Haddad Alessandra, Santos Ivan Dunshee de Abranches Oliveira, Gragnani Alfredo, Ferreira Lydia Masako
Plastic Surgery Division, Surgery Department, Federal University of São Paulo, São Paulo, Brazil.
Photomed Laser Surg. 2011 Jun;29(6):427-32. doi: 10.1089/pho.2009.2733.
Photodynamic therapy (PDT) with 5-aminolevulinic acid (ALA) and intense pulsed light (IPL) is a relatively new combination for the treatment of actinic keratosis (AK) and photodamage. The objective of this study was to determine the effect of increasing the fluence of IPL on the outcome of patients with these skin conditions.
Patients (N = 24) were randomly assigned to five treatment treatment groups: control (IPL alone) and ALA with 20, 25, 40, and 50 J/cm(2) fluence of IPL. Each patient received a single treatment. ALA was applied twice and allowed to incubate 2 h before IPL irradiation. Results were evaluated 5-7 days and 8 weeks after treatment. Clearance of AK lesions was evaluated by counting lesions before and after treatment, and improvement in photodamage was assessed by comparing pre- and post-treatment photographs. Statistical evaluation was based at nonparametric tests with a cut-off level at p < 0.10 and a confidence interval at 95%.
Responses to treatment were greatest in patients who received ALA and IPL fluences of 40 and 50 J/cm(2). Responses were "marked" in 19% of the patients receiving 50 J and "moderate" in 19% of the patients receiving 40 J. Compared to the mean pre-treatment AK grades, the mean post-treatment grades were 56% lower in the 50 J treatment group, 32% lower in the 25 J group, 50% lower in the 40 J group, 20% lower in the 20 J group, and 7% lower in the control group. Erythema, edema, crusts and erosion, and pain did not cause any patient to discontinue the study.
AK clearance, but not photorejuvenation, appears to improve with increasing fluence at the ALA PDT-IPL levels used in this study without serious adverse effects.
5-氨基酮戊酸（ALA）光动力疗法（PDT）与强脉冲光（IPL）联合应用是治疗光化性角化病（AK）和光损伤的一种相对较新的方法。本研究的目的是确定增加IPL能量密度对患有这些皮肤疾病患者治疗效果的影响。
患者（N = 24）被随机分为五个治疗组：对照组（单纯IPL）以及ALA联合IPL能量密度分别为20、25、40和50 J/cm²的组。每位患者接受单次治疗。ALA涂抹两次，在IPL照射前孵育2小时。在治疗后5 - 7天和8周评估结果。通过计数治疗前后的皮损数量评估AK皮损的清除情况，通过比较治疗前后的照片评估光损伤的改善情况。统计评估基于非参数检验，截断水平为p < 0.10，置信区间为95%。
接受ALA和IPL能量密度为40和50 J/cm²的患者对治疗的反应最大。接受50 J的患者中19%的反应为“显著”，接受40 J的患者中19%的反应为“中度”。与治疗前AK的平均分级相比，50 J治疗组治疗后的平均分级降低了56%，25 J组降低了32%，40 J组降低了50%，20 J组降低了20%，对照组降低了7%。红斑、水肿、结痂和糜烂以及疼痛均未导致任何患者中断研究。
在本研究使用的ALA PDT - IPL水平下，随着能量密度增加，AK清除情况似乎有所改善，但光嫩肤效果未改善，且无严重不良反应。
