Photodynamic Therapy Success: A Breakthrough in Severe Cystic Acne Treatment

2025-03-26 15:56

Patient Background

Gender: Male
Age: 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