The Clinical Study Of Photodynamic Therapy Combined With Low-dose Isotretinoin In The Treatment Of Moderate To Severe Acne

BackgroundAcne vulgaris,as a chronic inflammatory dermatosis of sebaceous gland unit,mainly occurs in adolescents and adults.The incidence of acne vulgaris is increasing year by year.Clinical features include non-inflammatory lesions(comedones)and inflammatory lesions(papules,pustules,nodules,cysts).At present,the pathogenesis of acne is attributed to a variety of factors,such as excessive keratinization of pilosebaceous ductal epithelium,the proliferation of Propionibacterium acnes(P.acnes),excessive secretion of sebaceous glands,inflammation and immune response.Inflammatory reaction runs through the pathogenesis of acne,including the whole process from non-inflammatory lesions to inflammatory esions,even to post-inflammatory erythema,post-inflammatory pigmentation and scar formation.The inflammation of skin lesions in moderate and severe acne is relatively serious and the treatment is time-consuming.If not treated promptly and effectively,the optimal treatment time is delayed,and sequelae such as hyperchrome and scar are often left behind,which has a great negative impact on the life and psychology of patients.Photodynamic therapy has been widely used in the treatment of moderate and severe acne.It can target sebaceous gland cells and reduce inflammation.It not only has a significant effect,but also shortens the course of treatment.However,photodynamic therapy is expensive and has significant local response,which affects the work and limits the use of this therapy.Oral isotretinoin is the most effective drug to treat acne,especially severe nodular cystic acne.However,its side effects and low compliance duing to long-term course limit its clinical use.In this study,we combined 5-ALA photodynamic therapy with low-dose isotretinoin to treat moderate to severe acne,so as to achieve rapid effects,long-term remission,shorten the course of treatment and reduce recurrence.Objective By comparing the clinical efficacy and adverse reactions of PDT combined with low-dose isotretinoin and PDT alone in the treatment of moderate and severe acne,the efficacy and safety of PDT in the treatment of moderate and severe acne were discussed.MethodsA total of 45 patients with moderate to severe acne were collected in our department from August 2016 to February 2018.Patients were randomly divided into the treatment group and the control group,with 23 cases in the treatment group and 22 cases the control group.In the treatment group,5%5-ALA was applied to the skin lesions of the face,and the preservative film was wrapped for 1.5 hours.During the period of avoiding light,the whole face was irradiated with LED-1B photodynamic therapy instrument once every two weeks for 3 times.At the same time,the patients were given isotretinoin(Telsi),10 mg bid orally for 3 months.The control group was treated with PDT alone,and the method was the same as that of the experimental group.After 6,8 and 12 weeks of treatment,all patients were counted for skin lesions and adverse reactions were recorded.The recurrence rate was counted after 6 months of treatment.Results1.There was no significant difference in baseline data of sex ratio,age,course of disease between the two groups.2.The effective rates of the experimental group after 6,8 and 12 weeks of treatment were 69.6%、91.3%、91.3%respectively;those of the control group after 6,8 and 12 weeks of treatment were54.5%、77.3%、81.8%respectively;there was significant difference between the two groups after 8 and 12 weeks of treatment(P<0.05).3.Pain,edematous erythema and post-inflammatory ecchymosis were found in both groups during the treatment,and there was no significant difference in the incidence.In the experimental group,skin dryness and lip desquamation occurred during the treatment,and the moisturizer was tolerable for external use.4.6 months after treatment,the recurrence rate of the experimental group(5.9%)was significantly lower than that of the control group(42.9%).Conclusions1.Photodynamic therapy combined with isotretinoin and photodynamic therapy alone are both effective in the treatment of moderate to severe acne.2.Photodynamic therapy combined with isotretinoin is more effective than photodynamic therapy alone.It is a new choice for the treatment of moderate to severe acne.3.The recurrence rate of photodynamic therapy combined with isotretinoin is lower than that of photodynamic therapy alone,which is worthy of clinical promotion and application.