Clinical practice Guidelines for 5-Aminolevulinic acid photodynamic therapy for acne vulgaris in China

作者：Wang, Peiru; Wang, Bo; Zhang, Linglin; Liu, Xiaojing; Shi, Lei; Kang, Xiaojing; Lei, Xia; Chen, Kun; Chen, Zhou; Li, Chengxin; Zhang, Chunlei; Tu, Ping; Pan, Meng; Ju, Qiang; Man, Xiaoyong; Lu, Yan; Yu, Nan; Li, Yuzhen; Zhu, Huilan; Zhang, Ruzhi; Su, Juan; Tao, Shiqin; Qiao, Jianjun; Mu, Qiri; Zeng, Weihui; Li, Zhiming; Gao, Ying; Gu, Heng^*; Wang, Xiuli^*

来源：Photodiagnosis and Photodynamic Therapy, 2023, 41: 103261.

DOI：10.1016/j.pdpdt.2022.103261

• Acne vulgaris
• Guidelines
• 5-Aminolevulinic acid
• Photodynamic therapy

A variety of evidence suggest that 5-Aminolevulinic acid-based photodynamic therapy (ALA-PDT) is clinically effective in management of acne vulgaris. Several clinical guidelines for acne recommend PDT as an alternative treatment modality for severe acne. However, there is a lack of detailed clinical guideline for PDT in acne treatment. To propose up-to-date, evidence-based and practical recommendations on application of ALA-PDT for acne vulgaris, dermatologists and PDT experts from the Photodynamic Therapy Research Center of the CMA and Photodynamic Therapy Rehabilitation Training Center of CARD achieved consensus and guidelines based on careful evaluation of published literature, expert opinions and experience. ALA-PDT plays a therapeutic role in all four major pathogenesis of acne, and is suitable for moderate to severe acne and scar-prone acne, especially for patients who cannot tolerate or refused systemic antibiotics and isotretinoin. The efficacy and adverse re-actions of ALA-PDT are closely related to therapeutic parameters including ALA concentration, incubation time, light source and dosage. Proper pretreatment helps to improve transdermal absorption of ALA and enhances its efficacy. We reviewed and proposed recommended protocols for four PDT procedures including conventional PDT (C-PDT), modified painless PDT (M-PDT), intense pulsed light PDT (IPL-PDT) and daylight PDT (DL-PDT). M-PDT with lower ALA concentration (3-5%), shorter incubation time (30 mins), and lower dose but prolonged illumination (630nm, 40-60 mW/cm2, 150 J/cm2) can improve lesions of moderate to severe acne vulgaris effectively with minimal pain and easier manipulation, and thus was recommended by Chinese dermatologists. Lastly, management of adverse reactions were addressed.

• 单位
  中国医学科学院北京协和医院; 西安交通大学; 1; 华中科技大学; 同济大学; 复旦大学; 上海交通大学; 浙江大学; 哈尔滨医科大学; 北京大学