Lee Jin Woong, Kim Beom Joon, Kim Myeung Nam
Department of Dermatology, Chung-Ang University College of Medicine, Seoul 140-757, South Korea.
Lasers Surg Med. 2010 Feb;42(2):192-6. doi: 10.1002/lsm.20857.
Malassezia folliculitis commonly has been treated with oral antifungal medications. However, it has many therapeutic weaknesses such as infection relapse, drug resistance, or adverse effects like hepatotoxicity and gastrointestinal discomfort. Hence, there remains an ongoing need for alternative treatments for recalcitrant Malassezia folliculitis. Recently, many dermatologists suggest photodynamic therapy (PDT) as an alternative therapeutic option for its antimicrobial effect.
To investigate the efficacy of methyl 5-aminolevulinic acid (MAL)-PDT for the treatment of recalcitrant Malassezia folliculitis.
Six Korean patients aged 23-47 years with recalcitrant Malassezia folliculitis were enrolled in this study. The patients enrolled in this study either refused oral medication or were unable to take oral antifungal agents due to hepatotoxicity concerns. Thus, we offered these patients MAL-PDT as an alternative treatment option. For all patients, photographs of the lesion(s) were taken prior to initiating treatment. MAL cream (Metvix, Galderma, France) was applied to each lesion (located on the patients' trunks) and covered with an adhesive occlusive dressing polyurethane film (Tegaderm, 3M Healthcare, St. Paul, MN). After 3 hours, the cream was wiped off and illumination was performed immediately thereafter with non-coherent red light using light-emitting diodes (Aktilite lamp, PhotoCure, Oslo, Norway, average wavelength 630 nm, light dose 37 J/cm(2)). Illumination was performed for 7.5 minutes. Patients underwent totally three sessions of MAL-PDT at 2-week intervals. One month after the last PDT treatment, patients returned to the hospital and lesions were photographed.
After three sessions of MAL-PDT, inflammatory lesions had decreased and improved obviously in four patients, had improved slightly in one patient, and had not improved in one patient.
MAL-PDT may be an effective treatment option for patients with recalcitrant Malassezia folliculitis. However, the data on MAL-PDT are still limited, and additional controlled trials including multiple patients will be necessary to verify the results of this pilot study.
马拉色菌毛囊炎通常采用口服抗真菌药物治疗。然而，它存在许多治疗弱点，如感染复发、耐药性，或出现肝毒性和胃肠道不适等不良反应。因此，对于顽固性马拉色菌毛囊炎，仍持续需要替代治疗方法。最近，许多皮肤科医生建议将光动力疗法（PDT）作为一种具有抗菌作用的替代治疗选择。
探讨5-氨基酮戊酸甲酯（MAL）-PDT治疗顽固性马拉色菌毛囊炎的疗效。
本研究纳入了6例年龄在23至47岁之间的顽固性马拉色菌毛囊炎韩国患者。参与本研究的患者要么拒绝口服药物，要么因担心肝毒性而无法服用口服抗真菌药物。因此，我们为这些患者提供MAL-PDT作为替代治疗选择。对于所有患者，在开始治疗前拍摄皮损照片。将MAL乳膏（Metvix，高德美，法国）涂抹于每个皮损（位于患者躯干），并用粘性封闭敷料聚氨酯薄膜（泰德 Derm，3M医疗保健公司，明尼苏达州圣保罗）覆盖。3小时后，擦去乳膏，随后立即使用发光二极管发出的非相干红光进行光照（Aktilite灯，PhotoCure，挪威奥斯陆，平均波长630 nm，光剂量37 J/cm²）。光照持续7.5分钟。患者每隔2周接受总共3次MAL-PDT治疗。最后一次PDT治疗1个月后，患者返回医院并拍摄皮损照片。
经过3次MAL-PDT治疗后，4例患者的炎性皮损明显减少并改善，1例患者略有改善，1例患者无改善。
MAL-PDT可能是顽固性马拉色菌毛囊炎患者的一种有效治疗选择。然而，关于MAL-PDT的数据仍然有限，需要进行包括多名患者的额外对照试验来验证本初步研究的结果。
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