Ablative Fractional CO₂ Laser Assisted 5-Aminolevulinic On The Treatment Of Severe Acne Vulgaris

BackgroundAcne is a multifactorial inflammatory disease of pilosebaceous unit.Subclinical microcomedones are the initial acne lesions that mature into clinically apparent comedones,inflammatory lesions,nodules and cysts.In all patients with acne,the following symptoms occur:release of inflammatory mediators in the skin,excessive sebum production,development of bacterial flora,increased reaction of sebaceous glands to physiological concentrations of androgens.Development of genetics and diet contributed to a significant progress in studies on the pathogenesis of acne.Lesions of severe acne are of nodules and cysts.Without prompt or properly treatment,acne will not only affects the appearance,but also cause psychological burden.Topical 5-aminolaevulinic acid-photodynamic therapy?ALA-PDT?is the first choice for the treatment of severe acne,which can selective kill sebaceous gland cells,and reduce inflammatory response.Ablative fractional CO₂ laser generates microscopic ablation zones in the skin,consisting of vertical channels of ablated tissue.The MAZs temporarily disrupt the skin-barrier and provide a pathway for uptake of topically 5-aminolaevulinic acid.ObjectiveTo compare the efficacy,safety and psychological status of combination of ablative fractional CO₂ laser and 5-aminolevulinic acid?ALA?mediated photodynamic therapy in severe acne patients.MethodsThirty-one subjects with severe facial acne from October 2014 to October 2016 treated in our department were enrolled and randomly divided into study group with 16 cases and control group with 15 cases.Patients in study group were treated with ablative fractional CO₂ laser before 5%ALA-PDT,and patients in control group were treated with 5%ALA-PDT only.Another difference between the two groups is that the incubation time of study group is 1.5 hours and 3 hours for control group.All patients were given ice compress or blowing cool air immediately after the treatment.The observation include three-course of treatments with an interval of 2 weeks and two times of follow-ups at 4,8 weeks after the final treatment.Efficacy and safety was evaluated by the same investigator before each treatment and follow-up.Side-effects were observed during the course of treatment.Cardiff acne disability index was administered to assess acne-related quality of life among all subjects.Result1.After the first course,the second course,the third course of treatment,four weeks and eight weeks after the final treatment,the reduction of pustule?%?of study group is 20.5±53.3,75.2±17.9,93.9±8.4,99.3±2.8,100±0,the reduction of pustule?%?of control group is 42.5±29.5,61.9±20.9,86.8±12.0,96.9±6.1,98.6±2.8.After two times of treatment,the reduction of pustule of study group compared with control group is significantly decreased?P<0.05?.2.After the first course,the second course,the third course of treatment,four weeks and eight weeks after the final treatment,the reduction of all skin lesions of study group is 28.9±12.1,53.3±14.6,67.9±14.1,80.5±12.6,88.7±10.1,the reduction of control group is 27.5±17.2,51.6±14.0,68.9±14.5,83.3±11.8,91.2±9.3.After treatment,all types of skin lesions are gradually reduced compared with baseline.There is no significant difference between the study group and the control group?P>0.05?.3.After the first course,the second course,the third course of treatment,four weeks and eight weeks after the final treatment,the effective rate of study group is 0%,31.3%,62.5%,87.5%,93.8%,the effective rate of control group is 0%,26.7%,66.7%,93.3%,93.3%.The effective rate between the two groups shows no significant difference?P>0.05?.4.After the first course,the second course,the third course of treatment,four weeks and eight weeks after the final treatment,the cure rate of study group is 0%,0%,0%,25%,62.5%,the cure rate of control group is 0%,0%,6.7%,20%,66.7%.The cure rate between the two groups shows no significant difference?P>0.05?5.There is no significant difference between study group and control group in the incidence of erythema,edema and pigmentation after treatment?P>0.05?.The incidence rate of reactive acne in study group is higher than control group after the first and the second treatment?P<0.05?.6.The number of mild and severe mental disordered patients is significantly decreased both in study group and control group?P<0.05?.The difference between two groups shows no statistically significance?P>0.05?.Conclusion1.The reduction of pustule of topical 5-aminolaevulinic acid-photodynamic therapy pretreated with ablative fractional CO₂ laser with the incubation time of 1.5 hours compared with topical 5-aminolaevulinic acid-photodynamic therapy with the on the incubation time of 3 hours on the treatment of severe acne vulgaris is significantly effective.2.The effective rate and cure rate of topical 5-aminolaevulinic acid-photodynamic therapy pretreated with ablative fractional CO₂ laser with the incubation time of 1.5 hours compared with topical 5-aminolaevulinic acid-photodynamic therapy with the on the incubation time of 3 hours on the treatment of severe acne vulgaris are almostly equal.The combination of ablative fractional CO₂ laser and ALA-PDT can significantly decrease one single treating time and relief the painful feeling.3.Combination of ablative fractional CO₂ laser and ALA-PDT on the treatment of severe acne vulgaris decrease a single treating time.It is a effective and safe treatment for severe acne and worthy of clinical popularization and application.