PDL/ ALA combination is safe, effective for photorejuvenation

Grapevine, Texas - Aminolevulinic acid (ALA; Levulan, Dusa Pharmaceuticals) activated by a pulsed-dye laser (PDL) has shown efficacy against fine wrinkles and other signs of photodamage in the first study combining these modalities as a photoaging treatment, says an expert.

Based on previous studies, it's reasonable to expect that the combination of ALA and PDL would work as a photoaging treatment, says Christopher M. Hunzeker, M.D., a third-year resident in dermatology at New York University School of Medicine and the ALA-PDL study's lead author.

Previous studies

New study

However, Dr. Hunzeker says the study he co-authored - with Roy G. Geronemus, M.D., and Anne M. Chapas, M.D., of the Laser & Skin Surgery Center of New York - is "the first to examine whether combining ALA with PDL would be effective in treating fine-line wrinkles and additional signs of photodamage, including erythema, pigmentation and skin texture."

For the study, investigators enrolled 12 subjects ages 47 to 66 years with skin types I through III and class I through III facial rhytids. Physicians gave patients a total of three treatments spaced four weeks apart, with a total of four follow-up visits. The first was scheduled one week after the first treatment and the others at one month, three months and six months following the final treatment.

Before ALA application, patients underwent an acetone scrub of their entire faces. Next, they got two applications of topical ALA on half of the face, with a 45- to 60-minute incubation period. Researchers then treated them with a 595 nm PDL (Vbeam, Candela) operating at subpurpuric energy levels (6 to 8 J/cm² ) with a 10 ms pulse duration and a nonoverlapping 10 mm spot size. They gave each patient a single pass with the laser over the entire face.

In any study involving ALA, Dr. Hunzeker tells Dermatology Times, "One certainly must warn patients that they will experience mild to moderate erythema and extreme photosensitivity, and that they must be very cautious in avoiding the sun for 48 hours after treatment." To that end, investigators provided patients with a broad-spectrum sunscreen and instructions emphasizing the importance of sun avoidance following their treatment.

Analysis

Evaluation of results involved physicians' clinical assessments (using a five-point scale where zero = no improvement and four = greater than 75 percent improvement), along with blinded observers' assessments of digital photographs and patients' self-evaluations.

The study's primary endpoint was to examine fine lines, he continues, "and we did see an improvement with the combination of ALA-PDL over the side treated with PDL alone." Regarding crow's feet, blinded assessors noted an average improvement of 1.13 points on the facial sides treated with ALA-PDL versus an improvement of 0.83 on the side treated with PDL alone.

Likewise, when patients were asked to assess their own improvement in fine-line wrinkles at the study's conclusion, six said ALA-PDL achieved "some" improvement, three said the combined treatment achieved "mild" improvement, while one treated patient reported "marked" improvement. Two subjects said the combined treatment achieved no improvement, versus five who said PDL alone achieved no improvement.