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Aebisher D, Rogóż K, Myśliwiec A, Dynarowicz K, Wiench R, Cieślar G, Kawczyk-Krupka A, Bartusik-Aebisher D. The use of photodynamic therapy in medical practice. Front Oncol 2024; 14:1373263. [PMID: 38803535 PMCID: PMC11129581 DOI: 10.3389/fonc.2024.1373263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 04/16/2024] [Indexed: 05/29/2024] Open
Abstract
Cancer therapy, especially for tumors near sensitive areas, demands precise treatment. This review explores photodynamic therapy (PDT), a method leveraging photosensitizers (PS), specific wavelength light, and oxygen to target cancer effectively. Recent advancements affirm PDT's efficacy, utilizing ROS generation to induce cancer cell death. With a history spanning over decades, PDT's dynamic evolution has expanded its application across dermatology, oncology, and dentistry. This review aims to dissect PDT's principles, from its inception to contemporary medical applications, highlighting its role in modern cancer treatment strategies.
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Affiliation(s)
- David Aebisher
- Department of Photomedicine and Physical Chemistry, Medical College of The Rzeszów University, Rzeszów, Poland
| | - Kacper Rogóż
- English Division Science Club, Medical College of The Rzeszów University, Rzeszów, Poland
| | - Angelika Myśliwiec
- Center for Innovative Research in Medical and Natural Sciences, Medical College of The University of Rzeszów, Rzeszów, Poland
| | - Klaudia Dynarowicz
- Center for Innovative Research in Medical and Natural Sciences, Medical College of The University of Rzeszów, Rzeszów, Poland
| | - Rafał Wiench
- Department of Periodontal Diseases and Oral Mucosa Diseases, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Grzegorz Cieślar
- Department of Internal Medicine, Angiology and Physical Medicine, Center for Laser Diagnostics and Therapy, Medical University of Silesia, Bytom, Poland
| | - Aleksandra Kawczyk-Krupka
- Department of Internal Medicine, Angiology and Physical Medicine, Center for Laser Diagnostics and Therapy, Medical University of Silesia, Bytom, Poland
| | - Dorota Bartusik-Aebisher
- Department of Biochemistry and General Chemistry, Medical College of The Rzeszów University, Rzeszów, Poland
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Qu Z, Cui G, Wang Z, Liu M, Lin X. Combination of biopsy forceps excision and ALA-PDT for the treatment of cervical condylomata acuminata. Photodiagnosis Photodyn Ther 2024; 46:104002. [PMID: 38367921 DOI: 10.1016/j.pdpdt.2024.104002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/27/2024] [Accepted: 02/02/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Human papilloma virus (HPV) infection and cervical condyloma acuminatum (CA) often co-exist. Although there are many methods to treat cervical CA, high recurrence rate and cervical scars are still troublesome. Biopsy forceps excision combined with 5-aminolevulinic acid photodynamic therapy (ALA-PDT) is a feasible approach for cervical CA, but its efficacy and limitation need to be evaluated. METHODS This retrospective study consisted of 49 patients aged 18-50 years with a histologically or colposcopic confirmed cervical CA and with HPV infection. Patients were treated with biopsy forceps excision and ALA-PDT. The efficacy was evaluated through HPV typing and colposcopy directed biopsy. RESULTS Three months after the combination treatment the total lesion remission rate was 93.88 % (46/49) and the HPV clearance rate was 83.67 % (41/49). One patients showed some residual lesions and two patients showed new lesions. Recurrence rate was 4.34 % at 6 months follow-up. There was no significant difference in HPV clearance rate at 3 and 6 months follow-up. Univariate analysis showed that the combination treatment was less effective for patients who had size of visible lesion > 1.5 cm2. Adverse effects were minimal and no structural complications were reported. The main side effects were abdominal pain and increased vaginal secretions. CONCLUSION Combination of biopsy forceps excision and ALA-PDT is safe and effective for eliminating cervical condylomata lesion and eradicating HPV infection. Colposcopic evaluation is recommended before and after treatment.
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Affiliation(s)
- Zhongyu Qu
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China.
| | - Guoying Cui
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China
| | - Zhifeng Wang
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China
| | - Ming Liu
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China
| | - Xueyan Lin
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China.
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Nugent D, Apoola A, Coleman H, Gilmour C, Lawton MD, Nori A, D C Ross J, Whitlock G, Yeend-Curd-Trimble H. British association for sexual health and HIV national guideline for the management of anogenital warts in adults (2024). Int J STD AIDS 2024:9564624241233338. [PMID: 38456387 DOI: 10.1177/09564624241233338] [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: 03/09/2024]
Abstract
This guideline offers recommendations on the diagnosis, treatment and health promotion principles needed for the effective management of human papillomavirus (HPV)-related warts at anogenital sites including the external genitals, vagina, cervix, urethra, perianus and anal canal. The guideline is aimed primarily at patients aged 16 years or older presenting to healthcare professionals working in level 3 sexual health services in the United Kingdom. However, the principles of the recommendations may be applied in other care settings, including in primary care, using locally adapted care pathways where appropriate. The management of HPV-related anogenital dysplasia or warts at other extragenital sites is outside the scope of this guideline.
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Affiliation(s)
- Diarmuid Nugent
- Chelsea & Westminster Hospitals NHS Foundation Trust, London, UK
| | - Ade Apoola
- Derbyshire Community Health Services NHS Foundation Trust, Derby, UK
| | - Harry Coleman
- Central & North West London NHS Foundation Trust, London, UK
| | - Cindy Gilmour
- Chelsea & Westminster Hospitals NHS Foundation Trust, London, UK
| | | | - Achyuta Nori
- Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Jonathan D C Ross
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Gary Whitlock
- Chelsea & Westminster Hospitals NHS Foundation Trust, London, UK
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Zhao Z, Jama AA, Gao H, Lu Y. Clinical observation of laser combined with 5-aminolevulinic acid photodynamic therapy for female vulva condyloma acuminatum. J Obstet Gynaecol Res 2023. [PMID: 37230948 DOI: 10.1111/jog.15679] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 05/04/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Condylomata acuminata, or genital warts (GW), are exceedingly prevalent, with human papilloma virus infection accounting for 90% of cases. It can be treated in a variety of methods, but the high recurrence rate and cervical scars make it difficult to choose the best treatment option. Hence, the study aims to find the effect of laser combined with 5-aminolevulinic acid (ALA) photodynamic therapy for condyloma acuminata in the vulva, vagina, and cervix. METHODS A total of 106 female patients with GW of the vulva, vagina, and cervical condyloma acuminata were treated in the Dermatology Department of Subei People's Hospital in Yangzhou from May 2020 to July 2021. All these patients were treated with laser combined with 5-ALA photodynamic therapy to observe the therapeutic effect. RESULTS About 84.9% of patients responded to the first session of ALA-photodynamic treatment. Five patients relapsed in the 2nd week, two patients relapsed in the 4th week, one relapsed in the 8th week, one relapsed in the 12th week, and the relapsed patients were given 1-3 times of photodynamic therapy again, and no recurrence was seen in the 24th week. After four courses of treatment in 106 patients, the wart clearance rate was 100%. CONCLUSION Laser combined with 5-ALA photodynamic therapy for female vulva, vagina, and cervix condyloma acuminata has a reliable curative effect, low recurrence rate, few adverse reactions, and less pain. It is worth promoting in female vulva, vagina, and cervical condyloma acuminata.
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Affiliation(s)
- Zian Zhao
- School of Clinical medicine, Yangzhou University, Yangzhou, Jiangsu, China
| | | | - Hui Gao
- School of Clinical medicine, Yangzhou University, Yangzhou, Jiangsu, China
| | - Yao Lu
- School of Clinical medicine, Yangzhou University, Yangzhou, Jiangsu, China
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Prayogo SA, Andrew H, Cong S, Intaran KDA. Photodynamic therapy in the treatment of condyloma acuminata: A systematic review of clinical trials. Int J STD AIDS 2023; 34:76-86. [PMID: 36420589 DOI: 10.1177/09564624221138351] [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: 11/25/2022]
Abstract
INTRODUCTION Condylomata acuminata (CA) is a sexually transmitted infection with a high prevalence associated with psychosexual morbidity in both men and women of various age. Up to now, treatment modalities yield low clearance and recurrence rate (RR) and are also deemed low quality evidence-wise. Photodynamic therapy (PDT) is a novel and promising therapy to effectively cure and prevent CA recurrence. METHOD This systematic review was reported according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) and registered to the International Prospective Register of Systematic Review (PROSPERO) (CRD42022332760). RESULTS Ten studies were included in this systematic review. A significant value of complete response (CR) ranging from 63-100% in patients with genital warts after receiving several sessions of PDT. A relatively low recurrence rate was seen in all 10 studies, with an RR of less than 17%. Quality assessment of included studies reported mostly high-quality research. CONCLUSIONS PDT therapy resulted in a higher CR with significantly lower RR compared to other therapies. Thus, PDT can be an alternative treatment of CA with low RR and minimal side effects. Additional research, especially randomized clinical trials in various countries, is needed to further substantiate this treatment and formulate definitive protocols.
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Affiliation(s)
| | - Hubert Andrew
- Faculty of Medicine, 64733Universitas Indonesia, Jakarta Pusat, Indonesia
| | - Stefanny Cong
- Faculty of Medicine, 64733Universitas Indonesia, Jakarta Pusat, Indonesia
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Dey A, Singhvi G, Puri A, Kesharwani P, Dubey SK. An insight into photodynamic therapy towards treating major dermatological conditions. J Drug Deliv Sci Technol 2022; 76:103751. [PMID: 36159728 PMCID: PMC9495279 DOI: 10.1016/j.jddst.2022.103751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
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.
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Affiliation(s)
- Anuradha Dey
- R&D Healthcare Division, Emami Ltd, 13, BT Road, Belgharia, Kolkata 700056, India
| | - Gautam Singhvi
- Department of Pharmacy, Birla Institute of Technology and Science, Pilani, Pilani Campus, Rajasthan, India-333031
| | - Anu Puri
- RNA Structure and Design Section, RNA Biology Laboratory (RBL), Center for Cancer Research, National Cancer Institute — Frederick, Frederick, MD, 21702, USA
| | - Prashant Kesharwani
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062, India
- University Institute of Pharma Sciences, Chandigarh University, Mohali, Punjab, India
| | - Sunil Kumar Dubey
- R&D Healthcare Division, Emami Ltd, 13, BT Road, Belgharia, Kolkata 700056, India
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Bu Z, Xiang T, Lei Z, Yang Q, Wu Y, Ye E, He B, Zheng M, Ali K. A new option for the treatment of condyloma acuminatum in the male urethra: Multimodal ultrasound image-guided scraping and photodynamic therapy (USP). Photodiagnosis Photodyn Ther 2022; 39:102985. [PMID: 35753674 DOI: 10.1016/j.pdpdt.2022.102985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/09/2022] [Accepted: 06/22/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Condyloma acuminatum (CA) is a sexually transmitted disease with a high recurrence rate due to the rapid replication of human papillomavirus (HPV) and its subtle immune escape mechanism, which makes the diagnosis and treatment of CA in the male urethra particularly difficult. This study aims to evaluate the efficacy of comprehensive treatments for male urethral CA after accurate localization of warts under ultrasound guidance. METHODS The study included 15 men with intraurethral CA. Before treatment, the urethra was examined by ultrasonography and HPV-PCR. After examination of the invisible urethral warts, wart curettage (penetrating operation with a special stainless steel medical curettage tool) combined with ALA-PDT was used for treatment. The ultrasound and HPV load were reviewed 1 week after treatment, and again at 1, 3, and 6 months after treatment. RESULTS All patients achieved satisfactory results 1 week after the last treatment. The viral load of human papilloma was significantly reduced or turned negative, ultrasound imaging exploration showed no neoplasm in the urethra, and no obvious intraoperative or postoperative complications were observed. The side effects in patients included a mild burning or tingling sensation confined to the treated area. After a 6 month follow-up period, only 2 patient relapsed. CONCLUSION The combined diagnosis and treatment of CA in the male urethra under the guidance of multi-mode ultrasound imaging is an effective, economical, safe, and well-tolerated treatment method.
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Affiliation(s)
- Zhangyu Bu
- Department of Dermatology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, hangzhou,310006,China.
| | - Tingkai Xiang
- The Fourth School of Medicine Affiliated to Zhejiang Chinese Medical University,hangzhou, 310053,China
| | - Zhikai Lei
- Department of Ultrasound, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine,hangzhou, 310006,China
| | - QingYun Yang
- The Fourth School of Medicine Affiliated to Zhejiang Chinese Medical University,hangzhou, 310053,China
| | - YangFan Wu
- The Fourth School of Medicine Affiliated to Zhejiang Chinese Medical University,hangzhou, 310053,China
| | - EnYi Ye
- The Fourth School of Medicine Affiliated to Zhejiang Chinese Medical University,hangzhou, 310053,China
| | - BeiLei He
- The Fourth School of Medicine Affiliated to Zhejiang Chinese Medical University,hangzhou, 310053,China
| | - Min Zheng
- Department of Dermatology, Second Affiliated Hospital, Zhejiang University School of Medicine,hangzhou,310001
| | - Kamran Ali
- Department of Dermatology,International Education College of Zhejiang Chinese Medical University,hangzhou,310053,China
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Shen S, Feng J, Song X, Xiang W. Efficacy of photodynamic therapy for warts induced by human papilloma virus infection: A systematic review and meta-analysis. Photodiagnosis Photodyn Ther 2022; 39:102913. [DOI: 10.1016/j.pdpdt.2022.102913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/14/2022] [Accepted: 05/16/2022] [Indexed: 12/21/2022]
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Khairkhah N, Bolhassani A, Najafipour R. Current and future direction in treatment of HPV-related cervical disease. J Mol Med (Berl) 2022; 100:829-845. [PMID: 35478255 PMCID: PMC9045016 DOI: 10.1007/s00109-022-02199-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/24/2022] [Accepted: 04/08/2022] [Indexed: 02/06/2023]
Abstract
Human papillomavirus (HPV) is the most common sexually transmitted virus in the world. About 70% of cervical cancers are caused by the most oncogenic HPV genotypes of 16 and 18. Since available prophylactic vaccines do not induce immunity in those with established HPV infections, the development of therapeutic HPV vaccines using E6 and E7 oncogenes, or both as the target antigens remains essential. Also, knocking out the E6 and E7 oncogenes in host genome by genome-editing CRISPR/Cas system can result in tumor growth suppression. These methods have shown promising results in both preclinical and clinical trials and can be used for controlling the progression of HPV-related cervical diseases. This comprehensive review will detail the current treatment of HPV-related cervical precancerous and cancerous diseases. We also reviewed the future direction of treatment including different kinds of therapeutic methods and vaccines, genome-editing CRISPR/Cas system being studied in clinical trials. Although the progress in the development of therapeutic HPV vaccine has been slow, encouraging results from recent trials showed vaccine-induced regression in high-grade CIN lesions. CRISPR/Cas genome-editing system is also a promising strategy for HPV cancer therapy. However, its safety and specificity need to be optimized before it is used in clinical setting.
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Affiliation(s)
- Niloofar Khairkhah
- Department of Molecular Medicine, School of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran.,Department of Hepatitis and AIDS, Pasteur Institute of Iran, Tehran, Iran
| | - Azam Bolhassani
- Department of Hepatitis and AIDS, Pasteur Institute of Iran, Tehran, Iran.
| | - Reza Najafipour
- Genetics Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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The evolution of clinical guidelines for antimicrobial photodynamic therapy of skin. Photochem Photobiol Sci 2022; 21:385-395. [PMID: 35132604 PMCID: PMC8821777 DOI: 10.1007/s43630-021-00169-w] [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: 07/13/2021] [Accepted: 12/28/2021] [Indexed: 11/28/2022]
Abstract
Antimicrobial photodynamic therapy has become an important component in the treatment of human infection. This review considers historical guidelines, and the scientific literature to envisage what future clinical guidelines for treating skin infection might include. Antibiotic resistance, vertical and horizontal infection control strategies and a range of technologies effective in eradicating microbes without building up new resistance are described. The mechanism of action of these treatments and examples of their clinical use are also included. The research recommendations of NICE Guidelines on the dermatological manifestations of microbial infection were also reviewed to identify potential applications for PDT. The resistance of some microbes to antibiotics can be halted, or even reversed through the use of supplementary drugs, and so they are likely to persist as a treatment of infection. Conventional PDT will undoubtedly continue to be used for a range of skin conditions given existing healthcare infrastructure and a large evidence base. Daylight PDT may find broader antimicrobial applications than just Acne and Cutaneous Leishmaniasis, and Ambulatory PDT devices could become popular in regions where resources are limited or daylight exposure is not possible or inappropriate. Nanotheranostics were found to be highly relevant, and often include PDT, however, new treatments and novel applications and combinations of existing treatments will be subject to Clinical Trials.
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Romero M, Jibaja I, Bucheli J, Inada N, Bagnato V. CLINICAL STUDY OF ANOGENITAL CONDYLOMA ACUMINATA TREATMENT WITH PHOTODYNAMIC THERAPY: REPORT OF IMMUNOCOMPROMISED CONDITIONS. Photodiagnosis Photodyn Ther 2022; 37:102735. [DOI: 10.1016/j.pdpdt.2022.102735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 01/16/2022] [Accepted: 01/18/2022] [Indexed: 10/19/2022]
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Wang D, Kuzma ML, Tan X, He TC, Dong C, Liu Z, Yang J. Phototherapy and optical waveguides for the treatment of infection. Adv Drug Deliv Rev 2021; 179:114036. [PMID: 34740763 PMCID: PMC8665112 DOI: 10.1016/j.addr.2021.114036] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 10/11/2021] [Accepted: 10/28/2021] [Indexed: 02/07/2023]
Abstract
With rapid emergence of multi-drug resistant microbes, it is imperative to seek alternative means for infection control. Optical waveguides are an auspicious delivery method for precise administration of phototherapy. Studies have shown that phototherapy is promising in fighting against a myriad of infectious pathogens (i.e. viruses, bacteria, fungi, and protozoa) including biofilm-forming species and drug-resistant strains while evading treatment resistance. When administered via optical waveguides, phototherapy can treat both superficial and deep-tissue infections while minimizing off-site effects that afflict conventional phototherapy and pharmacotherapy. Despite great therapeutic potential, exact mechanisms, materials, and fabrication designs to optimize this promising treatment option are underexplored. This review outlines principles and applications of phototherapy and optical waveguides for infection control. Research advances, challenges, and outlook regarding this delivery system are rigorously discussed in a hope to inspire future developments of optical waveguide-mediated phototherapy for the management of infection and beyond.
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Affiliation(s)
- Dingbowen Wang
- Department of Biomedical Engineering, Materials Research Institute, The Huck Institutes of the Life Sciences, The Pennsylvania State University, University Park, PA 16802, USA
| | - Michelle Laurel Kuzma
- Department of Biomedical Engineering, Materials Research Institute, The Huck Institutes of the Life Sciences, The Pennsylvania State University, University Park, PA 16802, USA
| | - Xinyu Tan
- Department of Biomedical Engineering, Materials Research Institute, The Huck Institutes of the Life Sciences, The Pennsylvania State University, University Park, PA 16802, USA; Academy of Orthopedics, Provincial Key Laboratory of Bone and Joint Degenerative Diseases, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong Province 510280, China
| | - Tong-Chuan He
- Molecular Oncology Laboratory, Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL 60637, USA; Department of Surgery, The University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Cheng Dong
- Department of Biomedical Engineering, Materials Research Institute, The Huck Institutes of the Life Sciences, The Pennsylvania State University, University Park, PA 16802, USA
| | - Zhiwen Liu
- Department of Electrical Engineering, Materials Research Institute, The Pennsylvania State University, University Park, PA 16802, USA
| | - Jian Yang
- Department of Biomedical Engineering, Materials Research Institute, The Huck Institutes of the Life Sciences, The Pennsylvania State University, University Park, PA 16802, USA.
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Zhou S, Gu L, Shi Z, Gu L, Zhou B, Hua H. A novel nomogram based on a retrospective study of 346 patients to predict the recurrence risk of condyloma acuminatum after 5-aminolevulinic acid photodynamic therapy. J Dermatol 2021; 49:272-281. [PMID: 34741355 DOI: 10.1111/1346-8138.16218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/08/2021] [Accepted: 10/20/2021] [Indexed: 11/27/2022]
Abstract
Condyloma acuminatum (CA) is a sexually transmitted disease caused by human papillomavirus (HPV) often with high recurrence rate after treatment. This study aimed to construct and evaluate a nomogram model containing three clinical parameters to predict the recurrence risk of CA after 5-aminolevulinic acid photodynamic therapy (ALA-PDT). A predictive model was established based on a training cohort of 346 CA patients treated with ALA-PDT between January 2013 and July 2018. A validation cohort of 123 CA patients was recruited from August 2018 to December 2019. The least absolute shrinkage and selection operator (LASSO) regression model was used to optimize the clinical feature selection. A nomogram predicting the recurrence of CA after ALA-PDT was constructed based on the predictors identified by LASSO regression. C-index and area under the curve (AUC) values were used to evaluate the discrimination. Calibration was evaluated with a calibration curve. The net benefit was performed via decision curve analysis (DCA). In the training cohort, 55 (15.89%) patients experienced recurrences after ALA-PDT. Predictors selected by LASSO regression were concomitant human immunodeficiency virus (HIV) infection [Hazard ratio (HR) = 4.4; 95% confidence interval (CI), 2.5-7.9; p < 0.001], skin and mucosa as affected area (HR = 1.7; 95% CI, 0.9-3.1; p = 0.109), and more than one time of CO2 laser therapy (HR = 6.3; 95% CI, 2.8-13.9; p < 0.001). The nomogram showed a good performance in predicting recurrence as the C-indexes were 0.843 (95% CI, 0.799-0.887) in the training cohort, and 0.831 (95% CI, 0.727-0.934) in the validation cohort. The AUCs of the nomogram were 0.85 in training and 0.8 in validation. DCA confirmed the nomogram was clinically useful when the intervention was determined at the non-adherence possibility threshold of 5%. This nomogram can provide individualized prediction for the recurrence risk of CA in patients treated by ALA-PDT.
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Affiliation(s)
- Shu Zhou
- Department of Dermatology, Nantong Third People's Hospital Affiliated to Nantong University, Nantong, China
| | - Li Gu
- Department of Dermatology, Nantong Third People's Hospital Affiliated to Nantong University, Nantong, China
| | - Zhinan Shi
- Department of Dermatology, Nantong Third People's Hospital Affiliated to Nantong University, Nantong, China
| | - Liqun Gu
- Department of Dermatology, Nantong Third People's Hospital Affiliated to Nantong University, Nantong, China
| | - Bingrong Zhou
- Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hui Hua
- Department of Dermatology, Nantong Third People's Hospital Affiliated to Nantong University, Nantong, China
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Niu J, Cheng M, Hong Z, Ling J, Di W, Gu L, Qiu L. The effect of 5-Aminolaevulinic Acid Photodynamic Therapy versus CO 2 laser in the Treatment of Cervical Low-grade Squamous Intraepithelial Lesions with High-Risk HPV Infection: A non-randomized, controlled pilot study. Photodiagnosis Photodyn Ther 2021; 36:102548. [PMID: 34562648 DOI: 10.1016/j.pdpdt.2021.102548] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/01/2021] [Accepted: 09/20/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND There are insufficient studies comparing the efficacy of 5-aminolaevulinic acid (ALA) photodynamic therapy (PDT) against CO2 laser therapy in the treatment of cervical low-grade squamous intraepithelial lesion (LSIL) with high-risk human papillomavirus (HR-HPV), especially for long-term efficacy. METHODS Patients with cervical LSIL and HR-HPV infection were divided into two treatment groups based on their own choice. All patients had a follow-up test including HPV testing, cytology and colposcopy at 4-6 months and 12 months after the treatment. RESULTS (1) Among 277 patients, 176 patients received 5-ALA PDT and 101 patients received CO2 laser therapy. (2) 4-6 months after treatment, there was no significant difference between two groups in the complete remission (CR) rates of cervical LSIL and the clearance rate of HR-HPV infection. (3) 12 months after treatment, compared with the CO2 laser group, the CR rates of cervical LSIL in the 5-ALA PDT group was significantly higher than the CO2 laser group. There was no statistical difference in the clearance rate of HR-HPV infection between the two groups. (4) 12 months after treatment, the recurrence rate of cervical lesions and the reinfection rate of HR-HPV infection in 5-ALA PDT group were significantly lower than those in CO2 laser group. CONCLUSION The effect of 5-ALA PDT is similar to CO2 laser at 4-6 months. The long-term efficacy of 5-ALA PDT appears better than CO2 laser. As a non-invasive treatment, 5-ALA PDT is a highly effective therapeutic procedure for cervical LSIL with HR-HPV infection.
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Affiliation(s)
- Jiaxin Niu
- Department of Obstetrics and Gynecology, Renji Hospital, Shanghai Jiaotong University School of Medicine; Shanghai Key Laboratory of Gynecologic Oncology, Renji Hospital, Shanghai Jiaotong University School of Medicine
| | - Mengxing Cheng
- Department of Obstetrics and Gynecology, Renji Hospital, Shanghai Jiaotong University School of Medicine; Shanghai Key Laboratory of Gynecologic Oncology, Renji Hospital, Shanghai Jiaotong University School of Medicine
| | - Zubei Hong
- Department of Obstetrics and Gynecology, Renji Hospital, Shanghai Jiaotong University School of Medicine; Shanghai Key Laboratory of Gynecologic Oncology, Renji Hospital, Shanghai Jiaotong University School of Medicine
| | - Jiayan Ling
- Department of Obstetrics and Gynecology, Renji Hospital, Shanghai Jiaotong University School of Medicine
| | - Wen Di
- Department of Obstetrics and Gynecology, Renji Hospital, Shanghai Jiaotong University School of Medicine; Shanghai Key Laboratory of Gynecologic Oncology, Renji Hospital, Shanghai Jiaotong University School of Medicine; State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine
| | - Liying Gu
- Department of Obstetrics and Gynecology, Renji Hospital, Shanghai Jiaotong University School of Medicine; Shanghai Key Laboratory of Gynecologic Oncology, Renji Hospital, Shanghai Jiaotong University School of Medicine.
| | - Lihua Qiu
- Department of Obstetrics and Gynecology, Renji Hospital, Shanghai Jiaotong University School of Medicine; Shanghai Key Laboratory of Gynecologic Oncology, Renji Hospital, Shanghai Jiaotong University School of Medicine; State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine.
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15
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Buzzá HH, Stringasci MD, de Arruda SS, Crestana RHS, de Castro CA, Bagnato VS, Inada NM. HPV-induced condylomata acuminata treated by Photodynamic Therapy in comparison with trichloroacetic acid: A randomized clinical trial. Photodiagnosis Photodyn Ther 2021; 35:102465. [PMID: 34333146 DOI: 10.1016/j.pdpdt.2021.102465] [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: 04/23/2021] [Revised: 06/14/2021] [Accepted: 07/26/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES This is a randomized controlled clinical trial comparing Photodynamic Therapy (PDT) and the application of trichloracetic acid (TAA) in the treatment of HPV condyloma in the perianal and vulva regions. Design, Randomised controlled, open label, trial. They were allocated to each treatment following randomization by a computer program. SETTING Women Health Ambulatory in São Carlos city, São Paulo State in the Brazil. PARTICIPANTS 36 patients evaluated. 31 patients fulfilled the study requirements. INTERVENTION Photodynamic Therapy (PDT) versus trichloracetic acid (TAA). The PDT protocol used the prodrug methyl aminolevulinate incubated for 3 hours and irradiation at 630 nm (100 J/cm²). In the treatment using TAA, warts received a small amount of acid using a cotton swab. Both treatments were repeated weekly until the lesions disappeared completely or until 10 sessions were completed. MAIN OUTCOME MEASURE Clinical analysis. Follow-up between 12 and 30 months after the complete treatment. RESULTS A total of 16 patients were treated with PDT and 15 patients with TAA. A complete response rate of 60% for TAA and 63% for PDT, with a recurrence rate of 33% for TAA and 0% for PDT. CONCLUSION PDT appears not only to treat lesions due to physical destruction of condyloma and subclinical lesions, but also to modulate the immune system and/or also to decrease the local viral load, suggesting a lower recurrence compared to the TAA group.
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Affiliation(s)
- Hilde Harb Buzzá
- Sao Carlos Institute of Physics, University of Sao Paulo, Sao Carlos, SP, Brazil.
| | | | - Semira Silva de Arruda
- Sao Carlos Institute of Physics, University of Sao Paulo, Sao Carlos, SP, Brazil; Biological and Health Sciences Center, Federal University of Sao Carlos, Sao Carlos, SP, Brazil
| | | | | | - Vanderlei Salvador Bagnato
- Sao Carlos Institute of Physics, University of Sao Paulo, Sao Carlos, SP, Brazil; Hagler Fellow, Texas A&M University, College Station, TX, USA
| | - Natalia Mayumi Inada
- Sao Carlos Institute of Physics, University of Sao Paulo, Sao Carlos, SP, Brazil
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16
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Gilson R, Nugent D, Werner RN, Ballesteros J, Ross J. 2019 IUSTI-Europe guideline for the management of anogenital warts. J Eur Acad Dermatol Venereol 2021; 34:1644-1653. [PMID: 32735077 DOI: 10.1111/jdv.16522] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 04/01/2020] [Indexed: 12/31/2022]
Abstract
This guideline is an update of the 2011 European Guideline for the Management of Anogenital Warts. It is intended to support best practice in the care of patients with anogenital warts by including evidence-based recommendations on diagnosis, treatment, follow-up and advice to patients. It is intended for use by healthcare professionals in sexual healthcare or dermato-venereology clinics in Europe but may be adapted for use in other settings where the management of anogenital warts is undertaken. As a European guideline, recommendations should be adapted according to national circumstances and healthcare systems. Despite the availability of vaccine to prevent HPV types 6 and 11, the cause of >95% anogenital warts, they remain an important and frequent health problem. The previous systematic review of randomized controlled trials for anogenital warts was updated. The changes in the present guideline include the following: Updated background information on the prevalence, natural history and transmission of human papillomavirus (HPV) infection and anogenital warts. Key recommendations for diagnosis and treatment have been graded according to the strength of the recommendation and the quality of supporting evidence. 5-fluorouracil, local interferon and photodynamic therapy have been evaluated and included as potential second-line treatment options. Evidence of the impact of HPV vaccination on the incidence of anogenital warts has been updated.
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Affiliation(s)
- R Gilson
- Centre for Clinical Research in Infection and Sexual Health, Institute for Global Health, University College London, London, UK.,The Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK
| | - D Nugent
- Centre for Clinical Research in Infection and Sexual Health, Institute for Global Health, University College London, London, UK.,The Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK
| | - R N Werner
- Department of Dermatology, Venereology and Allergy, Division of Evidence-Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | | | - J Ross
- University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
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17
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Chinese guidelines on the clinical application of 5-aminolevulinic acid-based photodynamic therapy in dermatology (2021 edition). Photodiagnosis Photodyn Ther 2021; 35:102340. [PMID: 33991660 DOI: 10.1016/j.pdpdt.2021.102340] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/12/2021] [Accepted: 05/07/2021] [Indexed: 12/24/2022]
Abstract
Photodynamic Therapy with 5-aminolevulinic acid (ALA-PDT) has been widely applied in the treatment of skin diseases in China. To further standardize, guide, and promote the clinical applications of ALA-PDT in dermatology, the Chinese Society of Dermatology, Chinese Association of Rehabilitation Dermatology, Photomedicine Therapeutic Equipment Group of Committee on Skin Disease, and Cosmetic Dermatology of China Association of Medical Equipment invited relevant experts engaged in ALA-PDT to revise and update the first edition of "Clinical application of 5-aminolevulinic acid-based photodynamic therapy: an expert consensus statement" and establish a more current edition, to provide an updated reference for Chinese dermatologists in clinical practice. In the guideline, the expert group reached consensus opinions on ALA-PDT with regard to mechanisms of action, therapeutic protocol, clinical applications, adverse reactions and countermeasures, precautions, care, and evaluation of efficacy.
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18
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Kechichian E, Helou E, Sarkis J, Hayek C, Labaki C, Nemr E, Tomb R. The place of 5-aminolaevulinic acid-photodynamic therapy in the treatment landscape of urethral warts: A systematic review. Photodiagnosis Photodyn Ther 2021; 33:102204. [PMID: 33529745 DOI: 10.1016/j.pdpdt.2021.102204] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 12/27/2020] [Accepted: 01/25/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Human papilloma virus (HPV) infection is the most common sexually transmitted disease worldwide and the main cause of genital warts. Clear recommendations for the management of urethral warts, which are often hard to detect and difficult to treat, are still lacking. OBJECTIVE To summarize all available data describing treatment modalities of urethral warts, compare their efficacy and side effects, and provide physicians a treatment strategy outline. MATERIAL AND METHODS Till June 2020, we conducted a systematic review of articles studying the different treatment modalities of urethral condylomas. A chi-square test was used to compare the recurrence rates between treatment modalities, the complete clearance rates at first follow-up and the rates of adverse events. RESULTS A total of 26 articles with 1730 patients were included in our review. 61 % of patients were deemed completely cured on the first follow-up while 21 % recurred. 5-aminolevulinic acid (ALA) mediated photodynamic therapy (PDT) was the most common treatment and yielded the lowest recurrence rate (7.5 %) followed by laser therapy (24 %) and topical therapy (31 %) (p < 0.01). ALA-PDT resulted in a higher rate of clearance on follow up (96 %) compared to laser therapy (69 %) and topical therapy (14 %) (p < 0.01). Adverse events were more frequent in the ALA-PDT group (69 %) compared to laser therapy (28 %) and topical treatment (30 %) (p < 0.01). CONCLUSION ALA-PDT appears to be the most effective treatment of urethral condylomas in term of clearance and recurrence rate, but with a higher risk of adverse events. Management should be tailored to the type of lesion found at presentation.
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Affiliation(s)
- Elio Kechichian
- Department of Dermatology, Saint-Joseph University, Beirut, Lebanon.
| | - Elie Helou
- Department of Urology, Saint-Joseph University, Beirut, Lebanon
| | - Julien Sarkis
- Department of Urology, Saint-Joseph University, Beirut, Lebanon
| | - Claude Hayek
- Department of Dermatology, Saint-Joseph University, Beirut, Lebanon
| | - Chris Labaki
- Department of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Elie Nemr
- Department of Urology, Saint-Joseph University, Beirut, Lebanon
| | - Roland Tomb
- Department of Dermatology, Saint-Joseph University, Beirut, Lebanon
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19
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Iranmanesh B, Khalili M, Zartab H, Amiri R, Aflatoonian M. Laser therapy in cutaneous and genital warts: A review article. Dermatol Ther 2020; 34:e14671. [PMID: 33314577 DOI: 10.1111/dth.14671] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 12/06/2020] [Indexed: 11/27/2022]
Abstract
Traditional treatment modalities for wart require long-term treatment course and usually have high recurrence rates and unwanted side effects. In this review article, we evaluated different types of laser therapy in the treatment of warts. Published articles since 2000 up to July 2020 about laser therapy in genital and non-genital warts were searched and assessed. Fifty articles were selected for the final review, including 22 pulsed dye laser (PDL), 10 neodymium-yttrium-aluminum-garnet (Nd: YAG), 3 erbium-doped yttrium-aluminum-garnet (Er: YAG), 14 carbon dioxide (CO2 ) laser and one systematic review. Complete response rates were different in terms of laser type used (0%-100%, 9.1%-100%, 83.3%-100%, and 59.15%-100% for PDL, Nd: YAG, Er: YAG, and CO2 laser, respectively). There was no significant difference between conventional treatment modalities and laser therapy regarding efficacy and recurrence rate. Combination of lasers with keratolytic agents, immunomodulators and photodynamic therapy can be helpful especially in immunosuppressed patients, refractory, and recurrent lesions. PDL has the lowest occurrence of adverse effects relative to other types of lasers.
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Affiliation(s)
- Behzad Iranmanesh
- Department of Dermatology, Kerman University of Medical Sciences, Kerman, Iran
| | - Maryam Khalili
- Department of Dermatology, Kerman University of Medical Sciences, Kerman, Iran
| | - Hamed Zartab
- Department of Dermatology, Kerman University of Medical Sciences, Kerman, Iran
| | - Rezvan Amiri
- Department of Dermatology, Kerman University of Medical Sciences, Kerman, Iran
| | - Mahin Aflatoonian
- Department of Dermatology, Kerman University of Medical Sciences, Kerman, Iran
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20
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[Consensus on HPV of the Portuguese Society of Andrology, Sexual Medicine and Reproduction: Treatment]. Rev Int Androl 2020; 19:150-159. [PMID: 32684426 DOI: 10.1016/j.androl.2020.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 01/19/2020] [Indexed: 11/22/2022]
Abstract
The treatment of condyloma is generally a challenge in clinical practice. Although the spontaneous resolution rate is high, a significant proportion of patients seek treatment, not because of symptomatology, but mainly for aesthetic issues and concerns related to the transmission or worsening of existing lesions. The available treatments should be applied only for clinically evident macroscopic lesions. Ideally, available therapies should have rapid action onset and clearance, resolve symptoms, reduce recurrence rate and viral load, be effective in treating small lesions, and be well tolerated. However, none of the currently available treatments is clearly more effective than the others and there is no ideal treatment for all patients or for all condyloma. Therefore, the therapeutic decision should be based on the clinician's experience, available resources, lesion morphology, size, number and location, primary or recurrent lesions, disease severity, patient preference and expectations, patient's immune competence, convenience, tolerance, cost of treatment and results of previous therapies. The available treatments are divided into three groups: applied by the patient himself (imiquimod 3.75 or 5%, podophyllotoxin .5%, synecatekines 10% or 15%), applied by the health care provider (bi- and tricloacetic acids 80%-90%, intralesional interferon alpha, cryotherapy, surgical removal, electrofulguration, laser ablation) and experimental or alternative therapies (topical cidofovir, intralesional bleomycin, photodynamic therapy). Treatment methodologies can be further divided into their action - ablative or destructive treatment (cryotherapy, electrofulguration, laser ablation, surgical excision), cytotoxic or proapoptotic treatments (podophyllotoxin .5%, 5-fluoruracil, bleomycin) and immunomodulatory treatments (imiquimod 3.75% or 5%, synecatekines 10% or 15%, intralesional interferon alpha). The overall success rate of the various treatments available ranges from 23% to 94%. Only treatments that include cryotherapy or surgical excision are suitable in condyloma with any anatomical location and that have the highest success rate in monotherapy. Recurrences are common regardless of the treatment received. In contrast, immunomodulatory therapies despite having lower initial clearance rates appear to have higher probabilities of cure in the medium term, with low recurrence rates. Some treatments may be combined with each other and the effectiveness of combined therapies appears to be superior to monotherapy (proactive sequential treatment). The consensuses for the treatment of HPV also consider special situations: immunocompromised patients, meatus and intraurethral lesions and treatment of the partner.
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21
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Zhang H, Shi L, Zhang Y, Wang P, Zhang G, Cao Y, Zhou Z, Wang X. Modified photodynamic therapy to minimize pain in the treatment of condylomata acuminata: A prospective, randomized, self-controlled study. Photodiagnosis Photodyn Ther 2020; 32:101915. [PMID: 32634656 DOI: 10.1016/j.pdpdt.2020.101915] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/27/2020] [Accepted: 06/29/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pain is a major concern associated with conventional photodynamic therapy (C-PDT). OBJECTIVE To evaluate the efficacy, pain and safety of modified photodynamic therapy(M-PDT) for the treatment of condylomata acuminata. METHODS A prospective, randomized, self-controlled study was conducted. Warts were randomized to the M-PDT or C-PDT side. 5-aminolevulinic acid (ALA; 20 %) was incubated for 3 h before patients were exposed to LED red light (100 J/cm2) on the C-PDT side and for 30 min before being exposed to LED red light (300 J/cm2) on the M-PDT side. Treatment was administered with 1-week interval for three weeks. The clearance rates were determined at one week and the recurrence rates at 4, 8, and 12 weeks after treatment. The pain and other side effects were also investigated. RESULTS A total of 24 patients with condylomata acuminata were enrolled in this trial. Twenty patients completed the trial. The clearance rates were 98.17 % in the M-PDT side and 98.20 % in the C-PDT side(P > 0.05). The recurrence rates were 11.11 % and 10.53 % (P > 0.05). However, M-PDT was almost painless (mean score 0.3 ± 0.47, range 0∼1), which was significantly less than that on the C-PDT side (mean score 3.6 ± 0.94, range 0∼1) (P < 0.05). Local erythema, mild edema and erosion were observed on both sides. CONCLUSION The modified PDT is basically painless with similar efficacy to conventional PDT, which is a major breakthrough of pain management in PDT.
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Affiliation(s)
- Haiyan Zhang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lei Shi
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yunfeng Zhang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China
| | - Peiru Wang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China
| | - Guolong Zhang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yajing Cao
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhongxia Zhou
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiuli Wang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China.
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22
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Monfrecola G, Megna M, Rovati C, Arisi M, Rossi M, Calzavara-Pinton I, Fabbrocini G, Calzavara-Pinton P. A Critical Reappraisal of Off-Label Use of Photodynamic Therapy for the Treatment of Non-Neoplastic Skin Conditions. Dermatology 2020; 237:262-276. [PMID: 32554971 DOI: 10.1159/000507926] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 04/16/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In the past 30 years, topical photodynamic therapy (PDT) has been investigated for the treatment of a broad spectrum of cosmetic, inflammatory, and infectious skin conditions with variable, and often contrasting, results. However, the non-expert clinician may be in difficulty evaluating these results because different sensitizers, concentrations, formulations, light sources, and irradiation protocols have been used. In addition, many of these studies have poor quality design being case reports and uncontrolled studies of few cases. SUMMARY With the aim to clarify the potential usefulness of PDT for the treatment of infectious and inflammatory skin diseases as well as selected cosmetic indications, we searched for randomized controlled clinical trials, non-randomized comparative studies, retrospective studies, and case series studies with a number of at least 10 patients, published since 1990. Later, we reappraised the results in order to give a simple critical overview. Key Messages: Evidence from the literature seems to strongly support the use of ALA- and MAL-PDT for the treatment of common skin diseases such as acne, warts, condylomata, and Leishmania skin infection and for photorejuvenation, i.e., the correction of selected cosmetic changes of aging and photoaging. For other disorders, the level of evidence and strength of recommendation are lower, and controlled randomized studies with prolonged follow-ups are necessary in order to assess the clinical usefulness and other potential advantages over current treatment options.
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Affiliation(s)
- Giuseppe Monfrecola
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Matteo Megna
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Chiara Rovati
- Dermatology Department, University of Brescia, Brescia, Italy
| | | | | | | | - Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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23
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Shi L, Liu P, Liu J, Yang Y, Chen Q, Zhang Y, Zhang H, Wang X. Application of 5‐aminolevulinic acid‐photodynamic therapy in common skin diseases. TRANSLATIONAL BIOPHOTONICS 2020. [DOI: 10.1002/tbio.201900028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Lei Shi
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine Shanghai China
| | - Pei Liu
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine Shanghai China
| | - Jia Liu
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine Shanghai China
| | - Yuling Yang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine Shanghai China
| | - Qi Chen
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine Shanghai China
| | - Yunfeng Zhang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine Shanghai China
| | - Haiyan Zhang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine Shanghai China
| | - Xiuli Wang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine Shanghai China
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24
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Bertolotti A, Ferdynus C, Milpied B, Dupin N, Huiart L, Derancourt C. Local Management of Anogenital Warts in Non-Immunocompromised Adults: A Network Meta-Analysis of Randomized Controlled Trials. Dermatol Ther (Heidelb) 2020; 10:249-262. [PMID: 32030564 PMCID: PMC7090115 DOI: 10.1007/s13555-020-00357-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION No hierarchy of first-line treatments for anogenital warts (AGWs) is provided in international guidelines. This study aimed to determine the efficacy of topical treatments and ablative procedures for the management of AGWs. METHODS Twelve electronic databases were systematically searched from inception to August 2018. All randomized controlled trials (RCTs) comparing immunocompetent adults with AGWs who received at least 1 provider-administered or patient-administered treatment in at least 1 parallel group were included. Risk of bias assessment followed the Cochrane Handbook. The study endpoint was complete lesion response after clearance and recurrence assessment. A network meta-analysis was performed. RESULTS A network geometry was constructed based on 49 of the 70 RCTs included in our systematic review. All but 4 RCTs had a high risk of bias. The most efficacious treatments compared to placebo were surgery (RR 10.54; CI 95% 4.53-24.52), ablative therapy + imiquimod (RR 7.52; CI 95% 4.53-24.52), and electrosurgery (RR 7.10; CI 95% 3.47-14.53). SUCRA values confirmed the superiority of surgery (90.9%), ablative therapy + imiquimod (79.8%), and electrosurgery (77.1%). The most efficacious patient-administered treatments were podophyllotoxin 0.5% solution (63.5%) and podophyllotoxin 0.5% cream (62.2%). CONCLUSIONS With low-level evidence of most included RCTs, surgery and electrosurgery were superior to other treatments after clearance and recurrence assessment. Podophyllotoxin 0.5% was the most efficacious patient-administered treatment. Combined therapies should be evaluated in future RCTs in view of their identified effectiveness. The results of future RCTs should systematically include clinical type, number and location of AGWs, and sex of the patient, to refine therapeutic indications. PROTOCOL REGISTRATION PROSPERO-CRD42015025827.
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Affiliation(s)
- Antoine Bertolotti
- Department of Infectious Disease, Saint-Pierre Hospital, Reunion Island, France.
- EA 4537, Antilles-Guyane University, Martinique, France.
- INSERM CICEC 1410, Reunion Island, France.
| | | | - Brigitte Milpied
- Department of Dermatology and Pediatric Dermatology, National Center for Rare Skin Disorders, Saint-André and Pellegrin Hospitals, Bordeaux, France
| | - Nicolas Dupin
- Department of Dermatology, Cochin Hospital, Paris Descartes University, Paris, France
| | - Laetitia Huiart
- Department of Population Health, Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - Christian Derancourt
- EA 4537, Antilles-Guyane University, Martinique, France
- Department of Dermatology, Hôpital de Briançon, Briançon, France
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25
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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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Bertolotti A, Milpied B, Fouéré S, Dupin N, Cabié A, Derancourt C. Local Management of Anogenital Warts in Non-immunocompromised Adults: A Systematic Review and Meta-analyses of Randomized Controlled Trials. Dermatol Ther (Heidelb) 2019; 9:761-774. [PMID: 31606873 PMCID: PMC6828858 DOI: 10.1007/s13555-019-00328-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Several therapeutic options are available to manage anogenital warts (AGWs). However, no hierarchy of treatments is provided in the latest European and American recommendations. This study aimed to determine the efficacy and safety of local treatments for the management of AGWs. METHODS A search was conducted through 12 databases from inception to August 2018. All randomized controlled trials (RCTs) in which at least one parallel treatment group composed of immunocompetent adults with AGWs received at least one provider-administered or patient-administered treatment were included. Risk of bias assessment and meta-analyses of aggregated study data were performed on the basis of the Cochrane Handbook, and quality of evidence evaluation followed the Grading of Recommendation Assessment, Development and Evaluation (GRADE) approach. Primary endpoints were complete clearance and recurrence at 3 months. RESULTS Seventy RCTs (9931 patients) were included. All but four RCTs had a high risk of bias. CO2 laser was slightly more efficacious than cryotherapy [risk ratio (RR) 2.05; 95% confidence interval (CI) 1.61-2.62], with fewer recurrences at 3 months (RR 0.28; 95% CI 0.09-0.89). Electrosurgery was slightly more efficacious than cryotherapy. No differences in efficacy or side effects were found between cryotherapy and imiquimod or trichloroacetic acid. Podophyllotoxin gel was slightly more efficacious than podophyllotoxin cream. 5-Fluorouracil (5-FU) was slightly more efficacious and caused less erosion than CO2 laser (RR 1.37; 95% CI 1.11-1.70). CONCLUSION The vast majority of included RCTs had a low level of evidence, thereby preventing the establishment of a hierarchy of treatments. Nevertheless, our results provide an overview of the main AGW treatments available for general practitioners and specialists. While provider-administered treatments are superior, patient-administered treatments (e.g., imiquimod, podophyllotoxin) are useful solutions for compliant patients. PROTOCOL REGISTRATION PROSPERO-CRD42015025827.
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Affiliation(s)
- Antoine Bertolotti
- EA 4537, Antilles University, Martinique, France.
- Infectious Diseases, Centre Hospitalier Universitaire de la Réunion, Saint-Pierre, La Réunion, France.
| | - Brigitte Milpied
- Department of Dermatology and Pediatric Dermatology, National Centre for Rare Skin Disorders, Saint-André and Pellegrin Hospitals, Bordeaux, France
| | - Sébastien Fouéré
- Department of Dermatology, Saint-Louis Hospital, Paris Diderot University, Paris, France
| | - Nicolas Dupin
- Department of Infectious Diseases, CHU Martinique, Fort-de-France, Martinique, France
| | - André Cabié
- EA 4537, Antilles University, Martinique, France
- Department of Dermatology, Cochin Hospital, Paris Descartes University, Paris, France
| | - Christian Derancourt
- EA 4537, Antilles University, Martinique, France
- Department of Dermatology, Briançon Hospital, Briançon, France
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Xie J, Ao C, Li J, Jiang L, Liu H, Zeng K. 5-aminolevulinic acid photodynamic therapy for condyloma acuminatum of urethral meatus. J DERMATOL TREAT 2019; 30:714-717. [PMID: 30427239 DOI: 10.1080/09546634.2018.1544406] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 10/27/2018] [Indexed: 10/27/2022]
Abstract
Objectives: Condyloma acuminatum are the most common sexually transmitted diseases worldwide, and they are closely associated with human papillomavirus (HPV) infection. Urethral meatus is one of the places that warts occur. Many treatments for uretheral warts have limitations. In this study, we performed 5-aminolevulinic acid-photodynamic therapy (ALA-PDT) on patients and investigated the effectiveness of reducing HPV viral loads. Materials and Methods: In our study, 21 patients diagnosed with urethral condyloma acuminatum were included. After 4 h treatment of ALA, patients received PDT. Each patient received HPV test before every PDT cycle. The frequency of PDT was dependent on viral load changes. Results: All patients achieved complete clinical remission after the last session of ALA-PDT. There were significant differences in HPV viral loads between pretherapy and after one or three rounds of PDT treatment. Conclusions: ALA-PDT is a safe and effective method for treatment of condyloma acuminatum in urethra meatus. Dynamic monitoring of HPV viral loads can more objectively demonstrate the effectiveness and guide the treatment of PDT.
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Affiliation(s)
- Jiajia Xie
- a Department of Dermatology and Venereology, Nanfang Hospital, Southern Medical University , Guangzhou , China
| | - Chunping Ao
- a Department of Dermatology and Venereology, Nanfang Hospital, Southern Medical University , Guangzhou , China
| | - Junpeng Li
- a Department of Dermatology and Venereology, Nanfang Hospital, Southern Medical University , Guangzhou , China
| | - Lifen Jiang
- a Department of Dermatology and Venereology, Nanfang Hospital, Southern Medical University , Guangzhou , China
| | - Hui Liu
- a Department of Dermatology and Venereology, Nanfang Hospital, Southern Medical University , Guangzhou , China
| | - Kang Zeng
- a Department of Dermatology and Venereology, Nanfang Hospital, Southern Medical University , Guangzhou , China
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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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Wiehe A, O'Brien JM, Senge MO. Trends and targets in antiviral phototherapy. Photochem Photobiol Sci 2019; 18:2565-2612. [PMID: 31397467 DOI: 10.1039/c9pp00211a] [Citation(s) in RCA: 152] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Photodynamic therapy (PDT) is a well-established treatment option in the treatment of certain cancerous and pre-cancerous lesions. Though best-known for its application in tumor therapy, historically the photodynamic effect was first demonstrated against bacteria at the beginning of the 20th century. Today, in light of spreading antibiotic resistance and the rise of new infections, this photodynamic inactivation (PDI) of microbes, such as bacteria, fungi, and viruses, is gaining considerable attention. This review focuses on the PDI of viruses as an alternative treatment in antiviral therapy, but also as a means of viral decontamination, covering mainly the literature of the last decade. The PDI of viruses shares the general action mechanism of photodynamic applications: the irradiation of a dye with light and the subsequent generation of reactive oxygen species (ROS) which are the effective phototoxic agents damaging virus targets by reacting with viral nucleic acids, lipids and proteins. Interestingly, a light-independent antiviral activity has also been found for some of these dyes. This review covers the compound classes employed in the PDI of viruses and their various areas of use. In the medical area, currently two fields stand out in which the PDI of viruses has found broader application: the purification of blood products and the treatment of human papilloma virus manifestations. However, the PDI of viruses has also found interest in such diverse areas as water and surface decontamination, and biosafety.
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Affiliation(s)
- Arno Wiehe
- biolitec research GmbH, Otto-Schott-Str. 15, 07745 Jena, Germany. and Institut für Chemie und Biochemie, Freie Universität Berlin, Takustr. 3, 14195 Berlin, Germany
| | - Jessica M O'Brien
- Medicinal Chemistry, Trinity Translational Medicine Institute, Trinity Centre for Health Sciences, Trinity College Dublin, The University of Dublin, St. James's Hospital, Dublin 8, Ireland.
| | - Mathias O Senge
- Medicinal Chemistry, Trinity Translational Medicine Institute, Trinity Centre for Health Sciences, Trinity College Dublin, The University of Dublin, St. James's Hospital, Dublin 8, Ireland.
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Widschwendter A, Böttcher B, Riedl D, Coban S, Mutz-Dehbalaie I, Matteucci Gothe R, Ciresa-König A, Marth C, Fessler S. Recurrence of genitals warts in pre-HPV vaccine era after laser treatment. Arch Gynecol Obstet 2019; 300:661-668. [PMID: 31286210 PMCID: PMC6694085 DOI: 10.1007/s00404-019-05242-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 07/02/2019] [Indexed: 11/27/2022]
Abstract
Purpose Human papillomavirus (HPV) can cause condylomata acuminata, also known as genital warts. Our aim was to evaluate the long-term recurrence of genital warts after primary carbon dioxide laser treatment before the introduction of the vaccination against HPV. Methods Recurrence rate and localization of genital warts were analysed in a retrospective study in 1798 women presenting with a new diagnosis of genital warts from 1992 to 2009 at a University hospital and had received laser treatment. Additionally, data on topography, pregnancy status, and cervical smear were available for women treated from 2003 to 2009 (n = 825, data subset 1) and systematic follow-up data for women treated in 2006 and 2007 (n = 242, data subset 2). Results Median time from laser treatment to first recurrence was 14.6 weeks (data subset 2). The site most affected was the vulva (90.7%) followed by the perineum/perianal region (59.3%) and the vagina (47.3%). Abnormal Pap smear was observed in 22.6%. Systematic follow-up with a median follow-up time of 3.1 years revealed at least one recurrence in 68 (28.1%) of 242 women. Women with multifocal genital warts had a 2.9 times increased risk for recurrence compared to women with unifocal lesions (p = 0.01). Conclusions Nearly 30% of women presenting with genital warts experienced at least one recurrence after treatment with carbon dioxide laser. Multifocal lesions are the strongest indicator of recurrence. These data provide an important insight to recurrence rates of genital warts before HPV vaccination and underline the significance of a long-term follow-up and HPV vaccination.
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Affiliation(s)
- Andreas Widschwendter
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Bettina Böttcher
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| | - David Riedl
- University Clinic of Medical Psychology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Serab Coban
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Irene Mutz-Dehbalaie
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Raffaella Matteucci Gothe
- Department of Public Health, Medical Informatics and Technology, Health Services Research and Health Technology Assessment, UMIT University for Health Sciences, Eduard-Wallnöfer-Zentrum 1, 6060, Hall i.T, Austria
| | - Alexandra Ciresa-König
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Christian Marth
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Siegfried Fessler
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
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Efficacy of the combination of superficial shaving with photodynamic therapy for recalcitrant periungual warts. Photodiagnosis Photodyn Ther 2019; 27:340-344. [PMID: 31252143 DOI: 10.1016/j.pdpdt.2019.06.021] [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] [Received: 05/03/2019] [Revised: 06/07/2019] [Accepted: 06/24/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Periungual warts are a viral infectious disease that occurs in a particular location. It is difficult to eliminate completely, and recurrence is common. Photodynamic therapy (PDT) as an option that has been widely recommended to treat viral warts. However, there are always a few patients with poor efficacy after PDT treatment. We have considered that the reason is the limitation of PDT penetrating deep into tissue. Thus, we combined superficial shaving with PDT to treat recalcitrant periungual warts. METHODS Twenty-three patients had a total of 61 periungual wart lesions. All patients had recalcitrant periungual warts that had failed to respond to various treatments that had poor curative effects. After local injection of anesthesia, the lesions were shaved in situ, and PDT was performed immediately. A total of three sessions of PDT were applied for each patient after only one superficial shaving. The overall clinical response rate, recurrence rates, cosmetic outcomes, adverse events, patient satisfaction and quality of life were assessed. The potential risk factors have also been recorded. RESULTS We achieved a 96% success rate (defined as more than 50% on clearance) in our 23 patients using combination superficial shaving with PDT after treatment for 3 months. At the 12-month follow-up, 21 patients (91%) had excellent cosmetic outcomes. All patients had satisfactory therapeutic effects and significant improvement in the quality of life. Pain during the illumination process was the main adverse event, but all patients were able to tolerate it. We also found that frequent or continuous hand activity, such as playing Mah-jong, may be a potential risk factor for periungual warts. CONCLUSION Our results offer promise for combining superficial shaving with PDT as an effective and safe therapy for patients with periungual warts, especially for those periungual warts that are recurrent, have multiple lesions, and thickness corneum stratum of lesions. For nails that are not suitable for routine surgery, combined superficial shaving with PDT is recommended.
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Sendagorta-Cudós E, Burgos-Cibrián J, Rodríguez-Iglesias M. Infecciones genitales por el virus del papiloma humano. Enferm Infecc Microbiol Clin 2019; 37:324-334. [DOI: 10.1016/j.eimc.2019.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 01/28/2019] [Accepted: 01/29/2019] [Indexed: 12/22/2022]
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Xie F, Yu HS, Wang R, Wang D, Li YM, Wen HY, Du JB, Ba W, Meng XF, Yang J, Lin BW, Li HJ, Li CX, Zhang LG, Fang XD, Zhao H. Photodynamic Therapy for Genital Warts Causes Activation of Local Immunity. J Cutan Med Surg 2019; 23:370-379. [PMID: 31010295 DOI: 10.1177/1203475419838548] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND 5-aminolevulinic acid photodynamic therapy (PDT) for genital warts is effective, safe, and can prevent recurrence. It is believed that PDT can induce immune responses, but the mechanism is not completely understood. OBJECTIVES The objectives of this article are to confirm the effect of PDT for genital warts on local immunity and to investigate the recruitment and significance of immune cells in tissues. METHODS Local immune changes in T lymphocytes (CD3+, CD4+, CD8+), plasmacytoid dendritic cells (pDCs) (CD123+), and myeloid dendritic cells (CD1a+) after PDT in patients were evaluated by immunohistochemistry staining. Changes in mRNA levels of IFN-γ, IFN-α, IFN-ß, interferon-stimulated gene 15 kDa (ISG-15), Mx2, Toll-like receptor 9 (TLR9), and interferon regulatory factor 7 (IRF7) were analyzed by real-time quantitative polymerase chain reaction. RESULTS At 4 hours after PDT, CD4+ increased, accompanied by increased levels of mRNA expression of IFN-γ, but CD4+ and mRNA expression levels of IFN-γ were decreased at 24 hours after PDT. CD123+ pDCs showed an increasing trend. CD1a+ LCs in the epidermis gradually decreased, and DCs in the epidermis gradually increased. CD3+ infiltrated and migrated to the superficial dermis, but CD8+ did not change significantly after PDT. The mRNA expression levels of IFN-α, IFN-ß, ISG-15, Mx2, TLR9, and IRF7 showed an increasing trend after PDT. As compared with the patients without significantly increased IFN-α and IFN-ß after PDT sessions, patients with significant increases needed fewer sessions of PDT for remission. CONCLUSIONS PDT for genital warts can activate T lymphocyte-mediated, DC-related, and pDC-related immunity. The clinical efficacy of PDT for genital warts may be related to the increased levels of IFN-α and IFN-ß after treatment.
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Affiliation(s)
- Fang Xie
- 1 Department of Dermatology, First Medical Center of Chinese PLA General Hospital, Beijing
| | - Haisheng S Yu
- 3 Key Laboratory of Immunity and Infection, Institute of Biophysics, Chinese Academy of Sciences, Beijing
| | - Rui Wang
- 1 Department of Dermatology, First Medical Center of Chinese PLA General Hospital, Beijing
| | - Dong Wang
- 1 Department of Dermatology, First Medical Center of Chinese PLA General Hospital, Beijing
| | - Yanming M Li
- 2 CAS Key Laboratory of Genome Sciences and Information, Beijing Institute of Genomics, Chinese Academy of Sciences
| | - Haiying Y Wen
- 1 Department of Dermatology, First Medical Center of Chinese PLA General Hospital, Beijing
| | - Jiangbo B Du
- 3 Key Laboratory of Immunity and Infection, Institute of Biophysics, Chinese Academy of Sciences, Beijing
| | - Wei Ba
- 1 Department of Dermatology, First Medical Center of Chinese PLA General Hospital, Beijing
| | - Xianfu F Meng
- 1 Department of Dermatology, First Medical Center of Chinese PLA General Hospital, Beijing
| | - Jie Yang
- 4 Department of Dermatology, North China University of Science and Technology Affiliated Hospital, Tangshan
| | - Biwen W Lin
- 1 Department of Dermatology, First Medical Center of Chinese PLA General Hospital, Beijing
| | - Hengjin J Li
- 1 Department of Dermatology, First Medical Center of Chinese PLA General Hospital, Beijing
| | - Chengxin X Li
- 1 Department of Dermatology, First Medical Center of Chinese PLA General Hospital, Beijing
| | - Liguo G Zhang
- 3 Key Laboratory of Immunity and Infection, Institute of Biophysics, Chinese Academy of Sciences, Beijing
| | - Xiangdong D Fang
- 2 CAS Key Laboratory of Genome Sciences and Information, Beijing Institute of Genomics, Chinese Academy of Sciences
| | - Hua Zhao
- 1 Department of Dermatology, First Medical Center of Chinese PLA General Hospital, Beijing
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Song W, Zhang J, Gao N, Tan W, Wang G, Gao L. A combination of 2940-nm laser and photodynamic therapy for treatment of recalcitrant facial flat warts. Photodiagnosis Photodyn Ther 2019; 26:97-100. [PMID: 30836209 DOI: 10.1016/j.pdpdt.2019.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 03/01/2019] [Accepted: 03/01/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Photodynamic therapy (PDT) is one of the treatment options for generalized facial flat warts, which results in elimination of virus and inhibition of proliferation of warts due to photochemical and phototoxic reactions. In this research, we attempted to evaluate the efficacy and safety profiles of a combination of 2940-nm laser and PDT for the treatment of generalized recalcitrant facial flat warts. METHODS Retrospective analysis of the patients with recalcitrant facial warts was performed. Patients in the combined group (n = 40) were treated with a 2940-nm single spot abrasion followed by a PDT; while the PDT group (n = 40) received a PDT treatment only. The efficacy was assessed by the lesion numbers and lesion clearance rate. The effective rate was calculated with the cured and excellent response rates. RESULTS The combined group showed significant improvements in the total effective rate (77.5%vs. 57.5%, p = 0.0416) and average clearance rate (81.68±2.83% vs. 68.13 ± 3.97%, p = 0.0068) as compared with the PDT-only group. The degree of lesion clearance was positively correlated with the treatment times in both groups. After three months of follow-up, no relapse occurred in patients from either group. Furthermore, an accumulation of photosensitizer in the lesional areas was observed in the combined treatment group. CONCLUSIONS A combination of 2940-nm laser and PDT was safe and showed significantly more effect than PDT alone in treatment for recalcitrant facial flat warts, partially due to the improved uptake of photosensitizer after 2940-nm laser induced skin abrasion.
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Affiliation(s)
- Wenting Song
- Department of Dermatology, Xi Jing Hospital, the Fourth Military Medical University, Xi'an, 710032, PR China
| | - Jine Zhang
- Department of Dermatology, Xi Jing Hospital, the Fourth Military Medical University, Xi'an, 710032, PR China
| | - Ni Gao
- Department of Dermatology, Xi Jing Hospital, the Fourth Military Medical University, Xi'an, 710032, PR China
| | - Wenbin Tan
- Department of Cell Biology and Anatomy, University of South Carolina School of Medicine, Columbia, South Carolina, 29209, USA
| | - Gang Wang
- Department of Dermatology, Xi Jing Hospital, the Fourth Military Medical University, Xi'an, 710032, PR China
| | - Lin Gao
- Department of Dermatology, Xi Jing Hospital, the Fourth Military Medical University, Xi'an, 710032, PR China.
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Yang Y, Zhang Y, Zou X, Guo X, Lin H. Perspective clinical study on effect of 5-aminolevulinic acid photodynamic therapy (ALA-PDT) in treating condylomata acuminata in pregnancy. Photodiagnosis Photodyn Ther 2019; 25:63-65. [PMID: 30447414 DOI: 10.1016/j.pdpdt.2018.11.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/07/2018] [Accepted: 11/13/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To observe the clinical efficacy of 5-aminolevulinic acid photodynamic therapy (ALA-PDT) in treating vulval condylomata acuminata (CA) in pregnancy. METHODS The clinical efficacies of ALA-PDT on 16 cases of CA in pregnancy as well as cryotherapy on 22 cases of CA in pregnancy were analyzed in this prospective study. RESULTS The treatment group showed a wart clearance rate of 93.8% after 3 PDT treatments, while the control group showed a wart clearance rate of 72.7% after 3 cryotherapy treatments. After the 3-month follow-up period, the treatment group registered a recurrence rate of 6.3%, whereas the control group recorded a recurrence rate of 36.4%, indicating a statistically significant difference (χ2 = 4.674, p = 0.031 < 0.05). After the 1-month postpartum follow-up period, the newborns grew and developed well, without any abnormality in physical examinations. CONCLUSION ALA-PDT is safe and effective in treating CA in pregnancy.
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Affiliation(s)
- Yuguang Yang
- Department of Dermatology of the First Affiliated Hospital of PLA General Hospital, Beijing 100048, China.
| | - Yunjie Zhang
- Department of Dermatology of the First Affiliated Hospital of PLA General Hospital, Beijing 100048, China
| | - Xianbiao Zou
- Department of Dermatology of the First Affiliated Hospital of PLA General Hospital, Beijing 100048, China
| | - Xiaojuan Guo
- Department of Dermatology of the First Affiliated Hospital of PLA General Hospital, Beijing 100048, China
| | - Hui Lin
- Department of Dermatology of the First Affiliated Hospital of PLA General Hospital, Beijing 100048, China
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Hu S, Yang Y, Jiang B, Su D, Zhang L, Huang Z, Zhang F. Treatment of condyloma acuminatum using the combination of laser ablation and ALA-PDT. Photodiagnosis Photodyn Ther 2018; 25:193-196. [PMID: 30579992 DOI: 10.1016/j.pdpdt.2018.12.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 12/10/2018] [Accepted: 12/19/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Human papilloma virus (HPV) infection and condyloma acuminatum (CA) in the genital area often exist in extensive and multi-point fashion. Laser ablation combined with topical photodynamic therapy (PDT) is a feasible approach for genital CA but its effectiveness and limitations need to be evaluated. METHODS This single-arm prospective study consisted of 100 newly diagnosed CA cases of both sexes. All patients underwent laser ablation and then three times aminolaevulinic acid-based photodynamic therapy (ALA-PDT). The outcomes were evaluated and analyzed 3 months after the treatment. RESULTS A total of 98 patients completed the study. Except for 6 patients (4 males and 2 females) showed some residual lesions other 92 patients (93.8%) showed complete cure. However, there were 18 patients (10 males and 8 females) showed new lesions near the treated areas. Although the HPV types of 18 patients before and after treatment were not completely consistent, 94.4% percent of patients (17/18) had the same HPV type as the primary lesion, which suggested that these late-onset CA might have latent infection or subclinical infection in the early stage of the disease but the length of the incubation period was longer. CONCLUSION Combination approach is effective in treating genital CA and preventing CA recurrence. But its limitations need to be recognized as the late-onset CA might occur near the treated area. The treatment plan needs to be optimized for multiple genital CA lesions.
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Affiliation(s)
- Shaoshan Hu
- Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, Harbin, 150001, China
| | - Yun Yang
- Department of Dermatology, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Bingbing Jiang
- Department of Dermatology, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Dongqiang Su
- Department of Dermatology, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Likun Zhang
- Department of Hematology, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Zheng Huang
- Medical Photonics Center, Fujian Normal University, Fuzhou, 350007, China
| | - Feng Zhang
- Department of Dermatology, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China.
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Photodynamic therapy as an alternative to antibiotic therapy for the treatment of infected leg ulcers. Photodiagnosis Photodyn Ther 2018; 23:132-143. [DOI: 10.1016/j.pdpdt.2018.05.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 03/25/2018] [Accepted: 05/02/2018] [Indexed: 12/29/2022]
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Pérez-Laguna V, García-Malinis AJ, Aspiroz C, Rezusta A, Gilaberte Y. Antimicrobial effects of photodynamic therapy. GIORN ITAL DERMAT V 2018; 153:833-846. [PMID: 29683289 DOI: 10.23736/s0392-0488.18.06007-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The microorganisms that cause infections are increasing their resistance to antibiotics. In this context, alternative treatments are necessary. The antimicrobial photodynamic therapy (aPDT) is a therapeutic modality based on photosensitizing molecules that end up generating reactive oxygen species that induce the destruction of the target cells when are irradiated with light of a suitable wavelength and at a proper dose. The cells targeted by aPDT are all types of microorganisms (bacteria, fungi and parasites) including viruses and has been proven effective against representative members of all of them. In the field of dermatology, aPDT has been tested with promising results in different infections such as chronic ulcers, acne, onychomycosis and other cutaneous mycoses, as well as in leishmaniasis. Therefore, it is presented as a possible treatment option against the agents that cause skin and/or mucous infections.
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Affiliation(s)
| | | | - Carmen Aspiroz
- Unit of Microbiology, Hospital Royo Villanova, Zaragoza, Spain
| | - Antonio Rezusta
- IIS Aragón, Zaragoza, Spain.,Department of Microbiology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Yolanda Gilaberte
- IIS Aragón, Zaragoza, Spain - .,Department of Dermatology, Hospital Universitario Miguel Servet, Zaragoza, Spain
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Wu Y, Qiao J, Bai J, Fang H. Aminolevulinic acid photodynamic therapy for bowenoid papulosis. Photodiagnosis Photodyn Ther 2017. [DOI: 10.1016/j.pdpdt.2017.01.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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40
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Treatment of lip florid papillomatosis with topical ALA-PDT combined with curettage: Outcome and safety. Photodiagnosis Photodyn Ther 2016; 15:83-7. [DOI: 10.1016/j.pdpdt.2016.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 05/12/2016] [Accepted: 05/30/2016] [Indexed: 12/20/2022]
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Soler DC, Ohtola J, Sugiyama H, Rodriguez ME, Han L, Oleinick NL, Lam M, Baron ED, Cooper KD, McCormick TS. Activated T cells exhibit increased uptake of silicon phthalocyanine Pc 4 and increased susceptibility to Pc 4-photodynamic therapy-mediated cell death. Photochem Photobiol Sci 2016; 15:822-31. [PMID: 27161819 DOI: 10.1039/c6pp00058d] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Photodynamic therapy (PDT) is an emerging treatment for malignant and inflammatory dermal disorders. Photoirradiation of the silicon phthalocyanine (Pc) 4 photosensitizer with red light generates singlet oxygen and other reactive oxygen species to induce cell death. We previously reported that Pc 4-PDT elicited cell death in lymphoid-derived (Jurkat) and epithelial-derived (A431) cell lines in vitro, and furthermore that Jurkat cells were more sensitive than A431 cells to treatment. In this study, we examined the effectiveness of Pc 4-PDT on primary human CD3(+) T cells in vitro. Fluorometric analyses of lysed T cells confirmed the dose-dependent uptake of Pc 4 in non-stimulated and stimulated T cells. Flow cytometric analyses measuring annexin V and propidium iodide (PI) demonstrated a dose-dependent increase of T cell apoptosis (6.6-59.9%) at Pc 4 doses ranging from 0-300 nM. Following T cell stimulation through the T cell receptor using a combination of anti-CD3 and anti-CD28 antibodies, activated T cells exhibited increased susceptibility to Pc 4-PDT-induced apoptosis (10.6-81.2%) as determined by Pc 4 fluorescence in each cell, in both non-stimulated and stimulated T cells, Pc 4 uptake increased with Pc 4 dose up to 300 nM as assessed by flow cytometry. The mean fluorescence intensity (MFI) of Pc 4 uptake measured in stimulated T cells was significantly increased over the uptake of resting T cells at each dose of Pc 4 tested (50, 100, 150 and 300 nM, p < 0.001 between 50 and 150 nM, n = 8). Treg uptake was diminished relative to other T cells. Cutaneous T cell lymphoma (CTCL) T cells appeared to take up somewhat more Pc 4 than normal resting T cells at 100 and 150 nm Pc 4. Confocal imaging revealed that Pc 4 localized in cytoplasmic organelles, with approximately half of the Pc 4 co-localized with mitochondria in T cells. Thus, Pc 4-PDT exerts an enhanced apoptotic effect on activated CD3(+) T cells that may be exploited in targeting T cell-mediated skin diseases, such as cutaneous T cell lymphoma (CTCL) or psoriasis.
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Affiliation(s)
- David C Soler
- Department of Dermatology, Case Western Reserve University, University Hospitals Case Medical Center, Cleveland, OH, USA.
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Lavogiez C, Mortier L, Mordon S. La PDT antimicrobienne en dermatologie. Partie II : les infections virales et parasitaires ; les perspectives. Ann Dermatol Venereol 2016; 143:62-9. [DOI: 10.1016/j.annder.2015.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 01/30/2015] [Accepted: 02/20/2015] [Indexed: 10/23/2022]
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Topical PDT in the Treatment of Benign Skin Diseases: Principles and New Applications. Int J Mol Sci 2015; 16:23259-78. [PMID: 26404243 PMCID: PMC4632697 DOI: 10.3390/ijms161023259] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 09/21/2015] [Accepted: 09/22/2015] [Indexed: 02/04/2023] Open
Abstract
Photodynamic therapy (PDT) uses a photosensitizer, light energy, and molecular oxygen to cause cell damage. Cells exposed to the photosensitizer are susceptible to destruction upon light absorption because excitation of the photosensitizing agents leads to the production of reactive oxygen species and, subsequently, direct cytotoxicity. Using the intrinsic cellular heme biosynthetic pathway, topical PDT selectively targets abnormal cells, while preserving normal surrounding tissues. This selective cytotoxic effect is the basis for the use of PDT in antitumor treatment. Clinically, PDT is a widely used therapeutic regimen for oncologic skin conditions such as actinic keratosis, squamous cell carcinoma in situ, and basal cell carcinoma. PDT has been shown, under certain circumstances, to stimulate the immune system and produce antibacterial, and/or regenerative effects while protecting cell viability. Thus, it may be useful for treating benign skin conditions. An increasing number of studies support the idea that PDT may be effective for treating acne vulgaris and several other inflammatory/infective skin diseases, including psoriasis, rosacea, viral warts, and aging-related changes. This review provides an overview of the clinical investigations of PDT and discusses each of the essential aspects of the sequence: its mechanism of action, common photosensitizers, light sources, and clinical applications in dermatology. Of the numerous clinical trials of PDT in dermatology, this review focuses on those studies that have reported remarkable therapeutic benefits following topical PDT for benign skin conditions such as acne vulgaris, viral warts, and photorejuvenation without causing severe side effects.
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Biel MA. Antimicrobial photodynamic therapy for treatment of biofilm-based infections. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2015; 831:119-36. [PMID: 25384666 DOI: 10.1007/978-3-319-09782-4_8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Merrill A Biel
- Ear, Nose and Throat Specialty Care of MN, Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, MN, USA,
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45
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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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Muñoz-Santos C, Pigem R, Alsina M. New Treatments for Human Papillomavirus Infection. ACTAS DERMO-SIFILIOGRAFICAS 2013. [DOI: 10.1016/j.adengl.2013.03.010] [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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47
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Blokker RS, Lock TM, de Boorder T. Comparing thulium laser and Nd:YAG laser in the treatment of genital and urethral condylomata acuminata in male patients. Lasers Surg Med 2013; 45:582-8. [DOI: 10.1002/lsm.22181] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2013] [Indexed: 11/07/2022]
Affiliation(s)
- Rudy S. Blokker
- Urology Department; University Medical Center Utrecht; Utrecht The Netherlands
| | - Tycho M.T.W. Lock
- Urology Department; University Medical Center Utrecht; Utrecht The Netherlands
- Central Military Hospital “Dr. Mathysen,”; Utrecht The Netherlands
| | - Tjeerd de Boorder
- Urology Department; University Medical Center Utrecht; Utrecht The Netherlands
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48
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Muñoz-Santos C, Pigem R, Alsina M. New treatments for human papillomavirus infection. ACTAS DERMO-SIFILIOGRAFICAS 2013; 104:883-9. [PMID: 23706272 DOI: 10.1016/j.ad.2013.03.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Revised: 12/24/2012] [Accepted: 03/09/2013] [Indexed: 12/11/2022] Open
Abstract
Human papillomavirus infection is very common. In this article, we review the latest developments in the treatment of lesions caused by this virus, with a particular focus on anogenital warts. Sinecatechins and new imiquimod formulations are among the most significant new developments. Others include photodynamic therapy and intralesional immunotherapy, but there is insufficient evidence to recommend their routine use. Finally, while therapeutic vaccines and inhibitory molecules appear to hold great promise, they are still in the early phases of investigation. More studies are needed, and these should have similar designs, larger samples, and sufficiently long follow-up periods to enable the direct comparison of the short-term and long-term effectiveness of different treatment options.
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Affiliation(s)
- C Muñoz-Santos
- Servicio de Dermatología, Hospital Clínic, Universitat de Barcelona, Barcelona, España.
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49
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Qian G, Wang S, Deng D, Yang G. Is the step-up therapy of topical 5-aminolevulinic acid photodynamic therapy effective and safe for the patients with recalcitrant facial flat wart? Dermatol Ther 2013; 27:83-8. [PMID: 24703264 DOI: 10.1111/dth.12060] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Facial flat wart, caused by human papilloma virus type 3 and less often, type 10, 27, and 41, often brings many cosmetic problems to children and young adults. Considering the disturbing cosmetic problem, the treatment of facial flat wart is always frustrating and often unsuccessful, although there are many treatment modalities. Considering the possible serious side effects of 5-aminolevulinic acid photodynamic therapy (ALA-PDT), we designed step-up therapy of ALA-PDT on different clinical phases of facial flat wart. As a new protocol of ALA-PDT, we found the step-up therapy of ALA-PDT could also receive excellent effects with the lower side effects. Meanwhile, the tolerance of patients to ALA-PDT could improve with subsequent treatment sessions and escalating doses of ALA-PDT.
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Affiliation(s)
- Ge Qian
- Department of Dermatology and Venereology, The 2nd Affiliated Hospital of Kunming Medical University, Kunming, China
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50
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Ying Z, Li X, Dang H. 5-aminolevulinic acid-based photodynamic therapy for the treatment of condylomata acuminata in Chinese patients: a meta-analysis. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2013; 29:149-59. [PMID: 23651275 DOI: 10.1111/phpp.12043] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/15/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Zuolin Ying
- Department of Dermatology, Shanghai First People's Hospital; School of Medicine, Shanghai Jiao Tong University; Shanghai; China
| | - Xiaojie Li
- Department of Dermatology, Shanghai First People's Hospital; School of Medicine, Shanghai Jiao Tong University; Shanghai; China
| | - Hong Dang
- Department of Dermatology, Shanghai First People's Hospital; School of Medicine, Shanghai Jiao Tong University; Shanghai; China
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