PDT and acne

PDT appears to be a useful therapeutic option for acne patients who are resistant to standard treatments and poor candidates for systemic retinoids. PDT is being used successfully to treat inflammatory acne vulgaris and associated sebaceous gland disorders.

However, PDT still has a lot to prove. Many physicians such as Dr Nick Lowe, Medical Director of the Cranley Clinic in London and Clinical Professor of Dermatology at UCLA School of Medicine in Los Angeles, believes that PDT is overrated. In the US, where PDT was first developed, the enthusiasm to use PDT of 5–10 years ago, not only for skin cancer lesions but off-label uses such as skin rejuvenation, has fallen flat.

It seems to be a more European trend these days, according to Dr Lowe, who will only use PDT in two cases — Bowen’s disease (squamous cell carcinoma) and superficial basal cell carcinoma in older patients. Dr Lowe does not use this treatment for acne, skin rejuvenation or basal cell carcinoma, as he believes there are other treatments that work more effectively, noting PDT is the last tool in his arsenal for these affections.

It seems obvious that further studies are still needed before a consensus protocol can be established for its use in the treatment of acne. Additional investigations are needed to establish an optimal incubation time, activating light source, as well as the frequency of the treatment.

Conclusions

In future, Dr Haedersdal would like to see PDT protocols being more customisable to each patient. She argues that one treatment does not fit all: where one patient could benefit more from a daylight PDT, others might benefit from intensified procedures with fractional laser pre-treatment.

Moving forward, Dr Bjerring believes that green light might be a new light option to consider in the treatment of AK. He pointed out that he has been evaluating a new halogen lamp based light chair from Ergoline, Germany, that seems effective in delivering the 5-ALA-activating wavelengths.