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Wu M, Huang X, Gao L, Zhou G, Xie F. The application of photodynamic therapy in plastic and reconstructive surgery. Front Chem 2022; 10:967312. [PMID: 35936104 PMCID: PMC9353173 DOI: 10.3389/fchem.2022.967312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
Photodynamic therapy (PDT) is a modern clinical treatment paradigm with the advantages of high selectivity, non-invasiveness, rare side-effect, no obvious drug resistance and easy combination with other therapies. These features have endowed PDT with high focus and application prospects. Studies of photodynamic therapy have been expanded in a lot of biomedical and clinical fields, especially Plastic and Reconstructive Surgery (PRS) the author major in. In this review, we emphasize the mechanism and advances in PDT related to the PRS applications including benign pigmented lesions, vascular malformations, inflammatory lesions, tumor and others. Besides, combined with clinical data analysis, the limitation of PDT and current issues that need to be addressed in the field of PRS have also been discussed. At last, a comprehensive discussion and outlooking represent future progress of PDT in PRS.
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Affiliation(s)
- Min Wu
- Department of Plastic and Reconstructive Surgery, School of Medicine, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University, Shanghai, China
- *Correspondence: Min Wu, ; Feng Xie,
| | - Xiaoyu Huang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Lu Gao
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Guoyu Zhou
- Department of Oral and Maxillofacial-Head Neck Oncology, School of Medicine, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Feng Xie
- Department of Plastic and Reconstructive Surgery, School of Medicine, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University, Shanghai, China
- *Correspondence: Min Wu, ; Feng Xie,
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Lonsdorf AS, Keller A, Hartmann J, Enk AH, Gholam P. Ablative Fractional Laser-assisted Low-irradiance Photodynamic Therapy for Treatment of Actinic Keratoses in Organ Transplant Recipients: A Prospective, Randomized, Intraindividual Controlled Trial. Acta Derm Venereol 2022; 102:adv00694. [PMID: 35356991 PMCID: PMC9558342 DOI: 10.2340/actadv.v102.1057] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Pain and inferior efficacy are major limiting factors of conventional photodynamic therapy for the field treatment of actinic keratoses in immunosuppressed organ transplant recipients. This prospective randomized controlled study evaluates the efficacy and tolerability of ablative fractional laser system pretreatment combined with low-irradiance photodynamic therapy (18.5 mW/cm2) compared with conventional photodynamic therapy (61.67 mW/cm2) in the treatment of actinic keratoses on the face and scalp in organ transplant recipients, using a red light-emitting diode lamp at a total light dose of 37 J/cm2. Low-irradiance photodynamic therapy combined with Er:YAG pretreatment achieved a significantly superior lesion response rate (mean ± standard deviation 77.3 ± 23.6%) compared with conventional photodynamic therapy (61.8 ± 21.4%; p = 0.025) in intra-individual fields at 3 months without negatively impacting pain (p = 0.777) or cosmetic outcome (p = 0.157).
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Affiliation(s)
- Anke S Lonsdorf
- Department of Dermatology, University Hospital Heidelberg, Germany.
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Field cancerization treatment: Adjustments to an ALA red light photodynamic therapy protocol to improve pain tolerance. Photodiagnosis Photodyn Ther 2021; 35:102415. [PMID: 34197970 DOI: 10.1016/j.pdpdt.2021.102415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 06/02/2021] [Accepted: 06/22/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Field cancerization (FC) is described as an area with multiple actinic keratosis (AK) in an actinic damaged skin that requires treatment. Photodynamic therapy (PDT) is a treatment option, however, long drug light intervals (DLI) and pain during the illumination remain a challenge OBJECTIVE: Pain and the efficacy of changes in DLI and illumination during PDT treatment for FC were evaluated METHODS: Thirty patients with widespread AK of upper limbs were selected. A 20% aminolevulinic acid (ALA) cream was applied on both forearms and hands after a light curettage. Three groups were evaluated: G1 (3 h of DLI); G2 (1.5 h of DLI); and, G3 (1.5 h of DLI with two-minutes pauses every 10 min during illumination). The limbs were treated with a LED prototype at 630 nm (36 J/cm2 of fluence in 40 min of irradiation). The pain score during illumination was evaluated with a numeric scale (from 0 to 10) and pain was defined as low (0-3), moderate (4-6), and severe (7-10). The AK counting was clinically performed before and 30 days after PDT. Significance between groups was tested using ANOVA single factor. RESULTS A mean reduction in AK number of 56% in G1, 55% in G2, and 66% in G3 were observed, with no statistical significance. The comparison pain among the groups showed best results for G3 (p < 0,05). CONCLUSION Using paused illumination and 1.5 h of DLI was possible to improve tolerance maintaining the clearance in red light ALA - PDT treatment.
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How Much Protoporphyrin IX Must Be Activated to Obtain Full Efficacy of Methyl Aminolevulinate Photodynamic Therapy? Implication for Treatment Modifications. Pharmaceuticals (Basel) 2021; 14:ph14040333. [PMID: 33917339 PMCID: PMC8067410 DOI: 10.3390/ph14040333] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 03/26/2021] [Accepted: 03/27/2021] [Indexed: 11/16/2022] Open
Abstract
Photodynamic therapy (PDT) with methyl aminolevulinate (MAL) is a popular treatment for actinic keratoses (AK), and several PDT treatment modalities with similar cure rates are in use. The effect relies on the activation of protoporphyrin IX (PpIX) in premalignant cells. This study aimed to measure PpIX during each treatment modality to determine the minimal PpIX activation and shortest exposure time for optimal cure rate. In four different treatment modalities, we established the PpIX formation up to three hours after MAL application without illumination and measured the speed of PpIX photoactivation during 9 min of red light (37 J/cm2). The level of PpIX three hours after MAL application was set to 100 PpIX units. In comparison, 85 PpIX units were formed during daylight PDT, 57 PpIX units during pulse PDT, and 52 PpIX units without any curettage prior to MAL. The activation of 50 PpIX units should, therefore, be enough to obtain a full effect on AK. Further, red light illumination may be shortened from 9 min to 1–2 min. The results indicate that PDT can be performed successfully with half the illumination time used in daylight PDT today and with one fourth of the illumination time used in classical PDT.
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Lee CN, Hsu R, Chen H, Wong TW. Daylight Photodynamic Therapy: An Update. Molecules 2020; 25:E5195. [PMID: 33171665 PMCID: PMC7664668 DOI: 10.3390/molecules25215195] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/02/2020] [Accepted: 11/04/2020] [Indexed: 12/17/2022] Open
Abstract
Daylight photodynamic therapy (dPDT) uses sunlight as a light source to treat superficial skin cancer. Using sunlight as a therapeutic device has been present for centuries, forming the basis of photodynamic therapy in the 20th century. Compared to conventional PDT, dPDT can be a less painful, more convenient and an effective alternative. The first clinical uses of dPDT on skin cancers began in Copenhagen in 2008. Currently, aminolevulinic acid-mediated dPDT has been approved to treat actinic keratosis patients in Europe. In this review article, we introduce the history and mechanism of dPDT and focus on the pros and cons of dPDT in treating superficial skin cancers. The future applications of dPDT on other skin diseases are expected to expand as conventional PDT evolves.
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Affiliation(s)
- Chaw-Ning Lee
- Department of Dermatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (C.-N.L.); (R.H.); (H.C.)
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng-Kung University, Tainan 704, Taiwan
| | - Rosie Hsu
- Department of Dermatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (C.-N.L.); (R.H.); (H.C.)
| | - Hsuan Chen
- Department of Dermatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (C.-N.L.); (R.H.); (H.C.)
| | - Tak-Wah Wong
- Department of Dermatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (C.-N.L.); (R.H.); (H.C.)
- Department of Biochemistry and Molecular Biology, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
- Center of Applied Nanomedicine, National Cheng Kung University, Tainan 701, Taiwan
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6
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Sharma A, Vincent L. Actinic keratosis area and severity index is not correlated with photodynamic therapy procedural pain. Photodiagnosis Photodyn Ther 2020; 31:101946. [PMID: 32795507 DOI: 10.1016/j.pdpdt.2020.101946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/20/2020] [Accepted: 07/31/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The Actinic Keratosis Area and Severity Index (AKASI) is a validated quantitative tool used to measure the severity of actinic keratoses. Given the success of AKASI in measuring outcomes and therapies related to actinic damage, we hypothesized that AKASI would be correlated to photodynamic therapy (PDT)-related pain. The aim of this study was to evaluate AKASI's correlation with PDT-associated pain for patients with AKs being treated with 5-Aminolevulinic acid (ALA) PDT. METHODS Thirty consecutive patients being treated for AKs with ALA PDT on the face and/or scalp were recruited from a single center. The AKASI of the treated areas were collected. The patient underwent a standard treatment with ALA-PDT for a total of 10 J/cm2 to treated area. Immediate post-procedural pain scores were measured using a visual-analog pain scale. Pain and AKASI scores were analyzed using Pearson's correlation coefficient. RESULTS AKASI was not correlated to pain score (Pearson correlation coefficient was 0.027, p = 0.87). In sub-group analyses, there was no strong correlation between the scalp AKASI or face AKASI and respective pain scores (p = 0.59 and p = 0.38, respectively). Furthermore, there was no strong correlation between the individual components of AKASI and pain score: distribution (p = 0.26), erythema (p = 0.66) and thickness (p = 0.43). CONCLUSION There is no correlation between the AKASI score and perceived pain from PDT. Therefore, the need for pain relief using a fan and evaporative cooling should be anticipated for all patients. We feel that this negative result is noteworthy as it supports mechanisms outside of AK destruction as the cause of immediate PDT-related pain.
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Morton CA, Szeimies RM, Basset-Séguin N, Calzavara-Pinton PG, Gilaberte Y, Haedersdal M, Hofbauer GFL, Hunger RE, Karrer S, Piaserico S, Ulrich C, Wennberg AM, Braathen LR. European Dermatology Forum guidelines on topical photodynamic therapy 2019 Part 2: emerging indications - field cancerization, photorejuvenation and inflammatory/infective dermatoses. J Eur Acad Dermatol Venereol 2019; 34:17-29. [PMID: 31805604 DOI: 10.1111/jdv.16044] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 10/24/2019] [Indexed: 12/12/2022]
Abstract
In addition to approved indications in non-melanoma skin cancer in immunocompetent patients, topical photodynamic therapy (PDT) has also been studied for its place in the treatment of, as well as its potential to prevent, superficial skin cancers in immune-suppressed patients, although sustained clearance rates are lower than for immune-competent individuals. PDT using a nanoemulsion of ALA in a daylight or conventional PDT protocol has been approved for use in field cancerization, although evidence of the potential of the treatment to prevent new SCC remained limited. High-quality evidence supports a strong recommendation for the use of topical PDT in photorejuvenation as well as for acne, refractory warts, cutaneous leishmaniasis and in onychomycosis, although these indications currently lack approvals for use and protocols remain to be optimized, with more comparative evidence with established therapies required to establish its place in practice. Adverse events across all indications for PDT can be minimized through the use of modified and low-irradiance regimens, with a low risk of contact allergy to photosensitizer prodrugs, and no other significant documented longer-term risks with no current evidence of cumulative toxicity or photocarcinogenic risk. The literature on the pharmacoeconomics for using PDT is also reviewed, although accurate comparisons are difficult to establish in different healthcare settings, comparing hospital/office-based therapies of PDT and surgery with topical ointments, requiring inclusion of number of visits, real-world efficacy as well as considering the value to be placed on cosmetic outcome and patient preference. This guideline, published over two parts, considers all current approved and emerging indications for the use of topical photodynamic therapy in Dermatology prepared by the PDT subgroup of the European Dermatology Forum guidelines committee. It presents consensual expert recommendations reflecting current published evidence.
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Affiliation(s)
- C A Morton
- Department of Dermatology, Stirling Community Hospital, Stirling, UK
| | - R-M Szeimies
- Department of Dermatology, Regensburg University Hospital, Regensburg, Germany.,Department of Dermatology & Allergology, Klinikum Vest GmbH, Recklinghausen, Germany
| | - N Basset-Séguin
- Department of Dermatology, Hôpital Saint Louis, Paris, France
| | | | - Y Gilaberte
- Department of Dermatology, Hospital Universitario miguel servet IIS Aragón, Zaragoza, Spain
| | - M Haedersdal
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - G F L Hofbauer
- Department of Dermatology, Zürich University Hospital, Zürich, Switzerland
| | - R E Hunger
- Department of Dermatology Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - S Karrer
- Department of Dermatology, Regensburg University Hospital, Regensburg, Germany
| | - S Piaserico
- Unit of Dermatology, Department of Medicine, University of Padova, Padova, Italy
| | - C Ulrich
- Skin Cancer Centre, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - A-M Wennberg
- Department of Dermatology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Zhao W, Shan XF, Wang CL, Liu XZ, Li Z, Xiao HL, Li ZW, Zheng RT, Hou JL, Tian HQ. Topical 5-aminolevulinic acid photodynamic therapy for intra anal-rectal warts. J DERMATOL TREAT 2019; 31:241-244. [PMID: 30990345 DOI: 10.1080/09546634.2019.1594670] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background: Condylomata acuminata (CA) are a common sexually transmitted disease. The recurrence rate of condyloma acuminatum using traditional treatments is higher than that of applying photodynamic therapy, and a variety of adverse reactions after treatment. At the same time, different parts of condyloma acuminatum after treatment recurrence rate is also different, especially for intra anal-rectal warts.Objective: To evaluate whether using photodynamic therapy (PDT) can effectively reduce recurrence of condylomata acuminata for intra anal-rectal warts.Methods: After the confirmation of the diagnosis of intra anal-rectal warts, the patients were treated with PDT with 5-aminolevulinic acid hydrochloride (ALA). PDT was performed with irradiation of 18-36 J/cm2 at an irradiance of 20-40 mW/cm2 with light-emitting diode (LED) light energy, wavelength 635 nm. We used a special PDT light equipment for intra anal-rectal area warts. PDT was repeated once every week for 4 weeks.Results: After PDT, the complete clearance rate was 76.1% (35 of 46 patients). At the end of the 12 weeks followed, recurrence occurred in five cases. We recorded pain in all 46 patients and the average visual analog scale (VAS) pain score was 6.96 ± 1.41 points.Conclusion: The treatment with PDT is effective in reducing the high rate of recurrence for intra anal-rectal warts. Pain is still a great challenge for the therapy.
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Affiliation(s)
- Wei Zhao
- Shandong Provincial Institute of Dermatology and Venereology, Shandong, China
| | - Xiao-Feng Shan
- Shandong Provincial Institute of Dermatology and Venereology, Shandong, China
| | - Chang-Liang Wang
- Shandong Provincial Institute of Dermatology and Venereology, Shandong, China
| | - Xin-Zhou Liu
- Shandong Provincial Institute of Dermatology and Venereology, Shandong, China
| | - Zhen Li
- Shandong Provincial Institute of Dermatology and Venereology, Shandong, China
| | - Hai-Lu Xiao
- Jining Medical College Affiliated Hospital of Jining Medical University, Jining, China
| | - Zhong-Wei Li
- Shandong Provincial Institute of Dermatology and Venereology, Shandong, China
| | - Rong-Tao Zheng
- Shandong Provincial Institute of Dermatology and Venereology, Shandong, China
| | - Jian-Ling Hou
- Shandong Provincial Institute of Dermatology and Venereology, Shandong, China
| | - Hong-Qing Tian
- Shandong Provincial Institute of Dermatology and Venereology, Shandong, China
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Hellen R, Nic Dhonncha E, Havelin A, Fleming L, Kavanagh A, Lally A, Kirby B, Moriarty B, Collins P. An audit of pain scores with conventional and white light topical 5-methyl aminolaevulinic acid photodynamic therapy for superficial basal cell carcinoma and squamous cell carcinoma in situ. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2019; 36:161-162. [PMID: 31613393 DOI: 10.1111/phpp.12521] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 09/16/2019] [Accepted: 10/12/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Rebecca Hellen
- Department of Dermatology, St. Vincent's University Hospital, Dublin 4, Ireland
| | - Eilis Nic Dhonncha
- Department of Dermatology, St. Vincent's University Hospital, Dublin 4, Ireland
| | - Alison Havelin
- Department of Dermatology, St. Vincent's University Hospital, Dublin 4, Ireland
| | - Louise Fleming
- Department of Dermatology, St. Vincent's University Hospital, Dublin 4, Ireland
| | - Ann Kavanagh
- Department of Dermatology, St. Vincent's University Hospital, Dublin 4, Ireland
| | - Aoife Lally
- Department of Dermatology, St. Vincent's University Hospital, Dublin 4, Ireland
| | - Brian Kirby
- Department of Dermatology, St. Vincent's University Hospital, Dublin 4, Ireland
| | - Blaithin Moriarty
- Department of Dermatology, St. Vincent's University Hospital, Dublin 4, Ireland
| | - Paul Collins
- Department of Dermatology, St. Vincent's University Hospital, Dublin 4, Ireland
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Successful Treatment of Adult-Onset Recurrent Respiratory Papillomatosis with CO 2 Laser and Photodynamic Therapy. Case Rep Otolaryngol 2019; 2019:7394879. [PMID: 31737395 PMCID: PMC6815980 DOI: 10.1155/2019/7394879] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 09/09/2019] [Indexed: 11/17/2022] Open
Abstract
Recurrent respiratory papillomatosis is a noninvasive benign epithelial tumor caused by human papillomavirus. Clinically, it featured rapid growth, multifocus, and frequent recurrence. Though a number of therapies have been investigated, the recurrence after treatment is always a challenge. In this report, we describe a 27-year-old male patient with recurrent respiratory papillomatosis who was treated with CO2 laser therapy followed by 5-aminolevulinic acid photodynamic therapy (ALA-PDT). There was no adverse reaction after treatment and no recurrence during the follow-up time.
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11
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What is the most relevent factor causing pain during ALA-PDT? A multi-center, open clinical pain score research trial of actinic keratosis, acne and condylomata acuminata. Photodiagnosis Photodyn Ther 2019; 26:73-78. [PMID: 30836211 DOI: 10.1016/j.pdpdt.2019.03.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 02/18/2019] [Accepted: 03/01/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND To date, it has been reported that the intrinsic factors(lesions location, lesions area, disease tynpes) and extrinsic factors(fluence rate) contribute to the pain during 5-aminolevulinic acid photodynamic therapy (ALA-PDT). But there are few studies on pain during ALA-PDT and lack of sufficient clinical evidence related to the pain intensity. OBJECTIVE To investigate pain intensity and its relative factors during ALA-PDT and to provide clinical implication. METHODS The pain numeric rating scale (PNRS) score was used to evaluate the patients' pain intensity at different times during ALA-PDT irradiation from 0 to 10 min during treatment. Gender, age, lesions location, lesions area, ALA concentration and fluence rate were recored. RESULTS The trial enrolled 274 patients in total, including 118 acne patients (in face), 30 actinic keratosis(AK)patients(in face), 126 Condylomatata acuminate patients(in genitalia). The average pain score in PDT was highest in the patients with actinic keratosis(7.3 ± 0.7), and that of condylomata acuminata was the lowest (4.5 ± 1.1) (p < 0.05). The highest pain score in patients with AK, acne and condylomata acuminata was 8, 6 and 6 respectively which occurred at 4 min, 4 min and 6 min respectively. The pain score of males was higher compared with females in all of the three diseases (p < 0.05). The pain score of facial diseases (5.6 ± 1.2) was higher than that of the genitalia (4.5 ± 1.1) (p < 0.05). The lesions area was positively correlated with the pain score (p < 0.05). In facial diseases, the pain score of patients with high fluence rate (7.3 ± 0.7) was higher than patients with low fluence rate (5.1 ± 0.9) (p < 0.05). CONCLUSIONS Intrinsic and extrinsic factors both correlate with pain during PDT. Intrinsic factors are difficult to change, so extrinsic factors are the key point to control. We can reduce the fluence rate and extend the treatment time, relieving pain intensity while still ensuring equivalent efficacy.
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Lydon E, Dawe R, Ibbotson S. Factors influencing pain and efficacy of topical photodynamic therapy: a retrospective study. Br J Dermatol 2018; 180:205-206. [DOI: 10.1111/bjd.17204] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- E. Lydon
- Photobiology Unit, Dermatology Department University of Dundee, Ninewells Hospital and Medical School Dundee DD1 9SY U.K
| | - R.S. Dawe
- Photobiology Unit, Dermatology Department University of Dundee, Ninewells Hospital and Medical School Dundee DD1 9SY U.K
| | - S.H. Ibbotson
- Photobiology Unit, Dermatology Department University of Dundee, Ninewells Hospital and Medical School Dundee DD1 9SY U.K
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13
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Ibbotson S, Wong T, Morton C, Collier N, Haylett A, McKenna K, Mallipeddi R, Moseley H, Rhodes L, Seukeran D, Ward K, Mohd Mustapa M, Exton L. Adverse effects of topical photodynamic therapy: a consensus review and approach to management. Br J Dermatol 2018; 180:715-729. [DOI: 10.1111/bjd.17131] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2018] [Indexed: 12/21/2022]
Affiliation(s)
- S.H. Ibbotson
- Photobiology Unit Department of Dermatology University of Dundee Ninewells Hospital and Medical School Dundee U.K
| | - T.H. Wong
- Stirling Community Hospital StirlingU.K
| | | | - N.J. Collier
- Photobiology Unit Dermatology Centre University of Manchester and Salford Royal NHS Foundation Trust ManchesterU.K
| | - A. Haylett
- Photobiology Unit Dermatology Centre University of Manchester and Salford Royal NHS Foundation Trust ManchesterU.K
| | - K.E. McKenna
- Department of Dermatology Belfast City Hospital BelfastU.K
| | - R. Mallipeddi
- St John's Institute of Dermatology Guy's and St Thomas’ NHS Foundation Trust London U.K
| | - H. Moseley
- Photobiology Unit Department of Dermatology University of Dundee Ninewells Hospital and Medical School Dundee U.K
| | - L.E. Rhodes
- Photobiology Unit Dermatology Centre University of Manchester and Salford Royal NHS Foundation Trust ManchesterU.K
| | | | | | | | - L.S. Exton
- British Association of Dermatologists London U.K
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Abstract
Topical photodynamic therapy (PDT) using daylight is effective in the treatment of actinic keratoses (AKs), offering the potential for treatment of large fields such as full face and balding scalp, but with minimal therapy-associated pain. Comparison with conventional PDT indicates similar efficacy for thin and moderate-thickness AKs, but with significantly less discomfort/pain, driving a patient preference for daylight-mediated PDT (DL-PDT) compared with conventional PDT using high-intensity office/hospital-based light sources. Treatment protocol involves the application of a photosensitizing agent without occlusion and subsequent exposure to ambient daylight within 30 min, with patients exposed to daylight for 1.5-2.0 h. Pivotal randomized controlled trials in Europe and Australia have confirmed the efficacy of methyl aminolevulinic acid (MAL) DL-PDT in comparison with conventional MAL-PDT for mild and moderate-thickness lesions on the face and scalp. Initial clearance rates of 70-89% are reported. DL-PDT using a nanoemulsion aminolevulinic acid (ALA) has recently been shown to be at least as effective as MAL DL-PDT in treating mild and moderate-thickness AKs. DL-PDT may offer a better-tolerated method for treating patients with extensive AK disease. There is emerging literature on the potential for field PDT to reduce the number of new AKs developing, potentially preventing/slowing skin cancer development. Conventional PDT remains established as a therapy for Bowen's disease (squamous cell carcinoma in situ), superficial and certain thin basal cell carcinomas (BCCs), and AKs. The evidence for the use of DL-PDT beyond AK is limited, although has been reported in actinic cheilitis, superficial BCC, and acne and cutaneous leishmaniasis. There is emerging interest in combination therapy for AK, using one or more field therapies such as DL-PDT as an option to complement with localized treatment for residual lesions. We review current recommendations and consider the appropriate place for DL-PDT in our treatment armamentarium.
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15
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Zhao W, Guan M, Nong X, Li Q, Chen Z. The safety and efficacy of daylight photodynamic therapy in the treatment of actinic keratoses: a systematic review and meta-analysis. Int J Dermatol 2018; 58:159-166. [PMID: 30198107 DOI: 10.1111/ijd.14211] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 06/20/2018] [Accepted: 08/07/2018] [Indexed: 11/30/2022]
Abstract
Daylight photodynamic therapy (DLPDT) is a novel therapeutic approach for actinic keratoses (AKs). This study aimed to evaluate the safety and efficacy of DLPDT in treating patients with AKs as compared to conventional photodynamic therapy (CPDT). PubMed, EMBASE, Web of Science, and the Cochrane Central Register of Controlled Trials were searched for relevant randomized controlled trials (RCTs) published before November 2017, based on the following search terms: "solar keratoses", "actinic keratoses", "photodynamic therapy", "daylight photodynamic therapy", "conventional photodynamic therapy", and "randomized". The complete response rate, patient satisfaction, and patient-reported pain after intervention with DLPDT or CPDT were primarily measured. Sensitivity analysis was conducted to determine the reliability of results. Begg's and Egger's tests were used to assess the likelihood of publication bias. Eight RCTs, comprising a total of 424 patients with AKs treated with DLPDT or CPDT, were included. No significant difference was found between the lesion response rate and the mean lesion response in a comparison of DLPDT and CPDT treatments. Generally, DLPDT was associated with higher patient satisfaction than CPDT. The patients who underwent DLPDT experienced less pain than those who underwent CPDT. Most of our results were of high stability and low sensitivity. Meanwhile, no statistical evidence of publication bias among studies was found under all comparisons. In conclusion, DLPDT is a safe and effective therapy, which could help in selecting the most appropriate therapeutic method for treating AKs and in guiding physicians to optimize treatment strategies.
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Affiliation(s)
- Weijia Zhao
- Department of Dermatology, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, China
| | - Meng Guan
- Department of Ophthalmology, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, China
| | - Xiang Nong
- Department of Dermatology, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, China
| | - Qian Li
- Department of Dermatology, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, China
| | - Zonghan Chen
- Office of Educational Administration, Yunnan University of Traditional Chinese Medicine, Kunming, Yunnan Province, China
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Development of Novel Photosensitizer Using the Buddleja officinalis Extract for Head and Neck Cancer. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2018; 2018:6917590. [PMID: 30026781 PMCID: PMC6031164 DOI: 10.1155/2018/6917590] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 04/21/2018] [Accepted: 05/22/2018] [Indexed: 11/22/2022]
Abstract
Photodynamic therapy (PDT) is generally safer and less invasive than conventional strategies for head and neck cancer treatment. However, currently available photosensitizers have low selectivity for tumor cells, and the burden and side effects are so great that research is needed to develop safe photosensitizers. In this study, it was confirmed that the Buddleja officinalis (BO) extract, used in the treatment of inflammation and vascular diseases, shows fluorescence when activated by LED light, and, based on this, we aimed to develop a new photosensitive agent suitable for PDT. MTT, Diff-Quick® staining, and DCF-DA were performed to measure the effects of treating head and neck cancer cells with BO extract and 625 nm LED light (BO-PDT). Cell cycle, TUNEL, and western blot assays, as well as acridine orange staining, were performed to explore the mechanism of BO-PDT-induced cell death. We found that when the BO extract was irradiated with 625 nm LED light, it showed sufficient fluorescence and stronger intracellular toxicity and ROS effect than the currently commercially available hematoporphyrin. BO-PDT resulted in a decrease of mTOR activity that was correlated with an increase in the levels of ATG5, beclin-1, and LC3-II, which interfere with the formation of autophagosomes. In addition, BO-PDT induced the activation of PARP and led to an increase in the expression of proapoptotic protein Bax and a decrease in the expression of the antiapoptotic protein Bcl-2. Moreover, BO-PDT has been shown to induce the autophagy pathway 4 h after treatment, while apoptosis was induced 16 h after treatment. Finally, we confirmed that BO-PDT caused cell death of head and neck cancer cells via the intrinsic pathway. Therefore, we suggest that BO extract can be used as a new photosensitizer in PDT of head and neck cancer.
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Abstract
Photodynamic therapy (PDT) is a well-established, non-invasive treatment for a variety of dermatologic disorders, including actinic keratosis. Furthermore, PDT results in marked improvements in the signs of skin aging, although currently there are no standardized guidelines for PDT in skin rejuvenation. Two types of PDT are available: conventional-PDT (c-PDT) and the newly introduced daylight-PDT (DL-PDT). Both require a topical photosensitizer, a light source and oxygen, and both are comparable regarding safety and efficacy for treatment of photo-induced skin aging. Treatment is particularly effective for improvement of fine wrinkles, skin roughness, actinic elastosis and mottled hyperpigmentation. The most widely studied topical sensitizers used in PDT are 5-aminolevulinic acid (ALA) and methyl aminolevulinate (MAL). A range of pre-treatment procedures help improve skin absorption of the photosensitizer and lead to significantly improved efficacy. A variety of activating light sources can be used for c-PDT, while DL-PDT uses natural daylight, making it easier to treat larger areas of photodamaged skin. A major limitation of c-PDT is significant treatment-related pain, but DL-PDT has proved to be an almost pain-free procedure. Treatment duration is based on individual patient need but most patients receive 2 to 3 treatment cycles, with results fully evident 3-6 months post-treatment. PDT for aesthetic-cosmetic treatments has established its value in modern procedural dermatology as mono- or combination therapy. A major, unique advantage of PDT is that it is a non-invasive treatment that effectively rejuvenates photodamaged skin, while successfully treating a range of dermatologic conditions, including prevention and therapy of pre-cancerous actinic keratosis.
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18
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Dobson J, de Queiroz GF, Golding JP. Photodynamic therapy and diagnosis: Principles and comparative aspects. Vet J 2018; 233:8-18. [DOI: 10.1016/j.tvjl.2017.11.012] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 08/22/2017] [Accepted: 11/21/2017] [Indexed: 12/16/2022]
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19
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Early and Late Onset Side Effects of Photodynamic Therapy. Biomedicines 2018; 6:biomedicines6010012. [PMID: 29382133 PMCID: PMC5874669 DOI: 10.3390/biomedicines6010012] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 01/20/2018] [Accepted: 01/25/2018] [Indexed: 01/06/2023] Open
Abstract
Photodynamic Therapy (PDT) is a non-invasive treatment successfully used for neoplastic, inflammatory and infectious skin diseases. One of its strengths is represented by the high safety profile, even in elderly and/or immuno-depressed subjects. PDT, however, may induce early and late onset side effects. Erythema, pain, burns, edema, itching, desquamation, and pustular formation, often in association with each other, are frequently observed in course of exposure to the light source and in the hours/days immediately after the therapy. In particular, pain is a clinically relevant short-term complication that also reduces long-term patient satisfaction. Rare complications are urticaria, contact dermatitis at the site of application of the photosensitizer, and erosive pustular dermatosis. Debated is the relationship between PDT and carcinogenesis: the eruptive appearance of squamous cell carcinoma (SCC) in previously treated areas has been correlated to a condition of local and/or systemic immunosuppression or to the selection of PDT-resistant SCC. Here we review the literature, with particular emphasis to the pathogenic hypotheses underlying these observations.
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Dantas Silva LAS, da Cruz de Jesus RL, Fiuza-Junior RA, Andrade HMC, Rigoli IC, de Assunção RMN, Barichello JM, de Lima RG. Aloe vera gel influence on the micellization behavior of copolymer Pluronic F127: A potential photosensitizer carrier for topical application. J Appl Polym Sci 2018. [DOI: 10.1002/app.46191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
| | | | | | | | | | | | - José Mario Barichello
- Laboratório de Tecnologia Farmacêutica, CCQFA; Universidade Federal de Pelotas, Campus Capão do Leão S/N; Pelotas 96900-010 Rio Grande do Sul Brazil
| | - Renata Galvão de Lima
- Faculdade de Ciências Integradas do Pontal; Universidade Federal de Uberlândia; Ituiutaba 38304-402 Minas Gerais Brazil
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21
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Ang JM, Riaz IB, Kamal MU, Paragh G, Zeitouni NC. Photodynamic therapy and pain: A systematic review. Photodiagnosis Photodyn Ther 2017; 19:308-344. [DOI: 10.1016/j.pdpdt.2017.07.002] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 06/08/2017] [Accepted: 07/06/2017] [Indexed: 01/23/2023]
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22
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Wang B, Shi L, Zhang Y, Zhou Q, Zheng J, Szeimies R, Wang X. Gain with no pain? Pain management in dermatological photodynamic therapy. Br J Dermatol 2017; 177:656-665. [PMID: 28122416 DOI: 10.1111/bjd.15344] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2016] [Indexed: 12/30/2022]
Affiliation(s)
- B. Wang
- Department of Dermatology Ruijin Hospital School of Medicine Shanghai Jiaotong University Shanghai China
| | - L. Shi
- Institute of Photomedicine Shanghai Skin Disease Hospital Tongji University School of Medicine 1278 Baode Road Shanghai 200443 China
| | - Y.F. Zhang
- Institute of Photomedicine Shanghai Skin Disease Hospital Tongji University School of Medicine 1278 Baode Road Shanghai 200443 China
| | - Q. Zhou
- Institute of Photomedicine Shanghai Skin Disease Hospital Tongji University School of Medicine 1278 Baode Road Shanghai 200443 China
| | - J. Zheng
- Department of Dermatology Ruijin Hospital School of Medicine Shanghai Jiaotong University Shanghai China
| | - R.M. Szeimies
- Department of Dermatology and Allergology Vest Clinic Recklinghausen Germany
| | - X.L. Wang
- Institute of Photomedicine Shanghai Skin Disease Hospital Tongji University School of Medicine 1278 Baode Road Shanghai 200443 China
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23
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Hambly RA, Mansoor N, Quinlan C, Shah Z, Lenane P, Ralph N, Moloney FJ. Factors predicting pain and effect of oral analgesia in topical photodynamic therapy. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2017; 33:176-179. [PMID: 28196277 DOI: 10.1111/phpp.12301] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/06/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Roisin A Hambly
- Department of Dermatology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Nazish Mansoor
- Department of Dermatology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Catherine Quinlan
- Department of Dermatology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Zahra Shah
- Department of Dermatology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Patsy Lenane
- Department of Dermatology, Mater Misericordiae University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - Nicola Ralph
- Department of Dermatology, Mater Misericordiae University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - Fergal J Moloney
- Department of Dermatology, Mater Misericordiae University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
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24
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Indole 3-acetic acid-photodynamic therapy in the treatment of multiple actinic keratoses: A proof of concept pilot study. Photodiagnosis Photodyn Ther 2016; 16:17-22. [DOI: 10.1016/j.pdpdt.2016.08.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 07/31/2016] [Accepted: 08/17/2016] [Indexed: 01/09/2023]
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25
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Fonda-Pascual P, Moreno-Arrones OM, Alegre-Sanchez A, Saceda-Corralo D, Buendia-Castaño D, Pindado-Ortega C, Fernandez-Gonzalez P, Velazquez-Kennedy K, Calvo-Sánchez MI, Harto-Castaño A, Perez-Garcia B, Bagazgoitia L, Vaño-Galvan S, Espada J, Jaen-Olasolo P. In situ production of ROS in the skin by photodynamic therapy as a powerful tool in clinical dermatology. Methods 2016; 109:190-202. [PMID: 27422482 DOI: 10.1016/j.ymeth.2016.07.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 07/10/2016] [Accepted: 07/11/2016] [Indexed: 11/17/2022] Open
Abstract
Photodynamic therapy (PDT) is a clinical modality of photochemotherapy based on the accumulation of a photosensitizer in target cells and subsequent irradiation of the tissue with light of adequate wavelength promoting reactive oxygen species (ROS) formation and cell death. PDT is used in several medical specialties as an organ-specific therapy for different entities. In this review we focus on the current dermatological procedure of PDT. In the most widely used PDT protocol in dermatology, ROS production occurs by accumulation of the endogenous photosensitizer protoporphyrin IX after treatment with the metabolic precursors 5-methylaminolevulinic acid (MAL) or 5-aminolevulinic acid (ALA). To date, current approved dermatological indications of PDT include actinic keratoses (AK), basal cell carcinoma (BCC) and in situ squamous cell carcinoma (SCC) also known as Bowen disease (BD). With regards to AKs, PDT can also treat the cancerization field carrying an oncogenic risk. In addition, an increasing number of pathologies, such as other skin cancers, infectious, inflammatory or pilosebaceous diseases are being considered as potentially treatable entities with PDT. Besides the known therapeutic properties of PDT, there is a modality used for skin rejuvenation and aesthetic purposes defined as photodynamic photorejuvenation. This technique enables the remodelling of collagen, which in turn prevents and treats photoaging stygmata. Finally we explore a new potential treatment field for PDT determined by the activation of follicular bulge stem cells caused by in situ ROS formation.
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Affiliation(s)
- Pablo Fonda-Pascual
- Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Grupo de Dermatología Experimental y Biología Cutánea, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Oscar M Moreno-Arrones
- Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Grupo de Dermatología Experimental y Biología Cutánea, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Adrian Alegre-Sanchez
- Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Grupo de Dermatología Experimental y Biología Cutánea, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - David Saceda-Corralo
- Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Grupo de Dermatología Experimental y Biología Cutánea, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | | | | | - Kyra Velazquez-Kennedy
- Grupo de Dermatología Experimental y Biología Cutánea, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - María I Calvo-Sánchez
- Grupo de Dermatología Experimental y Biología Cutánea, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | | | - Lorea Bagazgoitia
- Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Grupo de Dermatología Experimental y Biología Cutánea, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Sergio Vaño-Galvan
- Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Grupo de Dermatología Experimental y Biología Cutánea, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Jesus Espada
- Laboratorio de Bionanotecnolgía, Universidad Bernardo ÓHiggins, Santiago, Chile.
| | - Pedro Jaen-Olasolo
- Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Madrid, Spain.
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Sanclemente G, Mancilla G, Hernandez G. A double-blind randomized controlled trial to assess the efficacy of daylight photodynamic therapy with methyl-aminolevulinate vs. Placebo and daylight in patients with facial photodamage. ACTAS DERMO-SIFILIOGRAFICAS 2016. [DOI: 10.1016/j.adengl.2015.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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27
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Sanclemente G, Mancilla GA, Hernandez G. A double-blind randomized controlled trial to assess the efficacy of daylight photodynamic therapy with methyl-aminolevulinate vs. Placebo and daylight in patients with facial photodamage. ACTAS DERMO-SIFILIOGRAFICAS 2015; 107:224-34. [PMID: 26643786 DOI: 10.1016/j.ad.2015.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 10/02/2015] [Accepted: 10/12/2015] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Daylight PDT (dPDT) is easy to use and does not require light equipment. Such therapy has been exhaustively proved to be successful in the treatment of actinic keratosis, but its use in skin photodamage remains unclear. OBJECTIVE To evaluate dPDT's efficacy in skin facial photodamage. PATIENTS AND METHODS This was a parallel-group double-blind, randomized placebo-controlled trial. Sixty participants with symmetric facial photodamage were allocated to topical methyl aminolevulinate (MAL) and daylight vs. matching placebo and daylight. Primary outcome was global photodamage improvement/failure 1 month after the third session. Secondary outcomes included: pain evaluation; specific photodamage severity scores; sun irradiance quantification and Skindex-29 scores. Adverse events were also investigated. RESULTS Primary analysis included all randomized patients. All patients sun-exposed for 120min in 3 sessions. The risk of failure was lower in the MAL-dPDT group than in the placebo plus daylight group (RR: 0.18; 95% CI: 0.08-0.41). Mean solar irradiance (W/m(2)) during the first, second and third sessions was 480.82, 430.07 and 435.84, respectively. Items 5 and 14 of Skindex-29 in the MAL-dPDT group showed statistical significant differences. Two patients in the MAL-dPDT group had serious and non-serious events not directly related to the product. CONCLUSION dPDT with MAL was un-painful, effective and safe for the treatment of facial photodamage. Herpes simplex prophylaxis should be considered before sessions.
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Affiliation(s)
- G Sanclemente
- IPS Universitaria, Universidad de Antioquia, Medellín, Colombia; Grupo de Investigación Dermatológica (GRID), Instituto de Investigaciones Médicas, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.
| | - G A Mancilla
- Grupo de Investigación Dermatológica (GRID), Instituto de Investigaciones Médicas, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - G Hernandez
- Grupo de Investigación Dermatológica (GRID), Instituto de Investigaciones Médicas, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
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28
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Philipp-Dormston W, Sanclemente G, Torezan L, Tretti Clementoni M, Le Pillouer-Prost A, Cartier H, Szeimies R, Bjerring P. Daylight photodynamic therapy with MAL cream for large-scale photodamaged skin based on the concept of ‘actinic field damage’: recommendations of an international expert group. J Eur Acad Dermatol Venereol 2015; 30:8-15. [DOI: 10.1111/jdv.13327] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 07/01/2015] [Indexed: 01/05/2023]
Affiliation(s)
| | - G. Sanclemente
- Group of Investigative Dermatology (GRID); School of Medicine; University of Antioquia; Medellín Colombia
| | - L. Torezan
- Faculty of Medicine; Hospital das Clinicas; Universidade de Sao Paulo; Sao Paulo Brazil
| | | | | | | | - R.M. Szeimies
- Department of Dermatology and Allergology; Vest Clinic; Recklinghausen Germany
| | - P. Bjerring
- Department of Dermatology; Molholm Hospital; Vejle Denmark
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Fink C, Enk A, Gholam P. Photodynamic therapy--aspects of pain management. J Dtsch Dermatol Ges 2015; 13:15-22. [PMID: 25640485 DOI: 10.1111/ddg.12546] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Topical photodynamic therapy (PDT) is a highly effective and safe treatment method for actinic keratoses with an excellent cosmetic outcome and is commonly used for the therapy of large areas of photodamaged skin with multiple clinically manifest and subclinical lesions. However, the major drawback of photodynamic therapy is the pain experienced during the treatment that can be intense and sometimes even intolerable for patients, requiring interruption or termination of the process. Several strategies for controlling pain during photodynamic therapy have been studied but few effective methods are currently available. Therefore, this review puts the spotlight on predictors on pain intensity and aspects of pain management during photodynamic therapy.
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Affiliation(s)
- Christine Fink
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
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30
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Affiliation(s)
- R.S. Dawe
- Photobiology Unit; Department of Dermatology; Ninewells Hospital and Medical School; Dundee DD1 9SY U.K
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31
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Klein A, Karrer S, Horner C, Werner A, Heinlin J, Zeman F, Koller M, Landthaler M, Szeimies RM, Gruber M, Graf B, Hansen E, Kerscher C. Comparing cold-air analgesia, systemically administered analgesia and scalp nerve blocks for pain management during photodynamic therapy for actinic keratosis of the scalp presenting as field cancerization: a randomized controlled trial. Br J Dermatol 2015; 173:192-200. [DOI: 10.1111/bjd.13547] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2014] [Indexed: 01/02/2023]
Affiliation(s)
- A. Klein
- Department of Dermatology; University Hospital Regensburg; Regensburg Germany
| | - S. Karrer
- Department of Dermatology; University Hospital Regensburg; Regensburg Germany
| | - C. Horner
- Department of Anaesthesiology; University Hospital Regensburg; Regensburg Germany
| | - A. Werner
- Department of Dermatology; University Hospital Regensburg; Regensburg Germany
| | - J. Heinlin
- Department of Dermatology; University Hospital Regensburg; Regensburg Germany
| | - F. Zeman
- Department of Centre for Clinical Studies; University Hospital Regensburg; Regensburg Germany
| | - M. Koller
- Department of Centre for Clinical Studies; University Hospital Regensburg; Regensburg Germany
| | - M. Landthaler
- Department of Dermatology; University Hospital Regensburg; Regensburg Germany
| | - R.-M. Szeimies
- Department of Dermatology; University Hospital Regensburg; Regensburg Germany
| | - M. Gruber
- Department of Anaesthesiology; University Hospital Regensburg; Regensburg Germany
| | - B. Graf
- Department of Anaesthesiology; University Hospital Regensburg; Regensburg Germany
| | - E. Hansen
- Department of Anaesthesiology; University Hospital Regensburg; Regensburg Germany
| | - C. Kerscher
- Department of Anaesthesiology; University Hospital Regensburg; Regensburg Germany
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A prospective study of pain control by a 2-step irradiance schedule during topical photodynamic therapy of nonmelanoma skin cancer. Dermatol Surg 2015; 40:1390-4. [PMID: 25393353 DOI: 10.1097/dss.0000000000000183] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Topical photodynamic therapy (PDT) for selected nonmelanoma skin cancer using 5-aminolevulinic acid (ALA) or methyl aminolevulinate (MAL) has yielded high long-term complete response rates with very good cosmesis. Pain during light activation of the photosensitizer can be a serious adverse event. A 2-step irradiance protocol has previously been shown to minimize ALA-PDT pain. OBJECTIVE To determine the irradiance-dependent pain threshold for MAL-PDT, to adapt the 2-step protocol to a light-emitting diode (LED) light source, and assess clinical response. METHODS In this prospective study, 25 superficial basal cell carcinoma (sBCC) received an initial irradiance by laser at 40 or 50 mW/cm², or LED at 35 mW/cm² followed by an irradiance at 70 mW/cm² for a total of 75 J/cm². Pain levels were recorded for both irradiance steps. Efficacy was assessed at 6, 12, or 24 months. RESULTS Pain was mild in the 40/70 mW/cm² laser cohort. Three instances of irradiance-limiting pain occurred at 50/70 mW/cm². Pain was minimal in the 35/70 mW/cm² LED cohort. Clinical response rates were 80% in the 50/70 mW/cm² laser cohort and 90% in the 35/70 mW/cm² LED cohort. CONCLUSION Topical PDT can be effectively delivered to sBCC with minimal treatment-related pain by a 2-step irradiance protocol.
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33
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Fink C, Enk A, Gholam P. Aspekte der Schmerztherapie bei der photodynamischen Therapie. J Dtsch Dermatol Ges 2015. [DOI: 10.1111/ddg.12546_suppl] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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34
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Morton CA, Szeimies RM, Braathen LR. Update on topical photodynamic therapy for skin cancer. VESTNIK DERMATOLOGII I VENEROLOGII 2014. [DOI: 10.25208/0042-4609-2014-90-6-26-34] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Topical photodynamic therapy has become an established therapy option for superficial non-melanoma skin cancers with a substantial evidence base. In this update the increased choice in photosensitizers and light sources are reviewed as well as novel protocols to move beyond lesional treatment and address field therapy. Daylight PDT is emerging as an alternative to conventional office/hospital-based PDT that offers the advantage of much reduced pain. Although most studies have assessed efficacy of PDT in immune-competent patients, there is accumulating evidence for topical PDT being considered an option to assist in reducing the skin cancer burden in organ transplant recipients. The fluorescence associated with photosensitizer application can help delineate lesions prior to full treatment illumination and offers a useful adjunct to treatment in patients where diagnostic uncertainty or poor lesion outline complicates clinical care. PDT may also offer significant benefit in delaying/preventing new cancer development and combined with its recognized photo-rejuvenating effects, is emerging as an effective therapy capable of clearing certain superficial skin cancers, potentially preventing new lesions as well as facilitating photo-rejuvenating effects in treated areas.
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Samy NA, Salah MM, Ali MF, Sadek AM. Effect of methylene blue-mediated photodynamic therapy for treatment of basal cell carcinoma. Lasers Med Sci 2014; 30:109-15. [PMID: 25030404 DOI: 10.1007/s10103-014-1609-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 06/03/2014] [Indexed: 10/25/2022]
Abstract
Photodynamic therapy (PDT) is regarded as a treatment option for basal cell carcinoma (BCC). The aim of this study is to investigate the efficacy of methylene blue (MB)-based PDT in patients suffering from nodular or ulcerative BCCs. This study is a prospective clinical trial with a 6-months follow-up. The study setting is at the Dermatology Clinic at NILES, Cairo University, Egypt. Seventeen patients complaining of nodular BCC (nBCC) and three patients complaining of ulcerative BCC (uBCC) were taken as samples. Methylene blue, the photosensitizer, was prepared in two different formulas: liposomal-loaded MB (LMB) was prepared and formulated in hydrogel (MB 0.2%) to be used topically alone for treating BCCs <2 cm in diameter or to be combined with intralesional injection (ILI) of free MB 2% aqueous solution for treating BCCs ≥2 cm in diameter. A session was performed every 2 weeks until complete response (CR) of the lesion or for a maximum of six sessions. Clinical assessments of clinical improvement, dermatological photography, monthly follow-up visits for 6 months, and skin biopsy after 3 months of follow-up to confirm the response, recurrence, or both in cases in which the clinical evaluation was ambiguous. Seventeen patients of the 20 completed the study, 11 patients achieved CR with very good cosmetic outcome, photosensitizer tolerance, and minimal reported side effects. MB is a cheap promising alternative photosensitizer for PDT of nBCC.
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Affiliation(s)
- Nevien A Samy
- Dermatology Unit, Department of Medical Applications of Laser, National Institute of Laser Enhanced Sciences (NILES), Cairo University, Cairo, Egypt,
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Negosanti L, Pinto V, Sgarzani R, Negosanti F, Zannetti G, Cipriani R. Photodynamic therapy with topical aminolevulinic acid. World J Dermatol 2014; 3:6-14. [DOI: 10.5314/wjd.v3.i2.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 12/26/2013] [Accepted: 03/14/2014] [Indexed: 02/06/2023] Open
Abstract
Photodynamic therapy (PDT) is a relatively new therapy in dermatology that uses the topical application of a porphyrin derivative to selectively destroy a cutaneous target. The action is implemented by the application of a specific light frequency. The ability of porphyrin to selectively target tumor tissue has been known since the 1960s. In the late 1970s, the underlying mechanism was defined, and Dougherty’s discovery of the first chromophore led to the production and commercialization of Photofrin®. Many other chromophores that can act as photosensitizers have been studied since then, with aminolevulinic acid currently the most commonly used chromophore in clinical practice. PDT is simple, minimally invasive and can be administered on an outpatient basis. The efficacy of PDT has been proven for actinic keratosis, Bowen’s disease and basal cell carcinoma; another of its well-known applications is the treatment of photoaging. Indications for its use are continuously increasing, and promising results are reported for various skin diseases. In this paper we report the mechanism of action of PDT with aminolevulinic acid, the literature concerning the most common diseases treated with PDT and the subsequent level of evidence.
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Lakshmanan S, Gupta GK, Avci P, Chandran R, Sadasivam M, Jorge AES, Hamblin MR. Physical energy for drug delivery; poration, concentration and activation. Adv Drug Deliv Rev 2014; 71:98-114. [PMID: 23751778 DOI: 10.1016/j.addr.2013.05.010] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2013] [Revised: 05/15/2013] [Accepted: 05/31/2013] [Indexed: 12/11/2022]
Abstract
Techniques for controlling the rate and duration of drug delivery, while targeting specific locations of the body for treatment, to deliver the cargo (drugs or DNA) to particular parts of the body by what are becoming called "smart drug carriers" have gained increased attention during recent years. Using such smart carriers, researchers have also been investigating a number of physical energy forces including: magnetic fields, ultrasound, electric fields, temperature gradients, photoactivation or photorelease mechanisms, and mechanical forces to enhance drug delivery within the targeted cells or tissues and also to activate the drugs using a similar or a different type of external trigger. This review aims to cover a number of such physical energy modalities. Various advanced techniques such as magnetoporation, electroporation, iontophoresis, sonoporation/mechnoporation, phonophoresis, optoporation and thermoporation will be covered in the review. Special emphasis will be placed on photodynamic therapy owing to the experience of the authors' laboratory in this area, but other types of drug cargo and DNA vectors will also be covered. Photothermal therapy and theranostics will also be discussed.
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Mchepange UO, Huang CY, Sun Y, Tu YT, Tao J. Two-step irradiance schedule versus single-dose tramadol sustained-release tablets for pain control during topical 5-aminolevulinic acid-photodynamic therapy of condyloma acuminatum in Chinese patients: A randomized comparative study. Lasers Surg Med 2014; 46:389-95. [PMID: 24719394 DOI: 10.1002/lsm.22243] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Uwesu O. Mchepange
- Department of Dermatology; Affiliated Union Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
- Department of Internal Medicine; Mbeya Referral Hospital; P.O. Box 419 Mbeya Tanzania
| | - Chun-Yan Huang
- Department of Dermatology; Affiliated Union Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
| | - Yi Sun
- Department of Social Medicine and Health Management; School of Public Health, Tongji Medical College, Huazhong University of Science and Technology; Wuhan China
| | - Ya-Ting Tu
- Department of Dermatology; Affiliated Union Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
| | - Juan Tao
- Department of Dermatology; Affiliated Union Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
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Barge J, Glanzmann T, Zellweger M, Salomon D, van den Bergh H, Wagnières G. Correlations between photoactivable porphyrins' fluorescence, erythema and the pain induced by PDT on normal skin using ALA-derivatives. Photodiagnosis Photodyn Ther 2013; 10:683-93. [PMID: 24284128 DOI: 10.1016/j.pdpdt.2013.08.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 08/21/2013] [Accepted: 08/23/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Photodynamic therapy (PDT) with precursors of photoactivable porphyrins is a well-established treatment modality for skin pathologies as well as hair removal. Pain is a major side effect thereof, and it affects the treatment compliance and acceptance. METHODS Five male subjects underwent a PDT procedure on normal skin, either with a diode laser (635 nm) or a lamp (405 nm), 3 or 6h after application of various precursors of photoactivable porphyrins (ALA 1M; Metvix(®) 1M; ALA-DGME 1M; ALA-DGME 3.66 M). Light doses ranged from 30 to 150 J/cm(2) and irradiances were 100 or 180 mW/cm(2). Fluorescence measurements were performed just before PDT, pain was quantified during PDT, and erythema was determined 24h afterwards. RESULTS Because precursor ALA-DGME was very selective for the pilosebaceous apparatus vs. the epidermis, we solely carried out the PDTs using this precursor. In the absence of light, no pain was reported. An increase in pain was observed when increasing the irradiance. A correlation was observed between the follicular fluorescence and the maximal pain score during PDT. A correlation was observed between follicular fluorescence and skin erythema, and between pain score and skin erythema. CONCLUSIONS With our well-controlled PDT parameters and homogenous subjects' conditions, we showed that pain could be reduced by reducing irradiance during PDT procedures. With the various correlations observed, we conclude that both pain and PaP fluorescence are useful tools to predict the post-PDT tissue effects (side effects and outcome). We suggest that A∂ nerve fibres would be the best candidate as first generators of PDT-induced pain.
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Affiliation(s)
- Jérôme Barge
- Photoderma SA, Ch. du Raffort 6, 1055 Froideville, Switzerland.
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Buinauskaite E, Zalinkevicius R, Buinauskiene J, Valiukeviciene S. Pain during topical photodynamic therapy of actinic keratoses with 5-aminolevulinic acid and red light source: randomized controlled trial. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2013; 29:173-81. [DOI: 10.1111/phpp.12044] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/15/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Evelina Buinauskaite
- Department of Skin and Venereal Diseases; Lithuanian University of Health Sciences, Medical Academy; Kaunas; Lithuania
| | | | - Jurate Buinauskiene
- Medical Academy; Lithuanian University of Health Sciences; Kaunas; Lithuania
| | - Skaidra Valiukeviciene
- Department of Skin and Venereal Diseases; Lithuanian University of Health Sciences, Medical Academy; Kaunas; Lithuania
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Wiegell SR, Fabricius S, Heydenreich J, Enk CD, Rosso S, Bäumler W, Baldursson BT, Wulf HC. Weather conditions and daylight-mediated photodynamic therapy: protoporphyrin IX-weighted daylight doses measured in six geographical locations. Br J Dermatol 2013; 168:186-91. [PMID: 22860885 DOI: 10.1111/j.1365-2133.2012.11200.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Photodynamic therapy (PDT) is an attractive therapy for nonmelanoma skin cancers and actinic keratoses (AKs). Daylight-mediated methyl aminolaevulinate PDT (daylight-PDT) is a simple and painless treatment procedure for PDT. All daylight-PDT studies have been performed in the Nordic countries. To be able to apply these results in other parts of the world we have to compare the daily protoporphyrin IX (PpIX) light dose in other countries with the PpIX light doses found in Nordic countries. OBJECTIVES To calculate where and when daylight-PDT of AKs was possible in six different geographical locations using ground stations measuring PpIX-weighted daylight doses. METHODS PpIX-weighted daylight doses were measured using a dosimeter with a customer-specific photodiode with a detector sensitivity that mimics the PpIX absorption spectrum and measures in 'PpIX doses'. The dosimeters were built into ground stations that were placed in six geographical locations measuring from July to December 2008. Temperature data for each location were obtained from the internet. The maximal ultraviolet (UV) index for Copenhagen was obtained for the measuring period of the dosimeters. RESULTS If the PpIX light dose should be above 8Jcm(-2) and the maximum temperature of the day at least 10°C, it was possible to treat patients on nearly all days until the middle of September in Reykjavik and Oslo, until the last week of October in Copenhagen and Regensburg, until the middle of November in Turin and all year in Israel. CONCLUSIONS Where and when to perform daylight-PDT depends on the PpIX light dose and outdoor temperature. The PpIX light dose was influenced by the geographical location (latitude), weather condition and time of year. The UV index was not more suitable than temperature and weather to predict if the intensity of daylight would be sufficient for daylight-PDT.
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Affiliation(s)
- S R Wiegell
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400 Copenhagen NV, Denmark
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Baglo Y, Gabrielsen M, Sylte I, Gederaas OA. Homology modeling of human γ-butyric acid transporters and the binding of pro-drugs 5-aminolevulinic acid and methyl aminolevulinic acid used in photodynamic therapy. PLoS One 2013; 8:e65200. [PMID: 23762315 PMCID: PMC3676387 DOI: 10.1371/journal.pone.0065200] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Accepted: 04/23/2013] [Indexed: 12/28/2022] Open
Abstract
Photodynamic therapy (PDT) is a safe and effective method currently used in the treatment of skin cancer. In ALA-based PDT, 5-aminolevulinic acid (ALA), or ALA esters, are used as pro-drugs to induce the formation of the potent photosensitizer protoporphyrin IX (PpIX). Activation of PpIX by light causes the formation of reactive oxygen species (ROS) and toxic responses. Studies have indicated that ALA and its methyl ester (MAL) are taken up into the cells via γ-butyric acid (GABA) transporters (GATs). Uptake via GATs into peripheral sensory nerve endings may also account for one of the few adverse side effects of ALA-based PDT, namely pain. In the present study, homology models of the four human GAT subtypes were constructed using three x-ray crystal structures of the homologous leucine transporter (LeuT) as templates. Binding of the native substrate GABA and the possible substrates ALA and MAL was investigated by molecular docking of the ligands into the central putative substrate binding sites in the outward-occluded GAT models. Electrostatic potentials (ESPs) of the putative substrate translocation pathway of each subtype were calculated using the outward-open and inward-open homology models. Our results suggested that ALA is a substrate of all four GATs and that MAL is a substrate of GAT-2, GAT-3 and BGT-1. The ESP calculations indicated that differences likely exist in the entry pathway of the transporters (i.e. in outward-open conformations). Such differences may be exploited for development of inhibitors that selectively target specific GAT subtypes and the homology models may hence provide tools for design of therapeutic inhibitors that can be used to reduce ALA-induced pain.
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Affiliation(s)
- Yan Baglo
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
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Zeitouni NC, Paquette AD, Housel JP, Shi Y, Wilding GE, Foster TH, Henderson BW. A retrospective review of pain control by a two-step irradiance schedule during topical ALA-photodynamic therapy of non-melanoma skin cancer. Lasers Surg Med 2013; 45:89-94. [PMID: 23390058 DOI: 10.1002/lsm.22118] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2013] [Indexed: 11/12/2022]
Abstract
BACKGROUND AND OBJECTIVE Photodynamic therapy (PDT) with topical δ-aminolevulinic acid (ALA) of non-melanoma skin cancers is often associated with treatment-limiting pain. A previous study on basal cell carcinomas (BCCs) at Roswell Park Cancer Institute evaluated a two-step irradiance scheme as a means of minimizing pain, preserving outcomes, and limiting treatment time. We used an initial low irradiance until 90% of the protoporphyrin IX was photobleached, followed by a high irradiance interval until the prescribed fluence was delivered. Success of this pilot investigation motivated integration of the protocol into routine practice. Here, we present a retrospective review of recent clinical experience in a broad patient population. STUDY DESIGN/MATERIALS AND METHODS This was a retrospective review of an existing dermatology database. Fourteen caucasion patients-nine men and five women, ages 18-80, with a total of 51 superficial and 73 nodular BCCs, and three Bowen's disease lesions-were included. ALA was applied to each lesion for approximately 4 hours. Lesions received an initial irradiance of 30-50 mW/cm(2) for 20 J/cm(2) , followed by 150 mW/cm(2) for a total fluence of 200-300 J/cm(2) . Pain was assessed using a visual analog scale (VAS). Clinical outcome was determined at 6-12 months. RESULTS Median VAS scores were 1.0 for both irradiances. Five of 127 lesions required pain control with 1% xylocaine. Pain was strongly influenced by lesion location but not by lesion type, number, or size. Complete responses were achieved in 84.1% of BCCs, which compares favorably with reported results for single ALA-PDT treatments. Two of three Bowen's disease lesions showed a complete response. Complete responses for nodular BCCs were 37%, which are also within the range of reported outcomes. CONCLUSIONS A two-step irradiance protocol in ALA-PDT effectively minimizes pain, maintains excellent clinical outcomes in superficial lesions, and adds minimal treatment time.
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Affiliation(s)
- Nathalie C Zeitouni
- Department of Dermatology, Roswell Park Cancer Institute, Buffalo, NY 14263, USA.
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Wiegell SR, Skødt V, Wulf HC. Daylight-mediated photodynamic therapy of basal cell carcinomas - an explorative study. J Eur Acad Dermatol Venereol 2013; 28:169-75. [PMID: 23294223 DOI: 10.1111/jdv.12076] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 11/19/2012] [Indexed: 01/19/2023]
Abstract
BACKGROUND Studies have shown that daylight-photodynamic therapy (PDT) is an effective treatment of actinic keratoses, nearly pain free and more convenient for both the clinics and patients. Treatment of basal cell carcinomas (BCCs) is another main indication for PDT. OBJECTIVES The aim of this open, uncontrolled, prospective explorative study was to evaluate the efficacy of daylight-PDT for BCCs. METHODS Twenty-one patients with a total of 32 BCCs located in the face, scalp, chest, back and lower leg received one cycle of daylight-methyl aminolevulinate (MAL)-PDT, consisting of two treatments 1 week apart. After sunscreen application and lesion preparation, MAL was applied and patients exposed themselves to daylight for 2½ h. Daylight exposure was monitored with a wrist-borne dosimeter. RESULTS At 3-month follow-up, complete response was seen in 30 lesions (94%) and in 19 patients (90%). At 12-month follow-up, six lesions had recurred resulting in a total recurrence rate of 21% (6/29) as one lesion was lost to follow-up. Twelve months after daylight-PDT, 74% (23/31) of the treated lesions showed complete response. During each treatment, the mean effective light dose was 10.8 J/cm(2) during an average of 152 min of daylight exposure. Treatment was pain free with good or excellent cosmesis. CONCLUSIONS In conclusion, daylight-PDT proved to be as effective as conventional PDT in the treatment of BCCs in this explorative clinical study. Daylight-PDT was pain free and more convenient for both clinicians and patients. The cosmetic outcome was good or excellent. Larger studies need to confirm the findings of this study.
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Affiliation(s)
- S R Wiegell
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - V Skødt
- Department of Pathology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - H C Wulf
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
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Piffaretti F, Zellweger M, Kasraee B, Barge J, Salomon D, van den Bergh H, Wagnières G. Correlation between Protoporphyrin IX Fluorescence Intensity, Photobleaching, Pain and Clinical Outcome of Actinic Keratosis Treated by Photodynamic Therapy. Dermatology 2013; 227:214-25. [DOI: 10.1159/000353775] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 06/17/2013] [Indexed: 11/19/2022] Open
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Gholam P, Kroehl V, Enk AH. Dermatology Life Quality Index and Side Effects after Topical Photodynamic Therapy of Actinic Keratosis. Dermatology 2013; 226:253-9. [DOI: 10.1159/000349992] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 02/19/2013] [Indexed: 11/19/2022] Open
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Morton CA, Szeimies RM, Sidoroff A, Braathen LR. European guidelines for topical photodynamic therapy part 1: treatment delivery and current indications - actinic keratoses, Bowen's disease, basal cell carcinoma. J Eur Acad Dermatol Venereol 2012. [PMID: 23181594 DOI: 10.1111/jdv.12031] [Citation(s) in RCA: 246] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Topical photodynamic therapy (PDT) is a widely used non-invasive treatment for certain non-melanoma skin cancers, permitting treatment of large and multiple lesions with excellent cosmesis. High efficacy is demonstrated for PDT using standardized protocols in non-hyperkeratotic actinic keratoses, Bowen's disease, superficial basal cell carcinomas (BCC) and in certain thin nodular BCC, with superiority of cosmetic outcome over conventional therapies. Recurrence rates following PDT are typically equivalent to existing therapies, although higher than surgery for nodular BCC. PDT is not recommended for invasive squamous cell carcinoma. Treatment is generally well tolerated, but tingling discomfort or pain is common during PDT. New studies identify patients most likely to experience discomfort and permit earlier adoption of pain-minimization strategies. Reduced discomfort has been observed with novel protocols including shorter photosensitizer application times and in daylight PDT for actinic keratoses.
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Affiliation(s)
- C A Morton
- Department of Dermatology, Stirling Community Hospital, Stirling, UK.
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Paoli J, Halldin C, Sandberg C. Teaching peripheral nerve blocks for the head and neck area to dermatologists. J Eur Acad Dermatol Venereol 2012; 26:1035-1037. [DOI: 10.1111/j.1468-3083.2011.04218.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Chaves YN, Torezan LA, Niwa ABM, Sanches Junior JA, Festa Neto C. Pain in photodynamic therapy: mechanism of action and management strategies. An Bras Dermatol 2012; 87:521-6; quiz 527-9. [DOI: 10.1590/s0365-05962012000400001] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Accepted: 05/20/2011] [Indexed: 11/22/2022] Open
Abstract
Photodynamic therapy involves administration of a photosensitizing drug and its subsequent activation by irradiation with a light source at wavelengths matching the absorption spectrum of the photosensitizer. In many countries around the world, topical photodynamic therapy has been approved for treatment of cutaneous oncologic conditions such as actinic keratosis, Bowen's disease, and superficial basal cell carcinoma. Multicenter, randomized, controlled studies have confirmed its efficacy and superior cosmetic outcomes compared to conventional therapies. Nevertheless, this therapeutic method presents some adverse effects, such as erythema, edema, pigmentation, pustules, and pain. There is no doubt that pain is the most severe of the adverse effects, being sometimes responsible for definitive treatment interruption. The pain mechanism has not yet been fully understood, which makes complete pain control a challenge to be conquered. In spite of that, this literature review presents some useful pain management strategies as well as the most important pain-related factors in photodynamic therapy.
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Wiegell S, Wulf H, Szeimies RM, Basset-Seguin N, Bissonnette R, Gerritsen MJ, Gilaberte Y, Calzavara-Pinton P, Morton C, Sidoroff A, Braathen L. Daylight photodynamic therapy for actinic keratosis: an international consensus. J Eur Acad Dermatol Venereol 2011; 26:673-9. [DOI: 10.1111/j.1468-3083.2011.04386.x] [Citation(s) in RCA: 161] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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