Photodynamic therapy: New treatment for recalcitrant Malassezia folliculitis

Abstract

BackgroundMalassezia folliculitis commonly has been treated with oral antifungal medications. However, it has many therapeutic weaknesses such as infection relapse, drug resistance, or adverse effects like hepatotoxicity and gastrointestinal discomfort. Hence, there remains an ongoing need for alternative treatments for recalcitrant Malassezia folliculitis. Recently, many dermatologists suggest photodynamic therapy (PDT) as an alternative therapeutic option for its antimicrobial effect.ObjectiveTo investigate the efficacy of methyl 5‐aminolevulinic acid (MAL)‐PDT for the treatment of recalcitrant Malassezia folliculitis.Materials and MethodsSix Korean patients aged 23–47 years with recalcitrant Malassezia folliculitis were enrolled in this study. The patients enrolled in this study either refused oral medication or were unable to take oral antifungal agents due to hepatotoxicity concerns. Thus, we offered these patients MAL‐PDT as an alternative treatment option. For all patients, photographs of the lesion(s) were taken prior to initiating treatment. MAL cream (Metvix®, Galderma, France) was applied to each lesion (located on the patients' trunks) and covered with an adhesive occlusive dressing polyurethane film (Tegaderm®, 3M Healthcare, St. Paul, MN). After 3 hours, the cream was wiped off and illumination was performed immediately thereafter with non‐coherent red light using light‐emitting diodes (Aktilite® lamp, PhotoCure, Oslo, Norway, average wavelength 630 nm, light dose 37 J/cm2). Illumination was performed for 7.5 minutes. Patients underwent totally three sessions of MAL‐PDT at 2‐week intervals. One month after the last PDT treatment, patients returned to the hospital and lesions were photographed.ResultsAfter three sessions of MAL‐PDT, inflammatory lesions had decreased and improved obviously in four patients, had improved slightly in one patient, and had not improved in one patient.ConclusionMAL‐PDT may be an effective treatment option for patients with recalcitrant Malassezia folliculitis. However, the data on MAL‐PDT are still limited, and additional controlled trials including multiple patients will be necessary to verify the results of this pilot study. Lasers Surg. Med. 42:192–196, 2010. © 2010 Wiley‐Liss, Inc.

Antimicrobial photodynamic therapy: an effective alternative approach to control fungal infections

“…In another clinical trial of 30 patients with onychomycosis, patients that received aPDT therapy combining ALA and red light (570–670 nm, dose of 40 J/cm 2 ) had a 43% cure rate at 12 months after the treatment and 37% remained disease free at 18 months (Sotiriou et al, 2010). Lee et al (2010) reported that four of six patients with recalcitrant Malassezia folliculitis demonstrated significant improvement after treatment with methyl 5-ALA (MAL)-PDT and red LED light (630 nm, light dose of 37 J/cm 2 ).…”

Concepts and Principles of Photodynamic Therapy as an Alternative Antifungal Discovery Platform

“…Patients underwent three sessions of MAL-PDT at 2-week intervals. One month after the last PDT treatment, patients returned to the hospital and lesions were photographed (Lee et al, 2010). After three sessions of MAL-PDT, inflammatory lesions had decreased and improved obviously in four patients, had improved slightly in one patient, and had not improved in one patient.…”

Microneedle Pre-treatment of Human Skin Improves 5-Aminolevulininc Acid (ALA)- and 5-Aminolevulinic Acid Methyl Ester (MAL)-Induced PpIX Production for Topical Photodynamic Therapy Without Increase in Pain or Erythema

“…Lately, a few articles concerning the use of MNs on human skin were published. However, the first study concerns not as much the use of MNs as about a new condition, Recalcitrant Malassezia Folliculitis (6). The second study, although about the use of MNs in PDT, has a few drawbacks.…”

“…Lately, several reports show the positive effect of PDT against bacteria, viruses, fungi and protozoa (3)(4)(5)(6). The major drawbacks of topical PDT are shallow penetration depth (<2 mm) of ALA and MAL and pain experienced during light exposure (2,(7)(8)(9).…”