Topical methyl aminolaevulinate photodynamic therapy for treatment of facial acne vulgaris: results of a randomized, controlled study

Hörfelt, Camilla; Funk, J.; Frohm-Nilsson, M.; Edström, Desirée Wiegleb; Wennberg, Ann‐Marie

doi:10.1111/j.1365-2133.2006.07340.x

Cited by 118 publications

(95 citation statements)

References 26 publications

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“…MAL-PDT has antimicrobial effects and can eliminate members of the Malassezia species. The mode of action of these observed effects is not totally clear; however, these effects may be the result of either acting as a local immunomodulant, inhibiting growth via activation of endogenous porphyrins, and/or initiating photodynamic destruction of pilosebacous units [18][19][20]. Upon exposure to light, protoporphyrin IX (PpIX) induces cytotoxic effects through oxygen-dependent photochemical reactions that damage mainly the mitochondria, where PpIX is synthesized, and plasma membranes.…”

Section: Discussionmentioning

confidence: 99%

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Photodynamic therapy: New treatment for recalcitrant Malassezia folliculitis

Lee

Kim

2010

Lasers Surg Med

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BackgroundMalassezia folliculitis commonly has been treated with oral antifungal medications. However, it has many therapeutic weaknesses such as infection relapse, drug resistance, or adverse effects like hepatotoxicity and gastrointestinal discomfort. Hence, there remains an ongoing need for alternative treatments for recalcitrant Malassezia folliculitis. Recently, many dermatologists suggest photodynamic therapy (PDT) as an alternative therapeutic option for its antimicrobial effect.ObjectiveTo investigate the efficacy of methyl 5‐aminolevulinic acid (MAL)‐PDT for the treatment of recalcitrant Malassezia folliculitis.Materials and MethodsSix Korean patients aged 23–47 years with recalcitrant Malassezia folliculitis were enrolled in this study. The patients enrolled in this study either refused oral medication or were unable to take oral antifungal agents due to hepatotoxicity concerns. Thus, we offered these patients MAL‐PDT as an alternative treatment option. For all patients, photographs of the lesion(s) were taken prior to initiating treatment. MAL cream (Metvix®, Galderma, France) was applied to each lesion (located on the patients' trunks) and covered with an adhesive occlusive dressing polyurethane film (Tegaderm®, 3M Healthcare, St. Paul, MN). After 3 hours, the cream was wiped off and illumination was performed immediately thereafter with non‐coherent red light using light‐emitting diodes (Aktilite® lamp, PhotoCure, Oslo, Norway, average wavelength 630 nm, light dose 37 J/cm2). Illumination was performed for 7.5 minutes. Patients underwent totally three sessions of MAL‐PDT at 2‐week intervals. One month after the last PDT treatment, patients returned to the hospital and lesions were photographed.ResultsAfter three sessions of MAL‐PDT, inflammatory lesions had decreased and improved obviously in four patients, had improved slightly in one patient, and had not improved in one patient.ConclusionMAL‐PDT may be an effective treatment option for patients with recalcitrant Malassezia folliculitis. However, the data on MAL‐PDT are still limited, and additional controlled trials including multiple patients will be necessary to verify the results of this pilot study. Lasers Surg. Med. 42:192–196, 2010. © 2010 Wiley‐Liss, Inc.

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Section: Discussionmentioning

confidence: 99%

“…Thus, in this study, we attempted to treat recalcitrant Malassezia folliculitis with MAL-PDT. We chose to use MAL as the photosensitizer in this study because, compared with ALA, MAL has enhanced lipophilicity and should therefore be more effective than ALA for treating disorders of the pilosebaceous unit and fungus [18,19].…”

Section: Discussionmentioning

confidence: 99%

Photodynamic therapy: New treatment for recalcitrant Malassezia folliculitis

Lee

Kim

2010

Lasers Surg Med

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“…Nevertheless, almost 16 years have passed since the first studies on ALA-PDT in acne therapy; there is still no consensus on how to perform PDT for acne treatment, and its use still remains an off-label option for acne patients [22] . Despite numerous studies on PDT in acne (mainly mild to severe acne on the face but also acne lesions on the back and acne conglobata) [1,18,20,21,[23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] ( Table 1 ), they are generally difficult to compare because of the lack of controls, qualitative non-blinded methods, variable light dosimetry, and an extremely wide variation of the incubation time between drug application and light exposure. All these differences should not be neglected.…”

Section: Acnementioning

confidence: 99%

Photodynamic Therapy and Skin Appendage Disorders: A Review

Megna

Fabbrocini

Marasca

et al. 2016

Skin Appendage Disord

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Photodynamic therapy (PDT) is a noninvasive treatment that utilizes light treatment along with application of a photosensitizing agent. In dermatology, PDT is commonly used and approved for the treatment of oncological conditions such as actinic keratosis, Bowen disease and superficial basal cell carcinoma. In the last 2 decades however, PDT has also been used for the treatment of several nonneoplastic dermatological diseases. The present review summarizes published data on PDT application in skin appendage disorders. Our literature review shows that: (a) PDT may be a suitable treatment for acne, folliculitis decalvans, hidradenitis suppurativa, nail diseases, and sebaceous hyperplasia; (b) there is a lack of agreement on PDT features (type, concentrations and incubation period of used substances, number and frequency of PDT sessions, optimal parameters of light sources, and patient characteristics [e.g., failure to previous treatments, disease severity, body surface area involved, etc.] which should guide PDT use in these diseases); (c) further research is needed to establish international guidelines helping dermatologists to choose PDT for the right patient at the right time.

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“…All of the subjects experienced moderate to severe pain during illumination, and developed erythema, pustular eruptions, and epithelial exfoliation after treatment, which were more severe and uniform in the ALA-PDT-treated area. Another randomized controlled split-face study of MAL-PDT using red light also showed a 54% reduction of inflammatory lesions with significant side effects of pain and erythema [21]. Robust prospective, randomized, controlled trials in the areas of light-based therapy or photodynamic therapy for acne are limited.…”

Section: Discussionmentioning

confidence: 99%

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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Topical methyl aminolaevulinate photodynamic therapy for treatment of facial acne vulgaris: results of a randomized, controlled study

Abstract: MAL-PDT is effective in the treatment of moderate to severe inflammatory facial acne. Further studies are warranted to optimize this promising procedure.

Cited by 118 publications

References 26 publications

Photodynamic therapy: New treatment for recalcitrant Malassezia folliculitis

Photodynamic therapy: New treatment for recalcitrant Malassezia folliculitis

Photodynamic Therapy and Skin Appendage Disorders: A Review

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

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