Photodynamic therapy for acne vulgaris with topical 5-aminolevulinic acid.

After obtaining informed consent, the patient was treated with topical 5-aminolevulinic acid photodynamic therapy (ALA-PDT). Twenty percent ALA (A 7793; Sigma, St Louis, Mo) in an oil-in-water emulsion (Yoshida, Tokyo, Japan) was applied to a 5 3 5-cm area of the right cheek for 4 hours with a light-shielded dressing. On Wood lamp examination, the affected lesion showed numerous dots of vivid red fluorescence corresponding to pilosebaceous units in a 535-cm square pinkish fluorescence area. The lesion was then exposed to a 635-nm laser light of 5 J/cm total using a pulsed excimer-dye laser (PDT EDL.1; HAMAMATSU, Hamamatsu-shi, Japan) without anesthesia. The patient tolerated irradiation well. Immediately after treatment, the affected lesion demonstrated edematous erythema (Figure 1). Four days after the irradiation, the affected lesion showed a very thin crust formation, and was completely healed in 10 days. After healing, full face treatment of 30% to 40% wt/wt glycolic acid chemical peeling was performed every 3 to 4 weeks and 1% nadifloxacin cream was applied. In the lesions not treated by ALA-PDT, acne became aggravated 1 week before each menstrual cycle. However, the affected area did not present any new acne during a follow-up period of 8 months (Figure 2). The ALA-PDT was applied to the entire face at the patient’s request. COMMENT