PEER-REVIEW | DERMATOLOGY |
SKIN TYPE BASED ON FITZPATRICK SCALE
Type II Type III Type IV
Table 1 Patients’ baseline characteristics AREA WITH
ACNE
35.9% Face 53.8% Back 10.3% Chest
79.5% 15.4 5.1%
BEFORE TREATMENT
Grade III Grade IV N/A
ACNE SEVERITY
48.7% 51.3%
15–44 years of age (mean 23.36), affected by moderate-to- severe acne vulgaris (AV), unwilling to take conventional oral medications were evaluated. Fitzpatrick phototype distribution showed 53.9% were stage II, 53.8% stage III, and 10.3% stage IV. Facial regions were the most affected anatomical sites (79.5%), followed by dorsal regions (15.4%), and chest (5.1%) (Table 1).
Table 2 Acne severity grading system
GRADE DESCRIPTION 0 1
2 3 4 Full/almost full acne remission
Comedones and occasional small cysts confined to the face
Comedones and occasional pustules and small cysts confined to the face
Many comedones and small and large inflammatory papules and pustules, more extensive but confined to the face
Many comedones and deep lesions tending to coalesce and canalize, and involving the face and the upper aspects of the trunk
subsequent red light exposures with the purpose of
optimizing skin penetration and final PDT efficiency. They arbitrarily selected an inter-irradiation ‘resting interval’ of 20 minutes to allow cells still involved in converting pro-drug into active photosensitizer to continue their job, re-accumulating PpIX within affected tissues. According to their protocol, they theoretically generate three subsequent PDT effects — one superficial and two deep — increasing the overall efficiency of PDT procedures. The authors’ clinical analysis has been based on a
retrospective study aimed at evaluating efficacy, safety, and tolerability of the innovative sequential blue–red–red (SBRR) MAL-PDT protocol performed on a population of 39 patients during a period of 18 months.
Patients and method Study population A population of 39 patients (56.4% males, 43.6% females),
Table 3 PDT session results
MEAN NUMBER MEAN NUMBER OF LESIONS BEFORE PDT
OF LESIONS AFTER PDT
Papules Pustules Cysts
24
9.54 3.28 13.49
4.38 3.46 0.56
Mean number of lesions (papules, pustules, cysts) before and after photodynamic therapy sessions
August/September 2015 |
prime-journal.com
Procedure After informing patients about the grade of severity of their skin condition, various treatment options were presented along with possible clinical results, complications, and side effects. Specific informed consent was obtained. Acne severity was assessed according to the scale proposed by Pillsbury, Shelley, and Kligman (PSK scale), where ‘0’ represents full/almost full acne remission and ‘4’ identifies severe acne8
(Table 2). After informing
patients about the grade of severity of their skin condition, various
treatment options were presented along with
possible clinical results, complications, and side effects.
Acne severity for almost half of the patients (48.7%) was classified as grade 3 (moderate acne), and grade 4 (severe acne) for the remaining 51.3% before treatment (Table 1). The mean number of each type of lesion — papules, pustules, and cysts — was 9.54, 13.49, and 3.46, respectively (Table 3). Standardized clinical photographs were taken at baseline and 3 months after SBRR-MAL-PDT procedures. Baseline superficial skin fluorescence
(SSF-1) was measured on standardized anatomical spots within acne-affected areas using a hand-held digital fluorimeter (Fluoderm, Dia-Medico Aps, Denmark). Fluorescence dermal units (FDU) were recorded on patient charts. A thin layer of
MAL in a cream vehicle (Metvix ®, 160 mg/g, Galderma, Alby Sur Cheran, France) was evenly applied over affected areas and protected by a thin polyurethane film. Patients were kept in a dark room during pre-PDT photo- sensitizer bio-activation. Occlusive contact time was arbitrarily set at 1 hour for facial regions, and 2 hours for the trunk. After OCT expiration, the polyurethane film and topical cream residue were gently removed with
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