PEER-REVIEW | DERMATOLOGY | Protocol
Overall, the protocol used in the present study could be characterised as slightly stronger compared to previous SW-SE protocols. The purpose of this was two-fold; firstly to reduce inflammation within and around affected pilo- sebaceous units and to modify the surrounding tissue in order to prevent and/or reduce the chance of post-acne scarring activating MMPs and neocollagenesis; secondly, to reduce the size of residual sebaceous glands to achieve long-term control of inflammatory acne. Therefore, a stronger PDT result was necessary to achieve this effect. Furthermore, the present protocol is an elaboration of
the original report by the PDT group working with Professor Martino Neumann (Erasmus University in Rotterdam), which demonstrated that fractionated light exposure works better than continuous exposure. The blue light contributes towards photo-bleaching the external skin layers, opening the way for red light to proceed deeply into the skin without major interferences, resulting in an optimisation of the clinical effect. Two red light passes 20 minutes apart create a double PDT boost due to the reperfusion and re-oxygenation of deeper tissues28–29
.
Conclusion In conclusion, SBRR-MAL-PDT can be considered a safe and effective alternative treatment to control the clinical manifestations of moderate-to-severe acne vulgaris. This superficial skin fluorescence (SSF)-controlled PDT ensures a reliable objective assessment of photosensitizer concentrations within affected tissues before, during, and after PDT, significantly reducing post-treatment risks of unnecessary phototoxicity. SBRR-MAL-PDT was well tolerated and few, low intensity,
short-term side-effects have been observed. In common with other similar PDT studies, the authors’ have to admit
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Key points
Moderate-to-severe acne control strategies are numerous and are widely performed with variable degrees of success
Conventional single
exposure PDT has proven effective in temporarily controlling moderate acne
Skin fluorescence-
monitored sequential combination of blue and red LED PPIX activation within and around inflammatory acne lesions has proven successful in inducing relatively prolonged acne remission
Skin fluorescence monitoring should be a must in every PDT procedure
that even if SSF-controlled SBRR-LED-PDT represents an innovation in the complex field of acne treatments, the protocol should be considered as a simply organized sequential PDT strategy thought to logically combine progressively penetrating wavelengths to ensure a more uniform, multi-layer tissue irradiation and therefore a better and more efficient PDT effect. This is a preliminary study and a maintenance treatment
schedule was not assessed even if, when acne remission was achieved, clinical control was effective up to 3 months after the last PDT session. SSF-controlled SBRR-LED-PDT could potentially be ‘exported’ to other fields of dermatologic applications, including treatment of non- melanoma skin cancer. Further studies will certainly be needed before a consensus protocol could be reached for both acne control and other dermatologic PDT applications.
Declaration of interest None Figure 1–7, Table 1, 3–5 © Christopher Tzermias
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