Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
J Am Acad Dermatol. 2010 Aug;63(2):195-211; quiz 211-2. doi: 10.1016/j.jaad.2009.09.057.
Photodynamic therapy requires a photosensitizer, oxygen, and activating light. For acne, pilosebaceous units are "target" structures. Porphyrins are synthesized in vivo from 5-aminolevulinic acid (ALA), particularly in pilosebaceous units. Different photosensitizers and drug delivery methods have been reported for acne treatment. There are a variety of porphyrin precursors with different pharmacokinetic properties. Among them, ALA and methyl-ester of ALA (MAL) are available for possible off-label treatment of acne vulgaris. In addition, various light sources, light dosimetry, drug incubation time, and pre- and posttreatment care also change efficacy and side effects. None of these variables has been optimized for acne treatment, but a number of clinical trials provide helpful guidance. In this paper, we critically analyze clinical trials, case reports, and series of cases published through 2009.
After completing this learning activity, participants should be able to analyze photodynamic therapy using 5-aminolevulinic acid and its derivates for acne treatment, predict the effectiveness and outcomes of photodynamic therapy using different parameters and/or different porphyrin-related photosensitizers, and assess and manage the side effects of porphyrin-based photodynamic therapy for acne.
光动力疗法需要光敏剂、氧气和激活光。对于痤疮，毛囊皮脂腺单位是“靶”结构。卟啉在体内由 5-氨基酮戊酸（ALA）合成，特别是在毛囊皮脂腺单位中。已经报道了用于治疗痤疮的不同光敏剂和药物输送方法。有多种具有不同药代动力学特性的卟啉前体。其中，ALA 和 ALA 的甲酯（MAL）可用于寻常痤疮的可能标签外治疗。此外，各种光源、光剂量、药物孵育时间以及治疗前后的护理也会改变疗效和副作用。这些变量都没有针对痤疮治疗进行优化，但许多临床试验提供了有益的指导。在本文中，我们通过 2009 年分析了临床研究、病例报告和病例系列。
完成此学习活动后，参与者应该能够分析使用 5-氨基酮戊酸及其衍生物进行痤疮治疗的光动力疗法，预测使用不同参数和/或不同卟啉相关光敏剂的光动力疗法的有效性和结果，并评估和管理基于卟啉的光动力疗法治疗痤疮的副作用。
