光动力联合口服异维A酸治疗中重度痤疮疗效分析

Efficacy and safety of photodynamic therapy combined with oral isotretinoin in the treatment of moderate to severe acne

目的评估5-盐酸氨酮戊酸光动力疗法(ALA-PDT)联合口服异维A酸治疗中重度痤疮的有效性和安全性。方法本研究为单中心前瞻性队列临床研究。纳入2019年1月至2022年7月广州市皮肤病防治所门诊就诊的中重度痤疮患者,分为对照组和联合组,两组均接受3次ALA-PDT治疗,每次治疗间隔2周,联合组在ALA-PDT治疗的基础上,同时联合口服异维A酸10 mg每天2次。比较两组治疗后痤疮GAGS评分、总皮损清除率及炎性痤疮皮损清除率,并比较不良反应发生情况。结果共纳入并完成随访的对照组49例,联合组49例。治疗4周后,联合组的总皮损清除率(Z=2.45,P=0.014)、炎性痤疮清除率(Z=3.33,P=0.001)均优于对照组。治疗6周时,联合组GAGS评分(t=3.15,P=0.002)、总皮损清除率(Z=4.01,P<0.001)、炎性痤疮清除率(Z=3.60,P<0.001)均优于对照组。两组间色素沉着、红斑的发生率及疼痛(VAS)评分均无统计学差异(均P>0.05)。两组均无因不良反应中断治疗者。结论ALA-PDT联合异维A治疗中重度痤疮有效性优于单纯ALA-PDT治疗组,且安全性无显著差异。

Objective To evaluate the efficacy and safety of photodynamic therapy(PDT)combined with oral isotretinoin in the treatment of moderate to severe acne.Methods This study was a single center prospective cohort clinical study.Patients with moderate to severe acne who were admitted to the clinic of Guangzhou Institute of Dermatology from January 2019 to July 2022 were enrolled in the study.All patients received ALA-PDT treatment once every other two weeks for 3 times.Patients in the observation group were also given oral isotretinoin at a dose of 10 mg twice-daily.The GAGS score,total number of acne lesions,number of inflammatory lesions,as well as the main adverse reactions were compared between the two groups.Results A total of 49 cases each were enrolled in the ALA-PDT alone and the observation groups.After 4 weeks of treatment,the total skin lesion clearance rate and inflammatory acne clearance rate in the observation group were higher than that in the control group(Z=2.45,P=0.014 for lesion clearance rate;Z=3.33,P=0.001 for inflammatory acne clearance rate).In comparison to ALA-PDT treatment alone,other significant improvements in observation group included GAGS scores(t=3.15,P=0.002),total lesion clearance rate(Z=4.01,P<0.001)and inflammatory acne clearance rate(Z=3.60,P<0.001)after 6 weeks of treatment.The main adverse reactions,including pain(VAS score),incidence of pigmentation and erythema,did not differ significantly between the two groups(P>0.05).No patient in either group dropped out of the trial due to adverse reactions.Conclusions The efficacy of PDT combined with isotretinoin is superior to that of the ALA-PDT treatment alone in the treatment of moderate to severe acne,and there are no significant differences in safety between these two treatments.