Enhanced Efficacy of Photodynamic Therapy after Fractional Resurfacing: Fractional Photodynamic Rejuvenation
August 2007 | Volume 6 | Issue 8 | Original Article | 818 | Copyright © August 2007
Ricardo Ruiz-Rodriguez MD PhD, Laura López MD, Daniel Candelas MD, Brian Zelickson MD
Background and Objectives: Conventional ablative resurfacing is the gold standard for removing signs of cutaneous
photodamage. Despite the excellent results one can achieve with this technique, it is accompanied with significant downtime
and risks. Fractional resurfacing and photodynamic therapy (PDT) with aminolevulinic acid (ALA) have been used
to improve the signs of photodamage with less downtime. However, independently they do not yield results as good as
ablative resurfacing. This pilot study will examine the potential for synergistic effects of combining fractional resurfacing
Materials and Methods: Four women with Fitzpatrick skin types II or III, mild to moderate rhytides and no actinic keratosis
in the perioral area were treated. The perioral area was treated with 2 sessions of fractional resurfacing with the Fraxel
SR (formerly Fraxel SR750, Reliant Technologies Inc, Palo Alto, CA) 3 weeks apart. Immediately after each fractional
treatment we applied methyl 5-aminolevulinate (MAL or Metvix) on one half of the perioral area and 3 hours later we
illuminated that area with a red light (Aktilite lamp, PhotoCure ASA, Oslo, Norway) in a dose of 37 J/cm2. Prior to treatment
and at 4 and 12 weeks after the final treatment, a blinded investigator evaluated each side of the perioral area and
rated the improvement from baseline as excellent, good, fair, or poor improvement of superficial wrinkles by comparing
the results with pretreatment photographs. Patients also completed an evaluation form assessing their satisfaction with the
treatment on each side of the perioral area while comparing the results with pretreatment photographs.
Results: The study showed increased improvement in superficial wrinkles in 3 out of 4 patients on the combined treatment
side. In one patient, the investigator found no significant difference when comparing both sides. All the patients noted greater
improvement in the combined fractional and PDT-treated side compared to the side only treated with fractional surfacing.
Conclusion: This pilot study shows a potential for enhanced clinical results when using combined fractional resurfacing and ALA-PDT compared to fractional resurfacing alone.