title: Enhanced efficacy of photodynamic therapy after fractional resurfacing: fractional photodynamic rejuvenation.
abstract: OBJECTIVE
  Conventional ablative resurfacing is the gold standard for removing signs of cutaneous photodamage. Despite the excellent results one can achieve with this technique, it is accompanied with significant downtime and risks. Fractional resurfacing and photodynamic therapy (PDT) with aminolevulinic acid (ALA) have been used to improve the signs of photodamage with less downtime. However, independently they do not yield results as good as ablative resurfacing. This pilot study will examine the potential for synergistic effects of combining fractional resurfacing and ALA-PDT.
  
  
  METHODS
  Four women with Fitzpatrick skin types II or III, mild to moderate rhytides and no actinic keratosis in the perioral area were treated. The perioral area was treated with 2 sessions of fractional resurfacing with the Fraxel SR (formerly Fraxel SR750, Reliant Technologies Inc, Palo Alto, CA) 3 weeks apart. Immediately after each fractional treatment we applied methyl 5-aminolevulinate (MAL or Metvix) on one half of the perioral area and 3 hours later we illuminated that area with a red light (Aktilite lamp, PhotoCure ASA, Oslo, Norway) in a dose of 37 J/cm2. Prior to treatment and at 4 and 12 weeks after the final treatment, a blinded investigator evaluated each side of the perioral area and rated the improvement from baseline as excellent, good, fair, or poor improvement of superficial wrinkles by comparing the results with pretreatment photographs. Patients also completed an evaluation form assessing their satisfaction with the treatment on each side of the perioral area while comparing the results with pretreatment photographs.
  
  
  RESULTS
  The study showed increased improvement in superficial wrinkles in 3 out of 4 patients on the combined treatment side. In one patient, the investigator found no significant difference when comparing both sides. All the patients noted greater improvement in the combined fractional and PDT-treated side compared to the side only treated with fractional surfacing.
  
  
  CONCLUSIONS
  This pilot study shows a potential for enhanced clinical results when using combined fractional resurfacing and ALA-PDT compared to fractional resurfacing alone.
authors.affiliation: Department of Dermatology, Clínica Ruber, Madrid, Spain. ricardo@rruiz.org
authors.forename: Ricardo
authors.initials: R
authors.lastname: Ruiz-Rodriguez
authors.forename: Laura
authors.initials: L
authors.lastname: López
authors.forename: Daniel
authors.initials: D
authors.lastname: Candelas
authors.forename: Brian
authors.initials: B
authors.lastname: Zelickson
mesh_terms: D000279:Administration, Cutaneous; D000622:Aminolevulinic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D003357:Cosmetic Techniques; D004487:Edema / Q000209:etiology; D004890:Erythema / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017495:Hyperpigmentation / Q000209:etiology; D007249:Inflammation / Q000209:etiology; D053685:Laser Therapy / Q000009:adverse effects / Q000379:methods*; D017060:Patient Satisfaction; D010778:Photochemotherapy / Q000009:adverse effects / Q000379:methods*; D017319:Photosensitizing Agents / Q000008:administration & dosage / Q000627:therapeutic use; D010865:Pilot Projects; D011446:Prospective Studies; D012060:Rejuvenation / Q000502:physiology*; D015595:Skin Aging / Q000187:drug effects / Q000528:radiation effects; D012879:Skin Physiological Phenomena / Q000187:drug effects / Q000528:radiation effects; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D017319:Photosensitizing Agents; C475457:methyl 5-aminolevulinate; D000622:Aminolevulinic Acid