BackgroundAcne affects 83- 95% of 16- year-oldsof both sexes, and many seek help from a clinician. Emerging problems with conventional acne treatments, specifically antibiotic resistance of Propionibacterium acnes and...BackgroundAcne affects 83- 95% of 16- year-oldsof both sexes, and many seek help from a clinician. Emerging problems with conventional acne treatments, specifically antibiotic resistance of Propionibacterium acnes and fears over th e safety and tolerance of oral isotretinoin, create a demand for novel treatment modalities in acne. Objectives To study the efficacy of aminolaevulinic acid- photodynamic therapy (ALA-PDT) in the treatment of acne and to identify the mode of acti on, looking specifically at the effects on surface numbers of P. acnes and on se bum excretion. Methods Ten patients (nine men and one woman, age range 16- 40 y ears) with mild to moderate acne on their backswere recruited. Each patient’s backwasmarkedwith four 30- cm2 areas of equal acne severity. Each site was then randomly allocated to either ALA-PDT treatment, light alone, ALAalone or an u ntreated control site. At baseline, numbers of inflammatory and noninflammatory acne lesions were counted, sebum excretionmeasured by Sebutapes (CuDerm, Dallas, TX, U.S.A.) and surface P. acnes swabs performed. ALA cream (20% in Unguentum Merck) was applied under occlusion to the ALA-PDT and ALA alone sites for 3 h . Red light from a diode laser was then delivered to the ALA-PDT and light alo ne sites (635 nm, 25 mW cm- 2, 15 J cm- 2). Each patient was treated weekly fo r 3 weeks. At each visit acne lesion counts were performed and 3 weeks following the last treatment sebum excretion rates and P. acnes swabs were repeated. Resu lts There was a statistically significant reduction in inflammatory acne lesion counts from baseline after the second treatment at the ALA-PDT site but not at any of the other sites. No statistically significant reduction in P. acnes numb ers or sebum excretion was demonstrated at any sites including the ALA-PDT sit e. Conclusions ALA-PDT is capable of clinically improving acne. An alternative mode of action for ALA-PDT other than direct damage to sebaceous glands or ph otodynamickilling of P. acnes is suggested from the results of this study.展开更多
Background: There is a need for alternative treatments for moderate to severe acne vulgaris. Preliminary experience suggests that topical methyl aminolaevulinate photodynamic therapy (MAL-PDT) may have potential. Obje...Background: There is a need for alternative treatments for moderate to severe acne vulgaris. Preliminary experience suggests that topical methyl aminolaevulinate photodynamic therapy (MAL-PDT) may have potential. Objectives: To investigate the efficacy and tolerability of MAL-PDT for treatment of moderate inflammatory facial acne. Patients/methods: Thirty patients aged 15-28 years with moderate to severe acne were included in a blinded, prospective, randomized, placebo-controlled multicentre study. Each side of each patient’s face was randomly assigned to treatment with MAL (160 mg g-1) or placebo cream, applied for 3 h prior to illumination. A second treatment was given 2 weeks later. On each occasion, patients assessed the intensity of pain using a 10-cm visual analogue scale. Inflammatory and noninflammatory acne lesions were counted at baseline and 4 and 10 weeks after the last PDT treatment. The investigator assessed the global severity of acne at baseline (seven patients had severe acne on at least one side of the face) and each study visit using a six-point rating scale. Data were analysed on an intention-to-treat basis, including all 30 patients. Results: There was a statistically significant greater reduction in the total inflammatory lesion count with MAL-PDT compared with placebo PDT at week 12; median reduction 54%[95%confidence interval (CI) 35-64%] vs. 20%(95%CI 8-50%), P = 0.0006. MAL-PDT was associated with more pain than placebo PDT, although intensity varied across centres andwas reduced with repeated treatment. Local adverse events were consistent with this treatment modality. Conclusions: MAL-PDT is effective in the treatment of moderate to severe inflammatory facial acne. Further studies are warranted to optimize this promising procedure.展开更多
文摘BackgroundAcne affects 83- 95% of 16- year-oldsof both sexes, and many seek help from a clinician. Emerging problems with conventional acne treatments, specifically antibiotic resistance of Propionibacterium acnes and fears over th e safety and tolerance of oral isotretinoin, create a demand for novel treatment modalities in acne. Objectives To study the efficacy of aminolaevulinic acid- photodynamic therapy (ALA-PDT) in the treatment of acne and to identify the mode of acti on, looking specifically at the effects on surface numbers of P. acnes and on se bum excretion. Methods Ten patients (nine men and one woman, age range 16- 40 y ears) with mild to moderate acne on their backswere recruited. Each patient’s backwasmarkedwith four 30- cm2 areas of equal acne severity. Each site was then randomly allocated to either ALA-PDT treatment, light alone, ALAalone or an u ntreated control site. At baseline, numbers of inflammatory and noninflammatory acne lesions were counted, sebum excretionmeasured by Sebutapes (CuDerm, Dallas, TX, U.S.A.) and surface P. acnes swabs performed. ALA cream (20% in Unguentum Merck) was applied under occlusion to the ALA-PDT and ALA alone sites for 3 h . Red light from a diode laser was then delivered to the ALA-PDT and light alo ne sites (635 nm, 25 mW cm- 2, 15 J cm- 2). Each patient was treated weekly fo r 3 weeks. At each visit acne lesion counts were performed and 3 weeks following the last treatment sebum excretion rates and P. acnes swabs were repeated. Resu lts There was a statistically significant reduction in inflammatory acne lesion counts from baseline after the second treatment at the ALA-PDT site but not at any of the other sites. No statistically significant reduction in P. acnes numb ers or sebum excretion was demonstrated at any sites including the ALA-PDT sit e. Conclusions ALA-PDT is capable of clinically improving acne. An alternative mode of action for ALA-PDT other than direct damage to sebaceous glands or ph otodynamickilling of P. acnes is suggested from the results of this study.
文摘Background: There is a need for alternative treatments for moderate to severe acne vulgaris. Preliminary experience suggests that topical methyl aminolaevulinate photodynamic therapy (MAL-PDT) may have potential. Objectives: To investigate the efficacy and tolerability of MAL-PDT for treatment of moderate inflammatory facial acne. Patients/methods: Thirty patients aged 15-28 years with moderate to severe acne were included in a blinded, prospective, randomized, placebo-controlled multicentre study. Each side of each patient’s face was randomly assigned to treatment with MAL (160 mg g-1) or placebo cream, applied for 3 h prior to illumination. A second treatment was given 2 weeks later. On each occasion, patients assessed the intensity of pain using a 10-cm visual analogue scale. Inflammatory and noninflammatory acne lesions were counted at baseline and 4 and 10 weeks after the last PDT treatment. The investigator assessed the global severity of acne at baseline (seven patients had severe acne on at least one side of the face) and each study visit using a six-point rating scale. Data were analysed on an intention-to-treat basis, including all 30 patients. Results: There was a statistically significant greater reduction in the total inflammatory lesion count with MAL-PDT compared with placebo PDT at week 12; median reduction 54%[95%confidence interval (CI) 35-64%] vs. 20%(95%CI 8-50%), P = 0.0006. MAL-PDT was associated with more pain than placebo PDT, although intensity varied across centres andwas reduced with repeated treatment. Local adverse events were consistent with this treatment modality. Conclusions: MAL-PDT is effective in the treatment of moderate to severe inflammatory facial acne. Further studies are warranted to optimize this promising procedure.
