For over a century, PDT has been used to treat cutaneous neoplasia, and recently this application has been extended to include photoaging, the cutaneous manifestation of sun- induced aging to the skin. The current protocols in use involve the topical application of ALA for short incubation followed by blue light, LP PDL, or IPL. Among these light sources, the IPL is the best studied and most obvious choice, since it has well-demonstrated efficacy in photorejuvenation which is augmented with antecedent ALA application. Patients with AK and photoaging may be better candidates for topical ALA combined with either blue light or LP PDL, which appear to result in greater AK clearance per treatment as compared to IPL. Finally, with respect to side-effect profile, topical ALA followed by LP PDL or IPL appear to result in the fastest recovery in most cases, the former more
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(a) (b) Figure 21.3 Photorejuvenation with ALA and IPL. A patient prior to (A) and following a single treatment (B) with ALA 1-hour incubation and two passes of IPL (Aurora, Syneron) at optical fluence of 16 J/cm2, radiofrequency fluence of 18 J/cm2, and long pulse mode. Note the marked reduction in keratoses, erythema, and fine rhytides, with textural improvement. |
consistently so, and the latter more unpredictable in the extent of erythema and recovery. Long-term follow-up studies are needed in order to ascertain the long-term safety and proper maintenance treatment intervals in order to maintain the photorejuvenative results.