| Background and ObjectivesAcne is a common disease which is chronic inflammation of the hair follicle sebaceous glands. The pathogenesis is not clear, including:excessive secretion of sebum, follicle sebaceous gland duct hyperkeratosis, Propionibacterium acnes proliferation and excessive immune reactions ect. Photodynamic therapy is the method which combines photosensitizers with different light sources to treat acne.In our study, observing the efficacy and safety of intense pulsed light (IPL) therapy in combination with aminolevulinic acid-photodynamic therapy (ALA-PDT) in the treatment of inflammatory acne papules.Materials and Methods1. SubjectsTen patients (6 males and 4 females) with moderate to severe inflammatory acne were treated with IPL(Lumenis One, Lumenis Co., Santa Clara, USA) on one side of the face, and IPL plus ALA incubation on the other side. After the first treatment, the skin biopsies of both face of five subjects were taken and paraffin sections were produced.2. Preparation of treatment and treatment procedure(1) Preparation of treatmentAn informed consent was signed by each subject. Before treatment, subjects were required to rinse their face thoroughly with a neutral lotion, and rest in the temperature-controlled (20℃) and humidity-controlled (40-50%) room for at least 30 minutes. Standardized photographs were taken with a digital camera. (2) Treatment procedureApplied evenly with 5% ALA in the treatment side, and IPL treated after 1.5 hours' dark packet, IPL treatment plan:Cut-off filters of 590 nm was employed, Triple pulse mode of pulse, with a pulse width of 3.0-4.0ms and a delay time of 30-35ms were utilized. The energy fluency ranged from 16-18J/cm2.If the inflammation have reduced, the next treatment can increase the energy density of 1-2J/cm2. The treatment procedure last 10-20min.After treatment, the patients were required to wash their face with cold water and received the cold-wet compress with a soothing spring water for 5-10min. There sessions IPL treatment at 3-4 weeks intervals were applied to the treatment side. The patients were advised to avoid sun exposure and apply sun screen (SPF≥30) and moisturizer after each treatment.3. Evaluation Criteria(1) Subjective evaluation by the dermatologistsOne month after Last time treatment, doctor counted the number of acne lesions according to the photos including plaques, pustules, cysts, nodules, etc.and used for calculating the reduced rate and the total effective rate.(2) Patients'self-assessmentOne month after the final treatment of treatment side, the subjects were asked to rate the results as excellent (very satisfied), good (moderately satisfied), fair (slightly satisfied), or poor (not satisfied at all).(3) Objective evaluation①Invasive evaluationskin lightness (L value) of four sites on both facial sides:forehead, canthus, cheekbone, and cheilion were measured before each session and 4 weeks after the final session, At the same time, the mean value of keraphyllous water and sebum excretion were counted.②Evaluation of biopsy skinHematoxylin-eosine stain was used to observe the dstroyed of Sebaceous glands.4. Statistics The data were analyzed with SPSS 13.0 soft ware package. Student t-test was used for normal distribution data and nonparametric statistical methods Mann-Whitney test were used for skewness distribution data. P-values<0.05 were considered statistically significant.Results1. subjective evaluation by dermatologists and PatientAfter 3 treatment, the clearance rate, and the patients self-evaluation of the IPL+ALA side were higher than the control side. respectively. No differences were observed on improvement percentage of the tow side at various times. On treatment side, compared with pretreatment, patients self-evaluation after each session decreased variably and significant differences were observed.2. Objective evaluationThe mean L value on the IPL+ALA side was significantly higher than that of the control side.Both side of L values were increased in the 1st treatment,but fell slightly after 2nd treatment, no difference statistically significant (P>0.05);After the 3rd treatment increased again (significant higher than first time), The two sides had significant difference (P<0.05). Both sides have decreased surface sebum excretion and keraphyllous water content. Difference of surface sebum excretion between the pre-and post-treatment and between the two sides had statistically significant (P<0.05),however keraphyllous water content hadn't.3. Evaluation of biopsy skinHE staining showed that large number of neutrophil infiltration can be seen in the Sebaceous glands.ConclusionIPL in combination with ALA-PDT was superior to IPL alone in the treatment of inflammatory acne. The side-effects were transient and limited.
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