PEER-REVIEW | DERMATOLOGY | Table 5 Reported side-effects
1ST TREATMENT 2ND TREATMENT % %
Erythema
Burning sensation Dryness Flaking Itching
Hyperpigmentation Oedema
67.74 53.33 35.48 33.33 32.26 33.33 29.03 26.67 16.13 13.33 16.13 0 9.68 6.67
Percentage of patients reporting side-efffects and adverse events after the first and second SBRR-MAL-PDT session
by burning sensation (35.48%), dryness (32.26%), flaking
(29.03%), itching (16.13%), oedema (16.13%), and temporary hyperpigmentation (9.68%). Patients who were exposed to a second SBRR-MAL-PDT session reported the same series of side-effects in the same order of importance (Table 5). It is worth noting that all side-effects/adverse events
lasted no more than a few days following either one or two SBRR-MAL-PDT sessions. They all resolved spontaneously with simple topical skin care (gentle cleanser followed by spring thermal water and moisturizing creams). An average side-effect clearing time of 4.65 days was reported after the first SBRR-MAL- PDT session and 3.92 days after the second SBRR-MAL- PDT session.
Social activities Almost half the study patients (48.4%) reported a voluntary withdrawal from common social activities after SBRR-MAL-PDT. Voluntary withdrawal lasted a maximum of 7 days.
Overall treatment effectiveness The majority or SBRR-MAL-PDT exposed patients reported a substantial satisfaction with the clinical improvement observed from their baseline acne condition (61.3%), while 22.6% expressed themselves as partially unsatisfied. It is worth noting that no patient from the partially unsatisfied group underwent a second SBRR-MAL-PDT session even if advised to do so. A small percentage of patients (16.1%) expressed themselves selecting a neutral position (Table 6).
Figure 6 Patients’ face and back (top row) before and (bottom row) after the completion of MAL-PDT treatment
Discussion This retrospective single outpatient dermatological centre clinical study was carried out to investigate the effectiveness of a new multi-exposure PDT treatment protocol (SBRR-MAL-PDT) using a standardized concentration of MAL and a sequential series of LED irradiations with blue (415 nm, one exposure) and red light (633 nm, two exposures) to reduce and control the clinical manifestations associated with moderate-to- severe acne vulgaris. It is now known that when topical MAL is applied in a cream formulation to the skin, under occlusion, a selective accumulation of porphyrins (PpIX) has been noted, mainly within pilo-sebaceous units. Following the use of specific wavelengths of light,
porphyrin activation ensues. Highly reactive oxygen species are generated within porphyrin concentration sites and cause reversible or irreversible cellular
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