Journal of the American Academy of Dermatology
Volume 63, Issue 2 , Pages 195-211, August 2010

Photodynamic therapy for acne vulgaris: A critical review from basics to clinical practice:

Part II. Understanding parameters for acne treatment with photodynamic therapy

  • Fernanda H. Sakamoto, MD

      Affiliations

    • Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
    • Department of Dermatology at the Universidade Federal de São Paulo, Escola Paulista de Medicina (UNIFESP-EPM), São Paulo, Brazil
    • ,
  • Luis Torezan, MD

      Affiliations

    • Department of Dermatology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
    • ,
  • R. Rox Anderson, MD

      Affiliations

    • Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
    • Corresponding Author InformationReprint requests: Richard Rox Anderson, MD, Wellman Center for Photomedicine, Massachusetts General Hospital, 55 Fruit St, BHX 630, Boston, MA 02114.

Photodynamic therapy requires a photosensitizer, oxygen, and activating light. For acne, pilosebaceous units are “target” structures. Porphyrins are synthesized in vivo from 5-aminolevulinic acid (ALA), particularly in pilosebaceous units. Different photosensitizers and drug delivery methods have been reported for acne treatment. There are a variety of porphyrin precursors with different pharmacokinetic properties. Among them, ALA and methyl-ester of ALA (MAL) are available for possible off-label treatment of acne vulgaris. In addition, various light sources, light dosimetry, drug incubation time, and pre- and posttreatment care also change efficacy and side effects. None of these variables has been optimized for acne treatment, but a number of clinical trials provide helpful guidance. In this paper, we critically analyze clinical trials, case reports, and series of cases published through 2009.

Learning objectives

After completing this learning activity, participants should be able to analyze photodynamic therapy using 5-aminolevulinic acid and its derivates for acne treatment, predict the effectiveness and outcomes of photodynamic therapy using different parameters and/or different porphyrin-related photosensitizers, and assess and manage the side effects of porphyrin-based photodynamic therapy for acne.

Key words: adverse effects, 5-aminolevulinic acid, lasers, light, methyl 5-aminolevulinate, photochemotherapy, porphyrins, therapeutics

 

 Funding sources: None.

 Conflicts of interest: The authors, editors, JAAD CME council members, and peer reviewers have no relevant financial relationships.

PII: S0190-9622(10)00020-4

doi:10.1016/j.jaad.2009.09.057

Journal of the American Academy of Dermatology
Volume 63, Issue 2 , Pages 195-211, August 2010