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Journal of the American Academy of Dermatology
Volume 63, n° 2
pages 183-193 (août 2010)
Doi : 10.1016/j.jaad.2009.09.056
Continuing Medical Education

Photodynamic therapy for acne vulgaris: A critical review from basics to clinical practice : Part I. Acne vulgaris: When and why consider photodynamic therapy?

Fernanda H. Sakamoto, MD a, b, José Daniel Lopes, MD, PhD c, R. Rox Anderson, MD a,
a Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 
b Department of Dermatology, Universidade Federal de São Paulo, Escola Paulista de Medicina (UNIFESP-EPM), São Paulo, Brazil 
c Department of Immunology, Universidade Federal de São Paulo, Escola Paulista de Medicina (UNIFESP-EPM), São Paulo, Brazil 

Reprint requests: Richard Rox Anderson, MD, Wellman Center for Photomedicine, Massachusetts General Hospital, 55 Fruit St, BHX 630, Boston, MA 02114.

The first-line treatments for acne vulgaris are conventional topical and/or oral medications. However, many patients have contraindications, only partial response, significant adverse effects, or recurrence. Light-based treatments and photodynamic therapy (PDT) using topical precursors of porphyrins are off-label alternative treatments for acne vulgaris, with their own advantages and disadvantages. To date, there is no consensus on PDT methodology and parameters. An understanding of pathophysiology of acne, light–tissue interactions, and PDT mechanisms of action is helpful whenever PDT is considered as an alternative treatment. In general, blue light alone improves acne because of its antiinflammatory effects. PDT using 5-aminolevulenic acid (ALA) or ALA derivatives induces transient antimicrobial and antiinflammatory effects. At high doses, red light PDT may induce inhibition or destruction of sebaceous glands, resulting in clinical improvement.

Learning objectives

After completing this learning activity, participants should be able to compare different treatments of acne, recognize when photodynamic therapy may be a useful off-label treatment for acne vulgaris, and identify variables that may affect the efficacy of photodynamic therapy.

The full text of this article is available in PDF format.

Key words : 5-aminolevulinic acid, lasers, light, methyl 5-aminolevulinate, photochemotherapy, porphyrins, therapeutics, ultraviolet

 Funding sources: None.
 Conflicts of interest: The authors, editors, JAAD CME council members, and peer reviewers have no relevant financial relationships.

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