M-PDT efficacy similar to isotretinoin in acne vulgaris

Key takeaways:

• M-PDT showed similar efficacy rates compared with isotretinoin with fewer adverse events.
• A faster onset of improvement was shown with M-PDT vs. isotretinoin.

Modified 5-aminolevulinic acid photodynamic therapy was as effective as isotretinoin in the treatment of severe acne with a faster onset, according to a small study.

“According to recent systemic review, oral isotretinoin and photodynamic therapy (PDT) are the most effective therapies for moderate to severe acne vulgaris,” Linglin Zhang, MD, of the Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, and colleagues wrote. “Isotretinoin, a highly effective systemic medication for acne, has been regarded as the gold standard therapy for severe cases. However, the long treatment period and serious side effects such as teratogenicity, complicate its use, and lower dose regimens have been proposed to improve tolerance.”

A multicenter, randomized study across three Chinese skin care centers included 152 patients with moderate to severe acne vulgaris who were randomly assigned to receive modified 5-aminolevulinic acid photodynamic therapy (M-PDT) for up to five weekly sessions or isotretinoin (ISO) 0.5 mg/kg daily for 6 months. There were 101 patients that completed the study.

After 1 month of treatment, overall effective rates were 67.74% for the patients in the M-PDT group and 10.26% in the ISO group (P < 0.001). One month post therapy, however, 97.44% of the ISO group showed overall efficacy, compared with 75.81% of the M-PDT group (P < 0.05).

No significant difference in efficacy was found at 2, 4 or 6 months after therapy.

A median 50% lesion improvement was achieved in 1 week in the M-PDT group compared with 8 weeks in the ISO group.

Both groups rated quality of life scores to be significantly improved following therapy and through 6 months after therapy.

Adverse events resulted in 34.67% of the ISO group withdrawing from treatment. Also, 70.67% of the ISO group experienced some type of systemic side effect, such as hepatoxicity.

The adverse events in the M-PDT group were more minimal with no patients withdrawing from treatment.

“Compared with low dose ISO, M-PDT showed a rapid onset of effect with tolerable topical adverse effects and comparable outcomes at 6 months post therapy,” the authors wrote. “M-PDT represents a good alternative for the treatment of moderate to severe acne vulgaris.”