The author presents a review of the current evidence on the use of topical photodynamic therapy (PDT) for treating papulopustular rosacea, initially with a brief overview of the aetiology of the disease and licensed treatment options, before exploring the context of the emerging off-label interest of topical photodynamic therapy for this condition. The mode of action of conventional treatment is discussed with a summary of the literature findings comparing aminolevulinic acid (ALA) and methyl-aminolevulinic acid (MAL) as the most commonly used photosensitiser drugs. The limited collection of off-label studies hypothesise that the mode of action in the context of treating rosacea is thought to be a destructive effect on the sebaceous glands and an immunomodulatory effect with red light demonstrating the most potent effect, compared to blue and pulsed light. The literature is consistent in pre-treatment considerations, but highly variable in the context of incubation times for off-label applications such as rosacea as standardised times have been based on licensed indications for non-melanoma skin cancers. The author recommends that oral ibuprofen may be taken before illumination, yet, there is currently no consensus to support this. Similar side-effects and aspects of post-treatment care are described in the context of PDT for rosacea, akin to conventional protocols, with emphasis placed on the need for further research for standardised treatment protocols.

Use of photodynamic therapy in the management of papulopustular rosacea.
Boxley S.
Anna Baker

BJN Aesthetic Nurse of the Year 2016.

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