Ariel Hasson

Efficacy of red light alone and methyl-aminolaevulinate-photodynamic therapy for the treatment of mild and moderate facial acne

BACKGROUND Photodynamic therapy (PDT) has been shown to be an effective alternative for acne. However, there is little information comparing the efficacy of red light alone and methyl aminolaevulinate (MAL)-PDT. AIMS To compare the efficacy and tolerability of red light alone and MAL-PDT in patients with mild to moderate facial acne. METHODS Thirty six patients with mild to moderate acne were enrolled. Eighteen patients recieved MAL-PDT and 18 received red light alone in two sessions, 2 weeks apart. Acne grade and lesion counts were assessed by blinded evaluators at baseline, 2, 4 and 10 weeks. RESULTS At week 2, clinical improvement from acne grade II-IV to 0-I was observed in 82.3% of MAL-PDT group and 14.2% of red light alone group. Red light alone group had a gradual clinical improvement over time with a 77% response at week 10. In contrast, MAL-PDT group had a rapid clinical improvement with total response at week 10. Both treatments were significantly effective for improving acne lesions. However, MAL-PDT group had a greater response (P < 0.001). Histologically, decreased amounts of sebocytes and lipids along with atrophic sebaceous glands were observed after MAL-PDT. CONCLUSION MAL-PDT has a quicker onset of action with a higher response than red light alone. MAL-PDT may induce a reduction in the size of the sebaceous glands and then long-term acne remission.

Topical photodynamic therapy with methylaminolevulinate for the treatment of actinic keratosis and reduction of photodamage in organ transplant recipients: a case-series of 16 patients.

BACKGROUND Organ transplant recipients (OTR) are at high risk of developing cutaneous neoplasms. Topical photodynamic therapy (PDT) has been used for the treatment of actinic keratosis (AK) in OTR. AIMS The objective was to evaluate the efficacy of PDT with methylaminolevulinate (MAL) in the treatment of facial AK in OTR. As a secondary objective, we wanted to evaluate the usefulness of topical PDT in the reduction of photodamage in OTR. METHODS A prospective, single center, single arm study was made. 16 OTR were included. Topical PDT was applied for 1 or 2 cycles depending on the patients characteristics. An evaluation of AK was made at visits pre-treatment, at 12 weeks and at 24 weeks. Photodamage was measured with multispectral image technique (SkinCare). RESULTS A complete response rate of 100% was achieved for AK in all patients; it persisted without change at 12 and 24 weeks of follow-up. 62.5% of patients improved their photodamage as measured by SkinCare®, but this result was not statistically significant (P = 0.12). All patients had high level of satisfaction at the end of the therapy. CONCLUSIONS MAL-PDT is an effective therapy for the treatment of AK in OTRs. It can reduce photodamage in this group of patients, but these results were not statistically significant.

Efficacy of topical photodynamic therapy for keratoacanthomas: a case-series of four patients.

Topical photodynamic therapy (PDT) is an excellent treatment option for various non-melanoma skin cancers and precancerous lesions, including actinic keratosis, Bowens disease, and basal cell carcinoma. The clinical use of PDT includes a broad range of neoplastic, inflammatory, and infectious skin diseases. There is also anecdotal evidence suggesting the efficacy of PDT for the treatment of keratoacanthomas (KA). We report a case-series of four patients with solitary KA confirmed by histology, treated with topical PDT with methylaminolevulinic acid (MAL) cream. After three sessions of PDT, the lesions completely disappeared. There was no evidence of recurrence and excellent cosmetic outcome was achieved after three years of follow-up. Topical photodynamic therapy with MAL can be a therapeutic alternative for KA with good clinical and cosmetic outcomes.

Topical photodynamic therapy with 5-aminolevulinate for the treatment of tumor-stage mycosis fungoides: a case report

A 70-year-old male patient with generalized tumor-stage mycosis fungoides (MF) presented to our office. He had been treated with psoralen + ultraviolet A, bexarotene, and total-skin electron beam radiation with poor response. He rejected systemic chemotherapy. The most uncomfortable lesions were those involving his face, fingers, buttocks, and calcaneus region (Fig. 1a). Skin biopsy confirmed the diagnosis (Fig. 2a). We offered him topical photodynamic therapy (PDT) with methyl-aminolevulinate (MAL). A 1-mm thick layer of 160 mg/g MAL cream (Metvix ; Photocure ASA, Oslo, Norway) with a 5 mm of margin was applied and covered with an occlusive dressing (Tegaderm ; 3M Health Care, St. Paul, MN, USA) for three hours on his fingers and buttocks, and in the calcaneus region. MAL was then cleaned with physiologic solution 0.9%. Irradiation was done with red light using a Waldmann lamp (PDT 1200 L, incoherent light source lamp) with a wavelength of 570–670 nm, 37 J/cm, and 70 mW/cm. Two to three sessions were done, depending on the lesion, each one separated by two weeks. Complete clinical and histological remission was achieved after treatment (Figs. 1b and 2b). No recurrences after five years of follow-up have been observed in the treated areas. New lesions have appeared in non-treated areas with excellent response to conventional therapies.

When strength turns into disease: acne fulminans in a bodybuilder

A 31-year-old male visited our hospital seeking dermato-logical care. He had been bodybuilding for a long time and had recently initiated a strict preparation program for a contest. To this end, he took intramuscular testosterone injections on three occasions , developing severe acneiform lesions. The course was gradual but progressive, leading to limitations in his daily activities, with arthralgia of the shoulders and ankles, as well as difficulty to work, move, change clothes and even sleep at night. No fever was reported. Initial testing revealed: a white blood count of 12.570/ mm 3 ; an erythrocyte sedimentation rate of 50mm/h; a platelet count of 278.000/mm 3 , without liver abnormalities. Upon physical examination, multiple, nodulocystic, erythematous papules and pustules were found on his face, chest, back and arms. Extensive ulcerations with brown-yellowish thick crusts were scattered mainly over his shoulders, the proximal areas of both arms and the upper back (Figure 1). The diagnosis of acne fulminans was made and treatment was initiated with prednisone 45mg/daily, doxycycline 100mg twice daily and antihistamines. He was told to definitively discontinue hormonal treatment. Four weeks later, isotretinoin was started at an initial dose of 30mg/daily and corticosteroids were gradually tapered. A good clinical response was achieved, with progressive healing. Acne fulminans is a rare condition, considered the most severe form of acne. 1 It usually affects young individuals aged 13-22 years, predominantly males with a prior history of mild or moderate acne 2. It is characterized by the sudden onset of highly in-flammatory, ulcerative, painful lesions covered with haemorrhagic crusts, most often located on the upper chest and back. 2 Constitutional symptoms and laboratory abnormalities are frequently seen, as in this case. The etiology of acne fulminans remains unclear but it appears to be multifactorial. Doping acne is a variant, induced by exogenous hormones (EHs) such as testosterone or derivatives, provoking hypertrophy of the sebaceous glands, increased production of skin surface lipids and sebum, in addition to increased density of the Propionibacterium acnes population. 3,4 The prevalence of EH usage is increasing dramatically, especially among amateur bodybuilders (reaching up to 80%) and weightlifters (38-58%). This is favored by the non-therapeutic prescription of EH by some physicians who are unaware of its side effects. It has been estimated that up to 50% of users could develop doping acne. 3 Certainly, the most important indication in these cases is the immediate cessation of EH. Due …

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

Although progress has been made in the study of photodynamic therapy for acne, studies using current recommended therapies as active comparators are lacking.

Acquired telangiectatic plaque-like glomangioma on the forehead

Glomus tumor is an uncommon and benign condition first described in 1924. It originates from modified smooth muscle cells found in arteriovenous shunts that regulate temperature in acral sites. Glomovenous malformations (GVM), previously known as glomangioma or multiple glomus tumor, is a vascular malformation of venous type. It should not be confused with solitary glomus tumor, a painful 3–6-mm papule commonly located in the nail bed with different histopathological features. GVM are very rare; they are usually congenital multiple bluish nodules situated deep in the dermis. The plaque-like GVM is the most uncommon variant. In fact, only one acquired case has been reported in 1998; we present another patient with this rare and distinctive variant. A 38-year-old female presented with a history of 20 years of a purple plaque on the forehead. Physical examination revealed a 3 · 0.5-cm-sized, well-defined, telangiectatic plaque (Fig. 1), with atrophic appearance and painful on palpation. Family history was negative for similar lesions. The initial clinical diagnosis was morphea. A 4-mm-punch biopsy was performed. Small aggregations of round monomorphous glomus cells with large oval nuclei and slightly eosinophilic cytoplasm were observed surrounding numerous dilated ectatic vascular channels lined by one layer of endothelium (Fig. 2a). Immunohistochemical staining was positive for alpha-smooth muscle actin and negative for CD31 in the glomus cells, and a positive reaction for CD31 was observed in the endothelial cells (Fig. 2b). The clinical and histological findings were consistent with the diagnosis of GVM. The patient was treated with pulsed-dye-laser therapy. GVM are very uncommon and related to a gene localized to chromosome 1p21–22. Clinically, GVM resemble