Effect of 5-Aminolevulinic Acid Photodynamic Therapy Followed by Sequential 30% Supramolecular Salicylic Acid Treatment in Moderate-to-severe Acne Vulgaris: a Prospective, Randomized, Split-face Controlled Study.

Background: 5-Aminolevulinic acid photodynamic therapy (ALA-PDT) is one of the effective treatments for moderate to severe acne, but is associated with adverse effects such as erythema and requires multiple sessions. Supramolecular salicylic acid (SSA) is a type of chemical peel with good anti-inflammatory effects and mild adverse effects. Combining the two is novel for the treatment of acne vulgaris.

Objective: The purpose of this study was to investigate the efficacy and safety of ALA-PDT followed by sequential 30% SSA treatment on moderate to severe acne vulgaris.

Methods: A total of 19 patients with moderate-to-severe acne vulgaris were enrolled in this prospective, randomized, split-face controlled study. The patients were treated once a week for a total of two treatments and followed up until 4 weeks after the final treatment.

Results: ALA-PDT followed by sequential 30% SSA treatment significantly reduces the number of lesions compared to ALA-PDT treatment, especially for comedones and papules without additional damage to the skin barrier. Despite transient mild pain reported by patients during SSA treatment, the protocol demonstrated significant attenuation of post ALA-PDT erythema and ultraviolet (UV)-induced dermal pigmentation clusters.

Conclusion: ALA-PDT followed by sequential 30% SSA enhances the efficacy of ALA-PDT in moderate-to-severe acne vulgaris and attenuates adverse effects partially.