Il successo della terapia fotodinamica: una svolta nel trattamento dell'acne cistica grave
2025-03-26 15:56Esito del trattamento
Follow-up dopo 4 sedute di terapia fotodinamica (revisione a 2 mesi)Risoluzione significativa dell'acne cistica.
Non è stata osservata alcuna recidiva. 15 years old
Chief Complaint: Recurrent facial acne for three years, worsened over the past month.
Medical History
For the past three years, the patient experienced recurrent red follicular papules and comedones on the face, which were controlled with topical treatments. One month prior to consultation, the patient developed severe acne flare-ups accompanied by intermittent low-grade fever and joint pain. After intravenous cephalosporin administration, body temperature returned to normal, and facial acne showed slight improvement before the patient sought treatment at our dermatology department.
Clinical Examination
Physical Examination
Multiple inflammatory papules with visible pustules on the face.
Various sizes of red to dark red nodules and cysts with evident fluctuation and tenderness.
Coalescing lesions forming plaques with exudation and yellowish to brown scabs.
Laboratory Tests
| Test Date | WBC (×10^9/L) | NEUT% | NEUT (×10^9/L) | PLT (×10^9/L) | CRP (mg/L) |
|---|---|---|---|---|---|
| 2023.11.11 | 14.47 | 82.10% | 11.88 | 383 | 19.94 |
| 2023.11.27 | 13.64 | 77.50% | 10.59 | 345 | 8.69 |
Liver and kidney function: No abnormalities detected.
Diagnosis
Acne fulminans
Cystic acne
Treatment Plan
Photodynamic Therapy (PDT) Combined with Medications
1. Pre-Treatment Preparation
Povidone-iodine disinfection of the entire facial area.
Removal of surface scabs using a cotton swab.
Puncturing cysts and pustules with a syringe, followed by drainage of purulent contents.
Rolling needle therapy in subsequent sessions to enhance drug absorption.
2. Drug Preparation
Mixing 236 mg of 5-aminolevulinic acid (ALA) with 4 ml of thermosensitive gel to create a 5% ALA solution.
3. Drug Application and Occlusion
Even application of the ALA solution over all facial lesions.
Intracystic injection of ALA for cystic lesions.
Occlusion for 1 hour, followed by cleansing with water.
4. Light Exposure
Equipment: LED photodynamic therapy device (wavelength 633 ± 10 nm, power density 20-100 mW/cm²).
Distance: 10 cm from the nasal tip to the center of the light-emitting mask.
Initial power density: 60 mW/cm², gradually increased to 100 mW/cm².
Exposure time: 20 minutes per session.
5. Post-Treatment Care
Immediate cold compress for 20 minutes post-therapy.
Patients were advised to continue cold compresses, maintain hydration, and apply sun protection.
6. Combination Therapy
| Medication | Dosage | Duration/Adjustment |
| Minocycline | 100 mg, twice daily | Reduced to 50 mg, twice daily after 2 weeks |
| Triamcinolone | 24 mg, once daily | Reduced to 16 mg after 6 days, then gradually tapered off |
| Compound Glycyrrhizin Tablets | 3 tablets, three times daily | Ongoing |
| Fusidic Acid Cream & Hyaluronic Acid Gel | Topical application | Ongoing |
Treatment Outcome
Follow-Up After 4 Sessions of Photodynamic Therapy (2-Month Review)
Significant resolution of cystic acne.
No recurrence observed.