Few patients may experience acne flare at the initiation of oral isotretinoin. The traditional therapy remains oral corticosteroids; however, in a particular patient subset, it may also be accompanied by side effects, such as metabolic disorder, inhibition of immune function, etc.

A report describes a case of a 25-year-old unmarried male who sought treatment for recurrent nodules and abscesses on his face, which had struck him over the past 10 years and worsened recently. He suffered from comedones, dense grain-size pustules accompanied by pain in his face with no clear inducement, which later grew into abscesses with a diameter of 0.5∼2 cm in the past 2 months. He received isotretinoin 0.5 mg/kg/day for 1 week at a community hospital and experienced dramatic acne flaring. 

He then showed up for evaluation and received a schedule for treatment with 5-aminolevulinic acid photodynamic therapy (ALA-PDT). He received an application of 5-ALA cream (5%) on all skin lesions and remained under a black plastic film for 2 hours, followed by exposure of the skin lesions to light-emitting diode (LED) PDT illumination with a wavelength of 633 ± 6 mm, a power density of 42 mW/cm², irradiation duration of 30 minutes for each light spot and a light dose of 75.6 J/cm², for each treated area. He received a total of seven treatments, which yielded complete clearance and excellent cosmetic results.  

Thus, ALA-PDT can be a novel therapeutic option for acne flare.

Source: Liu J, Shi L, Zhang L, et al. Acute acne flare following isotretinoin administration successfully treated by 5-aminolevulinic acid photodynamic therapy. Photodiagnosis Photodyn Ther. 2022;39:102893.