الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Acne vulgaris is a common skin disease that affects more than 85% of adolescents and often continues into adulthood. It affects persons between 11 and 30 years of age and up to 5% of older adults. For most patients, acne is characterized by the appearance of comedones, papules, pustules and nodules. For other less fortunate patients, the disease is associated with permanent disfiguring scars. Teenagers who suffer from acne are at risk of depression and anxiety.
The most notable pathophysiologic factors that influence the development of acne are [1] Sebaceous gland hyperplasia with seborrhea, [2] Altered follicular growth and differentiation, [3] Propionibacterium acnes colonization of the follicle, and [4] Inflammation and immune response.
The standard treatments for acne vulgaris include topical antimicrobials, topical retinoids, oral antibiotics, hormonal therapy and, in severe cases, oral isotretinoin. Topical treatments are often not sufficient in moderate to severe acne and the success rates of the oral treatments are limited due to antibiotic-resistant P. acnes strains and side-effects and teratogenicity of isotretinoin.
Therefore the development of alternative treatments is desirable. It is known that P. acnes produce porphyrins, particularly coproporphyrin III. Visible light is able to activate these porphyrins to produce a photodynamic reaction which has the potential to destroy bacteria. Aminolaevulinic acid (ALA) is known to be preferentially taken up by the pilosebaceous units. This is metabolized via the haem synthesis pathway to produce a build-up of protoporphyrin IX (PpIX), a potent photosensitizer. Once photoactivated by light, PpIX is excited into a triplet state with the subsequent production of singlet oxygen and free radicals. This causes damage particularly to mitochondria, nuclei and cell membranes. Therefore PDT could be beneficial in the treatment of acne by selectively damaging the pilosebaceous unit and killing P. acnes. As porphyrins have absorption peaks in the area of 510 nm to 578 nm, their excitation spectrum within the intense pulsed light (IPL) spectrum allows IPL to be used as a light source for PDT.
The aim of this work is to compare the efficacy and safety of photodynamic therapy using 5-aminolevulinic acid with intense pulsed light and intense pulsed light alone for the treatment of mild to moderate acne vulgaris.
This study included 25 patients of both sexes, aged 14-39 years old with mild to moderate acne involving their faces. The patients were divided into 2 groups, group I included 15 patients who received ALA –PDT using IPL, after 1-hr ALA, face was exposed to IPL. Group II included 10 patients who received IPL only. Both groups received 2 sessions at 2-week interval. The patients clinically evaluated on the second and eighth weeks after the last treatment.
The results showed reduction of inflammatory lesion counts .The mean reduction was 73.4% and 18.9 % in the PDT group and IPL group respectively at 8 weeks after the second treatment. There was significant difference between the 2 studied groups.
Side effects of the treatment included pain, erythema and hyperpigmentation .These side effects were transient. Generally treatment was well tolerated and all patients completed the study.
The present study revealed that both ALA-PDT with IPL as a light source and IPL alone are efficient and safe treatment modalities for acne vulgaris with superiority of ALA-PDT in reduction of inflammatory lesions and longer remission period.