Study to Evaluate the Safety and Efficacy of BF-200 ALA (Ameluz®) and BF-RhodoLED® in the Treatment of Moderate to Severe Acne Vulgaris With Photodynamic Therapy in Adults

Inclusion Criteria:

1. Willingness and ability of the subject to provide informed consent and to sign theHealth Insurance Portability and Accountability Act (HIPAA) form. A study-specificinformed consent and HIPAA form must be obtained in writing prior to starting anystudy procedures. Minors under 18 years of age must be accompanied by the parent(s)or legal guardian(s) at the time of consent signing. The parent(s) or legalguardian(s) must also provide informed consent/HIPAA for the subject.

2. Subjects with moderate to severe acne on the face (IGA ≥3).

3. Presence of ≥20 inflammatory and ≥20 non-inflammatory (open and closed comedones)Acne vulgaris lesions on the face (should be located within not more than 2illumination areas) as assessed by investigator.

4. All sexes, ≥16 years of age.

5. Willingness and ability to comply with study procedures, particularly willingness toreceive up to 3 PDTs within 8 to 10 weeks.

6. Subjects with good general health or with clinically stable medical conditions willbe permitted to be included in the study.

7. Willingness to stop topical facial treatments other than medical cleansers (i.e.face washes etc.) at least 14 days prior to randomization visit (Visit 2, baseline)and discontinue medical cleansers in the face at least 1 week prior to randomizationvisit (Visit 2, baseline) and thereafter until the end of study (use of soap isallowed but the product used should not be changed during the study).

8. Females of reproductive potential must have a negative serum pregnancy test and mustuse an adequate and highly effective or two effective methods of contraceptionthroughout the study. (If hormonal contraception is used, the same product and doseshould be taken for at least 6 months before the first treatment and throughout theentire study.)

Exclusion Criteria:

1. Any known history of hypersensitivity to ALA, porphyrins or excipients of BF-200ALA.

2. History of soy or peanut allergy.

3. Subjects with sunburn or other possible confounding skin conditions (e.g. wounds,irritations, bleeding or skin infections) within or in close proximity (< 5 cmdistance) to treatment field. (Reassessment of subjects is allowed once if thesunburn or other confounding skin conditions is/are expected to resolve within thescreening period. Reassessment can be done on the day of the actual treatment.)

4. Clinical diagnosis of atopic dermatitis and other cutaneous conditions (e.g. lupuserythematosus), Bowen's disease, BCC, eczema, psoriasis, acne conglobate, acnefulminans, or secondary acne (steroid-induced acne, perioral dermatitis, acnerosacea), squamous cell carcinoma, other malignant or benign tumors in the treatmentfield.

5. Clinically significant (CS) medical conditions making implementation of the protocolor interpretation of the study results difficult or impairing subject's safety suchas:

6. Presence of photodermatoses or porphyria

7. Metastatic tumor or tumor with high probability of metastasis

8. Infiltrating skin neoplasia (suspected or known)

9. Unstable cardiovascular disease (New York Heart Association class III, IV)

10. Unstable hematologic (including Myelodysplastic syndrome), hepatic, renal,neurologic, or endocrine condition

11. Unstable collagen-vascular condition

12. Unstable gastrointestinal condition

13. Immunosuppressive condition

14. Presence of clinically significant inherited or acquired coagulation defect

15. Beard or other facial hair that might interfere with the study assessments unlesssubject agrees to be clean-shaven throughout the entire study period. (Reassessmentof subjects is allowed once if assessment of acne lesions is impaired by facial hairat screening. Reassessment can be performed on the day of the actual treatment).

16. Facial procedures such as dermabrasion, chemical or laser peels as well as exposureto UV radiation (other than sunlight) at least 4 weeks prior to randomization visit (Visit 2, baseline).

17. Presence of strong artificial pigmentation (e.g. tattoos) or any other abnormalitythat may impact lesion assessment or light penetration in the treatment field.

18. Suspicion of drug or alcohol abuse.

19. Any topical medication of the skin prior to screening as defined below:

20. Topical treatment with ALA or ALA-esters (e.g. MAL) or an investigational drugin- and outside the treatment field within 8 weeks prior to screening.

21. Topical treatment with immunosuppressive, cytostatic or cytotoxic drugs insidethe treatment field within 8 weeks prior to screening.

22. Start of a regular and continuous topical administration of medication withhypericin or other drugs with phototoxic or photoallergic potential inside thetreatment field within 4 weeks prior to screening. Subjects may, however, beeligible if such medication was regularly applied for more than 4 weeks priorto screening visit without evidence of an actual phototoxic/photoallergicreaction or if such medication is only administered for a limited time (e.g. anantibiotic)

23. Any use of the below specified systemic treatments within the designated periods:

24. Systemic acne therapy (oral antibiotics within 8 weeks or oral isotretinoinwithin 6 months or start with hormonal therapy for acne within 6 months priorto Visit 2).

25. Use of cytotoxic or cytostatic drugs within 6 months, or immunosuppressivetherapies or use of ALA or ALA-esters (e.g. MAL) within 12 weeks,investigational drugs or drugs known to have major organ toxicity within 8weeks, interferon or glycocorticosteroids (oral or injectable) within 6 weeksprior to screening.

26. Start of long-term intake of medication with hypericin or systemically actingdrugs with phototoxic or photoallergic potential within 8 weeks prior toscreening. Subjects may, however, be screened and randomized if such medicationwas taken in or was regularly applied for more than 8 weeks prior to screeningvisit without evidence of an actual phototoxic/photoallergic reaction or ifsuch a drug is only used for a limited time (e.g. an antibiotic).

27. Breast feeding women.

28. Subject unlikely to comply with protocol, e.g. inability to return for visits,unlikely to complete the study, or inappropriate in the opinion of the investigator.

29. Prior randomization in the study.

30. A member of study site staff or sponsor staff directly involved in the conduct ofthe protocol or a close relative thereof.

31. Simultaneous participation in a further clinical study.

32. Four or more nodular acne lesions on the face.

33. Unwillingness or inability to limit sun exposure for 48 hours post PDT treatment.

Dosing Day exclusion criteria:

1. Febrile or infectious disease within 7 days prior to PDT visits.

2. Subjects with sunburn, wounds, irritations, bleeding or other confounding skinconditions within illumination areas at PDT visits.

3. Application of topical glycocorticosteroids in- and outside the treatment fieldwithin 7 days prior to PDT visits

4. Administration of (topical or systemic) medication with phototoxic/photoallergicpotential for a limited time. After discontinuing the medication, a wash out periodof the medications 5-fold half-life time should be applied prior to the next PDT.