| [Background] Acne is one of the most common skin disease in population especially in adolescents.Because it manifests not only on visible body parts of children and adolescents,who are vulnerable both socially and psychologically problem,but also because it can heal with considerable scar sequelae,patients with acne usually need treatment for the clearing of lesions.The traditional treatments method for acne include topical therapy and systemic use of antibiotics,hormones,and retinoids.With an increasing antibiotic resistance of P.acnes and limits of contraindications or adverse effects of oral drugs,there is a need to develop safe,non-invasive and effective therapies.There are many kinds of bacteria especially propionibacterium acnes are normally found in acne lesions.propionibacterium acnes naturally produces endogenous porphyrins that are composed of coproporphyrin III and protoporphyrin IX,which absorb the energy when Illumination with blue/red light and produce singlet oxygen radicals to eradicate propionibacterium acnes.The therapy of blue/red light radiation now is a well-tolerated,non-antibiotic therapy for acne.For improve the effect of blue/red light therapy,topical photosensitizers that commonly used in dermatology are 5-aminolaevulinic acid and methyl aminolaevulinate are applied before light radiation.5-aminolaevulinic is taken up by epithelial cells and metabolized via the porphyrin pathway to protoporphyrin IX,which is a photosensitizer that accumulates in the pilosebaceous units.Following exposure to intense visible light,Pp IX is excited into a triplet state,which reacts with oxygen to produce singlet oxygen and reactive radicals,causing membrane damage and cell destruction.As a result,the aminolaevulinate-mediated photodynamic reaction directly kills the pathogenic P.acnes and specifically damages the pilosebaceous glands,thus leads to clinical improvement of acne lesions.The efficacy of photodynamic therapy for moderate to severe acnes has been shown by many studies,it resulted in a significant reduction of inflammatory lesions.But pain,acute inflammatory skin reactions,and skin tanning are the most common side effects happened on the whole face in traditional operation procedure.As for patients with mild to moderate acne,the adverse effect of pain,swelling,tanning of the whole face after photodynamic therapy affect their appearance severely and it is not suitable with them.So the specialists Consensus of Chinese society of Dermatology and venereal diseases did not recommended the therapy for mild to moderate acne.The disease of acne composed of many kinds of lesions,It has been proven that photodynamic therapy was especially an useful and superior method for inflammatory acne.So we applied 3.78% ALA emulsion targeted for the inflammatory lesions 1.5-2 hours without occlusion then plus LED red light for the mild to moderate inflammatory acne.Trying to find a new operating procedure for mild to moderate inflammatory acne with less adverse reactions.[objectives](1)To find a suitable photodynamic phototherapy operate procedure for mild to moderate inflammatory acne.(2)Evaluate the incubation time for 5-aminoleuvic acid emulsion that targeting contact acne inflammatory lesions.[Methods]: Patients with mild to moderate acne vulgaris from march 2014 to june 2015 were enrolled and randomized into two groups.The 3.78% 5-aminoleuvic acid emulsion was applied by targeting contact the inflammatory lesions and was not occluded by preservative film.The incubation time of the drug is 1.5 hours in one group and another are 2 hours,protoporphyrin fluorescence of the lesions was checked in dark room ?with Wood lamp in the first time of the treatment schedule.Then red light radiation 20 minutes each time was carry out every week after the face was cleaned.Patients were examined carefully and the numbers of skin Lesions of the whole face including comedo,inflammatory papule,pustule,nodule were recorded by dermatologist at the baseline and after 2,4 weeks.[Results] After 1.5 hours incubation of 5-aminoleuvic acid emulsion,most of the inflammatory lesions emitting brick red protoporphyrin? fluorescence visually and stronger fluorescence can be seen after 2 hours incubation in Wood lamp.The numbers of lesions fluorescence positive/all inflammatory lesions was different with statistically significant between two groups(P<0.05).Inflammatory lesions were erased quickly after the treament and the change were significant between baseline and 2,4 weeks(P<0.05).The number of inflammatory acne lesions after two hours drug incubation dropped more quickly than The control group.The non-inflammatory lesions had little response to the therapy,and the change were not significant between baseline and 2,4 weeks except the group with two hours drug incubation in 4 weeks(P>0.05).There were no difference of non-inflammatory lesions numbers between two groups in baseline and 2,4 weeks(P>0.05).Side effects mainly included mild to moderate burning sensation in the site of inflammatory acne lesions.At the end of the treatment,one patient experienced hyperpigmentation in 1.5 hours 5-aminoleuvic acid emulsion incubation group and three patients in another group and all of this were happened in the site of inflammatory lesions.[Conclusion] : 3.78% 5-aminoleuvic acid emulsion targeting and short contact the inflammatory lesions and radiation with LED red light after 1.5-2 hours drug incubation is a a simple and effective treatment option for mild to moderate inflammatory acne.The treatment can quickly erase the lesions and with few side reaction that was limited to the site of lesions... |
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