الفهرس 
SKIN AGINGOnly 14 pages are availabe for public view
Abstract
P
hotoaging does not make a person look less beautiful but also it with increases the risk of developing cutaneous benign and malignant neoplasms. Treatment of photoaged skin includes photoprotection, medications and procedures to reverse existing damage. Topical photodynamic therapy (PDT) has shown to be effective for the treatment of several aspects of skin ageing which includes improvement of fine wrinkles, mottled hyperpigmentation, tactile roughness and sallowness. The use of PDT for skin rejuvenation and cosmetic purposes has become an alternative therapeutic option since dermatologists, in several structured studies demonstrating a broad fading of thin wrinkles and clearance of solar lentigines in the PDT-exposed perilesional skin.
The study included 20 patients with photoaging (Grade I and II) using Glogau’s photoaging classification attending the Dermatology outpatient clinic of Ain Shams University Hospitals. Wrinkles on either side of patient’s face were treated with topical PDT using two different types of photosensitizers, ALA and liposome loaded MB. Each patient received two sessions. Skin biopsies were taken before intervention and 2 months after the second session to assess the degree of improvement.
Clinical photographic assessment of patients’ improvement in grading score of their wrinkles; in both the ALA and MB treated side, five out of twenty patients (25%) showed improvement by two grades, nine patients showed improvement by one grade (45%). Six out of the twenty patients (30%) had no grade change. There was no statistically significant difference between types of intervention as regard clinical photographic improvement. In both the ALA and MB treated side, four out of twenty patients (20%) reported that they had good response (51-75%), ten patients had fair response (26–50% improvement). Six out of the twenty patients (30%) had poor response. There was no statistically significant difference between types of intervention as regard patient satisfaction.
Histopathological examination was carried out pretreatment and three months after first session using H&E, Masson trichrome and Orcein stains. Compared to the pre-treatment state, both PS had a statistically significant increase in the epidermal thickness & collagen content. They were more significant on ALA side compared to MB. While changes in elastin content three months after first session was only significant on MB side.
There was no statistically significant difference between the two sides as regards the mean percentage of improvement in the epidermal thickness (P= 0.799), the collagen content (P= 0.242), and the elastin content (P= 0.002). There was no statistically significant difference in subgroup analysis as regard percentage of change of skin biopsy items after dividing the patients according to types of intervention in each subgroup of wrinkles individually.
There was no statistically significant difference between the two sides as regards the mean percentage of improvement in the epidermal thickness, the collagen content, and the elastin content. This means that no PS has significant superiority over the other on the histopathological level. However by expert pathologist analysis of biopsies there was apparent superiority of ALA in epidermal thickness and percentage of improvement in collagen content while, there was more improvement on MB side as regards elastin.
Photodynamic therapy (PDT) has been used widely, and with great success, for many off-label conditions, including its use in cosmetic dermatology, notably photorejuvenation. Improvement of skin condition involves different mechanisms involved in skin remodeling after PDT, such as cytokines induction, MMP expressions, solar elastosis reduction, and finally, collagen production.
The explanation of the relatively modest response in our study can be attributed to several reasons. The relatively young patient average age (48 years) and low Glagou scale grading with wrinkling as the only finding, with absence of photodamage on the molecular level, minimal elastosis was observed on histopathological level and negative p53 in all our patients. This can be explained further by Castano et al. (2004) who stressed on the concept of dual selectivity, where the accumulation of PS in normal tissue is minimal compared to diseased or tumor tissue.
Our study agrees with the previous studies done by other investigators using photosensitizers other than MB. Our results provide comparable results and further support the effectiveness of PDT in treatment of wrinkles thus photodynamic therapy can offer a good alternative as it provides better final cosmetic result with a non-invasive character.
Also there are advantages of using methylene blue instead of ALA as ALA is more expensive and needs longer contact time with the skin for 3-5 hours unlike methylene blue which is commercially available and needs 5-15 minutes contact with the skin. Also ALA may cause pain and erythema that last for at least 24 hours with residual skin pigmentation.
This study indicates that MB mediated PDT is safe, effective and an economic alternative to ALA in treatment of wrinkles.