Abstract
Objective: To perform a systematic review of available literature regarding the use of 5-aminolevulinic acid (ALA) and ALA derivative photodynamic therapy (PDT) in the treatment of hidradenitis suppurativa (HS) and provide recommendations on its use.
Methods: A systematic review was performed of all published studies up to September 1, 2019 from nine databases, including PubMed, that evaluated PDT in the treatment of HS. For each study, quality of evidence and risk of bias was evaluated. Recommendations from the body of evidence were created based on Strength of Recommendation and Taxonomy (SORT) criteria.
Results: Eighteen studies met inclusion criteria. The majority of studies had high risk of bias. Blue light PDT with 20% ALA and red light PDT with 16% methyl aminolevulinate (MAL) demonstrated some benefit based on a small number of poor quality studies with high risk of bias (Grade C, level III evidence). The most promising results were for 1-5% ALA with intralesional diode, with good to complete response in 78-94% of anatomic sites treated (Grade B, level II evidence). Limitations The majority of studies contained high levels of bias, with significant heterogeneity between studies. Conclusions are limited by small samples sizes, lack of randomized controlled trials, and differing protocols.
Conclusion: Further studies are needed to determine the clinical efficacy of 20% ALA with blue light and MAL with red light. Intralesional diode PDT shows the most promise and warrants further investigation in larger, randomized controlled trials.
Methods: A systematic review was performed of all published studies up to September 1, 2019 from nine databases, including PubMed, that evaluated PDT in the treatment of HS. For each study, quality of evidence and risk of bias was evaluated. Recommendations from the body of evidence were created based on Strength of Recommendation and Taxonomy (SORT) criteria.
Results: Eighteen studies met inclusion criteria. The majority of studies had high risk of bias. Blue light PDT with 20% ALA and red light PDT with 16% methyl aminolevulinate (MAL) demonstrated some benefit based on a small number of poor quality studies with high risk of bias (Grade C, level III evidence). The most promising results were for 1-5% ALA with intralesional diode, with good to complete response in 78-94% of anatomic sites treated (Grade B, level II evidence). Limitations The majority of studies contained high levels of bias, with significant heterogeneity between studies. Conclusions are limited by small samples sizes, lack of randomized controlled trials, and differing protocols.
Conclusion: Further studies are needed to determine the clinical efficacy of 20% ALA with blue light and MAL with red light. Intralesional diode PDT shows the most promise and warrants further investigation in larger, randomized controlled trials.
| Original language | English (US) |
|---|---|
| Journal | Photodermatology Photoimmunology and Photomedicine |
| DOIs | |
| State | Published - 2022 |
Bibliographical note
Funding Information:This material is based upon work supported in part by the Department of Veterans Affairs, Veterans Health Administration, Minneapolis, MN. The contents of this publication do not represent the views of the Department of Veterans Affairs or the United States Government.
Funding Information:
Sofiya Reshetylo, Shanthi Narla, Thomas Freeman have no conflicts of interest to report. Ronda Farah is an employee of the University of Minnesota Department of Dermatology, which has received equipment and funding from Syneron Candela. Iltefat Hamzavi is the president of the HS Foundation and has served as an advisory board member, investigator, and/or has received research funding from AbbVie, Pfizer Inc., Bayer, Lenicura, Incyte, UCB, HS Foundation, and Boehringer Ingelheim. Noah Goldfarb participates in clinical trials with Abbvie, Pfizer, Chemocentryx and Balter Medical and has served on advisory board for Novartis.
Publisher Copyright:
© 2022 The Authors. Photodermatology, Photoimmunology & Photomedicine published by John Wiley & Sons Ltd.
Keywords
- 5-aminolevulinic acid
- blue light
- hidradenitis suppurativa
- intense pulsed light
- intralesional diode
- methyl aminolevulinate
- photodynamic therapy
- pulsed dye laser
- red light
PubMed: MeSH publication types
- Journal Article
- Systematic Review