Topical photodynamic therapy (PDT) using the photosensitizer precursor 5-aminolevulinic acid or the ester methyl-aminolevulinic acid is a beneficial, short-course treatment for inflammatory acne vulgaris, according to results published in the Journal of Cosmetic Dermatology.
Investigators searched the EMBASE, Cochrane Library, and MEDLINE databases for studies with primary and secondary outcomes of mean percentage reduction in the inflammatory lesion count and the total effective response, respectively. Randomized controlled trials were included when PDT was compared with visible phototherapy alone or drug therapy. Numerous laser types were also included.
The resulting 13 trials included 701 patients. PDT had a beneficial effect on acne vulgaris in terms of the outcomes of inflammatory lesion count (cumulative mean difference, 15.97; 95% CI, 11.93-20.00; P <.00001) and total effective response (risk ratio, 1.55; 95% CI, 1.38-1.74, P <.00001). Investigators could find no indication that light wavelength affected the clinical efficacy, although additional studies are warranted.
The study was limited by the heterogeneity of the trials reviewed. Also, the investigators noted that the wavelengths of light in PDT “seemed to have little impact on the clinical efficacy” for treatment of inflammatory acne, and suggest stronger evidence is required to achieve more reliable conclusions.
The researchers recommended PDT for patients with acne “as the option for intervention based on evidence.” Furthermore, they wrote that they will “further explore the specific photosensitizer that has the best clinical effect and provide the most reliable evidence for clinical practice.”
Tang X, Li C, Ge S, Chen Z, Lu L. Efficacy of photodynamic therapy for the treatment of inflammatory acne vulgaris: a systematic review and meta-analysis [published online October 25, 2019]. J Cosmet Dermatol. doi:10.1111/jocd.13197