Effectiveness of photodynamic therapy with topical 5-aminolevulinic acid and intense pulsed light versus intense pulsed light alone in the treatment of acne vulgaris: comparative study

Abstract

Background: Photodynamic therapy (PDT) involves the activation of a photosensitizing agent by light to produce oxygen intermediates that destroy target tissues. Topical 5-aminolevulinic acid (ALA) is converted to protoporphyrin IX, a very potent photosensitizer, which accumulates in human skin, particularly in the epidermis and its appendages.

Objective: To study the effect of PDT in acne vulgaris using topical ALA and intense pulsed light (IPL).

Methods: Thirteen individuals with varying degrees of acne were treated after a 3-week washout period. Twenty percent ALA hydrochloride (DUSA Pharmaceuticals, Wilmington, MA, USA) was applied to half of the face, and after 3 hours, the whole face was exposed to intense pulsed light (Quantum SR, Lumenis, Santa Clara, CA, USA) using a 560 nm cutoff filter starting at a fluence of 26 J/cm. The procedure was done twice at 2-week intervals, and the patients were clinically evaluated on the second, fourth, and eighth weeks.

Results: All patients had no apparent improvement on the second week on both facial halves. In fact, some of the patients developed acute acneiform eruptions on the side treated with ALA. By the fourth week, however, most of the patients had visible improvement of facial acne that was more significant on the ALA-treated side of the face. This persisted until the eighth week post-treatment. On the other hand, the facial half treated with intense pulsed light only showed a return to baseline of their facial acne.

Conclusion: ALA-IPL are beneficial in the management of acne vulgaris and may be used in combination with other forms of acne treatment or may be an alternative treatment for patients who do not want to take systemic retinoids.