Topical 5-Aminolevulinic Acid Combined With Intense Pulsed Light in the Treatment of Photoaging

Dover, Jeffrey S.; Bhatia, Ashish C.; Stewart, Brigitte; Arndt, Kenneth A.

doi:10.1001/archderm.141.10.1247

Cited by 197 publications

(163 citation statements)

References 8 publications

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“…Fine lines, roughness and dyspigmentation on both sides were recorded as described by Dover et al [8]. The difference on the values of global scores was calculated by pretreatment values minus post-treatment values.…”

Section: Clinical Noninvasive Evaluationmentioning

confidence: 99%

“…For example, in 2006, Hedelund [5] reported a split-face trial to evaluate the efficacy of IPL treatment on skin texture, rhytids, telangiectasia and irregular pigmentation by patient self-assessments and by blinded clinical and photographic evaluations. Furthermore, several split-face trials were conducted to evaluate the effects of photodynamic therapy (PDT) with 5-aminolevulinic acid (ALA), and IPL activation by comparing ALA-PDT-IPL with IPL alone [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

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A split‐face study of intense pulsed light on photoaging skin in Chinese population

Chen³

et al. 2010

Lasers Surg Med

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Background and Objectives: Intense pulsed light (IPL) is regarded as the gold standard of nonablative photorejuvenation. Yet there is still a need to observe its efficacy and safety on dark skin using a split-face module. Study Design/Materials and Methods: Twenty-four Chinese women with photoaging were enrolled in this study. Patients were randomized to receive four IPL treatments at 3-to 4-week intervals on one side of face, with the other side spared as control. Changes of photoaging were evaluated using a global evaluation, an overall self-assessment, a Mexameter and a Corneometer. Skin biopsies were taken after four sessions of treatment on one side of face. The melanocyte density and the contents of melanin, collagen fibers, and elastic fibers were stained and used to evaluate the improvement on dyschromia and other signs of photoaging. Results: The global scores of photoaging on treated side decreased significantly from 3.02 to 1.22, while it remained unchanged on the untreated side. Twenty-one of 24 patients (87.5%) rated their improvement as excellent or good. The difference on the values of melanin index and erythema index on treated side were significantly larger than those on untreated side after the 1st session, the 4th session and at 3-month follow-up (P<0.05). The melanin contents were significantly decreased and the collagen fibers were obviously increased only on treated side (P<0.05). Adverse effects of treated side were limited to mild pain and transient erythema. Conclusion: Using this split-face module, IPL treatment is proved both clinically and histologically to be effective in treating photoaging skin in Chinese population. Adverse effects were minimal and acceptable.

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Section: Clinical Noninvasive Evaluationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A split‐face study of intense pulsed light on photoaging skin in Chinese population

Chen³

et al. 2010

Lasers Surg Med

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“…The short procedure time of an average of 10 minutes and minimally associated pain make IPL an attractive alternative in everyday clinical practice. A number of preliminary studies have indicated treatment efficacy for PDT in the treatment of acne and photoaging after using topical ALA from 30 minutes to 1 hour [14][15][16][17]. Under UV photographic study, we also observed a greater reduction of florescence in the PDT group than in the IPL and control groups as indirect evidence of P. acnes reduction, which indicates an effect despite the relatively brief contact of MAL.…”

Section: Discussionmentioning

confidence: 49%

A Comparative study of intense pulsed light alone and its combination with photodynamic therapy for the treatment of facial acne in Asian skin

et al. 2007

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Background and Objectives: The reaction to intense pulsed light (IPL) on Asian skin often differs from that on Caucasian skin. The study reported herein evaluated the effect on acne vulgaris of IPL alone and when IPL was combined with photodynamic therapy (PDT) using topical methyl aminolevulinate (MAL) in Asians. Study Design/Materials and Methods: Thirty Chinese subjects with phototypes IV or V and moderate acne were enrolled for a randomized, half-facial treatment study with IPL alone, IPL with PDT, or as controls. Sixteen percent MAL cream was applied to half of the face 30 minutes before treatment in the PDT group. The IPL was provided by the Ellipse Flex system (Danish Dermatologic Development, Denmark), which emitted wavelengths of 530 to 750 nm. The subjects were treated four times at 3-week intervals. Single passes of double pulses with a 10 milliseconds delay and a pulse duration of 2.5 milliseconds were used. The assessment of inflammatory and non-inflammatory acne lesions by two blinded investigators was based on standardized photographs that were taken before each treatment, and at 4 and 12 weeks after the final treatment. Results: Twenty-three patients completed the study. The mean reduction of the inflammatory lesion count was 53% in the PDT group, 22% in the IPL group, and 72% in the control group at 4 weeks, and 65% in the PDT group, 23% in the IPL group, and 88% in control group at 12 weeks. The mean clearance of non-inflammatory lesions was 52% in the PDT group, 15% in the IPL group, and 14% in the control group at 4 weeks, and 38% in the PDT group and 44% in the IPL group at 12 weeks, when and an increase of 15% was noted in the control group. Most patients experienced a reduction of inflammatory lesions that was not statistically significant on the PDT-treated side (P ¼ 0.06) or the IPLtreated side (P ¼ 0.82) at 12 weeks after treatment. Pretreatment with MAL resulted in a better clearance of inflammatory acne than IPL alone. There were no statistically significant differences between the intervention groups and the control group in the mean reduction of inflammatory lesions. Significant reductions of non-inflammatory lesions were observed in the MAL-PDT group (38%, P ¼ 0.05) and IPL groups (43%, P ¼ 0.00) 12 weeks after treatment. Twenty-five percent of the subjects in the PDT group withdrew because of intolerance to procedurerelated discomfort. Conclusions: MAL-PDT using IPL and MAL in Asians did not lead to significant improvement of moderate inflammatory acne compared with the control group. However, there was a delayed effect on non-inflammatory lesions, with significant reductions in both the PDT and IPL groups. A proportion of patients could not tolerate the discomfort that was related to PDT despite the short MAL incubation.

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“…82 Em 2005, Dover et al observaram eficácia superior da LIP-ALA sobre LIP isolada em um estudo prospectivo, randomizado. 83 Os resultados mostraram maior grau de melhora do envelhecimento global no lado tratado com LIP-ALA em relação ao outro lado tratado com LIP isolada. Os autores também relataram efeitos adversos e tolerância ao tratamento semelhantes em ambos os lados.…”

Section: Fotorejuvenescimentounclassified

Terapia fotodinâmica em dermatologia: princípios básicos e aplicações

Torezan

Niwa

Neto³

2009

An. Bras. Dermatol.

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Resumo:A terapia fotodinâmica envolve a administração de uma droga fotossensibilizante e sua ativação subsequente pela luz de comprimento de onda correspondente ao espectro de absorção do fotossensibilizador. Atualmente, a terapia fotodinâmica tópica é aprovada para o tratamento de condições oncológicas cutâneas como queratoses actínicas, doença de Bowen e carcinoma basocelular superficial em diversos países do mundo. Estudos multicêntricos controlados e randomizados demonstram a alta eficácia e resultado cosmético final superior dessa modalidade terapêutica em relação aos tratamentos convencionais. Para condições cutâneas não oncológicas, como acne vulgar, verrugas virais e esclerodermia localizada, há também relatos e série de casos confirmando o potencial terapêutico da terapia fotodinâmica. O desenvolvimento de fotossensibilizantes tópicos, ácido 5-aminolevulínico (ALA) ou seu metiléster (MAL), frente aos derivados da hematoporfirina de aplicação sistêmica, permitiu um grande avanço na popularidade da TFD na dermatologia, uma vez que tanto ALA quanto MAL tópicos não induzem mais fotossensibilidade generalizada prolongada. A produção de intermediários reativos de oxigênio, como oxigênio singlet, depende da concentração, da localização do fotossensibilizante no tecido alvo, assim como da dose de luz utilizada. Tanto as lâmpadas de amplo espectro quanto os LEDs (do inglês light emitting diodes) constituem fontes de luz adequadas para que os efeitos citotóxicos da terapia fotodinâmica resultem na destruição do tumor ou seus efeitos imunomodulatórios atuem melhorando as condições inflamatórias cutâneas. Palavras-chave: Carcinoma basocelular; Carcinoma in situ; Fotoquimioterapia Abstract: Photodynamic therapy involves the administration of a photosensitizing drug and its subsequent activation by light at wavelengths matching the absorption spectrum of the photosensitizer. Currently, topical photodynamic therapy has received approval for the treatment of cutaneous oncologic conditions such as actinic keratoses, Bowen's disease and superficial basal cell carcinoma in many countries in the world. Multicenter randomized controlled studies have demonstrated high efficacy and superior cosmetic outcome over standard therapies. For many non-oncologic dermatological diseases such as acne vulgaris, viral warts and localized scleroderma, case reports and small series have confirmed the potential of photodynamic therapy. After the development of topical photosensitizers 5-aminolevulinic acid (ALA) or its methyl ester (MAL), photodynamic therapy has gained worldwide popularity in dermatology, as these drugs do not induce prolonged phototoxicity as the systemic photosensitizing hematoporphyrin derivatives do. The production of reactive oxygen intermediates such as singlet oxygen depends on the concentration and localization of the photosensitizer in the diseased tissue as well as the applied light dose. Either incoherent lamps or LED arrays are suitable for the cytotoxic effects resulting in tumor destruction or immunomodulator...

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Topical 5-Aminolevulinic Acid Combined With Intense Pulsed Light in the Treatment of Photoaging

Cited by 197 publications

References 8 publications

A split‐face study of intense pulsed light on photoaging skin in Chinese population

A split‐face study of intense pulsed light on photoaging skin in Chinese population

A Comparative study of intense pulsed light alone and its combination with photodynamic therapy for the treatment of facial acne in Asian skin

Terapia fotodinâmica em dermatologia: princípios básicos e aplicações

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