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Sakhiya J, Sakhiya D, Kaklotar J, Hirapara B, Purohit M, Bhalala K, Daruwala F, Dudhatra N. Intralesional Agents in Dermatology: Pros and Cons. J Cutan Aesthet Surg 2021; 14:285-295. [PMID: 34908770 PMCID: PMC8611707 DOI: 10.4103/jcas.jcas_109_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Since introduced in 1961, intralesional (IL) agent has become an essential part of the dermatological practice. The term IL referred to the direct delivery of agent percutaneously into skin lesions. This therapeutic approach is relatively safe, easy to perform and applicable for a broad range of dermatological conditions. On the other hand, immediate side effects, including pain during administration, bleeding, high risk of infection and allergic reaction, and subsequent side effects involving skin changes such as atrophy, telangiectasia, pigmentary changes, and striae are usually associated with this modality. This review paper highlights the pros and cons of IL agents in modern dermatology practice.
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Affiliation(s)
- Jagdish Sakhiya
- Sakhiya Skin Clinic, 2nd Floor, Ayush Doctor House, Station-Lal Darwaja Road, Surat, Gujarat, India
| | - Dhruv Sakhiya
- B.J. Medical College, New Civil Hospital Asarwa, Ahmedabad, Gujarat, India
| | - Jitesh Kaklotar
- Sakhiya Skin Clinic, 2nd Floor, Ayush Doctor House, Station-Lal Darwaja Road, Surat, Gujarat, India
| | - Bansi Hirapara
- Sakhiya Skin Clinic, 2nd Floor, Ayush Doctor House, Station-Lal Darwaja Road, Surat, Gujarat, India
| | - Madhav Purohit
- Sakhiya Skin Clinic, 2nd Floor, Ayush Doctor House, Station-Lal Darwaja Road, Surat, Gujarat, India
| | - Krishna Bhalala
- Sakhiya Skin Clinic, 2nd Floor, Ayush Doctor House, Station-Lal Darwaja Road, Surat, Gujarat, India
| | - Feral Daruwala
- Sakhiya Skin Clinic, 2nd Floor, Ayush Doctor House, Station-Lal Darwaja Road, Surat, Gujarat, India
| | - Nimish Dudhatra
- Sakhiya Skin Clinic, 2nd Floor, Ayush Doctor House, Station-Lal Darwaja Road, Surat, Gujarat, India
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Zhang Y, Wu H, Tu C, Sun Y, Xiao B, Guo H, Liu Y, Wu Y. The assessment of psychology, quality of life in acne patients and evaluation of ALA-PDT for moderate to severe acne. Photodiagnosis Photodyn Ther 2020; 33:102099. [PMID: 33725799 DOI: 10.1016/j.pdpdt.2020.102099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 09/27/2020] [Accepted: 11/02/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To evaluate the state of psychology and quality of life of patients effected by acne and also the efficacy and safety of photodynamic therapy with topical 5-aminolevulinic acid (ALA-PDT) for moderate to severe acne patients. METHODS In the questionnaire part, a pre-designed form was filled out. The questionnaire was comprised of 2 sections related to acne including sociodemographic and disease information as well as Cardiff Acne Disability Index (CADI) and Self-Rating Anxiety Scale (SAS). In the trial part, the ALA-PDT was applied to moderate to severe acne patients. Fresh 5% ALA solution was topically applied to face or face & neck. After 1 h's incubation, a LED device was illuminated. A power density of 60-100 mW/cm2 was delivered for 20 min. All the patients finished 3-4 sessions of ALA-PDT at 7-10 days intervals. Non-invasive detections were taken for skin moisture, oil, and VISIA indexes. Adverse events were recorded during and after the treatment. RESULTS A total of 247 acne patients finished questionnaires. Over 97 % patients were assessed as mild to severe impacts in CADI questionnaire and 37.6 % patients had various degrees of anxiety in SAS questionnaire. The higher the BMI was, the higher the CADI points were (G = 0.278, p = 0.005). The severity of acne was correlated with psychology and quality of life (CADI: G = 0.367, p = 0.000; SAS: G = 0.285, p = 0.003). A total of 116 patients with moderate or severe acne accepted ALA-PDT and completed at least 3 sessions (PDT3) or even PDT4. After 1 session of treatment (AT1) and AT2, the efficiencies of all patients were 5.2 % and 29.3 %. For patients with PDT3, the efficiencies at follow-up at 1st month after last session (FU1), FU2 and FU3 were 59.4 %, 66.7 % and 78.3 %, respectively. For patients with PDT4, the efficiencies at AT3 and FU1-3 were 51.3 %, 63.6 %, 76.5 % and 85.7 %, respectively. The efficacies of PDT4 patients showed an increasing trend from FU1 to FU3 (G = 0.480, p = 0.004). Acne lesions of mild to severe were correlated with the treatment efficacies (FU1: G = 0.354, p = 0.000; FU2: G = 0.474, p = 0.000; FU3: G = 0.397, p = 0.000). Nearly 15 % patients were followed up for 12 months and among them 52.9 % patients were able to maintain ≥90 % improvement rate. There were no statistically significant differences before and after treatment (p > 0.05) according to the skin moisture content, oil content, ultraviolet ray spots, brown spots, red areas, and purple textures measured. The adverse reactions of ALA-PDT, including local burning sensation, mild pain sensation, mild edema erythema, reactive acne, pigmentation, etc., were temporary and tolerable. CONCLUSION In our study, 97.2 % patients were rated as impact in CADI questionnaire and 37.6 % patients had anxiety in SAS questionnaire. It is necessary to control weight and disease progression. The efficiencies of ALA-PDT for moderate and severe acne were 59.4%-85.7% at follow-ups of 1st, 2nd or 3rd month after last session. The adverse reactions of ALA-PDT were temporary and tolerable.
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Affiliation(s)
- Yuhui Zhang
- Department of Dermatology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710000, China; Department of Dermatology, The First Hospital of China Medical University, Shenyang, 110000, China.
| | - Haien Wu
- Department of Dermatology, The Seventh People's Hospital of Shenyang City, Shenyang, 110000, China.
| | - Chen Tu
- Department of Dermatology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710000, China.
| | - Yan Sun
- Department of Dermatology, The First Hospital of China Medical University, Shenyang, 110000, China.
| | - Bihuan Xiao
- Department of Dermatology, The First Hospital of China Medical University, Shenyang, 110000, China.
| | - Hongzuo Guo
- Department of Dermatology, The First Hospital of China Medical University, Shenyang, 110000, China.
| | - Yongbin Liu
- Department of Dermatology, The Seventh People's Hospital of Shenyang City, Shenyang, 110000, China.
| | - Yan Wu
- Department of Dermatology, The First Hospital of China Medical University, Shenyang, 110000, China.
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Lee HJ, Kim JY, Park KD, Lee WJ. Randomized controlled double-blind study of a cleanser composed of 5-aminolevulinic acid and peptides on mild and moderate acne vulgaris. J Cosmet Dermatol 2019; 19:1745-1750. [PMID: 31778021 DOI: 10.1111/jocd.13232] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 11/12/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Existing treatments of acne vulgaris may be complicated or elicit undesirable side effects. Therefore, new and safe therapeutic modalities are needed. OBJECTIVES We investigated the effects of a cleanser with 5-aminolevulinic acid and peptides on mild to moderate acne vulgaris. METHODS Sixty volunteers with mild to moderate acne vulgaris (IGA grade II-III) were randomly assigned to treatment or control groups of thirty respectively. Participants cleansed their faces twice a day for 8 weeks with either a cleanser with 5-aminolevulinic acid and peptides (treatment) or with basic cleanser (control). The number of acne lesions (comedones, papules, pustules, and nodules), Michaelson's acne severity, and IGA were measured every 2 weeks and patient satisfaction and adverse events at week 8. RESULTS Mean number of inflammatory acne lesions in treatment group decreased from 5.9 at baseline to 4.5 at week 4 and 4.1 at week 8 (in particular, P < .05). The mean number of noninflammatory lesions in treatment group decreased from 11.4 at baseline to 8.8 at week 4 and 7.4 at week 8 (in particular, P < .05). The mean value of Michaelson's acne severity index and IGA in treatment group also decreased from baseline to week 4 and week 8 (both in particular, P < .05). Investigator's assessment and patient satisfaction in treatment group at week 8 were better than control group. Adverse events in two groups were similar. CONCLUSIONS We think the cleanser with 5-aminolevulinic acid and peptides is a useful and safe therapeutic agent for mild to moderate acne vulgaris.
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Affiliation(s)
- Hyun Ji Lee
- Department of Dermatology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jun Young Kim
- Department of Dermatology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Kyung Duck Park
- Department of Dermatology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Weon Ju Lee
- Department of Dermatology, School of Medicine, Kyungpook National University, Daegu, Korea
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Wang Q, Jiang C, Liu W, Chen J, Lin X, Huang X, Duan X. A new optical intra-tissue fiber irradiation ALA-PDT in the treatment of acne vulgaris in rabbit model: improved safety and tolerability. An Bras Dermatol 2018; 92:350-355. [PMID: 29186247 PMCID: PMC5514575 DOI: 10.1590/abd1806-4841.20175543] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Accepted: 05/03/2016] [Indexed: 11/22/2022] Open
Abstract
Background Photodynamic therapy with topical aminolevulinic acid (ALA-PDT) has been
suggested to be effective in treatment of acne vulgaris. However, adverse
events occur during and after treatment. Objectives To compare the efficacy and tolerability of optical intra-tissue fiber
irradiation (OFI) ALA-PDT versus traditional ALA-PDT in treatment of acne
vulgaris in rabbit models. Methods Twenty-five rabbits of clean grade were used. Twenty rabbits were randomly
selected to establish acne model and the other five were used as control.
Rabbits in model group (40 ears) were further divided into four groups (10
ears/group): I, OFI-ALA-PDT with the head of optical fiber inserted into the
target lesion (intra-tissue); II, traditional ALA-PDT group; III, OFI group;
IV, blank control group without any treatment. Uncomfortable symptoms,
adverse events, and effectiveness rates were recorded on post-treatment day
14, 30, and 45. Results On post-treatment day 14, the effectiveness rate in OFI-ALA-PDT group was
obviously higher than that of the other three groups (P<0.05). However,
no improved effects were observed in OFI-ALA-PDT group on day 30 and 45.
During the period of treatment, the frequencies of uncomfortable symptoms in
ALA-PDT group were obviously higher than those in the other three groups
(P<0.05). The adverse event rate in OFI-ALA-PDT group was obviously lower
than that of the ALA-PDT group (P<0.05). Study limitations The unblindness of the study and temporary animal models of acne induced may
hamper the assessment and monitoring of the results, and future studies are
still needed to clarify it further. Conclusion The OFI-ALA-PDT group (intra-tissue irradiation) showed no improved efficacy
on treating rabbit ear acne but had higher safety and better
tolerability.
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Affiliation(s)
- Qian Wang
- Institute of Dermatology and Venereology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital - Chengdu, China
| | - Can Jiang
- School of Clinical Medicine, Southwest Medical University - Luzhou, China
| | - Wei Liu
- Institute of Dermatology and Venereology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital - Chengdu, China
| | - Jin Chen
- Institute of Dermatology and Venereology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital - Chengdu, China
| | - Xinyu Lin
- Institute of Dermatology and Venereology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital - Chengdu, China
| | - Xiangning Huang
- Clinical Laboratory Department, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital - Chengdu, China
| | - Xiling Duan
- Institute of Dermatology and Venereology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital - Chengdu, China
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Boen M, Brownell J, Patel P, Tsoukas MM. The Role of Photodynamic Therapy in Acne: An Evidence-Based Review. Am J Clin Dermatol 2017; 18:311-321. [PMID: 28276005 DOI: 10.1007/s40257-017-0255-3] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Acne vulgaris is a highly prevalent skin disorder that affects almost all adolescents and can persist into adulthood. Photodynamic therapy (PDT) is an emerging treatment for acne that involves the use of a photosensitizer in combination with a light source and oxygen. METHODS We performed a systematic review of the literature and critically evaluated the studies. Sixty-nine clinical trials, four case reports, and two retrospective studies met the inclusion criteria, and seven of the studies were high quality. RESULTS The most common photosensitizers used were 5-aminolevulinic acid and methyl aminolevulinate, and both showed similar response. Red light was the most frequently used light source, followed by intense pulsed light, and showed comparable results. Inflammatory and non-inflammatory lesions both responded to treatment, with inflammatory lesions showing greater clearance in most studies. Adverse events associated with PDT for acne were mild and included pain on illumination and post-procedural erythema and edema. PDT has been safely used in higher Fitzpatrick skin types (III-IV), although these patients had a higher risk of transient hyperpigmentation. CONCLUSION This review supports PDT as an efficacious treatment for acne and a good adjunctive treatment for mild to severe acne, especially in patients who have not responded to topical therapy and oral antibacterials, and are not great candidates for isotretinoin. Further studies are warranted to evaluate the optimal photosensitizers, light sources, incubation times, and number of treatments for PDT use in acne.
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Affiliation(s)
- Monica Boen
- Department of Dermatology, University of Illinois at Chicago, 808 S. Wood St., Suite 380, Chicago, IL, 60612, USA.
| | - Joshua Brownell
- College of Medicine, University of Illinois at Chicago, 1853 West Polk Street, Room 130, Chicago, IL, 60612, USA
| | - Priyanka Patel
- College of Medicine, University of Illinois at Chicago, 1853 West Polk Street, Room 130, Chicago, IL, 60612, USA
| | - Maria M Tsoukas
- Department of Dermatology, University of Illinois at Chicago, 808 S. Wood St., Suite 380, Chicago, IL, 60612, USA.
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Keyal U, Bhatta AK, Wang XL. Photodynamic therapy for the treatment of different severity of acne: A systematic review. Photodiagnosis Photodyn Ther 2016; 14:191-9. [DOI: 10.1016/j.pdpdt.2016.04.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 03/31/2016] [Accepted: 04/10/2016] [Indexed: 11/25/2022]
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Greaves AJ. The effects of narrowbands of visible light upon some skin disorders: a review. Int J Cosmet Sci 2016; 38:325-45. [DOI: 10.1111/ics.12305] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 12/16/2015] [Indexed: 12/13/2022]
Affiliation(s)
- A. J. Greaves
- L'Oréal Recherche; 1 Avenue Eugène Schueller 93601 Aulnay-Sous-Bois France
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Dong Y, Zhou G, Chen J, Shen L, Jianxin Z, Xu Q, Zhu Y. A new LED device used for photodynamic therapy in treatment of moderate to severe acne vulgaris. Photodiagnosis Photodyn Ther 2015; 13:188-195. [PMID: 26116283 DOI: 10.1016/j.pdpdt.2015.06.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 05/25/2015] [Accepted: 06/12/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study investigated the efficacy and safety of a newly designed LED device used in photodiagnosis and photodynamic therapy of moderate to severe acne vulgaris in Chinese patients. METHODS Forty-six patients with moderate to severe facial acne showing high degrees of fluorescence by ultraviolet light examination were illuminated during ALA-PDT with two wavelengths of light (543-548 nm, and 630±6 nm, respectively) after 2 h of incubation with ALA. Each patient received treatment once every 30 days for two or three sessions. Two independent investigators assigned an acne severity score at baseline, one week after each treatment, as well as 4, 8, and 12 weeks after the completion of treatment. Adverse effects were recorded during and after each treatment. All patients rated their satisfaction with the results of treatment at a 12-week follow up visit. RESULTS The ALA-PDL treatment regimen showed an overall effectiveness rate of 89.13% (41/46 patients). Some degree of clinical efficacy was seen in 71.42%, 86.67%, and 95.83% of patients with grades IV, V, and VI acne, respectively, and the rate of clinical effectiveness increased with increasing acne severity. When compared with baseline scores, significant reductions in acne scores were obtained at 8, and 12 weeks after completion of treatment. Maximum efficacy was shown at the 12 week follow up. No severe adverse events were observed. CONCLUSION ALA-PDT administered with the newly designed LED device was an effective treatment for moderate to severe acne vulgaris, and side effects were mild and reversible.
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Affiliation(s)
- Yiyun Dong
- Department of Oral & Maxillofacial-Head & Neck Oncology, Lab of Laser Surgery, Cosmetic Laser Center of the Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Guoyu Zhou
- Department of Oral & Maxillofacial-Head & Neck Oncology, Lab of Laser Surgery, Cosmetic Laser Center of the Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China.
| | - Jinan Chen
- Cosmetic Laser Center of the Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Lingyue Shen
- Department of Oral & Maxillofacial-Head & Neck Oncology, Lab of Laser Surgery, Cosmetic Laser Center of the Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Zhao Jianxin
- Department of Oral & Maxillofacial-Head & Neck Oncology, Lab of Laser Surgery, Cosmetic Laser Center of the Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Qing Xu
- Department of Oral & Maxillofacial-Head & Neck Oncology, Lab of Laser Surgery, Cosmetic Laser Center of the Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Yulan Zhu
- Cosmetic Laser Center of the Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
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Wan MT, Lin JY. Current evidence and applications of photodynamic therapy in dermatology. Clin Cosmet Investig Dermatol 2014; 7:145-63. [PMID: 24899818 PMCID: PMC4038525 DOI: 10.2147/ccid.s35334] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In photodynamic therapy (PDT) a photosensitizer – a molecule that is activated by light – is administered and exposed to a light source. This leads both to destruction of cells targeted by the particular type of photosensitizer, and immunomodulation. Given the ease with which photosensitizers and light can be delivered to the skin, it should come as no surprise that PDT is an increasingly utilized therapeutic in dermatology. PDT is used commonly to treat precancerous cells, sun-damaged skin, and acne. It has reportedly also been used to treat other conditions including inflammatory disorders and cutaneous infections. This review discusses the principles behind how PDT is used in dermatology, as well as evidence for current applications of PDT.
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Affiliation(s)
- Marilyn T Wan
- Melanoma Program, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jennifer Y Lin
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Li X, Wang X, Gu J, Ma Y, Liu Z, Shi Y. Needle-free injection of 5-aminolevulinic acid in photodynamic therapy for the treatment of condylomata acuminata. Exp Ther Med 2013; 6:236-240. [PMID: 23935753 PMCID: PMC3735532 DOI: 10.3892/etm.2013.1092] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 04/19/2013] [Indexed: 12/02/2022] Open
Abstract
The external application of 5-aminolevulinic acid (ALA) in photodynamic therapy (PDT) results in a shallow penetration depth in thick or extensive condylomata acuminata (CA) lesions, thus demonstrating a poor therapeutic effect for those patients. To compare the efficacy of needle-free injection with external application of ALA in PDT for the treatment of CA, 160 CA patients with thick or extensive warts received ALA-PDT by means of external application or needle-free injection of ALA, respectively. The complete response (CR) rate and recurrence rate in the two groups were analyzed. The CR rate after the first treatment in the needle-free injection group (68.8%) was significantly higher compared with that in the external application group (52.5%; P=0.035). The recurrence rates in the needle-free injection group and external application group were 4.1 and 15.4%, respectively (P=0.022). The needle-free injection of ALA increases the therapeutic effect of PDT for CA patients with thick or extensive lesions. It shortens the treatment time and reduces the recurrence rate, and has great potential in the treatment of CA.
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Affiliation(s)
- Xiuli Li
- Department of Dermatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, P.R. China
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Kharkwal GB, Sharma SK, Huang YY, Dai T, Hamblin MR. Photodynamic therapy for infections: clinical applications. Lasers Surg Med 2012; 43:755-67. [PMID: 22057503 DOI: 10.1002/lsm.21080] [Citation(s) in RCA: 340] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVE Photodynamic therapy (PDT) was discovered over 100 years ago by its ability to kill various microorganisms when the appropriate dye and light were combined in the presence of oxygen. However it is only in relatively recent times that PDT has been studied as a treatment for various types of localized infections. This resurgence of interest has been partly motivated by the alarming increase in drug resistance amongst bacteria and other pathogens. This review will focus on the clinical applications of antimicrobial PDT. STUDY DESIGN/MATERIALS AND METHODS The published peer-reviewed literature was reviewed between 1960 and 2011. RESULTS The basics of antimicrobial PDT are discussed. Clinical applications of antimicrobial PDT to localized viral infections caused by herpes and papilloma viruses, and nonviral dermatological infections such as acne and other yeast, fungal and bacterial skin infections are covered. PDT has been used to treat bacterial infections in brain abscesses and non-healing ulcers. PDT for dental infections including periodontitis and endodontics has been well studied. PDT has also been used for cutaneous Leishmaniasis. Clinical trials of PDT and blue light alone therapy for gastric Helicobacter pylori infection are also covered. CONCLUSION As yet clinical PDT for infections has been mainly in the field of dermatology using 5-aminolevulanic acid and in dentistry using phenothiazinium dyes. We expect more to see applications of PDT to more challenging infections using advanced antimicrobial photosensitizers targeted to microbial cells in the years to come.
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Affiliation(s)
- Gitika B Kharkwal
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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SHAABAN DALIA, ABDEL-SAMAD ZEINAB, EL-KHALAWANY MOHAMED. Photodynamic therapy with intralesional 5-aminolevulinic acid and intense pulsed light versus intense pulsed light alone in the treatment of acne vulgaris: a comparative study. Dermatol Ther 2012; 25:86-91. [DOI: 10.1111/j.1529-8019.2012.01427.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gilaberte Y, Paz-Cristobal MP, Rezusta A, Aspiroz C. Terapia fotodinámica antimicrobiana en dermatología. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.piel.2012.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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What is the role of photodynamic therapy in the treatment of acne vulgaris? Photodiagnosis Photodyn Ther 2012; 9:2-4. [DOI: 10.1016/j.pdpdt.2011.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Accepted: 12/27/2011] [Indexed: 11/21/2022]
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Elsaie ML, Choudhary S. Original Contribution: Photodynamic therapy in the management of acne: an update. J Cosmet Dermatol 2010; 9:211-217. [PMID: 20883294 DOI: 10.1111/j.1473-2165.2010.00502.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
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Photodynamic therapy for localized infections--state of the art. Photodiagnosis Photodyn Ther 2010; 6:170-88. [PMID: 19932449 DOI: 10.1016/j.pdpdt.2009.10.008] [Citation(s) in RCA: 494] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Revised: 10/27/2009] [Accepted: 10/28/2009] [Indexed: 12/22/2022]
Abstract
Photodynamic therapy (PDT) was discovered over 100 years ago by observing the killing of microorganisms when harmless dyes and visible light were combined in vitro. Since then it has primarily been developed as a treatment for cancer, ophthalmologic disorders and in dermatology. However, in recent years interest in the antimicrobial effects of PDT has revived and it has been proposed as a therapy for a large variety of localized infections. This revival of interest has largely been driven by the inexorable increase in drug resistance among many classes of pathogen. Advantages of PDT include equal killing effectiveness regardless of antibiotic resistance, and a lack of induction of PDT resistance. Disadvantages include the cessation of the antimicrobial effect when the light is turned off, and less than perfect selectivity for microbial cells over host tissue. This review will cover the use of PDT to kill or inactivate pathogens in ex vivo tissues and in biological materials such as blood. PDT has been successfully used to kill pathogens and even to save life in several animal models of localized infections such as surface wounds, burns, oral sites, abscesses and the middle ear. A large number of clinical studies of PDT for viral papillomatosis lesions and for acne refer to its antimicrobial effect, but it is unclear how important this microbial killing is to the overall therapeutic outcome. PDT for periodontitis is a rapidly growing clinical application and other dental applications are under investigation. PDT is being clinically studied for other dermatological infections such as leishmaniasis and mycobacteria. Antimicrobial PDT will become more important in the future as antibiotic resistance is only expected to continue to increase.
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Kim HS, Jun JH, Lee JY. Photodynamic therapy of facial nevus sebaceous. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2010; 26:98-100. [DOI: 10.1111/j.1600-0781.2010.00489.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Choudhary S, Nouri K, Elsaie ML. Photodynamic therapy in dermatology: a review. Lasers Med Sci 2009; 24:971-80. [PMID: 19653060 DOI: 10.1007/s10103-009-0716-x] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2009] [Accepted: 07/11/2009] [Indexed: 12/18/2022]
Abstract
Photodynamic therapy (PDT) is used for the prevention and treatment of non-melanoma skin cancer. Until recently, clinically approved indications have been restricted to actinic keratoses, nodular and superficial basal cell carcinoma, and, since 2006, Bowen disease. However, the range of indications has been expanding continuously. PDT is also used for the treatment of non-malignant conditions such as acne vulgaris and leishmaniasis, as well as for treating premature skin aging due to sun exposure. The production of reactive oxygen intermediates like singlet oxygen depends on the light dose applied as well as the concentration and localization of the photosensitizer in the diseased tissue. Either cytotoxic effects resulting in tumor destruction or immunomodulatory effects improving inflammatory skin conditions are induced. Treating superficial non-melanoma skin cancer, PDT has been shown to be highly efficient, despite the low level of invasiveness. The excellent cosmetic results after treatment are beneficial, too.
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Affiliation(s)
- Sonal Choudhary
- Department of Dermatology and Cutaneous Surgery, University of Miami, Miami, FL, USA
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