Enhanced Efficacy of Photodynamic Therapy after Fractional Resurfacing: Fractional Photodynamic Rejuvenation

By Ricardo Ruiz-Rodriguez, M.D., PhD, Laura Lopez, M.D., Daniel Candelas, M.D. & Brian Zelickson, M.D.
Published in J Drugs Dermatol 2007, 6;8:818–820

Introduction

Many nonablative lasers and light treatments are available to reduce the signs of photodamage. A newer technique, fractional resurfacing has shown improvement in rhytides without the prolonged healing time that is necessary with ablative resurfacing. The authors previously reported using intense pulsed light (IPL) with topical aminolevulinic acid (ALA) for treating photodamage, known as photodynamic photorejuvenation. The current study evaluated the efficacy of combining fractional resurfacing and photodynamic photorejuvenation to reduce superficial perioral rhytides.

Methods

Four female subjects, Fitzpatrick skin types II or III, with mild to moderate perioral rhytides and no actinic keratoses in the perioral area were included in this prospective, randomized, controlled, side-by-side study. The perioral area was treated with fractional resurfacing using the Fraxel® SR (Reliant Technologies, Mountain View, CA) for two sessions spaced three weeks apart. Immediately after the laser treatment, methyl 5-aminolevulinate (MAL or Metvix® Cream (Photocure™ ASA, Oslo, Norway)) was applied to half of the perioral area for three hours. Then the area treated with MAL was exposed to Aktilite® Lamp (Photocure™ ASA, Oslo, Norway) at 37 J/cm2 while the other side was shielded from the light. Patients’ responses were assessed by photographic evaluation at baseline and at four and twelve weeks after treatment by a blinded investigator who rated improvement of superficial rhytides from baseline as excellent, good, fair or poor. Patients also completed self evaluations assessing their improvement.

Results

Fractional resurfacing and photodynamic treatments caused mild discomfort for all four patients. More erythema and edema occurred on the combined treatment side for all patients and resolved within a week. More scaling was noted for all patients on the combined treatment side. All patients noted more improvement in their superficial wrinkles on the fractional and PDT treated side compared with the fractional resurfacing only side. The blinded investigator determined there was clinical improvement of superficial perioral wrinkles in three out of the four patients on the fractional and PDT treated side. No significant difference between the two sides was observed in one patient.

Discussion

This study illustrated the potential for greater clinical improvement when combining fractional resurfacing and ALA PDT than using fractional resurfacing alone.

Reprint Requests to Ricardo Ruiz-Rodriguez, M.D., PhD, Department of Dermatology, Clinica Ruber, Maldonado 50, 28006 Madrid, Spain.