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Your Guide to Acne.
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Speaking at the 65th Annual Meeting of the American Academy of Dermatology, Dermatologist Amy Taub hailed light therapies as "…the first new therapies to treat acne in more than 20 years." Dr. Taub, a clinical instructor of dermatology at Northwestern University Medical School in Chicago, states,

“The introduction of lasers, light sources and heat-based technologies mark the first new therapies to treat acne in more than 20 years. Unlike their systemic counterparts that offer a short-term solution to treating acne by killing acne-causing bacteria, these devices work differently by altering the structure of the oil glands."

Excitingly, light treatments have been getting more attention in recent years, and maybe none so much as photodynamic therapy. Short contact photodynamic therapy is rapidly emerging as the new "wonder" treatment for those who suffer from moderate to severe acne. Could photodynamic therapy really be the wave of the future when it comes to treating acne?

What is Photodynamic Therapy?

Photodynamic therapy (PDT) is a non-invasive therapy that utilizes light treatments along with an application of a photosensitizing agent, typically 5-aminolevulinic acid (ALA). The photosensitizing agent is applied to the skin, causing the skin to become more susceptible, or receptive, to light. After the photosensitizing agent is removed, a light treatment is administered. PDT was originally approved by the U.S. Food and Drug administration to treat cancer, and is often used to treat actinic keratoses. It is now being studied as a safe and effective treatment for acne.

PDT is thought to work by shrinking the skin's oil glands. This can drastically reduce the amount of oil within the pores, thereby reducing comedones. For those with moderate to severe acne that doesn't respond well to traditional topical treatments, this is good news. ALA-PDT may also kill bacteria that cause acne breakouts and normalize the shedding of dead skin cells within the follicle. It also seems to improve the skin's overall texture, and holds promise in the repair of acne scarring.

Treatment Method

While many patients participating in early photodynamic therapy trials reported moderate to severe pain, the treatments administered today are virtually painless, due to "short contact" therapy.

Most short contact photodynamic therapy treatments start with microdermabrasion, to remove excess dead cells on the skin's surface and enhance ALA penetration. The photosensitizing agent (ALA) is applied to the skin and allowed to set for a period of 15 to 60 minutes. The agent is then removed and the skin is treated, most commonly, with blue light.

A series of three to five treatments are usually performed at a period of two to four week intervals. The number of treatments recommended depends on the severity of acne. Some patients may notice results after the first treatment.

Photodynamic therapy can be used in conjunction with other acne treatments, such as topical retinoids or salicylic acid.

Results

The results of ALA-PDT for acne treatments seem promising. Some studies have shown a significant improvement of acne breakouts, improvement of skin texture, and the softening and reduction of acne scars. A few patients have even reported a 50% to 75% improvement in their acne. PDT can be used to treat moderate to severe cystic acne, and may provide results similar to those achieved with isotretinoin (Accutane).

Side Effects

The side effects of short contact photodynamic therapy may include redness and/or peeling of the treatment site. Patients have described it as being similar to a sunburn. It was generally mild and resolved quickly.

Conclusions

Results achieved with ALA-PDT seem promising. Unfortunately, photodynamic therapy treatments can cost more than conventional acne treatments, and they are not often covered by insurance. However, systemic medications usually prescribed for severe acne, such as isotretinoin, have serious side effects that short contact ALA-PDT does not.

Dermatologist Mark Steven Nestor, MD, PhD, concludes, “…photodynamic therapy, as well as light-based therapy for acne, appears to provide long-term improvement for patients." Photodynamic therapy may provide an effective alternative to systemic medications.

_{Sources: "Photodynamic therapy is lighting the way for medical and cosmetic treatments." 2007. American Academy of Dermatology. 20 Jun 2007. www.aad.org}

"Are lasers and light treatments really light years ahead of conventional acne therapy?" AcneNet. 2007. American Academy of Dermatology. 20 Jun 2007. www.skincarephysicians.com

Gold M. "The use of ALA-PDT and intense pulsed light therapy in the treatment of moderate to severe acne vulgaris". Journal of the American Academy of Dermatology (2005); 52 (3): 210.

McNamara D. "Combined Therapy Holds Promise for Severe Acne." Skin & Allergy News (2004); 35 (5): 53.

Melnic S. "Cystic acne improved by photodynamic therapy with short-contact 5-aminolevulinic acid and sequential combination of intense pulse light and blue light activation." Journal of Drugs in Dermatology; 4:742-745.

Taub AF. "Photodynamic therapy for the treatment of acne: a pilot study." Journal of Drugs in Dermatology; 3 (6):S10-14.