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Wu HE, Liu YB, Cui L, Xu GJ, Sun XD. Three-step irradiance schedule versus two-step irradiance schedule for pain control during topical 5-aminolevulinic acid-photodynamic therapy of facial acne in Chinese patients: A prospective randomized comparative study. Lasers Surg Med 2021; 54:224-229. [PMID: 34368971 DOI: 10.1002/lsm.23464] [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: 11/10/2020] [Revised: 05/24/2021] [Accepted: 07/23/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND A two-step irradiance schedule has been found to be useful for pain control during photodynamic therapy (PDT) on nonmelanotic skin cancer and condyloma acuminatum. OBJECTIVES To evaluate the efficacy of a new three-step irradiance schedule derived from the psychological "peak-end rule" and two-step irradiance schedule in relieving pain during 5-aminolevulinic acid PDT (ALA-PDT) on acne. METHODS A total of 90 moderate to severe acne patients were enrolled in our study and randomly divided into two groups with a ratio of 1:1. They were treated by a light-emitting diode light source of 633 ± 10 nm after being incubated with 5% ALA for an hour using a two-step or three-step irradiance schedule, respectively. The total irradiance intensity was 84 J/cm2 of each session and the treatment interval was 2 weeks. Pain was recorded 30 min after each PDT using a visual analog scale (VAS). Follow-up was done at baseline and 2 weeks after each treatment. The numbers of lesions were counted after the third treatment through the pictures taken before and all the side effects were recorded at each follow-up visit. RESULTS Eighty-seven subjects completed the total three treatments (44 cases in Group A and 43 cases in Group B). The average VAS of Group B (1.61 ± 0.67) was significantly lower than that of Group A (3.14 ± 0.67), with a difference of 1.52 ± 0.08 (p < 0.0001) between them. Both groups received a similar effective rate after the total three sessions (88.64% vs. 88.37%, p > 0.05). CONCLUSIONS The new three-step irradiance method could relieve pain during ALA-PDT more significantly than the two-step schedule with a similar effective rate.
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Affiliation(s)
- Hai-En Wu
- Department of Dermatology, The Seventh People's Hospital of Shenyang, Shenyang, China
| | - Yong-Bin Liu
- Department of Dermatology, The Seventh People's Hospital of Shenyang, Shenyang, China
| | - Liang Cui
- Department of Dermatology, The Seventh People's Hospital of Shenyang, Shenyang, China
| | - Gui-Juan Xu
- Department of Cardiology, The Seventh People's Hospital of Shenyang, Shenyang, China
| | - Xiao-Dong Sun
- Department of Dermatology, The Seventh People's Hospital of Shenyang, Shenyang, China
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Piquero-Casals J, Morgado-Carrasco D, Gilaberte Y, Del Rio R, Macaya-Pascual A, Granger C, López-Estebaranz JL. Management Pearls on the Treatment of Actinic Keratoses and Field Cancerization. Dermatol Ther (Heidelb) 2020; 10:903-915. [PMID: 32681454 PMCID: PMC7477025 DOI: 10.1007/s13555-020-00425-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Indexed: 01/10/2023] Open
Abstract
Field cancerization (FC) is a chronic disease involving multiple clinical and subclinical actinic keratoses (AK) on large photo-exposed surfaces with multifocal areas of dysplasia and precancerous changes. Patients and treatment must be properly monitored and managed to avoid aggravation and progression of the disease. Management of actinic keratoses includes lesion-directed treatments, such as cryotherapy and field-directed therapies. Field-directed therapies may have the potential to address subclinical damage, reduce AK recurrence rates and potentially reduce the risk of squamous cell carcinoma development. Multiple studies have demonstrated the efficacy of field-directed treatments, including 5-fluorouracil, photodynamic therapy, imiquimod, chemical exfoliation with trichloroacetic acid and diclofenac gel, for multiple AK and FC. The choice of therapy should be based on multiple factors, such as efficacy, tolerability, patient risk profile, costs and cosmetic results. Management of AK includes not only treatment but also prevention. Medical devices, such as sunscreens containing liposome-encapsulated DNA repair enzymes, can repair DNA damage associated with chronic UV radiation and reduce the number of new AK lesions. Here we provide therapeutic pearls and expert opinions on the treatment of AK and FC (as monotherapy or in combination) with the overall aim to achieve better, faster, and well-tolerated clinical responses.
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Affiliation(s)
| | - Daniel Morgado-Carrasco
- Dermatology Department, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Yolanda Gilaberte
- Dermatology Department, Instituto de Investigación Sanitaria (IIS) Aragón, Miguel Servet University Hospital, Zaragoza, Spain
| | - Rubén Del Rio
- Dermatology Department, Hospital de L'Esperit Sant, Santa Coloma de Gramenet, Barcelona, Spain
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3
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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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4
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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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5
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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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Bédane C. [Photodynamic therapy in dermatology, other indications and perspectives]. Ann Dermatol Venereol 2013; 140 Suppl 2:229-35. [PMID: 24199715 DOI: 10.1016/s0151-9638(13)70139-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PDT licensed indications in dermatology are actinic keratosis, Bowen's disease and superficial basal cell carcinomas. Skin tumors are sensitized by methyl aminomevulinate then illuminated with red light. Beyond these indication PDT is now widely used for the treatment of various others skin tumors and infectious or inflammatory skin disorders. PDT treatment of large areas can induce intense pain. Optimising PDT treatment needs to optimize pain control. Freezing or cooling procedure is the best way to decrease pain. The most interesting aspects of PDT is the absence of severe delayed adverse events and an optimal healing.
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Affiliation(s)
- Ch Bédane
- Service de Dermatologie, Hôpital Dupuytren, 2 avenue Martin Luther King 87042 Limoges, France.
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7
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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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Wlodek C, Ali FR, Lear JT. Use of photodynamic therapy for treatment of actinic keratoses in organ transplant recipients. BIOMED RESEARCH INTERNATIONAL 2012; 2013:349526. [PMID: 23509711 PMCID: PMC3591189 DOI: 10.1155/2013/349526] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 09/05/2012] [Indexed: 12/25/2022]
Abstract
Solid organ transplant recipients are predisposed to actinic keratoses (AK) and nonmelanoma skin cancers, owing to the lifelong immunosuppression required. Today, increasing numbers of organ transplants are being performed and organ transplant recipients (OTRs) are surviving much longer. Photodynamic therapy (PDT) is proving a highly effective treatment modality for AK amongst this susceptible group of patients. Following an overview of the pathogenesis of AK amongst OTRs, the authors review current safety and efficacy data and how this relates to the role of PDT for the treatment of AK in OTRs.
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Affiliation(s)
- Christina Wlodek
- St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - Faisal R. Ali
- The Dermatology Centre, Manchester Academic Health Science Centre, University of Manchester, Salford Royal NHS Foundation Trust, Manchester M6 8HD, UK
| | - John T. Lear
- The Dermatology Centre, Manchester Academic Health Science Centre, University of Manchester, Salford Royal NHS Foundation Trust, Manchester M6 8HD, UK
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9
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Basset-Seguin N, Baumann Conzett K, Gerritsen M, Gonzalez H, Haedersdal M, Hofbauer G, Aguado L, Kerob D, Lear J, Piaserico S, Ulrich C. Photodynamic therapy for actinic keratosis in organ transplant patients. J Eur Acad Dermatol Venereol 2011; 27:57-66. [DOI: 10.1111/j.1468-3083.2011.04356.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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10
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Bioimpedance for pain monitoring during cutaneous photodynamic therapy: Preliminary study. Photodiagnosis Photodyn Ther 2011; 8:307-13. [DOI: 10.1016/j.pdpdt.2011.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Revised: 06/01/2011] [Accepted: 06/03/2011] [Indexed: 12/29/2022]
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11
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Stangeland K, Kroon S. Cold air analgesia as pain reduction during photodynamic therapy of actinic keratoses. J Eur Acad Dermatol Venereol 2011; 26:849-54. [DOI: 10.1111/j.1468-3083.2011.04167.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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12
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The effect of air cooling pain relief on protoporphyrin IX photobleaching and clinical efficacy during dermatological photodynamic therapy. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2011; 103:1-7. [DOI: 10.1016/j.jphotobiol.2010.12.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Revised: 12/15/2010] [Accepted: 12/21/2010] [Indexed: 11/17/2022]
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13
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Zhao B, He YY. Recent advances in the prevention and treatment of skin cancer using photodynamic therapy. Expert Rev Anticancer Ther 2011; 10:1797-809. [PMID: 21080805 DOI: 10.1586/era.10.154] [Citation(s) in RCA: 109] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Photodynamic therapy (PDT) is a noninvasive procedure that involves a photosensitizing drug and its subsequent activation by light to produce reactive oxygen species that specifically destroy target cells. Recently, PDT has been widely used in treating non-melanoma skin malignancies, the most common cancer in the USA, with superior cosmetic outcomes compared with conventional therapies. The topical 'photosensitizers' commonly used are 5-aminolevulinic acid (ALA) and its esterified derivative methyl 5-aminolevulinate, which are precursors of the endogenous photosensitizer protoporphyrin IX. After treatment with ALA or methyl 5-aminolevulinate, protoporphyrin IX preferentially accumulates in the lesion area of various skin diseases, which allows not only PDT treatment but also fluorescence diagnosis with ALA-induced porphyrins. Susceptible lesions include various forms of non-melanoma skin cancer such as actinic keratosis, basal cell carcinoma and squamous cell carcinoma. The most recent and promising developments in PDT include the discovery of new photosensitizers, the exploitation of new drug delivery systems and the combination of other modalities, which will all contribute to increasing PDT therapeutic efficacy and improving outcome. This article summarizes the main principles of PDT and its current clinical use in the management of non-melanoma skin cancers, as well as recent developments and possible future research directions.
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Affiliation(s)
- Baozhong Zhao
- Laboratory of Toxicology and Pharmacology, National Institute of Environmental Health Sciences, NIH, Research Triangle Park, NC 27709, USA
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14
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Miller I, Nielsen J, Lophaven S, Jemec G. Factors related to pain during routine photodynamic therapy: a descriptive study of 301 patients. J Eur Acad Dermatol Venereol 2011; 25:1275-81. [DOI: 10.1111/j.1468-3083.2010.03964.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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15
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Ibbotson SH. An overview of topical photodynamic therapy in dermatology. Photodiagnosis Photodyn Ther 2009; 7:16-23. [PMID: 20230989 DOI: 10.1016/j.pdpdt.2009.12.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2009] [Revised: 11/26/2009] [Accepted: 12/01/2009] [Indexed: 10/20/2022]
Abstract
This article is a review of the use of topical photodynamic therapy in dermatology and its current role in 2009 and future developments. The content of this article was presented at the EPPM in Wroclaw, September 2009.
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Affiliation(s)
- Sally H Ibbotson
- Photobiology Unit, University of Dundee, Ninewells Hospital & Medical School, Dundee, DD1 9SY, UK.
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16
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Pain associated with aminolevulinic acid-photodynamic therapy of skin disease. J Am Acad Dermatol 2009; 61:1033-43. [PMID: 19925929 DOI: 10.1016/j.jaad.2009.03.048] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2008] [Revised: 03/02/2009] [Accepted: 03/16/2009] [Indexed: 12/21/2022]
Abstract
BACKGROUND Pain during topical aminolevulinic acid (ALA)-mediated photodynamic therapy (PDT) limits the use of this treatment of skin diseases. OBJECTIVE We sought to summarize the effectiveness of interventions to reduce ALA-PDT-related pain, and to explore factors contributing to pain induction. METHODS A PubMed search was performed to identify all clinical PDT trials (2000-2008) that used ALA or methyl-ALA, enrolled at least 10 patients per trial, and used a semiquantitative pain scale. RESULTS In all, 43 articles were identified for review. Pain intensity is associated with lesion size and location and can be severe for certain diagnoses, such as plaque-type psoriasis. Results are inconsistent for the correlation of pain with light source, wavelength of light, fluence rate, and total light dose. Cooling represents the best topical intervention. LIMITATIONS Pain perception differs widely between patients and can contribute to variability in the reported results. CONCLUSION Gamma-aminobutyric acid receptors, cold/menthol receptors (transient receptor potential cation channel, subfamily M, member 8), and vanilloid/capsaicin receptors (transient receptor potential cation channel, subfamily V, member 1) may be involved in pain perception during ALA-PDT and are therefore worthy of further investigation.
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New aspects in photodynamic therapy of actinic keratoses. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2009; 96:159-69. [DOI: 10.1016/j.jphotobiol.2009.06.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2009] [Revised: 03/19/2009] [Accepted: 06/08/2009] [Indexed: 11/21/2022]
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Wiegell S, Skiveren J, Philipsen P, Wulf H. Pain during photodynamic therapy is associated with protoporphyrin IX fluorescence and fluence rate. Br J Dermatol 2008; 158:727-33. [DOI: 10.1111/j.1365-2133.2008.08451.x] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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19
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Wiegell S, Hædersdal M, Philipsen P, Eriksen P, Enk C, Wulf H. Continuous activation of PpIX by daylight is as effective as and less painful than conventional photodynamic therapy for actinic keratoses; a randomized, controlled, single-blinded study. Br J Dermatol 2008; 158:740-6. [DOI: 10.1111/j.1365-2133.2008.08450.x] [Citation(s) in RCA: 256] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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20
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Ram R, Rosenbach A. Effects of ambient room temperature on cold air cooling during laser hair removal. J Cosmet Dermatol 2007; 6:203-6. [PMID: 17760700 DOI: 10.1111/j.1473-2165.2007.00327.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Forced air cooling is a well-established technique that protects the epidermis during laser heating of deeper structures, thereby allowing for increased laser fluences. The goal of this prospective study was to identify whether an elevation in ambient room temperature influences the efficacy of forced air cooling. Skin surface temperatures were measured on 24 sites (12 subjects) during cold air exposure in examination rooms with ambient temperatures of 72 degrees F (22.2 degrees C) and 82 degrees F (27.8 degrees C), respectively. Before cooling, mean skin surface temperature was 9 degrees F (5 degrees C) higher in the warmer room (P < 0.01). Immediately after exposure to forced air cooling (within 1 s), the skin surface temperature remained considerably higher (10.75 degrees F, or 5.8 degrees C, P < 0.01) in the warmer room. We conclude that forced air cooling in a room with an ambient temperature of 82 degrees F (27.8 degrees C) is not as effective as in a room that is at 72 degrees F (22.2 degrees C).
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Affiliation(s)
- Ramin Ram
- Department of Dermatology, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
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21
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Huerta Brogeras M, Romero Mate A, Nieto Perea O, Borbujo Martínez JM. Complicaciones en la terapia fotodinámica. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/s0213-9251(07)73078-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
Photodynamic therapy (PDT) is increasingly being recognized as an attractive, alternative treatment modality for superficial cancer. Treatment consists of two relatively simple procedures: the administration of a photosensitive drug and illumination of the tumor to activate the drug. Efficacy is high for small superficial tumors and, except for temporary skin photosensitization, there are no long-term side effects if appropriate protocols are followed. Healing occurs with little or no scarring and the procedure can be repeated without cumulative toxicity. Considering the efficacy and lack of long-term toxicity of PDT, and the fact that the first treatment of cancer with PDT was done more than 100 years ago, one might expect that this treatment had already become an established therapy. However, PDT is currently offered in only a few selected centers, although it is slowly gaining acceptance as an alternative to conventional cancer therapies. Here, we show the developmental steps PDT underwent and summarize the current clinical applications. The data show that, when properly used, PDT is an effective alternative treatment option in oncology.
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Affiliation(s)
- Martijn Triesscheijn
- Division of Experimental Therapy (H6), The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
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Juzeniene A, Juzenas P, Bronshtein I, Vorobey A, Moan J. The influence of temperature on photodynamic cell killing in vitro with 5-aminolevulinic acid. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2006; 84:161-6. [PMID: 16624569 DOI: 10.1016/j.jphotobiol.2006.02.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2005] [Revised: 02/28/2006] [Accepted: 02/28/2006] [Indexed: 11/25/2022]
Abstract
Cell survival was investigated after exposing cells in vitro to different temperatures before or after photodynamic therapy with 5-aminolevulinic acid. The photodynamic process was found to be temperature dependent. Cells exposed for 1h to 41 degrees C before light exposure or to 7 degrees C after light exposure showed decreased survival. Furthermore, the photobleaching rate of protoporphyrin IX in the cells was found to increase with increasing temperature during the light exposure. Thus, the photodynamic effect with 5-aminolevulinic acid may be enhanced by heating the tumour area before, and by cooling it immediately after the treatment.
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Affiliation(s)
- Asta Juzeniene
- Department of Radiation Biology, Institute for Cancer Research, The Norwegian Radium Hospital, N-0310 Montebello, Oslo, Norway.
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Morton C. How to optimise topical photodynamic therapy in dermatology. Photodiagnosis Photodyn Ther 2006; 3:112-5. [DOI: 10.1016/j.pdpdt.2006.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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van Oosten EJ, Kuijpers DIM, Thissen MRTM. Different pain sensations in photodynamic therapy of nodular basal cell carcinoma Results from a prospective trial and a review of the literature. Photodiagnosis Photodyn Ther 2006; 3:61-8. [PMID: 25049028 DOI: 10.1016/s1572-1000(05)00156-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2005] [Revised: 11/11/2005] [Accepted: 11/29/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Pain is a major side effect of topical photodynamic therapy (PDT), a relatively new and non-invasive treatment for particular types of basal cell carcinoma (BCC). In this study, we sought to characterise in more detail the quality and intensity of pain associated with PDT. Furthermore, we studied if gender, tumour size and localization as well as different light sources with comparable wavelengths had an influence on the pain. METHODS A total of 64 nodular BCCs in 55 patients, of which 48 BCCs underwent preceding debulking, were treated with 5-aminolevulinic acid (ALA-PDT). Two metal halogen light sources were randomly used. Pain assessment was performed using a visual analogue scale (VAS). RESULTS All patients experienced pain during illumination and 41.8% after illumination. The mean pain intensity was 3.88 with most patients experiencing burning (82.5%) or stinging (36.8%) sensations. Illumination with the Medeikonos(®) light source was experienced less painful than the Waldmann(®) lamp (4.64 versus 3.40; p=0.027). Gender as well as tumour localization and size did not alter the pain scores. Likewise, no differences were observed between patients who underwent debulking and those who did not. CONCLUSIONS Treatment of single BCCs with ALA-PDT rarely results in unbearable pain. However, the degree of pain can vary depending on the light source used. Further studies are needed to unravel the pathomechanisms underlying the development of pain in PDT in order to develop adequate solutions for this undesirable side effect.
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Affiliation(s)
- Eleonore J van Oosten
- Department of Dermatology, University Hospital Maastricht, P. Debijelaan 25, Postbus 5800, 6202 AZ Maastricht, The Netherlands
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Babilas P, Karrer S, Sidoroff A, Landthaler M, Szeimies RM. Photodynamic therapy in dermatology - an update. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2005; 21:142-9. [PMID: 15888131 DOI: 10.1111/j.1600-0781.2005.00147.x] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Topical photodynamic therapy (PDT) is a well-established treatment modality which has mainly shown to be effective for dermatooncologic conditions like actinic keratoses (AK), Bowen's disease, in situ squamous cell carcinoma and superficial basal cell carcinoma (BCC). However, a therapeutical benefit of PDT is also evident for inflammatory dermatoses like localized scleroderma, acne vulgaris and granuloma annulare. Recent work has been focused on the development and evaluation of topical photosensitizers like the heme precursor 5-aminolevulinic acid (5-ALA) or its methyl ester (methyl aminolevulinate) inducing photosensitizing porphyrins. These drugs do not induce strong generalized cutaneous photosensitization like the systemically applied porphyrins or their derivatives. For dermatological purposes, incoherent lamps or light-emitting diode arrays can be used for light activation. Depending on the applied light dose and the concentration of the photosensitizer either cytotoxic effects resulting in tumor destruction or immunomodulatory effects improving the inflammatory conditions occur. Treating superficial oncologic lesions (tumor thickness <2-3 mm) cure rates achieved by PDT are equal to the cure rates of the respective standard therapeutic procedure. The benefits of PDT are the low level of invasiveness and the excellent cosmetic results after treatment.
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Affiliation(s)
- Philipp Babilas
- Department of Dermatology, University of Regensburg, Franz-Josef-Strauss-Allee 11, 93042 Regensburg, Germany
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Affiliation(s)
- Ann‐Marie Wennberg
- Department of Dermatology, Sahlgrenska University Hospital, Göteborg, Sweden
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Affiliation(s)
- Ann‐Marie Wennberg
- Department of Dermatology, Sahlgrenska University Hospital, Göteborg, Sweden
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