Dermatologist Macrene Alexiades-Armenakas, MD, PhD, FAAD, assistant clinical professor of dermatology at Yale University School of Medicine in New Haven, Conn., demonstrated how photodynamic therapy combined with a long-pulse, pulsed-dye laser and topical 5-aminolevulinic acid provides long-lasting clearance of acne lesions.
“Laser technology has made great inroads in the treatment of acne, which until recently has been treated almost exclusively – and with varying degrees of success – with topical, systemic and hormonal medications,” said Alexiades-Armenakas.
She added: “Now, we have solid evidence-based medicine supporting the effectiveness of certain laser therapies as a long-term solution for treating active acne. The key is to distinguish the benefits and limitations of these available technologies and select the most effective treatments for each acne patient.”
In a preliminary study, Alexiades-Armenakas examined whether a combination of photodynamic therapy (PDT) with a photosensitizer known as
topical 5-aminolevulinic acid (ALA) and activated by long-pulse, pulsed dye laser could safely and effectively clear mild to severe cases of acne.
PDT works by using laser or light energy – in this case a pulsed dye laser was used – to activate the ALA, which is a solution that penetrates into the oil glands and is applied to the skin one hour prior to treatment.
As it penetrates, ALA binds to the oil glands and sensitizes the cells to light.
The researchers treated 14 patients with ALA PDT, who received one to six treatments depending on the severity of their acne and continued to use topical medications during and after the study.
The control group consisted of four patients who were either treated with conventional therapy (such as systemic or topical medications) or with laser energy but without ALA PDT.
After the analysis, Alexiades-Armenakas found that all (100 percent) of the 14 patients in the ALA PDT treatment group experienced complete clearance of their acne.
She reported that an average of 2.9 ALA PDT treatments was administered to this patient group and improvement in the acne lesions was visible within one to two weeks after the first treatment.
She said: “The first-of-a-kind study found this particular form of photodynamic therapy used in conjunction with topical therapy to be the first such treatment to achieve complete clearance of acne up to 13 months post treatment and a 77 percent clearance rate per treatment. Four subsequent studies conducted by other investigators involving an additional 75 patients demonstrated similar results.
“Patients also experienced an added benefit of significant improvement in their acne scars, as the pulsed dye laser offers superior penetration to the deeper layers of the skin where scars form.”
Side effects were limited to mild redness that lasted for 48 hours, and the treatment was found to be safe even for patients of colour with no complications, such as hyperpigmentation.
For patients with intermittent acne flares and pronounced oily skin with large pores, ALA PDT treatment with a 1450nm diode laser that heats the deep layer of skin where the oil glands are located has been shown to help these patients in as little as one to three treatments.
The findings of the study were presented at the 67th Annual Meeting of the American Academy of Dermatology (Academy).