【开放获取】氨基酮戊酸光动力疗法治疗寻常痤疮的临床应用专家共识（2022）

doi:10.35541/cjd.20220664

Abstract

Abstract: 【Abstract】 Aminolevulinic acid-based photodynamic therapy （ALA-PDT） is a safe and effective physical therapy for acne, and has been widely used in clinical practice. In order to further standardize the clinical application of ALA-PDT in the treatment of acne vulgaris, this consensus summarizes its mechanisms of action, and standardizes the patient selection criteria, treatment parameters, operating process and management of adverse reactions based on the 2011 version of consensus on ALA-PDT for treatment of acne vulgaris. This consensus also provides suggestions on ALA-PDT operation protocols and parameters for the treatment of acne from a clinical perspective, aiming to provide principles and guidance for clinical application of ALA-PDT in acne treatment.

Key words: Acne vulgaris, Photochemotherapy, Aminolevulinic acid, Photodynamic therapy, Clinical application, Consensus Practice Guideline Registration for Transparency, PREPARE-2022CN523

Chinese Dermatologist Association. Expert consensus on clinical application of aminolevulinic acid-based photodynamic therapy in the treatment of acne vulgaris （2022）[J]. Chinese Journal of Dermatology, 2022, 55(12): 1050-1057.doi:10.35541/cjd.20220664

References ［55］

［1］	Zaenglein AL. Acne vulgaris［J］. N Engl J Med, 2018,379（14）:1343⁃1352. doi: 10.1056/NEJMcp1702493.
［2］	Thiboutot DM, Dréno B, Abanmi A, et al. Practical management of acne for clinicians: an international consensus from the Global Alliance to Improve Outcomes in Acne［J］. J Am Acad Dermatol, 2018,78（2 Suppl 1）:S1⁃S23.e1. doi: 10.1016/j.jaad. 2017.09.078.
［3］	Barnes LE, Levender MM, Fleischer AB Jr, et al. Quality of life measures for acne patients［J］. Dermatol Clin, 2012,30（2）:293⁃300, ix. doi: 10.1016/j.det.2011.11.001.
［4］	Ma L, Xiang LH, Yu B, et al. Low⁃dose topical 5⁃aminolevulinic acid photodynamic therapy in the treatment of different severity of acne vulgaris［J］. Photodiagnosis Photodyn Ther, 2013,10（4）:583⁃590. doi: 10.1016/j.pdpdt.2013.06.007.
［5］	张玲琳, 王秀丽, 王宏伟, 等. 5⁃氨基酮戊酸光动力疗法治疗痤疮［J］. 中华皮肤科杂志, 2009,42（2）:78⁃80.
［6］	Nicklas C, Rubio R, Cárdenas C, et al. 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［J］. Photodermatol Photoimmunol Photomed, 2019,35（1）:3⁃10. doi: 10.1111/phpp. 12413.
［7］	Tang X, Li C, Ge S, et al. Efficacy of photodynamic therapy for the treatment of inflammatory acne vulgaris: a systematic review and meta⁃analysis［J］. J Cosmet Dermatol, 2020,19（1）:10⁃21. doi: 10.1111/jocd.13197.
［8］	Morton CA, Szeimies RM, Basset⁃Séguin N, et al. European Dermatology Forum guidelines on topical photodynamic therapy 2019 Part 2: emerging indications ⁃ field cancerization, photorejuvenation and inflammatory/infective dermatoses［J］. J Eur Acad Dermatol Venereol, 2020,34（1）:17⁃29. doi: 10.1111/jdv.16044.
［9］	Zaenglein AL, Pathy AL, Schlosser BJ, et al. Guidelines of care for the management of acne vulgaris［J］. J Am Acad Dermatol, 2016,74（5）:945⁃973.e33. doi: 10.1016/j.jaad.2015.12.037.
［10］	中国痤疮治疗指南专家组. 中国痤疮治疗指南（2019修订版）［J］. 临床皮肤科杂志, 2019,48（9）:583⁃588. doi: 10.16761/j.cnki.1000⁃4963.2019.09.020.
［11］	中华医学会皮肤性病学分会光动力治疗研究中心, 中国康复医学会皮肤病康复专业委员会, 中国医学装备协会皮肤病与皮肤美容分会光医学治疗装备学组. 氨基酮戊酸光动力疗法皮肤科临床应用指南（2021版）［J］. 中华皮肤科杂志, 2021,54（1）:1⁃9. doi: 10.35541/cjd.20200731.
［12］	中国医师协会皮肤科医师分会皮肤激光亚专业委员会. 5⁃氨基酮戊酸光动力疗法治疗寻常痤疮的共识［J］. 中华皮肤科杂志, 2011,44（2）:75⁃76. doi:10.3760/cma.j.issn.0412⁃4030. 2011.02.001
［13］	Tuo J, Wang Q, Zouboulis CC, et al. ALA⁃PDT suppressing the cell growth and reducing the lipogenesis in human SZ95 sebocytes by mTOR signaling pathway in vitro［J］. Photodiagnosis Photodyn Ther, 2017,18:295⁃301. doi: 10.1016/j.pdpdt.2017.03.006.
［14］	Yang J, Shi L, Xu D, et al. 5⁃Aminolaevulinic acid photodynamic therapy suppresses lipid secretion of primary sebocytes through AMPK/SREBP⁃1 pathway［J］. Photodiagnosis Photodyn Ther, 2021,36:102537. doi: 10.1016/j.pdpdt.2021.10 2537.
［15］	Choi MS, Yun SJ, Beom HJ, et al. Comparative study of the bactericidal effects of 5⁃aminolevulinic acid with blue and red light on Propionibacterium acnes［J］. J Dermatol, 2011,38（7）:661⁃666. doi: 10.1111/j.1346⁃8138.2010.01094.x.
［16］	刘宇甄, 曾荣, 段志敏, 等. 氨基酮戊酸光动力对痤疮丙酸杆菌生物膜的作用［J］. 中国医学科学院学报, 2020,42（3）:283⁃288. doi: 10.3881/j.issn.1000⁃503X.11774.
［17］	Tao S, Wang Z, Quan C, et al. The effects of ALA⁃PDT on microbiota in pilosebaceous units of patients with severe acne: a metagenomic study［J］. Photodiagnosis Photodyn Ther, 2021,33:102050. doi: 10.1016/j.pdpdt.2020.102050.
［18］	Hongcharu W, Taylor CR, Chang Y, et al. Topical ALA⁃photodynamic therapy for the treatment of acne vulgaris［J］. J Invest Dermatol, 2000,115（2）:183⁃192. doi: 10.1046/j.1523⁃1747.2000.00046.x.
［19］	Gozali MV, Yi F, Zhang JA, et al. Photodynamic therapy inhibit fibroblast growth factor⁃10 induced keratinocyte differentiation and proliferation through ROS in fibroblast growth factor receptor⁃2b pathway［J］. Sci Rep, 2016,6:27402. doi: 10.1038/srep27402.
［20］	Karrer S, Bosserhoff AK, Weiderer P, et al. Keratinocyte⁃derived cytokines after photodynamic therapy and their paracrine induction of matrix metalloproteinases in fibroblasts［J］. Br J Dermatol, 2004,151（4）:776⁃783. doi: 10.1111/j.1365⁃2133.2004. 06209.x.
［21］	Zhang L, Yang J, Liu X, et al. 5⁃Aminolaevulinic acid photodynamic therapy amplifies intense inflammatory response in the treatment of acne vulgaris via CXCL8［J］. Exp Dermatol, 2021,30（7）:923⁃931. doi: 10.1111/exd.14357.
［22］	Ma Y, Chen Q, Liu Y, et al. Effects of 5⁃aminolevulinic acid photodynamic therapy on TLRs in acne lesions and keratinocytes co⁃cultured with P. acnes［J］. Photodiagnosis Photodyn Ther, 2016,15:172⁃181. doi: 10.1016/j.pdpdt.2016.07. 002.
［23］	王丹, 骆丹, 闵玮. 5⁃氨基酮戊酸光动力疗法对痤疮丙酸杆菌感染金黄地鼠皮脂腺斑影响的研究［J］. 临床皮肤科杂志, 2010,39（7）:417⁃419. doi: 10.3969/j.issn.1000⁃4963.2010.07.007.
［24］	Trivedi NR, Gilliland KL, Zhao W, et al. Gene array expression profiling in acne lesions reveals marked upregulation of genes involved in inflammation and matrix remodeling［J］. J Invest Dermatol, 2006,126（5）:1071⁃1079. doi: 10.1038/sj.jid.5700213.
［25］	Choi JY, Piao MS, Lee JB, et al. Propionibacterium acnes stimulates pro⁃matrix metalloproteinase⁃2 expression through tumor necrosis factor⁃alpha in human dermal fibroblasts［J］. J Invest Dermatol, 2008,128（4）:846⁃854. doi: 10.1038/sj.jid.570 1188.
［26］	中华医学会医学美学与美容学分会激光美容学组, 中华医学会皮肤性病学分会美容激光学组, 中国医师协会美容与整形医师分会激光学组. 中国痤疮瘢痕治疗专家共识（2021）［J］. 中华皮肤科杂志, 2021,54（9）:747⁃756. doi: 10.35541/cjd.202 10182.
［27］	Linkner RV, Jim On S, Haddican M, et al. Evaluating the efficacy of photodynamic therapy with 20% aminolevulinic acid and microdermabrasion as a combination treatment regimen for acne scarring: a split⁃face, randomized, double⁃blind pilot study［J］. J Clin Aesthet Dermatol, 2014,7（5）:32⁃35.
［28］	Sakamoto FH, Torezan L, Anderson RR. Photodynamic therapy for acne vulgaris: a critical review from basics to clinical practice: part II. Understanding parameters for acne treatment with photodynamic therapy［J］. J Am Acad Dermatol, 2010,63（2）:195⁃212. doi: 10.1016/j.jaad.2009.09.057.
［29］	Wang HW, Lv T, Zhang LL, et al. Prospective study of topical 5⁃aminolevulinic acid photodynamic therapy for the treatment of moderate to severe acne vulgaris in Chinese patients［J］. J Cutan Med Surg, 2012,16（5）:324⁃333. doi: 10.1177/1203475412016 00509.
［30］	Yew YW, Lai YC, Lim YL, et al. Photodynamic therapy with topical 5% 5⁃aminolevulinic acid for the treatment of truncal acne in Asian patients［J］. J Drugs Dermatol, 2016,15（6）:727⁃732.
［31］	Zhang J, Zhang X, He Y, 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］. J Cosmet Dermatol, 2020,19（2）:368⁃374. doi: 10.1111/jocd.13038.
［32］	李飞, 陶诗沁, 杨莉佳, 等. 3.6％ 5⁃氨基酮戊酸光动力疗法治疗中重度痤疮的临床疗效及安全性观察［J］. 临床皮肤科杂志, 2016,45（4）:298⁃301. doi: 10.16761/j.cnki.1000⁃4963.2016. 04.025.
［33］	Zhang L, Wu Y, Zhang Y, 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［J］. Dermatoendocrinol, 2017,9（1）:e1375634. doi: 10.1080/19381980.2017.1375634.
［34］	Hong JS, Jung JY, Yoon JY, et al. Acne treatment by methyl aminolevulinate photodynamic therapy with red light vs. intense pulsed light［J］. Int J Dermatol, 2013,52（5）:614⁃619. doi: 10.1111/j.1365⁃4632.2012.05673.x.
［35］	Del Duca E, Manfredini M, Petrini N, et al. Daylight photodynamic therapy with 5⁃aminolevulinic acid 5% gel for the treatment of mild⁃to⁃moderate inflammatory acne［J］. Ital J Dermatol Venerol, 2021,156（1）:46⁃50. doi: 10.23736/S2784⁃8671.19.06392⁃2.
［36］	Zhang L, Zhang Y, Liu X, et al. Conventional versus daylight photodynamic therapy for acne vulgaris: a randomized and prospective clinical study in China［J］. Photodiagnosis Photodyn Ther, 2020,31:101796. doi: 10.1016/j.pdpdt.2020.101796.
［37］	Slutsky⁃Bank E, Artzi O, Sprecher E, et al. A split⁃face clinical trial of conventional red⁃light photodynamic therapy versus daylight photodynamic therapy for acne vulgaris［J］. J Cosmet Dermatol, 2021,20（12）:3924⁃3930. doi: 10.1111/jocd.14359.
［38］	刘沛, 石磊, 王秀丽. 皮肤疾病光动力治疗的光源和照光参数选择［J］. 中华皮肤科杂志, 2021,54（11）:1015⁃1018. doi: 10. 35541/cjd.20200041.
［39］	中华医学会皮肤性病学分会光动力治疗研究中心. 氨基酮戊酸光动力疗法临床应用专家共识［J］. 中华皮肤科杂志, 2015,48（10）:675⁃678.
［40］	Zheng W, Wu Y, Xu X, et al. Evidence⁃based review of photodynamic therapy in the treatment of acne［J］. Eur J Dermatol, 2014,24（4）:444⁃456. doi: 10.1684/ejd.2014.2347.
［41］	Ren R, Bao S, Qian W, et al. Topical ALA⁃photodynamic therapy combined with acne debridement and meticulous nursing for the treatment of moderate⁃severe acne in adolescent patients［J］. Clin Cosmet Investig Dermatol, 2021,14:1303⁃1310. doi: 10.2147/CCID.S322768.
［42］	Bay C, Lerche CM, Ferrick B, et al. Comparison of physical pretreatment regimens to enhance protoporphyrin IX uptake in photodynamic therapy: a randomized clinical trial［J］. JAMA Dermatol, 2017,153（4）:270⁃278. doi: 10.1001/jamadermatol. 2016.5268.
［43］	Qureshi S, Lin JY. Utilizing non⁃ablative fractional photothermolysis prior to ALA⁃photodynamic therapy in the treatment of acne vulgaris: a case series［J］. Lasers Med Sci, 2017,32（3）:729⁃732. doi: 10.1007/s10103⁃016⁃2029⁃1.
［44］	王佩茹, 张玲琳, 周忠霞, 等. 梅花针叩刺增强氨基酮戊酸光动力治疗光线性角化病、基底细胞癌、鳞状细胞癌的研究［J］. 中华皮肤科杂志, 2015,48（2）:80⁃84. doi: 10.3760/cma.j.issn.0412⁃4030.2015.02.003.
［45］	中华医学会皮肤性病学分会皮肤激光医疗美容学组, 中华医学会皮肤激光技术应用研究中心, 中国医师协会美容与整形医师分会激光亚专委会, 等. 化学剥脱术临床应用专家共识［J］. 实用皮肤病学杂志, 2019,12（5）:257⁃262. doi: 10.11786/sypfbxzz.1674⁃1293.20190501.
［46］	万丽, 赵晴, 陈军, 等. 疼痛评估量表应用的中国专家共识（2020版）［J］. 中华疼痛学杂志, 2020,16（3）:177⁃187. doi: 10.3760/cma.j.cn101379⁃20190915⁃00075.
［47］	崔娜. 使用一次性精密过滤输液器减少β⁃七叶皂普钠所致疼痛及静脉炎效果观察［J］. 中国实用内科杂志, 2014, 34: 118⁃119
［48］	Cottrell WJ, Paquette AD, Keymel KR, et al. Irradiance⁃dependent photobleaching and pain in delta⁃aminolevulinic acid⁃photodynamic therapy of superficial basal cell carcinomas［J］. Clin Cancer Res, 2008,14（14）:4475⁃4483. doi: 10.1158/1078⁃0432.CCR⁃07⁃5199.
［49］	Mchepange UO, Huang CY, Sun Y, et al. Two⁃step irradiance schedule versus single⁃dose tramadol sustained⁃release tablets for pain control during topical 5⁃aminolevulinic acid⁃photodynamic therapy of condyloma acuminatum in Chinese patients: a randomized comparative study［J］. Lasers Surg Med, 2014,46（5）:389⁃395. doi: 10.1002/lsm.22243.
［50］	Wang B, Shi L, Zhang YF, et al. Gain with no pain? Pain management in dermatological photodynamic therapy［J］. Br J Dermatol, 2017,177（3）:656⁃665. doi: 10.1111/bjd.15344.
［51］	Ibbotson SH, Wong TH, Morton CA, et al. Adverse effects of topical photodynamic therapy: a consensus review and approach to management［J］. Br J Dermatol, 2019,180（4）:715⁃729. doi: 10.1111/bjd.17131.
［52］	李飞, 陶诗沁, 杨莉佳, 等. 3.6％ 5⁃氨基酮戊酸光动力疗法治疗中重度痤疮的临床疗效及安全性观察［J］. 临床皮肤科杂志, 2016,45（4）:298⁃301. doi: 10.16761/j.cnki.1000⁃4963.2016. 04.025.
［53］	Elbuluk N, Grimes P, Chien A, et al. The pathogenesis and management of acne⁃induced post⁃inflammatory hyperpigmen⁃tation［J］. Am J Clin Dermatol, 2021,22（6）:829⁃836. doi: 10. 1007/s40257⁃021⁃00633⁃4.
［54］	Boen M, Brownell J, Patel P, et al. The role of photodynamic therapy in acne: an evidence⁃based review［J］. Am J Clin Dermatol, 2017,18（3）:311⁃321. doi: 10.1007/s40257⁃017⁃0255⁃3.
［55］	王艳青, 冯文莉, 吴媛, 等. 浅谈5⁃氨基酮戊酸光动力疗法治疗痤疮的影响因素［J］. 山西医药杂志, 2014,43（19）:2296⁃2297.

[1]	Peng Ying, Liu Yi. Medications for the treatment of acne [J]. Chinese Journal of Dermatology, 2023, 56(2): 173-176.
[2]	Zhu He, Wu Yingying, Yang Rongya, Wang Congmin, Ao Junhong. Efficacy of medical cold patches in relieving burning pain and restoring skin homeostasis after hematoporphyrin monomethyl ether-based photodynamic therapy for the treatment of port-wine stains [J]. Chinese Journal of Dermatology, 2022, 55(9): 784-789.
[3]	Wu Shuhui, Zhu Mingfang, Wei Lu, Zhang Xi, Qin Qiuyan, Wang Chang. Effect of pomegranate peel polyphenols on mTOR/HIF-1α/IL-17 signaling pathway in a rat auriclular model of acne [J]. Chinese Journal of Dermatology, 2022, 55(6): 511-516.
[4]	Wu Shuhui, Zhu Mingfang, Zhang Xi, Yang Yixuan, Zhang Juanjuan. Effect of milk on sebaceous gland spots and the IGF-1/SREBP-1/ACC-1 signaling pathway in golden hamsters [J]. Chinese Journal of Dermatology, 2022, 55(3): 238-242.
[5]	Liu Yuzhen, Zeng Rong, Zheng Nana, Duan Zhimin, Xu Haoxiang, Wu Qiuju, Lin Tong, Li Min. Effect of different incubation time of aminolevulinic acid on photodynamic inhibition of Propionibacterium acnes biofilms [J]. Chinese Journal of Dermatology, 2022, 55(3): 208-212.
[6]	Li Jiaqi, Ye Feng, Ju Qiang. Symbiotic homeostasis of Staphylococcus epidermidis is associated with common skin disorders [J]. Chinese Journal of Dermatology, 2022, 0(1): 20210072-e20210072.
[7]	Feng Mengdi, Wang Wenqing. Regulatory roles of transcription factors and receptors in the pathogenesis of acne [J]. Chinese Journal of Dermatology, 2022, 0(1): 20210457-e20210457.
[8]	Laser Cosmetology Group, Medical Aesthetics and Cosmetology Branch of Chinese Medical Association, Cosmetic Laser Group, Chinese Society of Dermatology, Laser Group, Cosmetic and Plastic Surgeon Branch of Chinese Medical Doctor Association. Consensus on treatment of acne scars in China （2021） [J]. Chinese Journal of Dermatology, 2021, 54(9): 747-756.
[9]	Wu Shuhui, Zhu Mingfang, Wei Lu, Zhang Xi, Zhu Yameng. Effect of pomegranate peel polyphenols on sebaceous gland spots and AKT/Sox9 signaling pathway in golden hamsters [J]. Chinese Journal of Dermatology, 2021, 54(8): 705-708.
[10]	Ying Jieya, Xiang Wenzhong, Song Xiuzu. Metabolic syndrome and skin diseases [J]. Chinese Journal of Dermatology, 2021, 54(7): 642-645.
[11]	Hu Yanyan, Jiang Qian, Chen Liuqing, Li Dongsheng. Application of reflectance confocal microscopy in the evaluation of clinical efficacy of hemoporfin-mediated photodynamic therapy for purple-type port-wine stain [J]. Chinese Journal of Dermatology, 2021, 54(4): 342-346.
[12]	Geng Wenjin, Liu Tongyun. Childhood acne [J]. Chinese Journal of Dermatology, 2021, 54(3): 273-275.
[13]	Zheng Zhe, Zhang Guolong, Wang Peiru, Ji Jie, Wang Xiuli, . Changes in immune cell subsets in cutaneous squamous cell carcinoma tissues from SKH-1 mouse models after aminolevulinic acid-based photodynamic therapy [J]. Chinese Journal of Dermatology, 2021, 54(11): 978-983.
[14]	Liu Pei, Shi Lei, Wang Xiuli. Selection of light sources and radiation parameters in photodynamic therapy for skin diseases [J]. Chinese Journal of Dermatology, 2021, 54(11): 1015-1018.
[15]	Jin Shuang, Huang Dan, Chen Kun. Daylight photodynamic therapy for the treatment of actinic keratosis [J]. Chinese Journal of Dermatology, 2021, 54(11): 1023-1027.

Expert consensus on clinical application of aminolevulinic acid-based photodynamic therapy in the treatment of acne vulgaris （2022）

PDF

Knowledge

Abstract

Cite this article

share this article

References ［55］

Related Articles 15

Metrics

Comments

Recommended 10