1. Fluorescence photometer guided PDT treatment using MAL and red/blue light for severe acne
Acknowledgments
The study was internally funded. Dr. Tzermias reported having no financial disclosure.
Dr. Christopher K. Tzermias – Dermatologist, Director of Invasive Dermatology Dept., Athens Medical Hospital
Objective
The present study was performed to evaluate the remission of papulopustular and
cystic acne in young men and women using methyl-aminolevulinate (MAL) and a
combination of red and blue light.
Photographs of patients before and after treatment with METVIX
References
Bjerring P & Christiansen K (2011). Fluorescence-Guided PhotodynamicTherapy. In: M.H. Gold (ed.), Photodynamic Therapy in
Dermatology. Springer New York
Fabbrocini G, Cacciapuoti S, De Vita V, Fardella N, Pastore F, Monfrecola G. (2009). The effect of aminolevulinic acid photodynamic
therapy on microcomedones and macrocomedones. Dermatology;219(4):322–8
Sakamoto FH, Lopes JD, Anderson RR (2010). Photodynamic Therapy for Acne Vulgaris: A Critical Review from Basics to Clinical
Practice. Part I. Acne Vulgaris: When and Why Consider Photodynamic Therapy? J Amer Acad Derm; 63(2):183-93
Sakamoto FH, Torezan L, Anderson RR (2010). Photodynamic Therapy for Acne Vulgaris: A Critical Review from Basics to Clinical
Practice. Part II. Understanding Parameters for Acne Treatment with Photodynamic Therapy. J Amer Acad Derm; 63(2):195-
211. Taub AM (2011). 5-Aminolevulinic Acid: Acne Vulgaris. In: M.H. Gold (ed.), Photodynamic Therapy in Dermatology.
Springer New York
Hypotheses
(i) Significant decrease in the severity of acne after treatment with Metvix.
(ii) Significant increase of fluorescence level after the application of Metvix and,
following this, a significant decrease of fluorescence level after cleaning the area.
Discussion
This therapeutic scheme is effective for the treatment of moderate to severe acne
and it can be used as an alternative to oral medications, even in countries with plenty
of sunshine. In addition it could be used as an effective alternative treatment for
people with neuropathy, hepatopathy, congenital lipidemia, and psychotic or
depressive disorder. Finally, it could be used alternatively to oral medications by
women who are trying or want to become pregnant.
Results
ALL SAMPLE:
Fluorescence level increased significantly after the application of MAL t(329)=-18,806;
p<.001 and then returned to normal after cleaning the area(s) t(329)=19,272; p<.001.
FACE ONLY:
Fluorescence level increased significantly after the application of MAL t(228)=-16,996;
p<.001 and then returned to normal after cleaning the area(s) t(228)=16,523; p<.001 .
ADVERSE EVENTS, PAIN DURING AND AFTER TREATMENT AND EVALUATION OF OUTCOME
Measurements of
fluorescence before and
after application of
METVIX and after cleaning
Rational
To provide an alternative treatment option to people with moderate to severe
acne who cannot or do not want to use orally administered medications who had
already used oral and/or topical medications ineffectively or with recurrence of acne.
Methods
Participants: A total number of 39 patients participated with mean age 24.36 years
(SD=7.08) of whom 56.4% were male and 43.6% female.
Materials: Hand-held fluorescence photometer (FluoDerm, Dia-Medico, Denmark).
METVIX, Self-assessment questionnaire
Design: Repeated Measures design
Procedure: After initial acne severity evaluation the first measurement of
fluorescence was conducted, followed by the application of MAL for either 1 hour (face)
or for 2 hours (back/chest). After this time interval, fluorescence was measured again
and then a combination of blue/red light at 415 and 630 nm respectively was applied
according to the following protocol : 8’ blue – 20’ break – 16’ red – 20’ break – 16’ red.
During light application cold air was being delivered using cold air machine “Cryo 5”
(Zimmer Elektromedizin, Germany). Finally, after thorough cleaning , fluorescence was
measured again. The duration of the study was 14 months and the patients were
followed for 1 year on average.
The majority of patients (61.3%) were
satisfied by the treatment, while all
patients who were not satisfied by
the treatment (22.6%) did not have a
2nd
treatment session.
Mean pain around 5 in both
treatment sessions as
assessed using VAS from 1-10.
Acne severity decreased significantly after treatment irrespectively of the area with
acne (χ2
= 78.000; df = 4; p < .001). This was also evident for the face only (χ2
=
62.000; df = 4; p < .001), as well as for chest and back only (χ2
= 16.000; df = 4; p < .
005). No differences were observed between male and female patients.