Prospective Study of Topical 5-Aminolevulinic Acid Photodynamic Therapy for the Treatment of Moderate to Severe Acne Vulgaris in Chinese Patients

Abstract

Background:

Topical photodynamic therapy (PDT) mediated with 5-aminolevulinic acid (ALA) offers an alternative option for the treatment of acne vulgaris.

Objective:

To study the effects of ALA dose, incubation time, and lesion type on protoporphyrin IX (PpIX) production and treatment outcomes.

Methods:

To examine the time course of PpIX production, 10% ALA was applied to inflammatory papules for 1 to 5 hours and followed by in situ fluorescence examination. To determine the effects of ALA dose and lesion type, 3, 5, and 10% ALA was applied to acne lesions in split-face fashion for 3 hours followed by whole-face light irradiation at 633 nm and 30 to 70 J/cm². Treatment was repeated twice at 2-week intervals.

Results:

PpIX reached a stable level after 3 hours of incubation. Similar PpIX levels were seen in areas receiving 3, 5, and 10% ALA. Poisson regression analyses indicated that lesion counts decreased by 0.791 times for a one-unit increase in treatment times (95% CI 0.782–0.799, p< .0001) but only by 0.999 times for a one-unit increase in ALA dose (95% CI 0.998–1.000, p = .22).

Conclusion:

The combination of low-dose ALA and a red light is a safe and effective option for the treatment of moderate to severe acne.

Renseignements de base:

La thérapie photodynamique topique (TPD) suivant l'administration de l'acide 5-aminolévulinique (ALA) représente une autre possibilité pour le traitement de l'acné vulgaire.

Objectif:

Étudier les effets de la dose d'ALA, la durée d'incubation, le type de lésion sur la production de PpIX, et les résultats du traitement.

Méthodes:

Pour examiner l'évolution temporelle de la production de PpIX, de l'ALA 10 % a été appliqué sur des papules inflammatoires pendant 1 à 5 heures et a été suivi d'un examen in situ en fluorescence. Afin de déterminer les effets de la dose d'ALA et le type de lésion, de l'ALA 3, 5, et 10 % a été appliqué sur les lésions d'acné sur une moitié du visage pendant 3 heures, suivi d'une irradiation de lumière de tout le visage à 633 nm et 30 à 70 J/cm². Le traitement a été répété deux fois à 2 semaines d'intervalle.

Résultats:

La PpIX a atteint un niveau stable après 3 heures d'incubation. Des taux de PpIX semblables ont été observés dans les parties ayant reçu de l'ALA 3, 5, et 10 %. Des analyses de régression de Poisson ont indiqué que le nombre de lésions a diminué de 0,791 fois pour une augmentation d'une unité de temps de traitement (IC 95 % 0,782 à 0,799, p <,0001), mais seulement par 0,999 fois pour un accroissement d'une unité de dose d'ALA (CI 95 % 0,998 à 1,000, p =, 22).

Conclusion:

La combinaison d'une faible dose d'ALA et de la lumière rouge est une option sûre et efficace pour traiter l'acné modérée à sévère.

Get full access to this article

View all access options for this article.

References

White

. Recent findings in the epidemiologic evidence, classification, and subtypes of acne vulgaris. J Am Acad Dermatol 1998;39 Suppl 2:s34-7, doi:10.1016/S0190-9622(98)70442-6.

van de Kerkhof

, Kleinpenning

, de Jong

. Current and future treatment options for acne. J Dermatolog Treat 2006;17:198–204, doi:10.1080/09546630600830596.

Kennedy

, Pottier

, Pross

. Photodynamic therapy with endogenous protoporphyrin IX: basic principles and present clinical experience. J Photochem Photobiol B 1990;16:143–8, doi:10.1016/1011-1344(90)85083-9.

Divaris

, Kennedy

, Pottier

. Phototoxic damage to sebaceous glands and hair follicles of mice after systemic administration of 5-aminolevulinic acid correlates with localized protoporphyrin IX fluorescence. Am J Pathol 1990;136:891–7.

Hongcharu

, Taylor

, Chang

. Topical ALA-photodynamic therapy for the treatment of acne vulgaris. J Invest Dermatol 2000;115:183–92, doi:10.1046/j.1523-1747.2000.00046.x.

Itoh

, Ninomiya

, Tajima

, Ishibashi

Photodynamic therapy of acne vulgaris with topical delta-aminolaevulinic acid and incoherent light in Japanese patients. Br J Dermatol 2001;144:575–9, doi:10.1046/j.1365-2133.2001.04086.x.

Pollock

, Turner

, Stringer

. Topical aminolaevulinic acid-photodynamic therapy for the treatment of acne vulgaris: a study of clinical efficacy and mechanism of action. Br J Dermatol 2004;151:616–22, doi:10.1111/j.1365-2133.2004.06110.x.

Mitra

, Stables

. Topical photodynamic therapy for noncancerous skin conditions. Photodiagn Photodyn Ther 2006;3:116–27, doi:10.1016/S1572-1000(06)00035-4.

Haedersdal

, Togsverd-Bo

, Wiegell

, Wulf

. Long-pulsed dye laser versus long-pulsed dye laser-assisted photodynamic therapy for acne vulgaris: a randomized controlled trial. J Am Acad Dermatol 2008;58:387–94, doi:10.1016/j.jaad.2007.11.027.

10.

Sadick

An open-label, split-face study comparing the safety and efficacy of levulan kerastick (aminolevulonic acid) plus a 532 nm KTP laser to a 532 nm KTP laser alone for the treatment of moderate facial acne. J Drugs Dermatol 2010;9:229–33.

11.

Zhang

, Wang

. [Topical aminolevulinic acid-photodynamic therapy in acne]. Chin J Dermatol 2009;42:78–80.

12.

Wang

, Wang

, Zhang

. Topical ALA PDT for the treatment of severe acne vulgaris. Photodiagn Photodyn Ther 2010;7:33–8, doi:10.1016/j.pdpdt.2010.01.003.

13.

Tyrrell

, Campbell

, Curnow

Protoporphyrin IX photobleaching during the light irradiation phase of standard dermatological methyl-aminolevulinate photodynamic therapy. Photodiagn Photodyn Ther 2010;7:232–8, doi:10.1016/j.pdpdt.2010.09.005.

14.

Shalita

, Berson

, Thiboutot

. Effects of tazarotene 0.1% cream in the treatment of facial acne vulgaris: pooled results from two multicenter, double-blind, randomized, vehicle-controlled, parallel-group trials. Clin Ther 2004;26:1865–73, doi:10.1016/j.clinthera.2004.11.012.

15.

Task Group of Chinese Guidelines of Acne Vulgaris Treatment, Chinese Dermatological Doctor Branch of Chinese Medical Doctor Association. [Chinese guidelines of acne vulgaris treatment (discussion version)]. J Clin Dermatol 2008;37:339–42.

16.

Huang

A review of progress in clinical photodynamic therapy. Technol Cancer Res Treat 2005;4:283–93.

17.

O'Riordan

, Akilov

, Hasan

The potential for photodynamic therapy in the treatment of localized infections. Photodiagn Photodyn Ther 2005;2:247–62, doi:10.1016/S1572-1000(05)00099-2.

18.

Wainwright

Photoantimicrobials—so what's stopping us? Photodiagn Photodyn Ther 2009;6:167–9, doi:10.1016/j.pdpdt.2009.10.007.

19.

Huang

, Dai

, Hamblin

. Antimicrobial photodynamic inactivation and photodynamic therapy for infections. Methods Mol Biol 2010;635:155–73, doi:10.1007/978-1-60761-697-9_12.

20.

Sakamoto

, Torezan

, Anderson

. Photodynamic therapy for acne vulgaris: a critical review from basics to clinical practice Part II. Understanding parameters for acne treatment with photodynamic therapy. J Am Acad Dermatol 2010;63:195–211, doi:10.1016/j.jaad.2009.09.057.

21.

Sakamoto

, Lopes

, Anderson

. Photodynamic therapy for acne vulgaris: a critical review from basics to clinical practice Part I., Acne vulgaris: when and why consider photodynamic therapy? J Am Acad Dermatol 2010;63:183–93.

22.

, Ryu

, Han

. A comparative study of topical 5-aminolevulinic acid incubation times in photodynamic therapy with intense pulsed light for the treatment of inflammatory acne. Dermatol Surg 2009;35:1918–26, doi:10.1111/j.1524-4725.2009.01315.x.

23.

Akaraphanth

, Kanjanawanitchkul

, Gritiyarangsan

Efficacy of ALA-PDT vs blue light in the treatment of acne. Photodermatol Photoimmunol Photomed 2007;23:186–90, doi:10.1111/j.1600-0781.2007.00303.x.

24.

Lin

, Ding

, Xiang

[Photodynamic therapy with 5% 5-aminolevulinic acid in the treatment of acne: a randomized, controlled trial]. Chin J Dermatol 2009;42:81–4.

25.

Ding

, Wang

, Huang

Successful treatment of refractory facial acne using repeat short-cycle ALA-PDT: case study. Photodiagn Photodyn Ther 2011;8:343–6, doi:10.1016/j.pdpdt.2011.07.003.

26.

Fabbrocini

, Cacciapuoti

, De Vita

. The effect of aminolevulinic acid photodynamic therapy on microcomedones and macrocomedones. Dermatology 2009;4:322–8, doi:10.1159/000252854.

27.

Wiegell

, Wulf

. Photodynamic therapy of acne vulgaris using 5-aminolevulinic acid versus methyl aminolevulinate. J Am Acad Dermatol 2006;54:647–51, doi:10.1016/j.jaad.2005.12.033.

28.

Hörfelt

, Funk

, Frohm-Nilsson

,. Topical methyl aminolaevulinate photodynamic therapy for treatment of facial acne vulgaris: results of a randomized, controlled study. Br J Dermatol 2006;155:608–13, doi:10.1111/j.1365-2133.2006.07340.x.

29.

Hong

, Lee

. Topical aminolevulinic acid-photodynamic therapy for the treatment of acne vulgaris. Photodermatol Photoimmunol Photomed 2005;21:322–5, doi:10.1111/j.1600-0781.2005.00181.x.

30.

Hörfelt

, Stenquist

, Halldin

. Single low-dose red light is as efficacious as methyl-aminolevulinate—photodynamic therapy for treatment of acne: clinical assessment and fluorescence monitoring. Acta Derm Venereol 2009;89:372–8, doi:10.2340/00015555-0667.

31.

Wang

, Wang

, Huang

Cutaneous photosensitization induced by exposure to colour cathode ray tube monitor following topical 5-aminolaevulinic acid-based photodynamic therapy: a case report. Acta Derm Venereol 2010;90:545–7, doi:10.2340/00015555-0917.

32.

Haider

, Shaw

. Treatment of acne vulgaris. JAMA 2004;292:726–35, doi:10.1001/jama.292.6.726.