| Objective: To observe the fluorescence characteristics of acne inflammatory lesions in photo-dynamic diagnosis(ALA-PDD),and to explore the feasibility and advantages of ALA-PDD in the evaluation of inflammatory lesions and severity during acne treatment.Methods: 20 patients with acne were selected according to the standard.After thorough cleansing,first collect white light(natural light)pattern and ultraviolet(UV)pattern without ALA(autofluorescence pattern)before 5-aminolevulinic acid(ALA)package.Five photos of 45 degrees and 90 degrees on both sides of the left and right sides,exported and stored;freshly equipped with 3.6% 5-aminolevulinic acid(ALA)gel,the cotton swab is evenly applied to the patient's facial skin lesions and skin lesions.After the skin lesions are protected by preservative film from light for 1.5 hours,the residual ALA was washed,and the five-angle photographs of the UV pattern(ALA-PDD pattern)after the ALA package were collected again and exported,the Optical Fiber Irradiation Aminolevulinic Acid OFI-ALA-PDT was then performed.One week later,the same method was used to collect white light and ALA-PDD pictures before the start of treatment,once a week for five consecutive times.The last time was to collect only pictures without photodynamic therapy.Two experienced dermatologists analyzed the overall and local fluorescence characteristics of the three patterns before the first OFI-ALA-PDT.The inflammatory papules,pustules and cystic nodules recognized by the white light pattern were selected as the classification markers.The labeled inflammatory lesions were randomly selected.Photoshop software was used to replace the labeled white light photos with the UV pattern photos before and after the ALA package.Observe the presence or absence of brick red fluorescence at the same position in different patterns.According to the inflammatory lesions under white light.The types were recorded separately,and the fluorescence characteristics found in the inflammatory lesions were compared with those of the surrounding non-inflammatory lesions.Photographs of white light patterns and ALA-PDD patterns during the collection of patient photodynamic therapy(ALA-PDT).Select each positive photo,according to the definition of white light inflammatory lesions and ALA-PDD pattern fluorescent lesions,two experienced dermatologists classified and counted inflammatory lesions and fluorescent lesions,respectively.Inflammatory lesions and fluorescent lesions were classified,labeled and counted.Side photographs were taken as reference supplements for those with unclear boundary lesions.The correlation between two patterns in different stages of treatment for acne inflammatory lesions was analyzed and compared.Result: 1.Ultraviolet Induced red fluorescence UVRF(Ultraviolet Induced Red Fluorescence UVRF)could be observed at the hair follicle opening in Non-ALA-UV and ALA-PDD patterns.Skin lesions could be seen in part of the red fluorescence spots and normal skin in part.2.Inflammatory lesions in the Non-ALA-UV pattern is dark brown,almost no brick-red fluorophore is observed,but there is obvious brick-red fluorescence in the corresponding ALA-PDD pattern;3.Different types of inflammatory lesions have their own fluorescence characteristics in ALA-PDD pattern,which are obviously different from the surrounding skin.4.Comparisons of inflammatory lesions with three pattern recognition methods before the first treatment,H=33.831,p<0.001,there was a significant statistical difference.Pairwise comparison,there was no significant difference between ALA-PDD and white-light pattern(z=-0.182,p> 0.05),but there was significant difference between ALA-UV and white-light pattern and ALA-PDD pattern(z=-3.922,p< 0.001).5.Before and after treatment,the classification of white light and ALA-PDD inflammatory lesions were p>0.05,no statistical difference.6.There was a strong correlation between ALA-PDD pattern and white light pattern in different treatment stages(r > 0.90),and the hypothesis test for the overall correlation coefficient was statistically significant(p<0.05).7.Rare cases: The inflammatory lesions visible to the naked eye under some white light have no characteristic brick-red fluorescence in the corresponding ALA-PDD pattern.one week later,the white-light pattern and the fluorescence in ALA-PDD are basically disappeared;some ALA-PDD patterns can see brick-red fluorescence,while the corresponding white-light pattern can not see inflammatory lesions in the naked eye,the fluorescence is more obvious a week later,and inflammatory lesions can be found in the original non-lesions 8.Safety observation: When photodynamic diagnosis and optical fiber introduction photodynamic therapy were performed simultaneously,one case developed erythema after the second treatment,and two cases developed erythema after the 3rd photodynamic treatment,and no special treatment was performed,Self-recovery in about a week.Conclusion: 1.The UV pattern without ALA,it is not certain to determine the severity of acne by confirming the acne non-inflammatory skin lesions(acne)by UVRF on the face of acne patients.More research is needed to confirm.2.All kinds of inflammatory lesions of acne have characteristic brick-red fluorescence in ALA-PDD pattern.It may be feasible to use ALA-PDD to evaluate inflammatory lesions of acne and the severity of acne.3.ALA-PDD may be an early predictor of potential or subclinical lesions.4.ALA-PDD may have great potential in guiding the treatment of acne and judging the curative effect.It is worth further exploring. |
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