| dermatology | ARTICLE
Photodynamic theraPy
for acne vulgaris
Andreas Katsambas, George Kontochristopoulos, Carmen Salavastru and Clio Dessinioti review the treatment protocols for acne, as well
as the data pertaining to photodynamic therapy ABSTRACT
Photodynamic therapy (PDT) is useful for the treatment of some forms of epithelial skin cancers, but may also have a role in the treatment of inflammatory dermatoses, such as acne. Laser and light therapies, including blue light, intense pulsed light (IPL), pulsed-dye laser (PDL), and red light have been used for the treatment of acne. Topical PDT uses light-activated agents which are absorbed into the pilosebaceous unit to amplify the response to light therapy, and 5-aminolaevulinic acid (ALA) and methyl aminolaevulinate (MAL) have been used for PDT in acne, in controlled randomised investigator-blinded trials, as well as in case reports.
It is suggested that PDT may represent a new emerging treatment for acne that does not increase the risk of bacterial resistance, and that is effective with a favourable safety profile. Current data shows that PDT results in a reduction of inflammatory lesions and a significant improvement in acne. However, no consensus exists on how to optimally perform PDT for acne therapy, and existing studies have used varying treatment protocols with regard to the treatment schedules, the chosen light source, and the parameters and concentration of the photosensitising agent used. In this article, the authors discuss current data with regard to the use of PDT for acne, its mode of action, and existing treatment protocols.
treatment options include oral and topical treatments depending on the form of acne. however, certain drawbacks related to acne treatments, such as
A
teratogenicity associated with oral isotretinoin, increased risk of bacterial resistance associated with oral and topical antibiotics, and the lack of an agent (with the exception of oral isotretinoin) effectively targeting all factors implicated in acne pathogenesis, highlight the need for new treatments for acne3
.
lasers and light-based therapies have been introduced as alternative treatments, including4
:
■ Intense pulsed light (IPl) ■ Pulsed-dye lasers (Pdl) ■ Potassium-titanyl-phosphate lasers (KtP) ■ Infrared diode lasers ■ Broad-spectrum continuous-wave light sources (blue light, blue–red light) ■ topical photodynamic therapy (Pdt) with photoactivation of aminolaevulinic acid (ala) or methyl aminolaevulinic acid (mal).
topical Pdt has been approved by the Food and drug
CnE, ThE mosT Common skIn disease, results from the interplay of increased seborrhoea, follicular hyperkeratinisation,
increased
proliferation of Propionibacterium acnes, and inflammation1, 2
. Current
administration (Fda) in the US and the european agency for the evaluation of medicinal Products (emea), for the treatment of at least one non-melanoma skin cancer (NmSC) indication. two photosensitising agents are licensed, namely a formulation of ala for actinic keratosis (aK) (levulan® Kerastick®, dusa Pharmaceuticals, Wilmington, ma), and an esterified formulation of mal for aK, Bowen’s disease, and superficial and nodular (up to 2 mm thick) basal cell carcinomas (BCC) (metvix®, PhotoCure aSa, oslo, Norway)5
. Furthermore, Pdt has been proposed as an off-label treatment for photo-rejuvenation and acne,
ANDREAS KATSAMBAS is Professor and Chairman, Department of Dermatology, Andreas Sygros Hospital, University of Athens, Greece; GEORGE KONTOCHRISTOPOULOS is dermatologist, Department of Dermatology, Andreas Sygros Hospital, University of Athens, Greece; CARMEN SALAVASTRU is dermatologist, Department of Dermatology, Colentina Hospital, Bucharest, Romania; CLIO DESSINIOTI is dermatologist, Department of Dermatology, Andreas Sygros Hospital, University of Athens, Greece email:
cliodes@hotmail.com
KEYWORDS acne vulgaris, photodynamic therapy intense pulsed light, pulsed-dye laser
prime-journal.com | July 2011 ❚ 43
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