title: The Role of Photodynamic Therapy in Acne: An Evidence-Based Review.
abstract: BACKGROUND
  Acne vulgaris is a highly prevalent skin disorder that affects almost all adolescents and can persist into adulthood. Photodynamic therapy (PDT) is an emerging treatment for acne that involves the use of a photosensitizer in combination with a light source and oxygen.
  
  
  METHODS
  We performed a systematic review of the literature and critically evaluated the studies. Sixty-nine clinical trials, four case reports, and two retrospective studies met the inclusion criteria, and seven of the studies were high quality.
  
  
  RESULTS
  The most common photosensitizers used were 5-aminolevulinic acid and methyl aminolevulinate, and both showed similar response. Red light was the most frequently used light source, followed by intense pulsed light, and showed comparable results. Inflammatory and non-inflammatory lesions both responded to treatment, with inflammatory lesions showing greater clearance in most studies. Adverse events associated with PDT for acne were mild and included pain on illumination and post-procedural erythema and edema. PDT has been safely used in higher Fitzpatrick skin types (III-IV), although these patients had a higher risk of transient hyperpigmentation.
  
  
  CONCLUSIONS
  This review supports PDT as an efficacious treatment for acne and a good adjunctive treatment for mild to severe acne, especially in patients who have not responded to topical therapy and oral antibacterials, and are not great candidates for isotretinoin. Further studies are warranted to evaluate the optimal photosensitizers, light sources, incubation times, and number of treatments for PDT use in acne.
authors.affiliation: Department of Dermatology, University of Illinois at Chicago, 808 S. Wood St., Suite 380, Chicago, IL, 60612, USA. mboen@uic.edu.
authors.forename: Monica
authors.identifier: http://orcid.org/0000-0001-8221-6697
authors.initials: M
authors.lastname: Boen
authors.affiliation: College of Medicine, University of Illinois at Chicago, 1853 West Polk Street, Room 130, Chicago, IL, 60612, USA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Brownell
authors.affiliation: College of Medicine, University of Illinois at Chicago, 1853 West Polk Street, Room 130, Chicago, IL, 60612, USA.
authors.forename: Priyanka
authors.initials: P
authors.lastname: Patel
authors.affiliation: Department of Dermatology, University of Illinois at Chicago, 808 S. Wood St., Suite 380, Chicago, IL, 60612, USA. tsoukasm@uic.edu.
authors.forename: Maria M
authors.initials: MM
authors.lastname: Tsoukas
mesh_terms: D000152:Acne Vulgaris / Q000188:drug therapy* / Q000473:pathology; D000293:Adolescent; D000328:Adult; D006801:Humans; D017495:Hyperpigmentation / Q000209:etiology; D010778:Photochemotherapy / Q000009:adverse effects / Q000379:methods*; D017319:Photosensitizing Agents / Q000008:administration & dosage*; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D017319:Photosensitizing Agents