什么是光动力疗法?

光动力疗法是使用特定波长的光结合外源性光敏剂,通过光毒性反应杀灭痤疮细菌,并促进痤疮愈合。目前临床上主要是 蓝光和/或红光 + ALA(5-氨基酮戊酸)或MAL(甲基氨基酮戊酸)。通常治疗3-5次,每次间隔2-4周,对中到重度痤疮预期有中等程度的疗效。

治疗过程:

首先是应用光敏剂(ALA或MAL)。通常是局部外用,封包(即用薄膜覆盖,封闭敷药)3小时以上,使其被皮肤和皮脂腺吸收。

之后,采用红光或蓝光或者二者联合照射。在光源作用下,光敏剂被激活,从而杀灭痤疮丙酸杆菌并使皮脂腺萎缩。

光源的选择:

光敏剂的选择:

光动力疗法中最常使用的光敏剂包括ALA(5-氨基酮戊酸)和MAL(甲基氨基酮戊酸)。其中,ALA是亲水性的,不容易穿透角质层。而MAL是脂溶性的,对油脂有更强的亲和力,更容易接近皮脂腺(分泌皮肤油脂的腺体),它的吸收较快,也更容易穿透角质层,比ALA更易与皮损部位结合,针对痤疮而言,它也许是更好的选择。

除了光敏剂的种类,给药时间也是影响治疗效果的关键因素。一些研究表明,给药3小时后再进行光照有助于提高疗效。不过,缩短光敏剂与皮肤的结合时间似乎更加温和,也有利于减少疼痛等不良反应,但可能会降低疗效。

MAL
photodynamic therapy MAL
ALA
photodynamic therapy ALA

疗效:

根据研究结果,3次光动力治疗后,炎症性痤疮平均消退了75%左右[5-15]。由于跟踪研究至多不超过三个月,因此难以判断这种疗法的持久性,不过,一些皮肤科医生的报告中,有疗效持续1到2年的案例。

副作用:

光动力治疗过程中,会出现疼痛,有时非常严重。除了疼痛外,常见的不良反应还包括:红斑、水肿、瘙痒、脱皮,大约会持续一周左右,还可能出现长期的色素沉着(皮肤变黑),大约持续一个月,另外,也有些患者还会暴发反应性痤疮。

不同的光敏剂也会产生不同的副作用,比如MAL可能会引起更严重的疼痛感,色素沉着的可能性也更高。目前的研究集中在,降低光敏剂的浓度是否能够在不影响疗效的情况下减少不良反应[2-3],或者有没有其他不良反应更小的光敏剂[4]

需要注意的是,为了避免产生光毒反应,治疗结束后需要避光2天左右,包括阳光或明亮的室内光线。

  1. Wan MT, Lin JY. "Current evidence and applications of photodynamic therapy in dermatology." Clinical, Cosmetic and Investigational Dermatology. 2014; 7: 145-163.
  2. Ma L, et al. "Low-dose topical 5-aminolevulinic acid photodynamic therapy in the treatment of different severity of acne vulgaris." Photodiagnosis and Photodynamic Therapy. 2013; 10(4): 583-90.
  3. Asayama-Kosaka S, Akilov OE, Kawana S. "Photodynamic Therapy with 5% Aminolevulinic Acid is Safe and Effective Treatment of Acne Vulgaris in Japanese Patients." Laser Therapy. 2014; 23(2): 115-20.
  4. Huh SY, et al. "The effect of photodynamic therapy using indole-3-acetic acid and green light on acne vulgaris." Annals of Dermatology. 2012; 24(1): 56-60.
  5. Hong JS, et al. "Acne treatment by methyl aminolevulinate photodynamic therapy with red light vs intense pulsed light." International Journal of Dermatology. 2013; 52(5): 614-619.
  6. Wiegell SR, Wulf HC. "Photodynamic therapy of acne vulgaris using 5-aminolevulinic acid versus methyl aminolevulinate." Journal of the American Academy of Dermatology. 2006; 54(4): 647-651.
  7. Hongcharu W, et al. "Topical ALA-photodynamic therapy for the treatment of acne vulgaris." Journal of Investigative Dermatology. 2000; 115(2): 183-192.
  8. Pollock B, et al. "Topical aminolaevulinic acid photodynamic therapy for the treatment of acne vulgaris: a study of clinical efficacy and mechanism of action." British Journal of Dermatology. 2004; 151(3): 616-622.
  9. Akaraphanth R, Kanjanawanitchkul W, Gritiyarangsan P. "Efficacy of ALA-PDT vs blue light in the treatment of acne." Photodermatology, Photoimmunoloty & Photomedicine. 2007; 23(5): 186-190.
  10. Horfelt C, et al. "Topical methyl aminolaevulinate photodynamic therapy for treatment of facial acne vulgaris: results of a randomized, controlled study." British Journal of Dermatology. 2006; 155(3): 608-613.
  11. Weigell SR, Wulf HC. "Photodynamic therapy of acne vulgaris using methyl aminolaevulinate: a blinded, randomized, controlled trial." British Journal of Dermatology. 2006; 154(5): 969-976.
  12. Pinto C, et al. "Efficacy of red light alone and methyl-aminolaevulinate photodynamic therapy for the treatment of mild and moderate facial acne." Indian Journal of Dermatology, Venereology, and Leprology. 2013; 79: 77-82.
  13. Shaaban D, Abdel-Samad Z, El-Khalawany M. "Photodynamic therapy with intralesional 5-aminolevulinic acid and intense pulsed light versus intense pulsed light alone in the treatment of acne vulgaris: a comparative study." Dermatology and Therapy. 2012; 25: 86-91.
  14. Hong SB, Lee MH. "Topical aminolevulinic acid photodynamic therapy for the treatment of acne vulgaris." Photodermatology, Photoimmunology & Photomedicine. 2005; 21: 322-325.
  15. Goldman MP, Boyce SM. "A single-center study of aminolevulinic acid and 417 NM photodynamic therapy in the treatment of moderate to severe acne vulgaris." Journal of Drugs in Dermatology. 2003; 2: 393-396.
  16. 邬宗周,袁定芬. 光动力疗法治疗寻常型痤疮的研究进展. 中国激光医学杂志. 2010, 19(3): 188-191.
  17. 王颖,杨慧兰. 光动力疗法在痤疮中的应用. 2009中华医学会第六次全国医学美学与美容学术年会

什么是激光疗法?

acne laser therapy machines 激光常用于治疗炎症性痤疮,根据痤疮的皮损和炎症程度可选择适当的能量密度和脉宽。这种治疗通常适用于炎症性的丘疹和脓包,对于非炎症性白头和黑头粉刺,以及比较严重的结节和囊肿并不是很有效[1]
激光治疗中采用的光源包括二极管激光、强脉冲光(IPL)、脉冲染料激光、点阵激光、红外线等[4,5],其中强脉冲光和脉冲染料激光有助于后期红色印痕的消退,点阵激光有助于改善痤疮瘢痕。

作用机制:

痤疮丙酸杆菌代谢产生光敏物质卟啉,而激光可以激活卟啉,产生光毒性反应,从而杀死痤疮细菌[3],同时,激光治疗也能够缩小皮脂腺并减少油脂分泌。有时医生也会应用外源性光敏剂配合激光进行治疗,比如在激光治疗前使用ALA(5-氨基酮戊酸)或MAL(甲基氨基酮戊酸),可以增加皮肤对激光的敏感性,也有助于产生更多的卟啉。[1,6-7,20]

疗效:

激光治疗可以使痤疮症状在一定程度上得到改善,不过,根据目前的研究,其效果并不持久,痤疮丙酸杆菌会很快再生。仅依靠激光治疗,很难完全清除痤疮,皮损的消除率从36%至83%不等。[2,10-19]

副作用:

治疗过程中,一些患者会出现疼痛或身体不适。根据使用激光的不同,患者可能会出现不同程度的红斑、发炎、脱皮、结痂、水疱等。另外,激光+ALA有可能导致色素沉着(皮肤变黑)和毛囊发炎。

需要注意的是,治疗结束后30小时,要严格避免阳光照射,以减小不良反应。[12]


  1. Orringer JS, et al. "Photodynamic therapy for acne vulgaris: A randomized, controlled, split-face clinical trial of topical aminolevulinic aid and pulsed dye laser therapy." Journal of Cosmetic Dermatology. 2010; 9(1): 28-34.
  2. "porphyrin." Encyclopedia Britannica. 2010. Encyclopedia Britannica Online. 29 Jan. 2010 <http://www.britannica.com/EBchecked/topic/470697/porphyrin>.
  3. Hamilton FL, et al. "Laser and other light therapies for the treatment of acne vulgaris: systematic review." British Journal of Dermatology. 2009; 160(6): 1273-85.
  4. Omi T, et al. "Ultrastructural evidence for thermal injury to pilosebaceous units during the treatment of acne using photopneumatic (PPX) therapy." Journal of Cosmetic and Laser Therapy. 2008; 10(1): 7-11.
  5. Boixeda P, Calvo M and Bagazgoitia L. "Recent advances in laser therapy and other technologies." Actas Dermo-Sifiliograficas. (2008); 99(4): 262-268.
  6. Yeung CK, et al. "Liposome-encapsulated 0.5% 5-aminolevulinic acid with intense pulsed light for the treatment of inflammatory facial acne: A pilot study." Dermatological Surgery. 2011; 37(4): 450-459.
  7. Haedersdal M, et al. "Long-pulsed dye laser versus long-pulsed dye laser-assisted photodynamic therapy for acne vulgaris: A randomized controlled trial." Journal of the American Academy of Dermatology. 2008; 58(3): 387-394.
  8. Shaaban D, Abdel-Samad-Z, El-Khalawany M. "Photodynamic therapy with intralesional 5-aminolevulinic acid and intense pulsed light versus intense pulsed light alone in the treatment of acne vulgaris: a comparative study." Dermatology and Therapy. 2012; 25(1): 86-91.
  9. Erceg A, et al. "The efficacy of pulsed dye laser treatment for inflammatory skin diseases: A systematic review." Journal of the American Academy of Dermatology. 2013; 69(4): 609-615.
  10. Kim BJ, et al. "Pilot study on photodynamic therapy for acne using indocyanine green and diode laser." Journal of Dermatology. 2009; 36(1): 17-21.
  11. Tzung TY, Wu KH and Huang ML. "Blue light phototherapy in the treatment of acne." Photodermatology, Photoimmunology & Photomedicine. 2004; 20(5): 266-9.
  12. Ross EV. "Optical treatments for acne." Dermatologic Therapy. 2005; 18(3): 253-66.
  13. Haedersdal M, Togsverd-Bo K and Wulf HC. "Evidence-based review of lasers, light sources and photodynamic therapy in the treatment of acne vulgaris." Journal of the European Academy of Dermatology and Venereology. 2008; 22(3): 267-278.
  14. Bowes LE, Manstein D, Anderson RR. "Effects of 532 nm KTP laser exposure on acne and sebaceous glands." Lasers in Surgery and Medicine. 2003; 18: S6-7.
  15. Seaton ED, et al. "Pulsed-dye laser treatment for inflammatory acne vulgaris: Randomised controlled trial." Lancet. 2003; 362: 1347-52.
  16. Elman M, Lask G. "The role of pulsed light and heat energy (LHE) in acne clearance." Journal of Cosmetic Laser Therapy. 2004; 6: 91-5.
  17. Prieto VG, Zhang PS, Sadick NS. "Evaluation of pulsed light and radiofrequency combined for the treatment of acne vulgaris with histological analysis of facial skin biopsies." Journal of Cosmetic Laser Therapy. 2005; 7: 63-8.
  18. Jung JY, et al. "Prospective randomized controlled clinical and histopathological study of acne vulgaris treated with dual mode of quasi-long pulse and Q-switched 1064-nm Nd:YAG laser assisted with a topically applied carbon suspension." Journal of the American Academy of Dermatology. 2012; 66(4): 626-33.
  19. Lee EJ, et al. "An open-label, split-face trial evaluating efficacy and safety of photopneumatic therapy for the treatment of acne." Annals of Dermatology. 2012; 24(3): 280-6.
  20. Lloyd Jr MM. "Selective photothermolysis of the sebaceous glands for acne treatment." Laser Surg Med. 2002; 31: 115-120.

Further Reading

  1. Borelli C, et al. "In vivo porphyrin production by P. acnes in untreated acne patients and its modulation by acne treatment." Acta Dermato-Venereologica. 2006; 86(4): 316-9.

什么是红蓝光疗法?

acne blue and red light

红蓝光疗法即采用红光或蓝光照射,通过杀灭细菌,消除炎症,并促进组织修复来达到治疗痤疮的目的。这种方法与光动力治疗(PDT)的区别在于,不使用外源性光敏剂,仅采用光线进行治疗。

这种治疗方法通常适用于常见的炎性丘疹和脓包,对于非炎性的黑头和白头粉刺,以及比较严重的结节和囊肿,则疗效较差。

作用机制:

红蓝光能够激活痤疮丙酸杆菌体内的代谢物卟啉,由内而外的杀死细菌[1-4],特定波长的光谱也能够抑制皮肤油脂的分泌,并减少炎症反应,促进皮损的愈合[5-6]

蓝光对卟啉的活化效果好,因此杀死痤疮丙酸杆菌的效用更强,但透皮深度较浅。红光对活化卟啉效果较弱,但对皮肤的穿透力强,透皮深度大于蓝光,因而对于深度皮损更有效,并且能更好的作用于皮脂腺并控制炎症。许多研究也尝试联合使用这两种光进行治疗。

疗效:

关于红蓝光治疗痤疮的研究数据有限,统计结果呈现出不同程度的疗效,对某些患者疗效不显著[9],而有些患者则达到了81%的痤疮消除率[10]。目前的研究多倾向于红蓝光疗效有限[11],至多达到中等程度的改善,痤疮症状可以得到暂时性改善,但疗效不持久。也有研究表明,红蓝光联合使用的疗效要优于单独使用蓝光的疗效。

副作用:

红蓝光治疗很少出现不良反应,只有对极其敏感的人群,可能会出现轻微的刺激或红斑。


  1. Ammad S, et al. "An assessment of the efficacy of blue light phototherapy in the treatment of acne vulgaris." Journal of Cosmetic Dermatology. 2008; 7(3): 180-8.
  2. Kjeldstad B. "Different photoinactivation mechanisms in Propionibacterium acnes for near-ultraviolet and visible light." Photochemistry and Photobiology. 1987; 46(3): 363-6.
  3. Dai T, et al. "Blue light for infectious diseases: Propinonibacterium acnes, Helicobacter pylori, and beyond?" Drug Resistance Update. 2012; 15(4): 223-36.
  4. Fabbrocini G, et al. "The effect of aminolevulinic acid photodynamic therapy on microcomedones and macrocomedones." Dermatology. 2009; 219(4): 322-328.
  5. Zane C, et al. "Non-invasive diagnostic evaluation of phototherapeutic effects of red light phototherapy of acne vulgaris." Photodermatology, Photoimmunology & Photomedicine. 2008; 24(5): 244-248.
  6. Young S., et al. "Macrophage responsiveness to light therapy." Lasers in Surgery and Medicine. 1989; 9: 497-505
  7. Webster GF. "Light and laser therapy for acne: Sham or science? Facts and controversies." Clinics in Dermatology. 2010; 28(1): 31-33.
  8. Sadick NS. "Handheld LED array device in the treatment of acne vulgaris." Journal of Drugs in Dermatology. 2008; 7(4): 347-350.
  9. Gold MH, et al. "Clinical efficacy of self-applied blue light therapy for mild-to-moderate facial acne." The Journal of Clinical and Aesthetic Dermatology. 2009; 2(3): 44-50).
  10. Goldberg DJ and Russell BA. "Combination blue (415 nm) and red (633 nm) LED phototherapy in the treatment of mild to severe acne vulgaris." Journal of Cosmetic and Laser Surgery. 2006; 8(2): 71-5.
  11. Hamilton FL, et al. "Laser and other light therapies for the treatment of acne vulgaris: systematic review." British Journal of Dermatology. 2009; 160(6): 1273-85.

0 个评论

要回复文章请先登录注册