Demonstration of protoporphyrin IX (PpIX) localized to areas of palmar skin injected with 5-aminolevulinic acid (ALA) and pre-treated with a fractionated CO2 laser prior to topically applied ALA.

BACKGROUND: Several techniques designed to enhance ALA delivery into subcorneal layers of palmar skin are described.
METHODS: Six palms from three subjects were treated with topical ALA, iontophoresis enhanced delivery of ALA, intradermal injections of ALA solution, or fractionated CO(2) laser (with or without erbium:YAG surface ablation). The relative efficacy of each technique was determined using Wood's lamp illumination for the presence of fluorescent PpIX.
RESULTS: Palms treated with topically applied ALA alone or with iontophoresis pre-treatment failed to exhibit fluorescence. The palm treated with intradermal injections of ALA and the palms pre-treated with fractionated CO(2) laser with or without erbium:YAG laser surface ablation exhibited fluorescence at treatment areas.
CONCLUSION: Both intradermal injections and fractionated CO(2) laser (with or without erbium:YAG laser pre-treatment) may provide an effective means for delivery of ALA into subcorneal layers of palmar skin. Numerous potential clinical applications of these techniques (including treatment of localized palmar hyperhidrosis) exist. (c) 2010 Elsevier B.V. All rights reserved.