Photodynamic therapy for rosacea in Chinese patients

Abstract

Background: Rosacea is a common chronic cutaneous disorder which is characterized by flushing, erythema, papulopustules and telangiectasia. The pathogenesis of the disease is still unknown. A multifaceted approach is necessary to control the disease because of its tendency to relapse. New more effective treatment options are desirable to achieve a complete remission. Aminolevulinic acid-photodynamic therapy (ALA-PDT) is a well-established treatment for non-melanoma skin cancer and precancerous lesions. ALA- PDT can also be used for inflammatory disease, including acne vulgaris. However, little is known about the efficacy and safety of ALA-PDT for rosacea in Chinese patients with Fitzpatrick skin types III and IV.

Objectives: To investigate the efficacy and safety of ALA-PDT in the treatment of rosacea classified as erythematotelangiectatic type or papulopustular type.

Methods: Twenty rosacea patients with either erythematotelangiectatic or papulopustular types were enrolled. 5% 5-Aminolevulinic acid in an oil-in-water emulsion was applied to the lesions under occlusion with plastic film for 2 h, and the lesions were irradiated with 100 mW/cm2, 80-90 J/cm2, LED red light (635 ± 15 nm) over 15 min in each session with four sessions at 10-day intervals. Objective measures (severity of flushing, erythema and telangiectasia, number of inflammatory lesions, VISIA Red Complexion Analysis images), subjective symptoms (including itching, prickling, burning, etc.) were recorded at baseline and at 4, 12 and 24 weeks after the last treatment. Adverse effects were recorded at each treatment and follow-up visit.

Results: During the follow-up period, all patients showed gradual objective clinical improvement compared with baseline (P < 0.01). Clinical inflammatory lesions disappeared completely in all patients after 24 weeks. Subjective symptoms, including flushing, itching, prickling, burning et al, had vanished and did not show any relapse during the follow-up period. The main side effects of ALA-PDT were pain, erythema, swelling and post- inflammatory hyperpigmentation. All side-effects were transient and tolerated by all the patients. No patients were dissatisfied with the therapeutic outcome.

Conclusions: ALA-PDT is an effective and safe approach for the treatment of rosacea of erythematotelangiectatic or papulopustular types, to control clinical manifestations and reduce subjective symptoms.

Keywords: 5-aminolevulinic acid; Chinese skin types; Erythemato-telangiectatic or papulopustular types; Photodynamic therapy; Red light emitting diodes; rosacea.

Figure 1.

Changes from baseline in flushing, erythema, telangiectasia and subjective symptoms at weeks 4, 12 and 24 after the last treatment. There was a statistically significant difference between baseline and all the time points post-treatment except in the telangiectasia score (P> 0.05). *P< 0.01 vs baseline;ΔP< 0.05.

Figure 2.

Mean±SD numbers of inflammatory lesions at baseline and follow-up visits treated with ALA-PDT. *P<0.01 vs baseline. ΔP< 0.05.

Figure 3.

Improvement in red/inflamed skin from baseline. *P<0.01 vs baseline; Δ P< 0.05.

Figure 4.

The values of the Patient’s Global Assessment for improvement in overall severity at the follow- up periods. (P>0.05)

Figure 5.

The satisfaction levels for the overall improvement and safety at weeks 4,12, 24.

Figure 6.

A single typical case originally presenting with moderate erythema and severe papulopustules who showed a significant improvement after 4-treatment sessions of PDT. (front A 0-3), (left side C 0-3), (right side E 0-3), photographs; and (front B 0-3), (left side D 0-3), (right side F 0-3), VISIA Red images. (A0-F0) baseline before treatment, (A1-F1) at the 4 week visit after 4 treatments; (A2-F2) continued improvement at 12 weeks; (A3-F3) at 24 week visit.