Aminolevulinic Acid Plus IPL Recommended for Photoaging

LAKE BUENA VISTA, FLA. — The adjunctive use of aminolevulinic acid with intense pulsed light treatment appears to be more effective than the light therapy alone for the treatment of photoaging, said Ashish Bhatia, M.D., at the annual meeting of the American Society for Laser Medicine and Surgery.

Aminolevulinic acid (ALA) 20% topical solution is currently approved for the treatment of actinic keratoses of the face and scalp. "Many studies have suggested that the adjunctive use of ALA with intense pulsed light [IPL] can enhance the therapeutic effects of IPL used for photoaging," said Dr. Bhatia, a dermatologist in Naperville, Ill.

In a prospective study, 20 patients received treatment with ALA and IPL on one side of the face and IPL alone on the other. The trial was conducted at the facilities of SkinCare Physicians of Chestnut Hill in Boston.

Materials, equipment, and funding for the study were provided by DUSA Pharmaceuticals Inc., maker of Levulan Kerastick (ALA).

Patients underwent five treatments 3 weeks apart. The first three treatments were split face. For the ALA treatment, patients first underwent a vigorous acetone scrub. Once the ALA was applied, it remained in contact with the face for 30–60 minutes before being washed off. Both sides of the face were then treated with IPL. The final two treatments consisted of IPL alone.

A blinded investigator evaluated patients for five photodamage parameters—global photodamage, fine lines, mottled pigmentation, tactile roughness, and sallowness—prior to every treatment and 1 month of follow-up. Each parameter was rated on a 0–4 scale. Each patient also rated satisfaction for each side of the face at the end of the study. A blinded investigator was also asked to perform cosmetic evaluations at the end of the study.

Pretreatment with ALA resulted in significant improvement in global photodamage scores and in mottled pigmentation. Treatment with ALA resulted in significantly greater reductions of mottled pigmentation and fine lines (to low or imperceptible levels) than IPL alone.

Patient satisfaction was greater for the ALA combination treatment than it was for IPL alone. Likewise, the blinded investigator cosmetic evaluation was greater for the combination treatment than for IPL alone.

Both treatments were well tolerated, with very little difference between the two in terms of adverse effects, Dr. Bhatia said.