Systemic photodynamic therapy in folliculitis decalvans

An insight into photodynamic therapy towards treating major dermatological conditions

Photodynamic therapy (PDT), as the name suggests is a light-based, non-invasive therapeutic treatment method that has garnered immense interest in the recent past for its efficacy in treating several pathological conditions. PDT has prominent use in the treatment of several dermatological conditions, which consequently have cosmetic benefits associated with it as PDT improves the overall appearance of the affected area. PDT is commonly used for repairing sun-damaged skin, providing skin rejuvenation, curbing pre-cancerous cells, treating conditions like acne, keratosis, skin-microbial infections, and cutaneous warts, etc. PDT mediates its action by generating oxygen species that are involved in bringing about immunomodulation, suppression of microbial load, wound-healing, lightening of scarring, etc. Although there are several challenges associated with PDT, the prominent ones being pain, erythema, insufficient delivery of the photosensitizing agent, and poor clinical outcomes, still PDT stands to be a promising approach with continuous efforts towards maximizing clinical efficacy while being cautious of the side effects and working towards lessening them. This article discusses the major skin-related conditions which can be treated or managed by employing PDT as a better or comparable alternative to conventional treatment approaches such that it also brings about aesthetic improvements thereof.

Folliculitis decalvans: a case report of satisfactory recovery after implementing isotretinoin therapy

Introduction: Folliculitis decalvans is a rare skin disease characterized by the presence of painful papules and pustules with an underlying neutrophilic infiltrate, usually on the scalp. Its treatment is lengthy and challenging, and recurrence is relatively common. Although its etiology is unknown, several theories explaining its development have been proposed, including colonization by Staphylococcus aureus. Case description: This is the case of a 26-year-old male healthcare worker who visited the outpatient service after experiencing a 4-year history of painful pustules on the scalp; initially these lesions were located in the occipital region, but then also started to appear in the temporal and parietal regions. After being treated for bacterial folliculitis and having several recurrences, a skin biopsy was performed, which allowed diagnosing him with folliculitis decalvans. Once the diagnosis was made, isotretinoin (20mg) treatment was implemented for a year and a half, achieving complete remission of the lesions. Conclusion: Although this case has some limitations, such as the lack of histopathology images and some control laboratory tests, it clearly shows the difficulties faced when treating this type of skin disorders and presents an overview of the use of isotretinoin, evidencing that although this drug is well tolerated, possible adverse reactions from drug interactions with trimethoprim/sulfamethoxazole may arise. In addition, this case is of great importance since the possible presence of a familial cluster of folliculitis decalvans could be confirmed, if further genetic testing is performed.

Photobiomodulation Therapy With Different Wavebands for Hair Loss: A Systematic Review and Meta-Analysis

BACKGROUND

Photobiomodulation is a promising therapy for hair loss with negligible side effects. However, the reported effects of photobiomodulation therapy for hair loss are inconsistent.

OBJECTIVE

To assess the curative effect of photobiomodulation therapy for the treatment of hair loss.

METHODS

A systematic review of self-controlled studies and randomized controlled trials was conducted. ScienceDirect, PubMed, and Wiley Online Library were searched from the earliest date to May 30, 2021.

RESULTS

Thirty-six studies (966 patients) were included. Two to 4 meta-analyses with different indices were performed separately on 4 groups of studies to test the effectiveness of the following hair loss treatments: ultraviolet light for alopecia areata (AA), red light for androgenetic alopecia (AGA), infrared light for AA, and infrared light for AGA. All meta-analyses showed that treatments were superior to control ( p < .05).

CONCLUSION

The meta-analyses strongly suggested that photobiomodulation therapies with ultraviolet and infrared light were effective for treating AA, and photobiomodulation therapies with red light and infrared light were effective for treating AGA.

Treatment of androgenetic alopecia with 5-aminolevulinic acid photodynamic therapy: A randomized, placebo-controlled, split-scalp study of efficacy and safety

BACKGROUND AND OBJECTIVES

Androgenetic alopecia (AGA) is one of the most common hair loss disorders. Treatment options for AGA are limited . New therapies for AGA are clinically needed. 5-aminolevulinic acid photodynamic therapy (ALA-PDT) is widely applied in diseases involving the pilosebaceous unit. However, limited research has explored the efficacy of ALA-PDT in treating alopecia. Some studies reported hair regrowth after PDT in alopecia areata patients, but the efficacy of ALA-PDT on AGA remains unclear. The objective of this study is to evaluate the efficacy and safety of ALA-PDT for the treatment of AGA.

METHODS

A randomized, placebo-controlled, split-scalp clinical study was conducted. Subjects with AGA received six sessions of 5% ALA-PDT on one half of their scalp and the red-light therapy on the other half. The treatments were applied every two weeks for six sessions on each subject.

RESULTS

There were 7 subjects enrolled in this study. No significant difference in hair density was observed between the red-light treatment and ALA-PDT treatment. The hair density in the ALA-PDT treated half of the scalp significantly decreased 1 week after the treatment, then it increased, and no statistical difference was found at 12 weeks after the last treatment compared to the baseline. There was no significant improvement in hair growth according to a 7-point scale and the subjects' self-assessments. The main adverse effects in ALA-PDT treatment were mild edema and tolerable pain, and no adverse effect was observed in red-light treatment.

CONCLUSIONS

6 sessions of 5% ALA-PDT did not increase the hair growth of AGA patients, but slightly suppressed the sebum secretion on the scalp. The adverse effects of ALA-PDT were mild, which indicated safety and tolerability of this treatment.

Photodynamic therapy should be considered for the treatment of folliculitis decalvans

BACKGROUND

Different therapies such as clindamycin, rifampicin, isotretinoin, or corticosteroids have been used for folliculitis decalvans with poor results. Recently, PDT has been used for treating folliculitis decalvans more frequently. However, the efficacy of PDT for treating folliculitis decalvans is lacking consensus. In this study, we conducted a retrospective analysis to evaluated the status of PDT for the treatment of folliculitis decalvans.

METHODS

13 cases of folliculitis decalvans patients were treated with ALA-PDT. The treatment totals 3 times, and the interval between each treatment was 10-14 days. A follow-up was conducted at 12 months after the last treatment. The condition was graded according to the following evaluation criteria: recovery, significant improvement, moderate improvement, ineffective.

RESULTS

A total of 7 cases improved significantly, and 6 cases improved moderately followed the first treatment. After the second treatment, 10 cases showed significant improvement, and 2 cases responded poorer than the first treatment. After the third treatment, 4 cases recovered, 7 cases improved significantly, and 2 case moderately improved. At the 12-months follow-up, 9 out of 13 patients were well controlled and with no recurrence. The other 4 patients relapsed.

CONCLUSION

In summary, photodynamic therapy shows overall favorable effect on folliculitis decalvans and should be considered as a  method for the treatment of folliculitis decalvans.

Excision combined with photodynamic therapy for scrotal Paget's disease in patients aged over 60 years

OBJECTIVE

To investigate the safety and efficacy of wide local excision combined with aminolevulinic acid (ALA) photodynamic therapy (PDT) for the treatment of scrotal Paget's disease in patients of advanced age.

METHODS

Data were collected for 16 patients (mean age, 68.44 years) with scrotal Paget's disease treated with wide local excision combined with ALA PDT and followed up from June 2014 to February 2018. Pathological examination after wide local excision confirmed Paget's disease. The patients underwent three courses of ALA PDT postoperatively and were followed up to determine the curative effect and complications in the short and middle term.

RESULTS

The disease duration ranged from 4 to 76 months (mean, 36 months). Ten patients underwent simple excision, six underwent skin flap transfer, and two required reoperations due to skin flap necrosis and infection. The patients were followed up for 3 to 42 months after ALA PDT, during which time two patients developed metastasis (recurrence rate, 12.50%). No other serious complications occurred during follow-up except for lower limb movement disorder in one patient (6.25%).

CONCLUSIONS

Wide local excision combined with ALA PDT shows good clinical efficacy and a low complication rate in patients of advanced age with scrotal Paget's disease.