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Chap. 52 - AMINOLEVULINIC ACID PHOTODYNAMIC THERAPY FOR FACIAL REJUVENATION AND ACNE

from PART FOUR - COSMETIC APPLICATIONS OF LIGHT, RADIOFREQUENCY, AND ULTRASOUND ENERGY

Published online by Cambridge University Press:  06 July 2010

Sorin Eremia
Affiliation:
University of California, Los Angeles, School of Medicine
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Summary

Light therapy is widely used in dermatology. The addition of a photosensitizing medication to the light, collectively known as photodynamic therapy (PDT), can enhance laser and light treatment. PDT has become an increasingly popular therapy for practitioners treating a variety of cosmetic and medical dermatologic conditions. The two commonly used photosensitizers are 20% 5-aminolevuline acid (ALA; Levulan, DUSA Pharmaceuticals) and the methyl ester of 20% 5-ALA (MAL; Metvixia, Galderma). Once ALA or MAL has been applied, it is metabolized into the photosensitizer protoporphyrin PpIX, which is preferentially taken up by rapidly proliferating cells such as tumor cells and sebaceous glands. Irradiation of photosensitized skin with various light and laser sources results in a photooxidation of the target molecules.

A variety of lasers and light sources have been utilized to activate ALA and MAL, including blue light (417 nm), red light (635 nm), pulse dye lasers (585 and 595 nm), and intense pulsed light (420–1200 nm). Table 52.1 demonstrates the absorption spectrum of PpIX and the corresponding PpIX absorbance of various light sources. Depending on the condition being treated, the PDT dose can be customized by controlling the amount of ALA/MAL that enters the skin, the time allowed for PpIX synthesis, the various laser and light sources, and the amount of light that is absorbed. This chapter will focus on the use of ALA-PDT for acne and photodamaged skin. Although currently off-label, its application for photorejuvenation and acne therapy is growing in use and popularity.

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Publisher: Cambridge University Press
Print publication year: 2010

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References

Alexiades-Armenakas, M. Laser-mediated photodynamic therapy. Clin. Dermatol. 2006;24:16–25.CrossRefGoogle ScholarPubMed
Avram, D, Goldman, MP. Effectiveness and safety of ALA-IPL in treating actinic keratoses and photodamage. J. Drugs Dermatol. 2004;3(Suppl):36–9.Google ScholarPubMed
Dover, J, Bhatia, A, Stewart, B, Arndt, K. Topical 5-aminolevulinic acid combined with intense pulsed light in the treatment of photoaging. Arch. Dermatol. 2005;141:1247–52.CrossRefGoogle ScholarPubMed
Gold, MH. A split face comparison study of ALA-PDT with intense pulsed light versus intense pulsed light alone for photodamage/photorejuvenation. Dermatol. Surg. 2006;32:795–803.Google Scholar
Goldman, MP, Atkin, D, Kincad, S. PDT/ALA in the treatment of actinic damage: real world experience. J. Lasers Surg. Med. 2002;14(Suppl):24.Google Scholar
Katz, BE, Truong, S, Maiwald, DC, Frew, KE, George, D. Efficacy of microdermabrasion preceding ALA application in reducing the incubation time of ALA in laser PDT. J. Drugs Dermatol. 2007;6:140–2.Google ScholarPubMed
Marmur, ES, Phelps, R, Goldberg, DJ. Ultrastructural changes seen after ALA-IPL photorejuvenation: a pilot study. J. Cosmet. Laser Ther. 2005;7:21–4.CrossRefGoogle Scholar
Nestor, MS, Gold, MH, Kauvar, AN, et al. The use of photodynamic therapy in dermatology: results of a consensus conference. J. Drugs Dermatol. 2006;5:140–54.Google ScholarPubMed
Nootheti, PK, Goldman, MP. Advances in photorejuvenation and the current status of photodynamic therapy. Expert Rev. Dermatol. 2006;1:51–61.CrossRefGoogle Scholar
Ruiz-Rodriquez, R, Sanz-Sachez, T, Cordoba, S. Photodynamic photorejuvenation. Dermatol. Surg. 2002;28:742–4.Google Scholar
Touma, D, Yaar, M, Whitehead, S, Konnikove, N, Gilchrest, BA. A trial of short incubation, broad-area photodynamic therapy for facial actinic keratoses and diffuse photodamage. Arch. Dermatol. 2004;140:33–40.CrossRefGoogle ScholarPubMed
Alexiades-Armenakas, MR. Long pulsed dye laser-mediated photodynamic therapy combined with topical therapy for mild-to-severe comedonal inflammatory and cystic acne. J. Drugs Dermatol. 2006;5:45–55.Google ScholarPubMed
Gold, MH, Bradshaw, VL, Boring, MM, Bridges, TM, Biron, JA, Carter, LN. The use of a novel intense pulsed light and heat source and ALA-PDT in the treatment of moderate to severe inflammatory acne vulgaris. J. Drugs Dermatol. 2004;3(Suppl):15–19.Google ScholarPubMed
Goldman, MP. Using 5-aminolevulinic acid to treat acne and sebaceous hyperplasia. Cosmet. Dermatol. 2003;16:57–8.Google Scholar
Goldman, MP, Boyce, S. A single-center study of aminolevulinic acid and 417 nm photodynamic therapy in the treatment of moderate to severe acne vulgaris. J. Drugs Dermatol. 2003;2:393–6.Google ScholarPubMed
Hongcharu, W, Taylor, CR, Chang, Y, Aghassi, D, Suthamjariya, K, Anderson, RR. Topical ALA-photodynamic therapy for the treatment of acne vulgaris. J. Invest. Dermatol. 2000;115:183–92.CrossRefGoogle ScholarPubMed
Itoh, Y, Ninomiya, Y, Tajima, S, Ishibashi, A. Photodynamic therapy for acne vulgaris with topical 5-aminolevulinic acid. Arch. Dermatol. 2000;136:1093–5.CrossRefGoogle ScholarPubMed
Orringer, JS, Kang, S, Hamilton, T, et al. Treatment of acne vulgaris with a pulsed dye laser: a randomized controlled trial. JAMA 2004;291:2834–9.CrossRefGoogle ScholarPubMed
Papageorgiou, P, Katsambas, A, Chu, A. Phototherapy with blue (415 nm) and red (660 nm) light in the treatment of acne vulgaris. Br. J. Dermatol. 2000;142:973–8.CrossRefGoogle ScholarPubMed
Pollock, B, Turner, D, Stringer, MR, et al. Topical aminolevulinic acid-photodynamic therapy for the treatment of acne vulgaris: a study of clinical efficacy and mechanism of action. Br. J. Dermatol. 2004;151:616–22.CrossRefGoogle ScholarPubMed
Seaton, ED, Charakida, A, Mouser, PE, Grace, I, Clement, RM, Chu, AC. Pulsed-dye laser treatment for inflammatory acne vulgaris: randomized controlled trial. Lancet 2003;362:1342–6.CrossRefGoogle Scholar
Taub, AF. Photodynamic therapy for the treatment of acne: a pilot study. J. Drugs Dermatol. 2004;3(Suppl):10–14.Google ScholarPubMed
Alexiades-Armenakas, M. Laser-mediated photodynamic therapy. Clin. Dermatol. 2006;24:16–25.CrossRefGoogle ScholarPubMed
Avram, D, Goldman, MP. Effectiveness and safety of ALA-IPL in treating actinic keratoses and photodamage. J. Drugs Dermatol. 2004;3(Suppl):36–9.Google ScholarPubMed
Dover, J, Bhatia, A, Stewart, B, Arndt, K. Topical 5-aminolevulinic acid combined with intense pulsed light in the treatment of photoaging. Arch. Dermatol. 2005;141:1247–52.CrossRefGoogle ScholarPubMed
Gold, MH. A split face comparison study of ALA-PDT with intense pulsed light versus intense pulsed light alone for photodamage/photorejuvenation. Dermatol. Surg. 2006;32:795–803.Google Scholar
Goldman, MP, Atkin, D, Kincad, S. PDT/ALA in the treatment of actinic damage: real world experience. J. Lasers Surg. Med. 2002;14(Suppl):24.Google Scholar
Katz, BE, Truong, S, Maiwald, DC, Frew, KE, George, D. Efficacy of microdermabrasion preceding ALA application in reducing the incubation time of ALA in laser PDT. J. Drugs Dermatol. 2007;6:140–2.Google ScholarPubMed
Marmur, ES, Phelps, R, Goldberg, DJ. Ultrastructural changes seen after ALA-IPL photorejuvenation: a pilot study. J. Cosmet. Laser Ther. 2005;7:21–4.CrossRefGoogle Scholar
Nestor, MS, Gold, MH, Kauvar, AN, et al. The use of photodynamic therapy in dermatology: results of a consensus conference. J. Drugs Dermatol. 2006;5:140–54.Google ScholarPubMed
Nootheti, PK, Goldman, MP. Advances in photorejuvenation and the current status of photodynamic therapy. Expert Rev. Dermatol. 2006;1:51–61.CrossRefGoogle Scholar
Ruiz-Rodriquez, R, Sanz-Sachez, T, Cordoba, S. Photodynamic photorejuvenation. Dermatol. Surg. 2002;28:742–4.Google Scholar
Touma, D, Yaar, M, Whitehead, S, Konnikove, N, Gilchrest, BA. A trial of short incubation, broad-area photodynamic therapy for facial actinic keratoses and diffuse photodamage. Arch. Dermatol. 2004;140:33–40.CrossRefGoogle ScholarPubMed
Alexiades-Armenakas, MR. Long pulsed dye laser-mediated photodynamic therapy combined with topical therapy for mild-to-severe comedonal inflammatory and cystic acne. J. Drugs Dermatol. 2006;5:45–55.Google ScholarPubMed
Gold, MH, Bradshaw, VL, Boring, MM, Bridges, TM, Biron, JA, Carter, LN. The use of a novel intense pulsed light and heat source and ALA-PDT in the treatment of moderate to severe inflammatory acne vulgaris. J. Drugs Dermatol. 2004;3(Suppl):15–19.Google ScholarPubMed
Goldman, MP. Using 5-aminolevulinic acid to treat acne and sebaceous hyperplasia. Cosmet. Dermatol. 2003;16:57–8.Google Scholar
Goldman, MP, Boyce, S. A single-center study of aminolevulinic acid and 417 nm photodynamic therapy in the treatment of moderate to severe acne vulgaris. J. Drugs Dermatol. 2003;2:393–6.Google ScholarPubMed
Hongcharu, W, Taylor, CR, Chang, Y, Aghassi, D, Suthamjariya, K, Anderson, RR. Topical ALA-photodynamic therapy for the treatment of acne vulgaris. J. Invest. Dermatol. 2000;115:183–92.CrossRefGoogle ScholarPubMed
Itoh, Y, Ninomiya, Y, Tajima, S, Ishibashi, A. Photodynamic therapy for acne vulgaris with topical 5-aminolevulinic acid. Arch. Dermatol. 2000;136:1093–5.CrossRefGoogle ScholarPubMed
Orringer, JS, Kang, S, Hamilton, T, et al. Treatment of acne vulgaris with a pulsed dye laser: a randomized controlled trial. JAMA 2004;291:2834–9.CrossRefGoogle ScholarPubMed
Papageorgiou, P, Katsambas, A, Chu, A. Phototherapy with blue (415 nm) and red (660 nm) light in the treatment of acne vulgaris. Br. J. Dermatol. 2000;142:973–8.CrossRefGoogle ScholarPubMed
Pollock, B, Turner, D, Stringer, MR, et al. Topical aminolevulinic acid-photodynamic therapy for the treatment of acne vulgaris: a study of clinical efficacy and mechanism of action. Br. J. Dermatol. 2004;151:616–22.CrossRefGoogle ScholarPubMed
Seaton, ED, Charakida, A, Mouser, PE, Grace, I, Clement, RM, Chu, AC. Pulsed-dye laser treatment for inflammatory acne vulgaris: randomized controlled trial. Lancet 2003;362:1342–6.CrossRefGoogle Scholar
Taub, AF. Photodynamic therapy for the treatment of acne: a pilot study. J. Drugs Dermatol. 2004;3(Suppl):10–14.Google ScholarPubMed

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