| Research background and purpose:Acne vulgaris is a multifactorial and common skin disease,which seriously affects the physical and mental health of patients.Grade Ⅲ-Ⅳ acne is characterized by heavy inflammation,deep,large,and numerous skin lesions,and involves a wide range of sites.As a result,its treatment cycle is relatively long and its efficacy is inferior to that of grade I and II acne.Long-term oral medication has great side effects,and it is very easy to leave erythema,hyperpigmentation and scars in the later stage,which affects the facial appearance and even causes psychological problems such as depression.At present,systematic therapy combined with topical drugs and drug combined with physical chemotherapy are mainly used.Combination therapy can not only improve efficacy,but also reduce side effects and increase patient compliance.Both oral isotretinoin and photodynamic therapy(PDT)can be used to treat grade Ⅲ-Ⅳ acne independently through the four key pathophysiological links affecting the onset of acne,and each has its own advantages.Not only that,but both have varying degrees of beauty effects.Therefore,in Sichuan(mainly Chengdu),patients with grade Ⅲ and Ⅳ acne were selected as research objects,and individualized treatment plans were developed according to different acne grades.To explore the clinical efficacy and safety of red light ALA photodynamic therapy(ALA-PDT)combined with oral isotretinoin in the treatment of grade Ⅲ-Ⅳ moderate-severe acne.This may be able to achieve the effect of "strong combination,complementary advantages",to provide a new means of clinical treatment.Materials and Methods:A total of 90 patients with grade Ⅲ and Grade Ⅳ acne admitted to the dermatology department of the First Affiliated Hospital of Chengdu Medical College from October2021 to August 2022 were randomly divided into combination group,PDT group and isotretinoin group,with 30 cases in each group.PDT group: red light ALA-PDT treatment,once /1-2 weeks,consecutive treatment for 3 times;Isotretinoin group: oral isotretinoin soft capsules(0.3-0.5mg/kg·d,divided into 2-3 oral times)were given for 4 months;Combination group: The above treatment methods of PDT group and isotretinoin group were combined simultaneously.Skin statistics were performed for all patients before treatment and at 1,2,3,and 4 months of treatment to evaluate the efficacy,and adverse reactions were recorded.Liver function and blood lipid were reviewed at 1 and 4 months of treatment in the combination group and the isotretinoin group,and adverse reactions and sequelae of acne were followed up at 2 months after treatment.Result:1.There were no significant differences in baseline data of age,sex,course of disease,acne severity grade,total number of lesions,number of inflammatory lesions and number of non-inflammatory lesions among the three groups(all P > 0.05).2.The regression rates of total lesions and inflammatory lesions in combination group,PDT group and isotretinoin group began to show differences at 2 months after treatment,and continued to 4 months after treatment(all P < 0.05),and the regression rates of total lesions and inflammatory lesions in combination group were better than PDT group and isotretinoin group(all P < 0.05).The regression rate of non-inflammatory lesions began to be different at 3 months of treatment and continued to be different at 4months of treatment(both P < 0.05),and both combination group and isotretinoin group were better than PDT group(both P < 0.05).3.At the 2nd,3rd and 4th month of treatment,the effective rates of the combination group were 81.5%,88.9% and 100%,respectively;The effective rates of PDT group were63%,74.1% and 85.2%,respectively.The effective rates of isotretinoin group were 53.6%,75% and 89.3%,respectively.4.Compared with PDT group and isotretinoin group,the common adverse reactions in combination group were all P > 0.05,and the difference was not statistically significant,and no photosensitive reaction and no other adverse reactions occurred.All defects are transient and recoverable.5.The levels of ALT,AST and TG in combination group and isotretinoin group were all P > 0.05 at 1 month and 4 months,and the difference was not statistically significant.ALT,AST and TG were examined in the combination group and isotretinoin group at 1 month of treatment,and the measured values of a few patients exceeded the normal range(ALT and AST were not more than 1 times of the upper limit of normal value,TG was not more than 2 times of the upper limit of normal value).No special treatment was given,the current medication was continued,and the normal range was basically restored at 4 months of treatment.6.2 months after treatment,the incidence/improvement of acne erythematous and scar in combination group was better than that in PDT group than that in isotretinoin group(both P < 0.05),and the incidence/improvement of acne pigmentation in combination group and PDT group was better than that in isotretinoin group(both P <0.05).Conclusion:1.Photodynamic combined with oral isotretinoin the treatment of grade Ⅲ and grade Ⅳ acne is more effective than photodynamic combined with oral isotretinoin alone.2.Photodynamic combined with oral isotretinoin has good curative effect on grade Ⅲ and Ⅳ acne.3.Photodynamic combined with oral isotretinoin in the treatment of grade Ⅲ and grade Ⅳ acne adverse reactions can be controlled with guaranteed safety.4.Photodynamic treatment combined with oral isotretinoin for grade Ⅲ and Ⅳ acne can reduce or improve the occurrence of acne sequelae to a certain extent.5.Simultaneous photodynamic therapy combined with oral isotretinoin in the treatment of grade Ⅲ and Ⅳ acne is worthy of further exploration and may become a powerful new treatment and be further popularized. |
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