Background: Photodynamic therapy (PDT) with aminolevulinic acid (ALA) has been shown to be an effective treatment for acne. However, the effect of ALA PDT on comedo formation has never been objectively evaluated. Cyanoacrylate follicular biopsy (CFB), a noninvasive procedure, has been proposed as the most reliable tool for studying follicular casts. Objective: To determine the possible effect of ALA and red light (550–700 nm) on macro- and microcomedones in acne patients. Patients and Methods: 10 patients with mild-to-moderate facial and/or chest/back acne resistant to conventional therapies received ALA PDT at 2-week intervals in 3 sessions. The severity of acne had been estimated by a system of points, the Global Acne Grading System. The patients underwent PDT utilizing ALA 10% (face) or 15% (back/chest) and red light (15 J/cm2 each session). CFBs were performed. Results: Four weeks after their last PDT session, the patients showed an average global score reduction of 50%. CFBs demonstrated a reduction in the total area, the average area and the density of macrocomedones. Conclusion: The results obtained in this study using CFB evaluation demonstrate that ALA PDT exerts an action on the comedogenic phase as well.

Keywords:
Acne, Photodynamic therapy, Cyanoacrylate follicular biopsy, Comedones
1.
Zouboulis CC, Eady A, Philpott M, Goldsmith LA, Orfanos C, Cunliffe WC: What is the pathogenesis of acne? Exp Dermatol 2005;14:143–152.
2.
Noborio R, Nishida E, Kurokawa M, Morita A: A new targeted blue light phototherapy for the treatment of acne. Photodermatol Photoimmunol Photomed 2007;23:32–34.
3.
Shnitkind E, Yaping E, Geen S, Shalita AR, Lee WL: Anti-inflammatory properties of narrow-band blue light. J Drugs Dermatol 2006;5:605–610.
4.
Elman M, Lebzelter J: Light therapy in the treatment of acne vulgaris. Dermatol Surg 2004;30:139–146.
5.
Lee SY, You CE, Park MY: Blue and red light combination LED phototherapy for acne vulgaris in patients with skin phototype IV. Lasers Surg Med 2007;39:180–188.
6.
Goldberg DJ, Russell BA: Combination blue (415 nm) and red (633 nm) LED phototherapy in the treatment of mild-to-severe acne vulgaris. J Cosmet Laser Ther 2006;8:71–75.
7.
Hongcharu W, Taylor CR, Chang Y, Aghassi D, Suthamjariya K, Anderson RR: Topical ALA-photodynamic therapy for the treatment of acne vulgaris. Invest Dermatol 2000;115:183–192.
8.
Kennedy JC, Pottier RH, Pross DC: Photodynamic therapy with endogenous protoporphyrin IX: basic principles and present clinical experience. J Photochem Photobiol B 1990;6:143–148.
9.
Barr H, Kendall C, Reyes-Goddard J, Stone N: Clinical aspects of photodynamic therapy. Sci Prog 2002;85:131–150.
10.
Divaris DX, Kennedy JC, Pottier RH: Phototoxic damage to sebaceous glands and hair follicles of mice after systemic administration of 5-aminolevulinic acid correlates with localized protoporphyrin IX fluorescence. Am J Pathol 1990;136:891–897.
11.
Pollock B, Turner D, Stringer MR, Bojar RA, Goulden V, Stables GI, Cunliffe WJ: Topical aminolaevulinic acid-photodynamic therapy for the treatment of acne vulgaris: a study of clinical effectiveness and mechanism of action. Br J Dermatol 2004;151:616–622.
12.
Haedersdal M, Togsverd-Bo K, Wulf HC: Evidence-based review of lasers, light sources and photodynamic therapy in the treatment of acne vulgaris. J Eur Acad Dermatol Venereol 2008;22:267–278.
13.
Hong SB, Lee MH: Topical aminolevulinic acid-photodynamic therapy for the treatment of acne vulgaris. Photodermatol Photobiol Photomed 2005;21:322–325.
14.
Rojanamatin J, Choawawanich P: Treatment of inflammatory facial acne vulgaris with intense pulsed light and short contact of topical 5-aminolevulinic acid: a pilot study. Dermatol Surg 2006;32:991–996, discussion 996–997.
15.
Wiegell SR, Wulf HC: Photodynamic therapy of acne vulgaris using methyl aminolaevulinate: a blinded, randomized, controlled trial. Br J Dermatol 2006;154:969–976.
16.
Doshi A, Zaheer A, Stiller MJ: A comparison of current acne grading systems and proposal of a novel system. Int J Dermatol 1997;36:416–418.
17.
Babilas P, Landthaler M, Szeimies RM: Photodynamic therapy in dermatology. Eur J Dermatol 2006;16:340–348.
18.
Nestor MS: The use of photodynamic therapy for treatment of acne vulgaris. Dermatol Clin 2007;25:47–57.
19.
Gerritsen MJ, Smits T, Kleinpenning MM, van de Kerkhof PC, van Erp PE: Pretreatment to enhance protoporphyrin IX accumulation in photodynamic therapy. Dermatology 2009;218:193–202.
20.
Dawber RP, Marks R, Swift JA: Scanning electron microscopy of the stratum corneum. Br J Dermatol 1972;86:272–281.
21.
Lindeburg KE, Brogaard HM, Jemec GB: Pain and photodynamic therapy. Dermatology 2007;215:206–208.
22.
Mills OH Jr, Kligman AM: A human model for assessing comedogenic substances. Arch Dermatol 1982;118:903–905.
23.
Thielitz A, Helmdach M, Röpke EM, Gollnick H: Lipid analysis of follicular casts from cyanoacrylate strips as a new method for studying therapeutic effects of antiacne agents. Br J Dermatol 2001;145:19–27.
24.
Röpke EM, Augustin W, Gollnick H: Improved method for studying skin lipid samples from cyanoacrylate strips by high-performance thin-layer chromatography. Skin Pharmacol 1996;9:381–387.
25.
Hong SB, Lee MH: Topical aminolevulinic acid-photodynamic therapy for the treatment of acne vulgaris. Photodermatol Photoimmunol Photomed 2005;21:322–325.
26.
Hörfelt C, Stenquist B, Larkö O, Faergemann J, Wennberg AM: Photodynamic therapy for acne vulgaris: a pilot study of the dose-response and mechanism of action. Acta Derm Venereol 2007;87:325–329.
27.
Jugeau S, Tenaud I, Knol AC, Jarrousse V, Quereux G, Khammari A, Dreno B: Induction of Toll-like receptors by Propionibacterium acnes. Br J Dermatol 2005;153:1105–1113.
28.
Nagy I, Pivarcsi A, Koreck A, Széll M, Urbán E, Kemény L: Distinct strains of Propionibacterium acnes induce selective human beta-defensin-2 and interleukin-8 expression in human keratinocytes through Toll-like receptors. J Invest Dermatol 2005;124:931–938.
29.
Knor T: The pathogenesis of acne. Acta Dermatovenerol Croat 2005;13:44–49.
30.
Jeremy AH, Holland DB, Roberts SG, Thomson KF, Cunliffe WJ: Inflammatory events are involved in acne lesion initiation. J Invest Dermatol 2003;121:20–27.
31.
Guy R, Kealey T: The effects of inflammatory cytokines on the isolated human sebaceous infundibulum. J Invest Dermatol 1998;110:410–415.
32.
Layton AM, Morris C, Cunliffe WJ, Ingham E: Immunohistochemical investigation of evolving inflammation in lesions of acne vulgaris. Exp Dermatol 1998;7:191–197.
33.
Takahashi H, Itoh Y, Miyauchi Y, Nakajima S, Sakata I, Ishida-Yamamoto A, Iizuka H: Activation of two caspase cascades, caspase 8/3/6 and caspase 9/3/6, during photodynamic therapy using a novel photosensitizer, ATX-S10(Na), in normal human keratinocytes. Arch Dermatol Res 2003;295:242–248.
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2009
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