is a well‐established modality in the treatment of acne. Nevertheless, PDT has limitations: it may not be effective for every patient; several treatments are usually required to achieve sufficient outcome; incubation time is 1–3 hours; treatment pain and post‐treatment downtime may be difficult for some patients to endure; and adverse effects may occur. This retrospective chart review was conducted to evaluate the efficacy and safety of PDT, assisted by a thermomechanical ablation (TMA) fractional injury device in the treatment of patients with moderate to severe acne. Study Design/Materials and Methods We conducted a retrospective chart review of 30 acne patients treated with TMA immediately before 5% ALA application with an incubation time of 1 hour and exposure to 60 J/cm2 red light (630 nm). Patients received up to three monthly treatments and were followed for 16 weeks. Two independent investigators evaluated the subject outcomes according to high definition photographs taken at baseline, before each treatment and at follow‐up visits. Three acne grading methods were used: Acne Grading Scoring System (AGSS), the Leeds revised acne grading system, and the general response to the treatment score. Patients also provided self‐assessments of improvement using the patient global impression of change (PGIC). Results Compared with baseline, the AGSS has showed a statistically significant reduction of 26.7% and 23.7%, respectively, at weeks 8 and 16 after final treatment. The Leeds score showed 65.2% and 60.6% improvement at the respective visits. The overall response rate was graded 3.3 ± 0.5 out of 4. PGIC score given by the patients was 5.5 out of 7, reflecting high satisfaction. Conclusion TMA used immediately prior to ALA application may enhance the effectiveness of PDT in the treatment of acne with minimal side effects, reduced downtime, and fewer sessions. The exact mechanism of TMA‐assisted PDT is still to be understood. Lasers Surg. Med. © 2020 Wiley Periodicals, Inc.

The Use of Lasers and Light Devices in Acne Management: An Update

“…Red light is the most widely used light source for PDT. In some small studies, several laser and light devices can additionally be used safely prior to PDT [116][117][118]. One retrospective chart review of 30 patients suggests thermomechanical ablation before ALA-PDT may enhance its efficacy in treating acne [116].…”

“…In some small studies, several laser and light devices can additionally be used safely prior to PDT [116][117][118]. One retrospective chart review of 30 patients suggests thermomechanical ablation before ALA-PDT may enhance its efficacy in treating acne [116]. A randomized controlled, and rater-blinded trial of ten patients showed that 15 minutes of radiant infrared LED therapy (970 nm) before PDT (median reduction of 73%) was significantly more effective at reducing acne lesions than PDT alone (median reduction of 38%) [118].…”

Treatment of periorbital wrinkles using thermo‐mechanical fractional injury therapy versus fractional non‐ablative 1565 nm laser: A comparative prospective, randomized, double‐arm, controlled study

“…It has been previously shown that pulse durations around 6 milliseconds are used for drug delivery and those greater than 10 milliseconds are used for rejuvenation; common settings for rejuvenation are 12-14 milliseconds. 11,25,26 As the periorbital region is a sensitive area, coordinating treatment at two centers in different countries with diverse populations warranted more conservative treatment parameters. The depth was chosen based on the depth of the periorbital skin to the reach the papillary dermis ~300 µm (Figure 1).…”

“…In this study, we chose a more conservative approach with a pulse duration of 10 milliseconds and 500 µm protrusion. It has been previously shown that pulse durations around 6 milliseconds are used for drug delivery and those greater than 10 milliseconds are used for rejuvenation; common settings for rejuvenation are 12–14 milliseconds 11,25,26 …”

Thermo‐Mechanical Fractional Injury Therapy for Facial Skin Rejuvenation in Skin Types II to V: A Retrospective Double‐Center Chart Review

“…When Tixel® is used over the exposed dermis, augmented results can be achieved. (4) TMFI-assisted drug delivery: Tixel, known to improve drug delivery [16], has already been utilized in the treatment of several medical conditions, including hypertrophic scars [17], acne [18], and rosacea [19]. Therefore, combining the esthetic thermomechanical effect with different cosmeceutical or drug delivery might augment the results.…”