5-Aminolevulinic Acid Photodynamic Therapy Versus Minocycline for moderate to severe rosacea: A single-center, randomized, evaluator-blind controlled study.

Background: 5-Aminolevulinic acid photodynamic therapy (ALA-PDT) showed potential to treat rosacea according to recent studies, but a lack of clinical evidence and unclear adverse effects limit its use.
Objective: To compare the effect of ALA-PDT versus minocycline for rosacea.
Methods: In this single-center, randomized, evaluator-blind, controlled study, patients with moderate to severe rosacea were allocated to receive 3 to 5 sessions of ALA-PDT or 8 weeks of 100 mg daily minocycline treatment, followed by a 24-week follow-up.
Results: Of all the 44 randomized patients, 41 received complete treatment (ALA-PDT 20, Minocycline 21). At the end of treatment, ALA-PDT showed non-inferior improvement of papulopustular lesions and Rosacea-related Quality of Life (RosaQoL) compared to minocycline (median reduction of lesion count: 19 vs. 22, median change of RosaQoL score: 0.48 vs. 0.53). The Clinician’s Erythema Assessment (CEA) success of ALA-PDT was lower than minocycline’s (35% vs. 67%). Demodex density and relapse rate were comparable in both groups. Erythema, mild pain and exudation were the most common adverse reactions of ALA-PDT.
Conclusion: As minocycline does, ALA-PDT can improve rosacea mainly in papulopustular lesions and patients’ quality of life, indicating a new option for rosacea.