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Photodynamic Therapy: A Promising Acne Solution

Around 80% of people aged 11 to 30 experience acne breakouts, however in some people, acne can become severe and persistent, lasting well into adulthood (1, 2). In fact, we treat patients weekly who are still dealing with acne in their 40’s and 50’s. Despite popular belief, acne is not caused by failing to wash your face, and it does not affect only teens. The cause of acne is multifactorial and can be caused or worsened by hormone imbalances, food intolerances, stress and genetics.

Severe Acne

Acne breakouts involve excess sebum (oil) production, along with bacteria, Propionibacterium acnes (2). Severe acne breakouts often include lesions that extend deep into the skin, known as cysts and nodules, which are painful to the touch and generally leave scars. The most common medication used to treat severe acne is Accutane (Isotretinoin), which is about 85% effective when used for that purpose (5). The downside to Accutane is that it comes with a host of harsh side effects that often leave patients feeling like the benefit is not remotely worth the cost. Many complain of skin that is severely dry and irritated and that routinely flakes and cracks. In some cases, Accutane has been responsible for severe depression, dizziness, joint pain, and stomach pain (4). In addition, to take this medication as a female, one must enroll in a monitoring program that includes routine pregnancy tests since Accutane can be incredibly harmful to an unborn fetus (5). Thankfully there are other options for those with severe acne.

Photodynamic Therapy: What is it?

Photodynamic therapy (PDT) is a noninvasive, in-office procedure, which addresses both excess sebum (oil) production and the growth of bacteria, Propionibacterium acnes. There are two steps in the process:

1. The first is the application of ALA (5-aminolevulinic acid), which sensitizes the skin to light.

2. The treatment area is exposed to blue light. The light is able to penetrate deeper into the skin and effectively kill bacteria as well as shrink the size of the (sebaceous glands) oil-secreting glands. The size of the sebaceous glands continue to shrink after each treatment (2)

Other benefits of the treatment include:

1. Improving the look of acne scars.

2. Improving the skin’s texture.

3. Regulating the skin’s ability to shed dead skin cells (2).

Who is a Good Candidate for PDT?

PDT is effective for all levels of acne, including severe acne. PDT therapy is an ideal option for those who have tried other treatments, like topical treatment options (including retinoids), with a poor response, as well as those who do not wish to take antibiotics or more aggressive drugs like Accutane (2).

What to Expect

The actual PDT treatment is essentially painless. However, there is some downtime following the treatment. Most patients experience redness, swelling, and some degree of sloughing/peeling, which can make them feel a bit itchy. Patients must strictly avoid all sun exposure for 48 hours post treatment and in some cases, even overhead lights can make the skin feel a bit warm and uncomfortable (i.e. a burning sensation). Every person’s skin is unique, however typically 2-4 treatments, spaced 2-4 weeks apart is recommended. Some people notice dramatic results after the first treatment and decide that is enough for them while others are slower to respond. Some people may also experience a transient worsening of acne for a few days to a couple of weeks post-treatment (2).

PDT Effectiveness for Acne

Recent studies suggest that PDT is as effective in treating severe acne, including cystic acne, as Accutane. A 2013 study demonstrated that 12 weeks post PDT treatment, the number of acne lesions decreased by about 83% (3) (compared to 85% with Accutane). The other benefit of PDT is that unlike Accutane, there are ZERO systemic side effects.

Summary

1. Acne can affect people of all ages and can range from mild to severe.

2. Acne is multifactorial, however, excess oil production and bacteria overgrowth are two key components to acne breakouts.

2. The most common medication treatment for severe acne is Accutane, which is 85% effective but can produce harsh, lasting side effects.

3. Photodynamic therapy (PDT) uses a photosensitizing agent, ALA (5-aminolevulinic acid), and blue light to kill bacteria and shrink oil-producing glands leading to long lasting results.

4. PDT is effective at treating severe acne, with recent study’s suggesting an 83% decrease in acne lesions 12 weeks post-treatment.

REFERENCES

1. Hannum, C. (2018, July 23) What is Acne? Retrieved from https://www.acnefoundation.org/acne-facts/

2. Hongcharu, W., Taylor, C. R., Aghassi, D., Suthamjariya, K., Anderson, R. R., & Chang, Y. (2000). Topical ALA-photodynamic therapy for the treatment of acne vulgaris. Journal of Investigative Dermatology, 115(2), 183-192.

3. Mei, X., Shi, W., & Piao, Y. (2013). Effectiveness of photodynamic therapy with topical 5‐aminolevulinic acid and intense pulsed light in C hinese acne vulgaris patients. Photodermatology, photoimmunology & photomedicine, 29(2), 90-96.

4. Ogbru, O. (2018, November 27) Accutane Side Effects Center. Retrieved from https://www.rxlist.com/accutane-side-effects-drug-center.htm

5. Zaenglein AL, Graber EM, et al. “Acne vulgaris and acneiform eruptions.” In: Wolff K. et al. Fitzpatrick’s Dermatology in General Medicine, 7th edition. McGraw-Hill Companies, Inc., USA, 2008:696-700.

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