Topical 5-aminolevulinic acid photodynamic therapy improved refractory acne conglobata and perifolliculitis capitis abscedens et suffodiens rather than hidradenitis suppurativa

Linglin Zhang,Zhongxia Zhou,Lei Shi,Zheng Huang,Yunfeng Zhang,Hongwei Wang,Peiru Wang,Guolong Zhang,Xiuli Wang

doi:10.1142/s1793545816400022

Abstract

Acne conglobata (AC), perifolliculitis capitis abscedens et suffodiens (PCAS) and hidradenitis suppurativa (HS) are uncommon refractory chronic, inflammatory, scarring diseases but cause serious damage to the quality of life. These three diseases are associated with follicular occlusion. Several studies indicated topical 5-aminolevulinic acid photodynamic therapy (ALA-PDT) improved follicular occlusion besides acne treatment. So we attempted to apply ALA-PDT to medicine resistant AC, PCAS and HS. Topical ALA-PDT was applied to 10 patients with AC, seven patients with PCAS and three patients with HS for more than three sessions. All the patients completed the dermatology life quality index (DLQI) questionnaire and were assessed for the efficacy at the baseline and on two weeks after each treatment. Adverse effects were recorded at each visit. The results showed 25.5% (5/20, two cases of AC and three cases of PCAS) of patients achieved excellent improvement after three sessions of PDT and another 60.0% (12/20, eight cases of AC and four cases of PCAS) of patients achieved good improvement. 15.0% (3/20, three cases of HS) got poor response ([Formula: see text] 20% lesions clearance). Another five cases (three cases of AC and two cases of PCAS) also achieved excellent response after 5–7 sessions of PDT. We also found that papular/nodular, cyst/abscess showed higher clearance rate than sinus/fistula (88.5%, 86.1% versus 11.1%). DLQI was reduced after three sessions of PDT in AC and PCAS patients rather than HS patients. 5-ALA-PDT could improve refractory AC and PCAS but could not lead to improvement in late stage of HS. The efficacy increased with more treatment sessions.

Highlights

Acne conglobata (AC), marked by suppuration, cysts, sinuses, and scarring on face and back, is a severe form of cystic acne that is most di±cult to manage
The key point of the di®erential diagnosis of these three diseases is the location: AC often occurrs in the back, chest and buttocks, Perifolliculitis capitis abscedens et su®odiens (PCAS) often occurrs on scalp and Hidradenitis suppurativa (HS) often occurrs in the armpits, groin and other apocrine gland rich areas.[4]
We evaluated 10 cases of AC, seven cases of PCAS and three cases of HS treated by aminolevulinic acid photodynamic therapy (ALA-PDT) in Shanghai Skin Disease Hospital from January 2009 to August 2011

Summary

Introduction

Acne conglobata (AC), marked by suppuration, cysts, sinuses, and scarring on face and back, is a severe form of cystic acne that is most di±cult to manage. The early and primary common event in AC, PCAS and HS was follicular occlusion in histology.[2] In 1956, Pillsbury, Shelley and Kligman coined the term \follicular occlusion triad" for the common association of AC, PCAS and HS.[3] This implied that the pathogenesis of these three diseases is similar and they can be treated with similar methods. These three types of diseases happened independently and a very small number of patients su®ered from all of them. We treated 10 cases of AC, seven cases of PCAS and three cases of HS and summarized our experience

Methods

Results

Conclusion