Yeung Chi K, Shek Samantha Y, Bjerring Peter, Yu Carol S, Kono Taro, Chan Henry H
Department of Medicine, Division of Dermatology, University of Hong Kong, Hong Kong.
Lasers Surg Med. 2007 Jan;39(1):1-6. doi: 10.1002/lsm.20469.
The reaction to intense pulsed light (IPL) on Asian skin often differs from that on Caucasian skin. The study reported herein evaluated the effect on acne vulgaris of IPL alone and when IPL was combined with photodynamic therapy (PDT) using topical methyl aminolevulinate (MAL) in Asians.
STUDY DESIGN/MATERIALS AND METHODS: Thirty Chinese subjects with phototypes IV or V and moderate acne were enrolled for a randomized, half-facial treatment study with IPL alone, IPL with PDT, or as controls. Sixteen percent MAL cream was applied to half of the face 30 minutes before treatment in the PDT group. The IPL was provided by the Ellipse Flex system (Danish Dermatologic Development, Denmark), which emitted wavelengths of 530 to 750 nm. The subjects were treated four times at 3-week intervals. Single passes of double pulses with a 10 milliseconds delay and a pulse duration of 2.5 milliseconds were used. The assessment of inflammatory and non-inflammatory acne lesions by two blinded investigators was based on standardized photographs that were taken before each treatment, and at 4 and 12 weeks after the final treatment.
Twenty-three patients completed the study. The mean reduction of the inflammatory lesion count was 53% in the PDT group, 22% in the IPL group, and 72% in the control group at 4 weeks, and 65% in the PDT group, 23% in the IPL group, and 88% in control group at 12 weeks. The mean clearance of non-inflammatory lesions was 52% in the PDT group, 15% in the IPL group, and 14% in the control group at 4 weeks, and 38% in the PDT group and 44% in the IPL group at 12 weeks, when and an increase of 15% was noted in the control group. Most patients experienced a reduction of inflammatory lesions that was not statistically significant on the PDT-treated side (P = 0.06) or the IPL-treated side (P = 0.82) at 12 weeks after treatment. Pretreatment with MAL resulted in a better clearance of inflammatory acne than IPL alone. There were no statistically significant differences between the intervention groups and the control group in the mean reduction of inflammatory lesions. Significant reductions of non-inflammatory lesions were observed in the MAL-PDT group (38%, P = 0.05) and IPL groups (43%, P = 0.00) 12 weeks after treatment. Twenty-five percent of the subjects in the PDT group withdrew because of intolerance to procedure-related discomfort.
MAL-PDT using IPL and MAL in Asians did not lead to significant improvement of moderate inflammatory acne compared with the control group. However, there was a delayed effect on non-inflammatory lesions, with significant reductions in both the PDT and IPL groups. A proportion of patients could not tolerate the discomfort that was related to PDT despite the short MAL incubation.
亚洲人皮肤对强脉冲光（IPL）的反应往往与白种人皮肤不同。本文报道的研究评估了IPL单独治疗以及IPL联合外用甲基氨基酮戊酸（MAL）光动力疗法（PDT）对亚洲人寻常痤疮的疗效。
研究设计/材料与方法：招募30名皮肤分型为IV或V型且患有中度痤疮的中国受试者，进行一项随机半脸治疗研究，治疗方式包括单独使用IPL、IPL联合PDT或作为对照。在PDT组中，治疗前30分钟在半侧面部涂抹16%的MAL乳膏。IPL由Ellipse Flex系统（丹麦皮肤病学发展公司，丹麦）提供，其发射波长为530至750nm。受试者每隔3周接受4次治疗。采用双脉冲单次照射，延迟10毫秒，脉冲持续时间为2.5毫秒。两名盲法研究者通过标准化照片对炎症性和非炎症性痤疮皮损进行评估，照片在每次治疗前以及最后一次治疗后4周和12周拍摄。
23名患者完成了研究。4周时，PDT组炎症性皮损计数平均减少53%，IPL组减少22%，对照组减少72%；12周时，PDT组减少65%，IPL组减少23%，对照组减少88%。4周时，PDT组非炎症性皮损平均清除率为52%，IPL组为15%，对照组为14%；12周时，PDT组为38%，IPL组为44%，对照组增加了15%。大多数患者在治疗12周后，PDT治疗侧（P = 0.06）或IPL治疗侧（P = 0.82）的炎症性皮损减少无统计学意义。与单独使用IPL相比，MAL预处理导致炎症性痤疮清除效果更好。干预组和对照组在炎症性皮损平均减少方面无统计学显著差异。治疗12周后，MAL-PDT组（38%，P = 0.05）和IPL组（43%，P = 0.00）的非炎症性皮损有显著减少。PDT组25%的受试者因无法耐受与治疗相关的不适而退出。
在亚洲人中，使用IPL和MAL进行MAL-PDT与对照组相比，中度炎症性痤疮并未得到显著改善。然而，对非炎症性皮损有延迟效应，PDT组和IPL组均有显著减少。尽管MAL孵育时间短，但仍有一部分患者无法耐受与PDT相关的不适。
