Photodynamic Therapy

Phototherapy

What Is It?

Photodynamic therapy is a more intense form of light therapy that includes first topically applying a photosensitizing agent that makes the skin more sensitive to light, and then applying medical-grade light therapy to the skin. It is thought to work primarily by reducing the size and activity of skin oil (sebaceous) glands.

Efficacy

Strength of Evidence
1
2
3
4
5
Average 67% reduction in acne after 1 - 5 sessions
  1. Soliman, M., Salah, M., Fadel, M., Nasr, M. & El-Azab, H. Contrasting the efficacy of pulsed dye laser and photodynamic methylene blue nanoemulgel therapy in treating acne vulgaris. Arch Dermatol Res 313, 173–180 (2021).
  2. Zhang, J. et al. Photodynamic therapy for severe facial acne vulgaris with 5% 5-aminolevulinic acid vs 10% 5-aminolevulinic acid: A split-face randomized controlled study. J Cosmet Dermatol 19, 368–374 (2020).
  3. Wanitphakdeedecha, R. et al. Acne treatment efficacy of intense pulsed light photodynamic therapy with topical licochalcone A, l-carnitine, and decanediol: A spilt-face, double-blind, randomized controlled trial. J Cosmet Dermatol 19, 78–87 (2020).
  4. Wangsuwan, S. & Meephansan, J. Comparative study of photodynamic therapy with riboflavin-tryptophan gel and 13% 5-aminolevulinic acid in the treatment of mild to moderate acne vulgaris. Clin Cosmet Investig Dermatol 12, 805–814 (2019).
  5. Nicklas, C., Rubio, R., Cárdenas, C. & Hasson, A. Comparison of efficacy of aminolaevulinic acid photodynamic therapy vs. adapalene gel plus oral doxycycline for treatment of moderate acne vulgaris-A simple, blind, randomized, and controlled trial. Photodermatol Photoimmunol Photomed 35, 3–10 (2019).
  6. Del Duca, E. et al. Daylight photodynamic therapy with 5-aminolevulinic acid 5% gel for the treatment of mild-to-moderate inflammatory acne. G Ital Dermatol Venereol (2019) doi:10.23736/S0392-0488.19.06392-2.
  7. Zhang, L. et al. Topical 5-aminolevulinic photodynamic therapy with red light vs intense pulsed light for the treatment of acne vulgaris: A spilit face, randomized, prospective study. Dermatoendocrinol 9, e1375634 (2017).
  8. Xu, X. et al. Efficacy of photodynamic therapy combined with minocycline for treatment of moderate to severe facial acne vulgaris and influence on quality of life. Medicine (Baltimore) 96, e9366 (2017).
  9. Kim, T. I. et al. Nonablative fractional laser-assisted daylight photodynamic therapy with topical methyl aminolevulinate for moderate to severe facial acne vulgaris: Results of a randomized and comparative study. Photodermatol Photoimmunol Photomed 33, 253–259 (2017).
  10. Tao, S.-Q. et al. Efficacy of 3.6% topical ALA-PDT for the treatment of severe acne vulgaris. Eur Rev Med Pharmacol Sci 20, 225–231 (2016).
  11. Pariser, D. M. et al. Photodynamic therapy with methyl aminolaevulinate 80 mg g(-1) for severe facial acne vulgaris: a randomized vehicle-controlled study. Br J Dermatol 174, 770–777 (2016).
  12. Moftah, N. H., Ibrahim, S. M. & Wahba, N. H. Intense pulsed light versus photodynamic therapy using liposomal methylene blue gel for the treatment of truncal acne vulgaris: a comparative randomized split body study. Arch Dermatol Res 308, 263–268 (2016).
  13. Kwon, H. H. et al. Daylight photodynamic therapy with 1.5% 3-butenyl 5-aminolevulinate gel as a convenient, effective and safe therapy in acne treatment: A double-blind randomized controlled trial. J Dermatol 43, 515–521 (2016).
  14. Ma, Y., Liu, Y., Wang, Q., Ren, J. & Xiang, L. Prospective study of topical 5-aminolevulinic acid photodynamic therapy for the treatment of severe adolescent acne in Chinese patients. J Dermatol 42, 504–507 (2015).
  15. Song, B. H. et al. Photodynamic therapy using chlorophyll-a in the treatment of acne vulgaris: a randomized, single-blind, split-face study. J Am Acad Dermatol 71, 764–771 (2014).
  16. Shaheen, B. & Gonzalez, M. Randomized, controlled, double-blind, clinical trial evaluating the mechanism of action, efficacies and safety of methylaminolaevulinate photodynamic therapy (PDT) and intense pulsed light, administered as placebo–PDT, compared with adapalene 0Æ1% gel in the treatment of adults with mild to moderate acne vulgaris. in British Society for Dermatological Surgery: Summaries of Papers (2014).
  17. Ragab, M., Hussein, T. & Salem, M. Photodynamic therapy using 5-aminolevulinic acid and intense pulsed light against intense pulsed light alone in the treatment of acne vulgaris. Journal of the Egyptian Women’s Dermatologic Society 11, 173–180 (2014).
  18. NCT00933543. Efficacy and safety study with visonac photodynamic therapy (PDT). https://clinicaltrials.gov/ct2/show/NCT00933543 (2013).
  19. NCT00673933. Photodynamic therapy (PDT) with methyl aminolevulinate (MAL) cream in patients with skin type V or IV with acne vulgaris. https://clinicaltrials.gov/ct2/show/NCT00673933 (2013).
  20. NCT00594425. Photodynamic therapy (PDT) with methyl aminolevulinate (MAL) cream in moderate to severe acne. https://clinicaltrials.gov/ct2/show/results/NCT00594425 (2013).
  21. Pinto, C., Schafer, F., Orellana, J. J., Gonzalez, S. & Hasson, A. Efficacy of red light alone and methyl-aminolaevulinate-photodynamic therapy for the treatment of mild and moderate facial acne. Indian J Dermatol Venereol Leprol 79, 77–82 (2013).
  22. Mei, X., Shi, W. & Piao, Y. Effectiveness of photodynamic therapy with topical 5-aminolevulinic acid and intense pulsed light in Chinese acne vulgaris patients. Photodermatol Photoimmunol Photomed 29, 90–96 (2013).
  23. Ma, L. et al. Low-dose topical 5-aminolevulinic acid photodynamic therapy in the treatment of different severity of acne vulgaris. Photodiagnosis Photodyn Ther 10, 583–590 (2013).
  24. Hong, J. S., Jung, J. Y., Yoon, J. Y. & Suh, D. H. Acne treatment by methyl aminolevulinate photodynamic therapy with red light vs. intense pulsed light. Int J Dermatol 52, 614–619 (2013).
  25. Lee, W. J., Jung, H. J., Kim, J. Y., Lee, S.-J. & Kim, D. W. Effect of photodynamic therapy on inflammatory acne using 3% liposomal 5-aminolevulinic acid emulsion and intense-pulsed light: A pilot study. J Dermatol 39, 728–729 (2012).
  26. Huh, S. Y., Na, J.-I., Huh, C.-H. & Park, K.-C. The effect of photodynamic therapy using indole-3-acetic acid and green light on acne vulgaris. Ann Dermatol 24, 56–60 (2012).
  27. Bissonnette, R., Bolduc, C., Maari, C. & Nigen, S. Short incubation photodynamic therapy with methylaminolevulinate and no occlusion for the treatment of actinic keratoses. J Am Acad Dermatol 67, 1386–1387 (2012).
  28. Yeung, C. K., Shek, S. Y., Yu, C. S., Kono, T. & Chan, H. H. Liposome-encapsulated 0.5% 5-aminolevulinic acid with intense pulsed light for the treatment of inflammatory facial acne: a pilot study. Dermatol Surg 37, 450–459 (2011).
  29. Jang, M. S. et al. A comparative split-face study of photodynamic therapy with indocyanine green and indole-3-acetic acid for the treatment of acne vulgaris. Br J Dermatol 165, 1095–1100 (2011).
  30. DUSA Pharmaceuticals, Inc. A randomized, evaluator-blinded, parallel group light dose ranging study of photodynamic therapy with levulan topical solution + blue light versus levulan topical solution vehicle + blue light on moderate to severe facial acne vulgaris. https://clinicaltrials.gov/ct2/show/study/NCT00706433 (2011).
  31. Yin, R., Hao, F., Deng, J., Yang, X. C. & Yan, H. Investigation of optimal aminolaevulinic acid concentration applied in topical aminolaevulinic acid-photodynamic therapy for treatment of moderate to severe acne: a pilot study in Chinese subjects. Br J Dermatol 163, 1064–1071 (2010).
  32. Orringer, J. S. et al. Photodynamic therapy for acne vulgaris: a randomized, controlled, split-face clinical trial of topical aminolevulinic acid and pulsed dye laser therapy. J Cosmet Dermatol 9, 28–34 (2010).
  33. Barolet, D. & Boucher, A. Radiant near infrared light emitting Diode exposure as skin preparation to enhance photodynamic therapy inflammatory type acne treatment outcome. Lasers Surg Med 42, 171–178 (2010).
  34. Zhu, X. et al. Efficacy and safety of intense pulsed light therapy in combination with ALA-PDT in the treatment of inflammatory acne papules. Chinese Journal of Aesthetic Medicine 8, 1136–9 (2009).
  35. Oh, S. H., Ryu, D. J., Han, E. C., Lee, K. H. & Lee, J. H. A comparative study of topical 5-aminolevulinic acid incubation times in photodynamic therapy with intense pulsed light for the treatment of inflammatory acne. Dermatol Surg 35, 1918–1926 (2009).
  36. Hörfelt, C., Stenquist, B., Halldin, C. B., Ericson, M. B. & Wennberg, A.-M. Single low-dose red light is as efficacious as methyl-aminolevulinate--photodynamic therapy for treatment of acne: clinical assessment and fluorescence monitoring. Acta Derm Venereol 89, 372–378 (2009).
  37. Fadel, M., Salah, M., Samy, N. & Mona, S. Liposomal methylene blue hydrogel for selective photodynamic therapy of acne vulgaris. J Drugs Dermatol 8, 983–990 (2009).
  38. Haedersdal, M., Togsverd-Bo, K., Wiegell, S. R. & Wulf, H. C. Long-pulsed dye laser versus long-pulsed dye laser-assisted photodynamic therapy for acne vulgaris: A randomized controlled trial. J Am Acad Dermatol 58, 387–394 (2008).
  39. Yeung, C. K. et al. A comparative study of intense pulsed light alone and its combination with photodynamic therapy for the treatment of facial acne in Asian skin. Lasers Surg Med 39, 1–6 (2007).
  40. Lee, J. H., Kim, S. E., Park, K. & Son, S. ja. Topical aminolevulinic acid-photodynamic therapy for the treatment of mild to moderate inflammatory acne. Annals of Dermatology 19, 55–59 (2007).
  41. Gold, M. H., Biron, J. A., Boring, M., Bridges, T. M. & Bradshaw, V. L. Treatment of moderate to severe inflammatory acne vulgaris: photodynamic therapy with 5-aminolevulinic acid and a novel advanced fluorescence technology pulsed light source. J Drugs Dermatol 6, 319–322 (2007).
  42. Akaraphanth, R., Kanjanawanitchkul, W. & Gritiyarangsan, P. Efficacy of ALA-PDT vs blue light in the treatment of acne. Photodermatol Photoimmunol Photomed 23, 186–190 (2007).
  43. Wiegell, S. R. & Wulf, H. C. Photodynamic therapy of acne vulgaris using 5-aminolevulinic acid versus methyl aminolevulinate. J Am Acad Dermatol 54, 647–651 (2006).
  44. Wiegell, S. R. & Wulf, H. C. Photodynamic therapy of acne vulgaris using methyl aminolaevulinate: a blinded, randomized, controlled trial. Br J Dermatol 154, 969–976 (2006).
  45. Rojanamatin, J. & Choawawanich, P. Treatment of inflammatory facial acne vulgaris with intense pulsed light and short contact of topical 5-aminolevulinic acid: a pilot study. Dermatol Surg 32, 991–996; discussion 996-997 (2006).
  46. Hörfelt, C., Funk, J., Frohm-Nilsson, M., Wiegleb Edström, D. & Wennberg, A.-M. Topical methyl aminolaevulinate photodynamic therapy for treatment of facial acne vulgaris: results of a randomized, controlled study. Br J Dermatol 155, 608–613 (2006).
  47. Hong, S.-B. & Lee, M.-H. Topical aminolevulinic acid-photodynamic therapy for the treatment of acne vulgaris. Photodermatol Photoimmunol Photomed 21, 322–325 (2005).
  48. Goldman, M. P. & Boyce, S. M. A single-center study of aminolevulinic acid and 417 NM photodynamic therapy in the treatment of moderate to severe acne vulgaris. J Drugs Dermatol 2, 393–396 (2003).

Side Effects

Medium-High
Medium-high side effects and adverse reactions

Acne.org's Real World Take

PDT as it’s called is an incredibly painful procedure, but one that may produce lasting results. It’s a less invasive option than isotretinoin for severe acne that doesn’t cause so many potentially lifelong side effects. However, it works by permanently disabling skin oil glands, and what happens long term when you do that remains unknown. Proceed with caution.

Reviews

2.8
217 Reviews