Photodynamic therapy (PDT) for acne – studies show 82% clearance after 3 sessions
PDT works via application of a photosensitizing agent immediately prior to light exposure.
At 23MD, we use a highly sophistacated photosensitizer containing 5% aminolevulinic acid (5-ALA). Acne Ellipse Photo Spray encapsulates 5-ALA in a liposome, which aids penetration into the top layer of the skin. Once absorbed, 5-ALA can be activated by specific wavelengths of light, to produce reactive oxygen that kills bacterial overgrowth of P. acnes, the bacteria that causes acne (1, 2, 3). At 23MD, Ellipse Nordyls Laser is used to deliver light at these specified wavelengths.
A 2009 systematic review of laser and light therapies for treatment of acne analyzed data from two trials comparing PDT to placebo. This study showed a significant reduction in inflammatory lesion counts in the PDT group compared with placebo. (4)
The two studies showed a reduction in inflammatory lesions of 27.6%, 7.9%, and 41.9% at 1, 3, and 6 months using ALA with 630 nm light for mild-to-moderate acne.
More recently, in a large self-controlled multicenter trial with 397 patients in China low-dose ALA (5% gel) with one hour incubation and 633 nm LED light resulted in overall clearance rates of 82.1% after three or four treatment sessions. (5) The efficacy of ALA-PDT was noted to increase with corresponding baseline acne severity.
Several studies comparing the effectiveness of PDT versus light therapy alone have found increased benefit of PDT over light therapy alone.
- Hongcharu et al.compared four treatment protocols: ALA plus red light (550–700 nm), ALA alone, red light alone, and untreated control for back acne. (6) ALA plus red light showed clinically and statistically significant clearance of inflammatory acne for up to 20 weeks after multiple treatments and for up to 10 weeks after a single treatment. No improvement was noted for ALA alone, red light alone, or untreated sites.
- Similar results showing a significant reduction in inflammatory acne lesions for ALA-PDT (69% at three weeks follow up) but none for ALA alone, 635 nm light alone, or untreated sites were obtained in a smaller study by Pollock et al.(7). According to the pilot study , ALA-PDT for moderate inflammatory acne demonstrated global clearance of 70%–80% with single treatment and up to 95% for two or three sessions that were performed sequentially every 4–6 weeks.
In general therefore, evidence supports that PDT therapy improves acne lesions, has increased benefit when compared with light therapy alone, and that inflammatory lesions have a more robust response to treatment with PDT.
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- Thiboutot D, Gollnick H, Bettoli V, Dreno B, Kang S, Leyden JJ, et al. Global Alliance to Improve Outcomes in Acne. New insights into the management of acne: An update from the Global Alliance to Improve Outcomes in Acne Group. J Am Acad Dermatol. 2009;60(Suppl):S1–50. [fusion_builder_container hundred_percent=”yes” overflow=”visible”][fusion_builder_row][fusion_builder_column type=”1_1″ background_position=”left top” background_color=”” border_size=”” border_color=”” border_style=”solid” spacing=”yes” background_image=”” background_repeat=”no-repeat” padding=”” margin_top=”0px” margin_bottom=”0px” class=”” id=”” animation_type=”” animation_speed=”0.3″ animation_direction=”left” hide_on_mobile=”no” center_content=”no” min_height=”none”][PubMed]
- Rai R, Natarajan K. Laser and light based treatments of acne. Indian J Dermatol Venereol Leprol. 2013;79:300–9. [PubMed]
- Morton CA, Szeimies RM, Sidoroff A, Braathen LR. European guidelines for topical photodynamic therapy part 1: Treatment delivery and current indications-actinic keratoses, Bowen’s disease, basal cell carcinoma. J Eur Acad Dermatol Venereol. 2013;27:536–44. [PubMed]
- Hamilton FL, Car J, Lyons C, Car M, Layton A, Majeed A. Laser and other light therapies for the treatment of acne vulgaris: Systematic review. Br J Dermatol. 2009;160:1273–85. [PubMed]
- Ma L, Xiang LH, Yu B, Yin R, Chen L, Wu Y, et al. Lose-dose topical 5-aminolevulinic acid photodynamic therapy in the treatment of different severity of acne vulgaris. Photodiagnosis Photodyn Ther. 2013;10:583–90. [PubMed]
- Hongcharu W, Taylor CR, Chang
Y, Aghassi D, Suthamjariya K, Anderson RR. Topical ALA-photodynamic therapy for the treatment of acne vulgaris. J Invest Dermatol. 2000;115:183–92. [PubMed]
- Pollock B, Turner D, Stringer MR, Bojar RA, Goulden V, Stables GI, et al. Topical aminolaevulinic acid-photodynamic therapy for the treatment of acne vulgaris: A study of clinical efficacy and mechanism of action. Br J Dermatol. 2004;151:616–22. [PubMed]