Photorejuvenation induced by 5-aminolevulinic acid photodynamic therapy in patients with actinic keratosis: A histologic analysis Min Young Park, MD,

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Photorejuvenation induced by 5-aminolevulinic acid photodynamic therapy in patients with actinic keratosis: A histologic analysis Min Young Park, MD, Seonghyang Sohn, PhD, Eun-So Lee, MD, You Chan Kim, MD Journal of the American Academy of Dermatology Volume 62, Issue 1, Pages 85-95 (January 2010) DOI: 10.1016/j.jaad.2009.06.025 Copyright © 2009 American Academy of Dermatology, Inc. Terms and Conditions

Fig 1 Patient 9, with AK on the nose, before (A) and after (B) PDT.Patient showed complete clearance of lesion. Journal of the American Academy of Dermatology 2010 62, 85-95DOI: (10.1016/j.jaad.2009.06.025) Copyright © 2009 American Academy of Dermatology, Inc. Terms and Conditions

Fig 2 Patient 7. A, H&E-stained and (B) Masson-trichrome–stained specimens demonstrated up-regulated collagen fibers in upper dermis after PDT. Specimens on the left are before PDT; specimens on the right are after PDT. (Original magnification: ×200). Journal of the American Academy of Dermatology 2010 62, 85-95DOI: (10.1016/j.jaad.2009.06.025) Copyright © 2009 American Academy of Dermatology, Inc. Terms and Conditions

Fig 3 A, Staining with procollagen type I and (B) procollagen type III antibodies showed increased expression in skin sections after ALA-PDT (patient 10, lesion 1; original magnification: ×200). Specimens on the left are before PDT; specimens on the right are after PDT. C, Demonstration of 18.03% ± 16.41% and 11.50% ± 9.97% average increase in staining density of procollagen type I and type III, respectively (asterisk, P < .05). Journal of the American Academy of Dermatology 2010 62, 85-95DOI: (10.1016/j.jaad.2009.06.025) Copyright © 2009 American Academy of Dermatology, Inc. Terms and Conditions

Fig 4 A, TGF-β and (B) TβRII (patient 13, original magnification: ×200) were more expressed in the epidermis after ALA-PDT. Specimens on the left are before PDT; specimens on the right are after PDT. C, Mean staining with TGF-β and TβRII antibodies demonstrated a 23.57% ± 15.16% and 6.61% ± 9.56% average increase in staining density, respectively (asterisk, P < .05). Journal of the American Academy of Dermatology 2010 62, 85-95DOI: (10.1016/j.jaad.2009.06.025) Copyright © 2009 American Academy of Dermatology, Inc. Terms and Conditions

Fig 5 Patient 8. Mean expression of TGF-β, TβR II, procollagen I, procollagen III, and total collagen volume increased with each session of ALA-PDT. Journal of the American Academy of Dermatology 2010 62, 85-95DOI: (10.1016/j.jaad.2009.06.025) Copyright © 2009 American Academy of Dermatology, Inc. Terms and Conditions

Fig 6 Patient 8. Lesion 1. A, After ALA-PDT, solar elastosis was improved (H&E stain; original magnification: ×200) and (B) elastin fiber reorganization was more clearly recognized with Verhoeff's stain (same patient, original magnification: ×400). Specimens on the left are before PDT; specimens on the right are after PDT. Journal of the American Academy of Dermatology 2010 62, 85-95DOI: (10.1016/j.jaad.2009.06.025) Copyright © 2009 American Academy of Dermatology, Inc. Terms and Conditions

Fig 7 Patient 8. Lesion 2. A, Fibrillin-1 and (B) tropoelastin expression decreased in the dermis after treatment (original magnification: ×200). Specimens on the left are before PDT; specimens on the right are after PDT. C, Mean difference was 1.32 ± 0.90 and 0.56 ± 0.58 in the semiquantitative analysis, respectively (asterisk, P < .001). Journal of the American Academy of Dermatology 2010 62, 85-95DOI: (10.1016/j.jaad.2009.06.025) Copyright © 2009 American Academy of Dermatology, Inc. Terms and Conditions

Fig 8 After ALA-PDT, the degree of MMP-1, -3, and -12 expression was reduced by 0.60 ± 0.91, 0.64 ± 0.91, and 0.68 ± 1.14 in the semiquantitative analysis, respectively (asterisk, P < .05). Journal of the American Academy of Dermatology 2010 62, 85-95DOI: (10.1016/j.jaad.2009.06.025) Copyright © 2009 American Academy of Dermatology, Inc. Terms and Conditions