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Jung D, Seung NR, Seo SB, Park EJ, Kim KH. Skin rejuvenation through topical application of indocyanine green with diffractive optical element mode of 785 nm picosecond laser in Asian females. J Cosmet Dermatol 2024; 23:2411-2419. [PMID: 38494897 DOI: 10.1111/jocd.16275] [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: 11/17/2023] [Revised: 02/09/2024] [Accepted: 03/01/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Indocyanine green (ICG) exhibits robust absorption near 800 nm. AIMS To examine the clinical effects of combining ICG with a 785 nm picosecond laser for treating photo-aged skin. PATIENT/METHODS A 785 nm 600 picosecond laser was used on the facial area of 16 female patients with Fitzpatrick skin type III and IV (mean age: 58.44 ± 5.24 years) after applying 0.0125% ICG cream. A total of 3000 shots were administered in diffractive optical element mode at a pulse energy of 200 mJ and frequency of 10 Hz. Hyperpigmented lesions were treated using the Zoom handpiece set at a spot size of 3-4 mm, pulse energy of 60-120 mJ, and frequency of 3-7 Hz. Patients underwent five sessions of treatment at intervals of 1-2 weeks. Wrinkles, pores and pigmented lesions were assessed at the initial assessment and 4 weeks after the final treatment using the Modified Fitzpatrick Wrinkle Scale and 10-point visual analog scale, respectively. Skin biopsy of the postauricular area was performed on two consenting patients. RESULTS Significant improvements in wrinkles (p = 0.02), pores (p = 0.034), and hyperpigmentation (p = 0.036) were observed, along with increased patient subjective improvement. Adverse effects were transient and well-tolerated. Hematoxylin and eosin and Masson's trichrome staining revealed increased and thickened dermal collagen fibers. Immunohistochemical staining revealed increased expression of collagen I and III throughout the papillary and upper reticular dermis, along with diffuse increase of STRO-1 in the dermis. CONCLUSIONS The combined application of a 785 nm picosecond laser and ICG yielded promising clinical outcomes for treating photo-aged skin in Asian patients with Fitzpatrick skin type III and IV.
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Affiliation(s)
- Dayeon Jung
- Department of Dermatology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | | | | | - Eun Joo Park
- Department of Dermatology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Kwang Ho Kim
- Department of Dermatology, Hallym University Sacred Heart Hospital, Anyang, Korea
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Luo OD, Bose R, Bawazir MA, Thuraisingam T, Ghazawi FM. A Review of the Dermatologic Clinical Applications of Topical Photodynamic Therapy. J Cutan Med Surg 2024; 28:NP1. [PMID: 38243786 DOI: 10.1177/12034754231216969] [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] [Indexed: 01/22/2024]
Abstract
Topical photodynamic therapy is a widely approved therapy for actinic keratoses and low-risk nonmelanoma skin cancers with a rapidly growing range of emerging indications for other cutaneous diseases. This review summarizes the best-available evidence to provide a clinical update for dermatologists on the approved and emerging indications of photodynamic therapy. The body of evidence suggests that photodynamic therapy is superior or noninferior to other available treatment modalities for actinic keratoses, low-risk basal cell carcinomas, Bowen's disease, skin field cancerization, chemoprevention of keratinocyte carcinomas in organ transplant recipients, photoaging, acne vulgaris, and cutaneous infections including verrucae, onychomycosis, and cutaneous leishmaniasis. There is emerging evidence that photodynamic therapy plays a role in the management of actinic cheilitis, early-stage mycosis fungoides, extramammary Paget disease, lichen sclerosis, and folliculitis decalvans but there are no comparative studies with other active treatment modalities. Common barriers to topical photodynamic therapy include procedural pain, costs, and the time required for treatment delivery. There is significant heterogeneity in the photodynamic therapy protocols reported in the literature, including different photosensitizers, light sources, number of treatments, time between treatments, and use of procedural analgesia. Topical photodynamic therapy should be considered in the management of a spectrum of inflammatory, neoplastic, and infectious dermatoses. However, more comparative research is required to determine its role in the treatment algorithm for these dermatologic conditions and more methodological research is required to optimize photodynamic therapy protocols to improve the tolerability of the procedure for patients.
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Affiliation(s)
- Owen Dan Luo
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Reetesh Bose
- Division of Dermatology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Mohammed A Bawazir
- Division of Dermatology, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Thusanth Thuraisingam
- Division of Dermatology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Division of Dermatology, Department of Medicine, McGill University, Montreal, QC, Canada
| | - Feras M Ghazawi
- Division of Dermatology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Division of Dermatology, Department of Medicine, McGill University, Montreal, QC, Canada
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Fusano M, Bencini PL, Galimberti MG. Hybrid fractional laser treatment for photodamaged facial skin rejuvenation 6 years following fractional CO 2 : Comparison of clinical outcome and patients' satisfaction. Lasers Surg Med Suppl 2022; 54:1045-1050. [PMID: 35819131 DOI: 10.1002/lsm.23583] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 05/09/2022] [Accepted: 06/26/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Fractional carbon dioxide (CO2 ) laser resurfacing is considered an effective treatment for skin rejuvenation. The request for clinical effectiveness with shorter downtime has led to the development of new hybrid technologies, including a traditional Er:YAG (erbium-doped yttrium aluminium garnet) fractional laser 2940 nm combined with a simultaneous nonablative 1470 nm wavelength. The aim of this study is to compare clinical outcomes and patients' satisfaction with face resurfacing performed with both the CO2 laser and the hybrid laser. METHODS Nineteen women underwent ultrapulsed CO2 fractional resurfacing for photodamaged facial skin; the same patients underwent the hybrid laser after almost 6 years. Clinical outcomes and patients' satisfaction were evaluated 6 months after the treatment and compared between the two technologies. RESULTS After both CO2 and hybrid treatment a significant improvement was found in terms of fine lines (p < 0.001 and p = 0.004, respectively), tactile roughness (p < 0.001 and p = 0.002, respectively), and mottled pigmentation (both p < 0.001). Healing times and complications were greater with the CO2 laser. Comparing the two technologies, patients showed better results with the CO2 laser for each score's item, but greater satisfaction with the hybrid laser (p = 0.012). CONCLUSIONS The present study confirms CO2 laser as the most effective treatment; however, the new hybrid technology revealed good results associated with faster healing and less discomfort.
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Affiliation(s)
- Marta Fusano
- Istituto di Chirurgia e Laserchirurgia in Dermatologia (I.C.L.I.D.), Milan, Italy
| | - Pier Luca Bencini
- Istituto di Chirurgia e Laserchirurgia in Dermatologia (I.C.L.I.D.), Milan, Italy
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Abrouk M, Gianatasio C, Li Y, Waibel JS. Prospective study of intense pulsed light versus pulsed dye laser with or without blue light in the activation of PDT for the treatment of actinic keratosis and photodamage. Lasers Surg Med 2022; 54:66-73. [PMID: 35043459 DOI: 10.1002/lsm.23492] [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: 04/21/2020] [Revised: 10/25/2021] [Accepted: 10/28/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Exposure to ultraviolet (UV) light from the sun is known to have a deleterious effect on the skin. Repeated insults to the dermal matrix from UV radiation result in the clinical signs of photodamage, including changes in skin elasticity, color, and texture. UV radiation also leads to the accumulation of DNA mutations and promotes tumor development, resulting in the formation of cutaneous precancerous and cancerous lesions. Continuous-wave incoherent blue light, intense pulsed light (IPL), and pulsed dye laser (PDL) are safe and efficacious light sources commonly used for aminolevulinic acid photodynamic therapy (PDT). The aim of this study was to prospectively evaluate the efficacy of PDT for the treatment of photodamage and actinic keratoses using four different combinations of light sources: PDL, PDL + blue light, IPL, and IPL + blue light. STUDY A total of 220 patients with either photodamage or actinic keratosis (AK) were recruited from the Miami Dermatology Laser Institute (Miami, FL) and were assigned prospectively to undergo one PDT treatment with one of the four light options: PDL, PDL + blue light, IPL or IPL + blue light. Of the 220 patients enrolled in treatment groups, 214 patients completed the study. Of the 214 patients, 88 received treatment for AK, and 126 received treatment for photodamage. All patients gave their consent to participate in the study and to allow their photographs to be utilized for the purpose of scientific presentations. RESULTS Treatment with IPL resulted in a 70.8% reduction of actinic keratoses at a 1-month follow-up. Treatment with IPL and blue light 84.4% reduction of actinic keratoses at 1 month follow up. Treatment with PDL 70.5% reduction of actinic keratoses at 1 month follow up. Treatment with PDL and blue light 69.3% reduction of actinic keratoses at 1 month follow up. Treatment with IPL resulted in an improvement score of 2.9. Treatment with IPL and blue light resulted in an improvement score of 3.0. Treatment PDL resulted in an improvement score of 1.5. Treatment with PDL and blue light resulted in an improvement score of 1.8. CONCLUSION Although all four treatment groups led to some improvement in signs of photoaging, IPL + blue light again demonstrated increased efficacy when compared to IPL, PDL, and PDL + blue light treatment groups. Results from our study were limited by an unequal distribution between treatment groups and a lack of follow-up beyond a 1-month period and warrant further research.
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Affiliation(s)
- Michael Abrouk
- Harvard Massachusetts General Hospital Laser & Cosmetic Dermatology, Wellman Center for Photomedicine, Boston, Massachusetts, USA
| | | | - Yumeng Li
- Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jill S Waibel
- Miami Dermatology & Laser Institute, Miami, Florida, USA
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Du YM, Zeng J, Li M, Wang YB, Wu Y, Qi RQ, Gao XH, Chen HD. Efficacy and safety of Resveratrol combined with Ablative Fractional CO 2 laser system in the treatment of skin photoaging. J Cosmet Dermatol 2021; 20:3880-3888. [PMID: 34719113 DOI: 10.1111/jocd.14569] [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: 05/15/2021] [Revised: 09/25/2021] [Accepted: 10/14/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of resveratrol combined with ablative fractional CO2 laser system (AFL) treating skin photoaging. METHODS Thirty-two subjects were assigned to the treatment group (TG) or the control group (CG), respectively, applied test product (resveratrol essence) or control product twice daily for 6 months. Each subject was given an AFL treatment or no laser treatment on left or right side of the face randomly. Subjective evaluations by investigators and subjects themselves were conducted after treatment. Melanin index, erythema index, and cuticle moisture content were conducted at baseline and after treatments. Adverse events (AEs) were evaluated during the study period. RESULTS All subjects in TG achieved improvements of their photoaging signs compared to pre-treatment both the laser side and the non-laser side at 6 months (p < 0.05). On the laser side, TG produced a better improvement than CG at 6 months (p < 0.05). On the laser side, the difference values of MI in TG at the 2 months after enrollment (M2), M3, and M4 were more obvious than those in CG (p < 0.05). On the non-laser side, the difference values of MI in TG at M3, M4, M5, and M6 were more obvious than those of CG (p < 0.05). Subjects in TG were more likely to have tingling and had a faster subsidence of erythema mild edema, and pigmentation induced by AFL compared to CG. CONCLUSION The resveratrol can improve photoaging alone and add an efficacy to the AFL treatment and subside the AEs induced by AFL.
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Affiliation(s)
- Yi-Mei Du
- Department of Dermatology, The First Hospital of China Medical University, Shenyang, China.,NHC Key Laboratory of Immunodermatology (China Medical University), Shenyang, China.,Key Laboratory of Immunodermatology (China Medical University), Ministry of Education, Shenyang, China.,National and Local Joint Engineering Research Center of Immunodermatological Theranostics, Shenyang, China
| | - Jing Zeng
- Department of Dermatology, The First Hospital of China Medical University, Shenyang, China.,NHC Key Laboratory of Immunodermatology (China Medical University), Shenyang, China.,Key Laboratory of Immunodermatology (China Medical University), Ministry of Education, Shenyang, China.,National and Local Joint Engineering Research Center of Immunodermatological Theranostics, Shenyang, China
| | - Meng Li
- Department of Dermatology, The First Hospital of China Medical University, Shenyang, China.,NHC Key Laboratory of Immunodermatology (China Medical University), Shenyang, China.,Key Laboratory of Immunodermatology (China Medical University), Ministry of Education, Shenyang, China.,National and Local Joint Engineering Research Center of Immunodermatological Theranostics, Shenyang, China
| | - Yang-Bin Wang
- Department of Dermatology, The First Hospital of China Medical University, Shenyang, China.,NHC Key Laboratory of Immunodermatology (China Medical University), Shenyang, China.,Key Laboratory of Immunodermatology (China Medical University), Ministry of Education, Shenyang, China.,National and Local Joint Engineering Research Center of Immunodermatological Theranostics, Shenyang, China
| | - Yan Wu
- Department of Dermatology, The First Hospital of China Medical University, Shenyang, China.,NHC Key Laboratory of Immunodermatology (China Medical University), Shenyang, China.,Key Laboratory of Immunodermatology (China Medical University), Ministry of Education, Shenyang, China.,National and Local Joint Engineering Research Center of Immunodermatological Theranostics, Shenyang, China
| | - Rui-Qun Qi
- Department of Dermatology, The First Hospital of China Medical University, Shenyang, China.,NHC Key Laboratory of Immunodermatology (China Medical University), Shenyang, China.,Key Laboratory of Immunodermatology (China Medical University), Ministry of Education, Shenyang, China.,National and Local Joint Engineering Research Center of Immunodermatological Theranostics, Shenyang, China
| | - Xing-Hua Gao
- Department of Dermatology, The First Hospital of China Medical University, Shenyang, China.,NHC Key Laboratory of Immunodermatology (China Medical University), Shenyang, China.,Key Laboratory of Immunodermatology (China Medical University), Ministry of Education, Shenyang, China.,National and Local Joint Engineering Research Center of Immunodermatological Theranostics, Shenyang, China
| | - Hong-Duo Chen
- Department of Dermatology, The First Hospital of China Medical University, Shenyang, China.,NHC Key Laboratory of Immunodermatology (China Medical University), Shenyang, China.,Key Laboratory of Immunodermatology (China Medical University), Ministry of Education, Shenyang, China.,National and Local Joint Engineering Research Center of Immunodermatological Theranostics, Shenyang, China
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6
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Abrouk M, Dong J, Waibel JS. Medical and aesthetic improvement of photodamaged skin by the combination of intense pulsed light and photodynamic therapy with 10% aminolevulinic acid hydrochloride gel. Lasers Surg Med 2021; 54:62-65. [PMID: 34324724 DOI: 10.1002/lsm.23460] [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: 03/02/2021] [Revised: 07/11/2021] [Accepted: 07/11/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of photodynamic therapy (PDT) with the novel 10% aminolevulinic acid (ALA) hydrochloride gel (10% ALA gel) and BF-RhodoLED® light (635 nm; 37 J/cm2 ) in combination with intense pulsed light (IPL) to augment the medical and aesthetic improvement of photodamaged skin of the décolleté. METHODS This was a single-site prospective, randomized, intraindividual split chest pilot study with 20 female subjects with moderate to severe photodamage of the décolleté. Subjects were randomized to ALA-PDT + IPL to one split-side of the chest and ALA-PDT only to the contralateral side. Three blinded raters assessed aesthetic improvement using the global aesthetic improvement scale (GAIS). RESULTS Eighteen subjects completed the study. Superior GAIS results were achieved on the ALA-PDT + IPL treatment side than on the ALA-PDT only treatment side (p < 0.001) after 24 weeks of follow-up. CONCLUSIONS ALA-PDT using 10% ALA hydrochloride gel and BF-RhodoLED® light had superior rejuvenation effects on the décolleté when combined with IPL compared to ALA-PDT alone.
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Affiliation(s)
- Michael Abrouk
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Joanna Dong
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jill S Waibel
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery (Voluntary Faculty), University of Miami, Miami, Florida, USA
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Arisi M, Rossi MT, Spiazzi L, Guasco Pisani E, Venturuzzo A, Rovati C, Tomasi C, Venturini M, Calzavara-Pinton PG. A randomized split-face clinical trial of conventional vs indoor-daylight photodynamic therapy for the treatment of multiple actinic keratosis of the face and scalp and photoaging. J DERMATOL TREAT 2021; 33:2250-2256. [PMID: 34152936 DOI: 10.1080/09546634.2021.1944594] [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] [Indexed: 10/21/2022]
Abstract
BACKGROUND Recently, indoor daylight photodynamic therapy (idl-PDT) has been developed; however, its efficacy and tolerability remain to be assessed. OBJECTIVE This is a not-inferiority study to compare treatment outcomes of cPDT with a red LED lamp and idlPDT with a polychromatic white LED lamp in adult patients affected by symmetrical AKs of face and/or scalp. METHODS In this comparative, intra-patient, split-face, randomized clinical trial forty-three adult patients were enrolled. Two contralateral and symmetrical target areas of the face and/or scalp harboring at least 5 AKs were selected and randomized 1:1 to treatment with cPDT and idlPDT. The AKs number and cumulative area were assessed at baseline (T0). Efficacy and cosmetic outcome were assessed 3 months after treatment (T1). RESULTS Total AKs number and area reduced significantly with both idlPDT (p < .0001) and cPDT (p < .0001) in comparison to baseline. cPDT was more painful (p < .0001) and induced a more severe inflammation (p < .0001). Twenty-nine patients (70.7%) gave their overall preference to idlPDT (p < .001). CONCLUSION idlPDT may represent an alternative treatment protocol to cPDT for in-office treatment of AKs patients with better tolerability and a not inferior efficacy.
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Affiliation(s)
- M Arisi
- Dermatology Department, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - M T Rossi
- Dermatology Department, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - L Spiazzi
- Medical Physics Department, ASST Spedali Civili di Brescia, Brescia, Italy
| | - E Guasco Pisani
- Dermatology Department, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - A Venturuzzo
- Dermatology Department, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - C Rovati
- Dermatology Department, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - C Tomasi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - M Venturini
- Dermatology Department, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - P G Calzavara-Pinton
- Dermatology Department, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
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Fusano M, Bencini PL, Fusano I, Bencini M, Zane C, Zerbinati N, Galimberti MG. Ultrapulsed CO 2 Resurfacing of Photodamaged Facial Skin in Vegan and Omnivore Patients: A Multicentric Study. Lasers Surg Med 2021; 53:1370-1375. [PMID: 34015157 DOI: 10.1002/lsm.23424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 04/07/2021] [Accepted: 05/09/2021] [Indexed: 01/23/2023]
Abstract
BACKGROUND AND OBJECTIVES Skin photoaging is related to extrinsic environmental exposures, mainly represented by ultraviolet radiation. One of the treatment options is laser resurfacing. As nutritional status is involved in cutaneous photodamage, we evaluated whether dietary patterns can also influence the response to facial resurfacing. Our prospective multicentric study involves three dermatologic centers specialized in laser therapy in northern Italy. The study aims to compare the outcome of a CO2 ablative laser therapy between omnivore and vegan patients. STUDY DESIGN/MATERIALS AND METHODS Fifty-three omnivore and fifty-three vegan women undergoing ultrapulsed CO2 resurfacing for photodamaged facial skin were enrolled in this study. Clinical improvement was evaluated 3 and 6 months after the treatment using the modified Dover score. RESULTS After laser treatment, vegans showed slower complete re-epithelialization (P < 0.001*) and disappearance of the erythema (P < 0.001*). After 3 and 6 months, vegans showed worse outcomes in terms of fine lines (P < 0.001* and P < 0.001*, respectively) and tactile roughness (P = 0.003* and P = 0.002*, respectively) compared with omnivores, while they did not differ in mottled pigmentation. CONCLUSIONS The present study suggests that diet influences the clinical outcome of fractioned CO2 laser treatment. Lasers Surg. Med. © 2021 Wiley Periodicals LLC.
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Affiliation(s)
- Marta Fusano
- Istituto di Chirurgia e Laserchirurgia in Dermatologia (I.C.L.I.D.), Via della Moscova 42, Milan, 20121, Italy
| | - Pier Luca Bencini
- Istituto di Chirurgia e Laserchirurgia in Dermatologia (I.C.L.I.D.), Via della Moscova 42, Milan, 20121, Italy
| | - Isabella Fusano
- Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, Via Mangiagalli 25, Milan, 20133, Italy
| | - Matelda Bencini
- Department of General Surgery, Università Degli Studi di Milano, Milan, 20157, Italy
| | - Cristina Zane
- ASST Spedali Civili di Brescia, Dermatology Department, P.le Spedali Civili 1, Brescia, 25123, Italy
| | - Nicola Zerbinati
- Dermatology, Department of Medicine and Surgery, "Insubria" University Hospital, Varese, Italy
| | - Michela Gianna Galimberti
- Istituto di Chirurgia e Laserchirurgia in Dermatologia (I.C.L.I.D.), Via della Moscova 42, Milan, 20121, Italy
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Zhang M, Huang Y, Wu Q, Lin T, Gong X, Chen H, Wang Y. Comparison of 1064-nm and Dual-Wavelength (532/1064-nm) Picosecond-Domain Nd:YAG Lasers in the Treatment of Facial Photoaging: A Randomized Controlled Split-Face Study. Lasers Surg Med 2021; 53:1158-1165. [PMID: 33783878 DOI: 10.1002/lsm.23404] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 02/05/2021] [Accepted: 03/13/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVES To compare the efficacy and safety of 1064-nm and dual-wavelength (532/1064 nm) picosecond Nd:YAG lasers with a holographic optic in the treatment of facial photoaging. STUDY DESIGN/MATERIALS AND METHODS In this prospective, randomized split-face study, each half of each participant's face was randomly treated with a 1064-nm or 532/1064-nm picosecond laser. All participants underwent five treatment sessions and follow-up visits 1 and 3 months after the final treatment. The primary outcomes were measured as the global photoaging scores, determined by two physicians who were blinded to the treatments. The secondary outcomes were the participant-assessed Global Aesthetic Improvement Scale (GAIS) and satisfaction scores. Histopathological examinations were performed. RESULTS Global photoaging scores decreased significantly after treatment with either laser. The global photoaging scores, GAIS scores, and satisfaction scores did not differ significantly between the 1064-nm and 532/1064-nm picosecond laser treatments. Histological changes were similar between the two groups. Intraepidermal vacuoles and dermal hemorrhaging were observed immediately and 24 h after treatment. After five treatments, neocollagenesis was observed in the upper dermis of both groups, and elastic fibers were more elongated and orderly. CONCLUSIONS Treatments with 1064-nm and 532/1064-nm picosecond Nd:YAG lasers were comparably effective at improving photodamaged facial skin by remodeling the collagen and elastin network through laser-induced optical degradation and vascular damage.
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Affiliation(s)
- Mengli Zhang
- Department of Cosmetic Laser Surgery, Hospital of Dermatology, Peking Union Medical College (PUMC), Chinese Academy of Medical Sciences (CAMS), Jiangwangmiao Street 12, Xuanwu District, Nanjing, Jiangsu, 210042, China
| | - Yuqing Huang
- Department of Cosmetic Laser Surgery, Hospital of Dermatology, Peking Union Medical College (PUMC), Chinese Academy of Medical Sciences (CAMS), Jiangwangmiao Street 12, Xuanwu District, Nanjing, Jiangsu, 210042, China
| | - Qiuju Wu
- Department of Cosmetic Laser Surgery, Hospital of Dermatology, Peking Union Medical College (PUMC), Chinese Academy of Medical Sciences (CAMS), Jiangwangmiao Street 12, Xuanwu District, Nanjing, Jiangsu, 210042, China
| | - Tong Lin
- Department of Cosmetic Laser Surgery, Hospital of Dermatology, Peking Union Medical College (PUMC), Chinese Academy of Medical Sciences (CAMS), Jiangwangmiao Street 12, Xuanwu District, Nanjing, Jiangsu, 210042, China
| | - Xiangdong Gong
- Division of Sexually Transmitted Disease Epidemiology, Hospital of Dermatology, Peking Union Medical College (PUMC), Chinese Academy of Medical Sciences (CAMS), Jiangwangmiao Street 12, Xuanwu District, Nanjing, Jiangsu, 210042, China
| | - Hao Chen
- Department of Pathology, Hospital of Dermatology, Peking Union Medical College (PUMC), Chinese Academy of Medical Sciences (CAMS), Jiangwangmiao Street 12, Xuanwu District, Nanjing, Jiangsu, 210042, China
| | - Yan Wang
- Department of Dermatologic Surgery, Hospital of Dermatology, Peking Union Medical College (PUMC), Chinese Academy of Medical Sciences (CAMS), Jiangwangmiao Street 12, Xuanwu District, Nanjing, Jiangsu, 210042, China
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10
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Zhang L, Zhao Z, Wang P, Zhang G, Wang B, Shi L, Liu X, Zhou Z, Wang X. Long-term improvement on photoaging after ALA photodynamic therapy for actinic keratosis: A retrospective study. Photodiagnosis Photodyn Ther 2021; 33:102181. [PMID: 33429100 DOI: 10.1016/j.pdpdt.2021.102181] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 01/02/2021] [Accepted: 01/04/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND 5-aminolevulinic acid photodynamic therapy (ALA-PDT) is not only the first-line treatment for actinic keratosis (AK), but also demonstrated to improve photoaging during AK field treatment. However, its long-term effect on photoaging remains elusive. OBJECTIVE To evaluate the long-term improvement effect of ALA-PDT on photoaging. METHODS The data of 10 patients with AK who received field-directed ALA-PDT on one side of the face and lesion-directed ALA-PDT on the other side were retrospectively reviewed. Their clinical photographs were evaluated with Global scores of photoaging (GSP) assessment independently by two dermatologists at baseline and 1 month, 6 months and 24 months after ALA-PDT. RESULTS GSP evaluation was performed after 24 months of follow-up. Improvements in the fine line and mottled pigmentation were observed (p < 0.05). All the 10 patients achieved complete response of AK lesions and had no relapse during the 24-month follow-up period. LIMITATION A small sample size. CONCLUSION Photoaging can be effectively alleviated in the long-term follow-up after ALA-PDT treatment for AK. The present study may inspire new treatment strategies for photoaging.
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Affiliation(s)
- Linglin Zhang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zijun Zhao
- 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
| | - Bo Wang
- Lincoln Medical Center, Department of Internal Medicine, Bronx, NY, United States
| | - Lei Shi
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiaojing Liu
- 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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11
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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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12
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Wang M, Yang X, Chang L, Chen J, Luo J, Wu Y, Lei X, Li Z. Low-level PDT treatment modulated photoaging mediated by UVA irradiation through regulating Bach2. Photodiagnosis Photodyn Ther 2020; 29:101606. [PMID: 31759126 DOI: 10.1016/j.pdpdt.2019.101606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 10/26/2019] [Accepted: 11/18/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate low-level ALA-PDT (Aminolevulinic acid photodynamic therapy) effects on photorejuvenation in vitro and in vivo, exploring the basic mechanism of Bach2 involved in PDT treatment in photoaging. METHOD Photoaging model was established by UVA chronic irradiation in human fibroblasts and mice skins. Cell viability was determined by MTS assay and cell senescence was detected by SA-β-gal activity. PDT treatment and Bach2 knockdown with adenovirus in fibroblasts were confirmed by Western blot. RESULTS UVA chronic irradiation induced photoaging in vitro and in vivo. Treatment of low-level PDT reduced photoaging by decreasing SA-β-gal activity and cell senescence-related proteins levels of p16 and p21 in fibroblasts. Moreover, low-level PDT treatment accompany with Bach2 accumulation increased in fibroblasts and in mice skin tissues. Bach2 knockdown with adenovirus induced cell senescence and Bach2 depletion with PDT treatment some extent decreased SA-β-gal activity, but was with no significant change of Bach2 itself and p16 protein levels in fibroblasts. CONCLUSION Low-level PDT treatment decreased skin photoaging which might be through up-regulating Bach2.
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Affiliation(s)
- Mei Wang
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, Chongqing University, Chongqing 400044, China; Department of Dermatology, Daping Hospital, The Army Medical University. Chongqing, 400042, China.
| | - Xing Yang
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, Chongqing University, Chongqing 400044, China.
| | - Li Chang
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, Chongqing University, Chongqing 400044, China.
| | - Jinyi Chen
- Department of Dermatology, Daping Hospital, The Army Medical University. Chongqing, 400042, China.
| | - Jiefu Luo
- Department of Dermatology, Daping Hospital, The Army Medical University. Chongqing, 400042, China.
| | - Yan Wu
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, Chongqing University, Chongqing 400044, China.
| | - Xia Lei
- Department of Dermatology, Daping Hospital, The Army Medical University. Chongqing, 400042, China.
| | - Zhong Li
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, Chongqing University, Chongqing 400044, China.
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13
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New Developments for Fractional CO2 Resurfacing for Skin Rejuvenation and Scar Reduction. Facial Plast Surg Clin North Am 2020; 28:17-28. [DOI: 10.1016/j.fsc.2019.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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14
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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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15
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Gellén E, Fidrus E, Janka E, Kollár S, Paragh G, Emri G, Remenyik É. 5-Aminolevulinic acid photodynamic therapy with and without Er:YAG laser for actinic keratosis: Changes in immune infiltration. Photodiagnosis Photodyn Ther 2019; 26:270-276. [DOI: 10.1016/j.pdpdt.2019.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 03/29/2019] [Accepted: 04/10/2019] [Indexed: 12/18/2022]
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16
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Karrer S, Aschoff R, Dominicus R, Krähn‐Senftleben G, Gauglitz G, Zarzour A, Kerrouche N, Chavda R, Szeimies R. Methyl aminolevulinate daylight photodynamic therapy applied at home for non‐hyperkeratotic actinic keratosis of the face or scalp: an open, interventional study conducted in Germany. J Eur Acad Dermatol Venereol 2019; 33:661-666. [DOI: 10.1111/jdv.15422] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 12/14/2018] [Indexed: 02/06/2023]
Affiliation(s)
- S. Karrer
- Department of Dermatology University Hospital Regensburg Regensburg Germany
| | - R.A.G. Aschoff
- Department of Dermatology University Hospital Carl Gustav Carus Dresden Germany
| | - R. Dominicus
- Private Practice Pro Derma Institute for Clinical Studies and Innovative Dermatology Dülmen Germany
| | | | | | | | | | - R. Chavda
- Galderma R&D Sophia Antipolis France
| | - R.‐M. Szeimies
- Department of Dermatology and Allergology Klinikum Vest GmbH Recklinghausen Germany
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17
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A Prospective Study of the Safety and Efficacy of a Microneedle Fractional Radiofrequency System for Global Facial Photoaging in Chinese Patients. Dermatol Surg 2018; 44:964-970. [DOI: 10.1097/dss.0000000000001469] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Marra K, LaRochelle EP, Chapman MS, Hoopes PJ, Lukovits K, Maytin EV, Hasan T, Pogue BW. Comparison of Blue and White Lamp Light with Sunlight for Daylight-Mediated, 5-ALA Photodynamic Therapy, in vivo. Photochem Photobiol 2018; 94:1049-1057. [PMID: 29663426 DOI: 10.1111/php.12923] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 04/02/2018] [Indexed: 12/24/2022]
Abstract
Daylight-mediated photodynamic therapy (d-PDT) as a treatment for actinic keratosis (AK) is an increasingly common technique due to a significant reduction in pain, leading to better patient tolerability. While past studies have looked at different light sources and delivery methods, this study strives to provide equivalent PpIX-weighted light doses with the hypothesis that artificial light sources could be equally as effective as natural sunlight if their PpIX-weighted fluences were equalized. Normal mouse skin was used as the model to compare blue LED light, metal halide white light and natural sunlight, with minimal incubation time between topical ALA application and the onset of light delivery. A total PpIX-weighted fluence of 20 Jeff cm-2 was delivered over 2 h, and the efficacy of response was quantified using three acute bioassays for PDT damage: PpIX photobleaching, Stat3 crosslinking and quantitative histopathology. These bioassays indicated blue light was slightly inferior to both sunlight and white light, but that the latter two were not significantly different. The results suggest that metal halide white light could be a reasonable alternative to daylight PDT, which should allow a more controlled treatment that is independent of weather and yet should have similar response rates with limited pain during treatment.
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Affiliation(s)
- Kayla Marra
- Thayer School of Engineering, Dartmouth College, Hanover, NH
| | | | - M Shane Chapman
- Department of Surgery, Geisel School of Medicine, Hanover, NH
| | - P Jack Hoopes
- Department of Surgery, Geisel School of Medicine, Hanover, NH
| | - Karina Lukovits
- Thayer School of Engineering, Dartmouth College, Hanover, NH
| | - Edward V Maytin
- Department of Biomedical Engineering, Learner Research Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Tayyaba Hasan
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Brian W Pogue
- Thayer School of Engineering, Dartmouth College, Hanover, NH.,Department of Surgery, Geisel School of Medicine, Hanover, NH
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19
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Jaros A, Zasada M, Budzisz E, Dębowska R, Gębczyńska‐Rzepka M, Rotsztejn H. Evaluation of selected skin parameters following the application of 5% vitamin C concentrate. J Cosmet Dermatol 2018; 18:236-241. [DOI: 10.1111/jocd.12562] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Anna Jaros
- Department of Cosmetic Raw Materials Chemistry Faculty of Pharmacy Medical University of Lodz Lodz Poland
| | - Malwina Zasada
- Department of Cosmetic Raw Materials Chemistry Faculty of Pharmacy Medical University of Lodz Lodz Poland
| | - Elżbieta Budzisz
- Department of Cosmetic Raw Materials Chemistry Faculty of Pharmacy Medical University of Lodz Lodz Poland
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20
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Sanclemente G, Ruiz-Cañas V, Miranda J, Ferrín A, Ramirez P, Hernandez G. Photodynamic Therapy Interventions in Facial Photodamage: A Systematic Review. ACTAS DERMO-SIFILIOGRAFICAS 2018; 109:218-229. [DOI: 10.1016/j.ad.2017.05.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 05/03/2017] [Accepted: 05/07/2017] [Indexed: 10/18/2022] Open
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21
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Sanclemente G, Ruiz-Cañas V, Miranda J, Ferrín A, Ramirez P, Hernandez G. Photodynamic Therapy Interventions in Facial Photodamage: A Systematic Review. ACTAS DERMO-SIFILIOGRAFICAS 2018. [DOI: 10.1016/j.adengl.2017.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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22
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Abstract
Photodynamic therapy (PDT) is a well-established, non-invasive treatment for a variety of dermatologic disorders, including actinic keratosis. Furthermore, PDT results in marked improvements in the signs of skin aging, although currently there are no standardized guidelines for PDT in skin rejuvenation. Two types of PDT are available: conventional-PDT (c-PDT) and the newly introduced daylight-PDT (DL-PDT). Both require a topical photosensitizer, a light source and oxygen, and both are comparable regarding safety and efficacy for treatment of photo-induced skin aging. Treatment is particularly effective for improvement of fine wrinkles, skin roughness, actinic elastosis and mottled hyperpigmentation. The most widely studied topical sensitizers used in PDT are 5-aminolevulinic acid (ALA) and methyl aminolevulinate (MAL). A range of pre-treatment procedures help improve skin absorption of the photosensitizer and lead to significantly improved efficacy. A variety of activating light sources can be used for c-PDT, while DL-PDT uses natural daylight, making it easier to treat larger areas of photodamaged skin. A major limitation of c-PDT is significant treatment-related pain, but DL-PDT has proved to be an almost pain-free procedure. Treatment duration is based on individual patient need but most patients receive 2 to 3 treatment cycles, with results fully evident 3-6 months post-treatment. PDT for aesthetic-cosmetic treatments has established its value in modern procedural dermatology as mono- or combination therapy. A major, unique advantage of PDT is that it is a non-invasive treatment that effectively rejuvenates photodamaged skin, while successfully treating a range of dermatologic conditions, including prevention and therapy of pre-cancerous actinic keratosis.
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23
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Kohl E, Koller M, Zeman F, Szeimies RM, Philipp-Dormston WG, Prager W, Gerber PA, Karrer S. Daylight photodynamic therapy versus cryosurgery for the treatment and prophylaxis of actinic keratoses of the face - protocol of a multicenter, prospective, randomized, controlled, two-armed study. BMC DERMATOLOGY 2017; 17:12. [PMID: 29070025 PMCID: PMC5657041 DOI: 10.1186/s12895-017-0064-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 10/18/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Photodynamic therapy with daylight (DL-PDT) is efficacious in treating actinic keratosis (AK), but the efficacy of field-directed, repetitive DL-PDT for the treatment and prophylaxis of AK in photodamaged facial skin has not yet been investigated. METHODS/DESIGN In this multicenter, prospective, randomized, controlled, two-armed, observer-blinded trial, patients with a minimum of 5 mild-to-moderate AK lesions on photodamaged facial skin are randomly allocated to two treatment groups: DL-PDT with methyl aminolevulinate (MAL) and cryosurgery. In the DL-PDT group (experimental group), 5 treatments of the entire face are conducted over the course of 18 months. After preparation of the lesion and within 30 min after MAL application, patients expose themselves to daylight for 2 h. In the control group, lesion-directed cryosurgery is conducted at the first visit and, in the case of uncleared or new AK lesions, also at visits 2 to 5. The efficacy of the treatment is evaluated at visits 2 to 6 by documenting all existing and new AK lesions in the face. Cosmetic results and improvement of photoaging parameters are evaluated by means of a modified Dover scale. Primary outcome parameter is the cumulative number of AK lesions observed between visits 2 and 6. Secondary outcome parameters are complete clearance of AK, new AK lesions since the previous visit, cosmetic results independently evaluated by both patient and physician, patient-reported pain (visual analogue scale), patient and physician satisfaction scores with cosmetic results, and patient-reported quality of life (Dermatology Life Quality Index). Safety parameters are also documented (adverse events and serious adverse events). DISCUSSION This clinical trial will assess the efficacy of repetitive DL-PDT in preventing AK and investigate possible rejuvenating effects of this treatment. (Trial registration: ClinicalTrials.gov Identifier: NCT02736760). TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02736760 . Study Code Daylight_01. EudraCT 2014-005121-13.
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Affiliation(s)
- E Kohl
- Department of Dermatology, University Hospital Regensburg, 93042, Regensburg, Germany
| | - M Koller
- Center for Clinical Studies, University Hospital Regensburg, 93042, Regensburg, Germany
| | - F Zeman
- Center for Clinical Studies, University Hospital Regensburg, 93042, Regensburg, Germany
| | - R-M Szeimies
- Department of Dermatology and Allergology, Vest Hospital, Academic Teaching Hospital University of Bochum, 45657, Recklinghausen, Germany
| | | | - W Prager
- Prager & Partner, 22609, Hamburg, Germany
| | - P A Gerber
- Department of Dermatology, Medical Faculty, Heinrich-Heine University, 40225, Düsseldorf, Germany
| | - S Karrer
- Department of Dermatology, University Hospital Regensburg, 93042, Regensburg, Germany. .,Department of Dermatology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
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24
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Li D, Lin SB, Cheng B. Intense Pulsed Light: From the Past to the Future. Photomed Laser Surg 2016; 34:435-447. [DOI: 10.1089/pho.2016.4139] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Dan Li
- Joint Shantou International Eye Center of Shantou University and Chinese University of Hong Kong, Shantou, China
- Southern Medical University, Guangzhou, China
| | - Shi-Bin Lin
- Joint Shantou International Eye Center of Shantou University and Chinese University of Hong Kong, Shantou, China
| | - Biao Cheng
- Southern Medical University, Guangzhou, China
- Department of Plastic Surgery, General Hospital of Guangzhou Military Command of PLA, Guangzhou, China
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25
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Thomas C, Kim B, Lam J, Richards S, See A, Kalouche S, Paver R, Fernández Peñas P. Objective severity does not capture the impact of rosacea, acne scarring and photoaging in patients seeking laser therapy. J Eur Acad Dermatol Venereol 2016; 31:361-366. [DOI: 10.1111/jdv.13945] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 08/08/2016] [Indexed: 11/30/2022]
Affiliation(s)
- C.L. Thomas
- Skin & Cancer Foundation Australia; Sydney NSW Australia
- The University of Sydney; Sydney NSW Australia
| | - B. Kim
- Skin & Cancer Foundation Australia; Sydney NSW Australia
- The University of Sydney; Sydney NSW Australia
| | - J. Lam
- Skin & Cancer Foundation Australia; Sydney NSW Australia
- The University of Melbourne; Melbourne Vic. Australia
| | - S. Richards
- Skin & Cancer Foundation Australia; Sydney NSW Australia
- The University of Sydney; Sydney NSW Australia
| | - A. See
- Skin & Cancer Foundation Australia; Sydney NSW Australia
- The University of Sydney; Sydney NSW Australia
| | - S. Kalouche
- Skin & Cancer Foundation Australia; Sydney NSW Australia
- The University of Sydney; Sydney NSW Australia
| | - R.D. Paver
- Skin & Cancer Foundation Australia; Sydney NSW Australia
- The University of Sydney; Sydney NSW Australia
| | - P. Fernández Peñas
- Skin & Cancer Foundation Australia; Sydney NSW Australia
- The University of Sydney; Sydney NSW Australia
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26
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Fonda-Pascual P, Moreno-Arrones OM, Alegre-Sanchez A, Saceda-Corralo D, Buendia-Castaño D, Pindado-Ortega C, Fernandez-Gonzalez P, Velazquez-Kennedy K, Calvo-Sánchez MI, Harto-Castaño A, Perez-Garcia B, Bagazgoitia L, Vaño-Galvan S, Espada J, Jaen-Olasolo P. In situ production of ROS in the skin by photodynamic therapy as a powerful tool in clinical dermatology. Methods 2016; 109:190-202. [PMID: 27422482 DOI: 10.1016/j.ymeth.2016.07.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 07/10/2016] [Accepted: 07/11/2016] [Indexed: 11/17/2022] Open
Abstract
Photodynamic therapy (PDT) is a clinical modality of photochemotherapy based on the accumulation of a photosensitizer in target cells and subsequent irradiation of the tissue with light of adequate wavelength promoting reactive oxygen species (ROS) formation and cell death. PDT is used in several medical specialties as an organ-specific therapy for different entities. In this review we focus on the current dermatological procedure of PDT. In the most widely used PDT protocol in dermatology, ROS production occurs by accumulation of the endogenous photosensitizer protoporphyrin IX after treatment with the metabolic precursors 5-methylaminolevulinic acid (MAL) or 5-aminolevulinic acid (ALA). To date, current approved dermatological indications of PDT include actinic keratoses (AK), basal cell carcinoma (BCC) and in situ squamous cell carcinoma (SCC) also known as Bowen disease (BD). With regards to AKs, PDT can also treat the cancerization field carrying an oncogenic risk. In addition, an increasing number of pathologies, such as other skin cancers, infectious, inflammatory or pilosebaceous diseases are being considered as potentially treatable entities with PDT. Besides the known therapeutic properties of PDT, there is a modality used for skin rejuvenation and aesthetic purposes defined as photodynamic photorejuvenation. This technique enables the remodelling of collagen, which in turn prevents and treats photoaging stygmata. Finally we explore a new potential treatment field for PDT determined by the activation of follicular bulge stem cells caused by in situ ROS formation.
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Affiliation(s)
- Pablo Fonda-Pascual
- Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Grupo de Dermatología Experimental y Biología Cutánea, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Oscar M Moreno-Arrones
- Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Grupo de Dermatología Experimental y Biología Cutánea, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Adrian Alegre-Sanchez
- Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Grupo de Dermatología Experimental y Biología Cutánea, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - David Saceda-Corralo
- Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Grupo de Dermatología Experimental y Biología Cutánea, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | | | | | - Kyra Velazquez-Kennedy
- Grupo de Dermatología Experimental y Biología Cutánea, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - María I Calvo-Sánchez
- Grupo de Dermatología Experimental y Biología Cutánea, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | | | - Lorea Bagazgoitia
- Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Grupo de Dermatología Experimental y Biología Cutánea, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Sergio Vaño-Galvan
- Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Grupo de Dermatología Experimental y Biología Cutánea, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Jesus Espada
- Laboratorio de Bionanotecnolgía, Universidad Bernardo ÓHiggins, Santiago, Chile.
| | - Pedro Jaen-Olasolo
- Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Madrid, Spain.
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Epithelial–mesenchymal interaction during photodynamic therapy-induced photorejuvenation. Arch Dermatol Res 2016; 308:493-501. [DOI: 10.1007/s00403-016-1666-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 05/15/2016] [Accepted: 06/17/2016] [Indexed: 10/21/2022]
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Friedmann DP, Goldman MP, Fabi SG, Guiha I. Multiple sequential light and laser sources to activate aminolevulinic acid in the treatment of photodamage: A retrospective study. J COSMET LASER THER 2016; 17:252-8. [PMID: 25724011 DOI: 10.3109/14764172.2015.1022187] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The aim of this study was to retrospectively evaluate photodynamic therapy (PDT) with aminolevulinic acid (ALA) for cutaneous photorejuvenation using blue light sequentially with red light, pulsed-dye laser (PDL), and/or intense pulsed light (IPL). MATERIALS AND METHODS Ninety-six patients (121 treatments) had photodamage treated with field-directed ALA-PDT from 2001 to 2010 in this single-center study. Treatments were performed with blue light + PDL, blue light + IPL, blue light + PDL + IPL, or blue light + red light + PDL + IPL. Outcome measures were obtained via telephone questionnaire and graded on a four-point scale. RESULTS There were no significant differences in patient-reported improvement in photodamage, overall skin quality, and postprocedure adverse events between treatment arms. However, number of patients in the blue light + red light + PDL + IPL group was markedly smaller (n = 2) than that in the other groups (n = 14-46). DISCUSSION Although results showed a trend toward greater efficacy with similar tolerability using multiple, sequential light and laser sources with ALA-PDT for photorejuvenation, the potential for recall bias and widely disparate number of patients between treatment groups and follow-up times between patients severely limit this retrospective study. Nevertheless, despite these major statistical flaws, the results may provide valuable information regarding the safety of multiple modalities with PDT of photodamage in a single session.
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Affiliation(s)
- Daniel P Friedmann
- a Westlake Dermatology Clinical Research Center, Westlake Dermatology & Cosmetic Surgery , Austin , TX , USA
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Abstract
INTRODUCTION Topical photodynamic therapy (PDT) is acknowledged to be a safe and efficient therapeutic option for the selective destruction of actinic keratosis and superficial carcinomas. Over the past 15 years, topical PDT has also been shown to be a possible method for "photorejuvenation." MATERIALS AND METHODS An extensive review was performed of in vitro and in vivo (animals, organ transplant recipients, or immunocompetent patients) studies. RESULTS The studies point to a high level of efficacy. Tone, lentigos, skin roughness, and moreover texture and fine wrinkles because of the effects of dermal remodeling are improved. Adverse effects are generally described as mild to moderate, without scarring, along with a fast recovery time. Patients with fair phototypes and a history of sun exposure and actinic damage of varying severity are the best candidates for this technique. Photodynamic photorejuvenation sessions can both rejuvenate their skins and also treat their visible or incipient UV-induced lesions. New protocols either with daylight use and/or previous intensification by laser or microneedling seem promising. CONCLUSION The photodynamic rejuvenation technique seems to show excellent short-term efficacy and tolerability.
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Sanclemente G, Mancilla G, Hernandez G. A double-blind randomized controlled trial to assess the efficacy of daylight photodynamic therapy with methyl-aminolevulinate vs. Placebo and daylight in patients with facial photodamage. ACTAS DERMO-SIFILIOGRAFICAS 2016. [DOI: 10.1016/j.adengl.2015.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Yang C, Li Q. A prospective study of safety and efficacy of combination therapy with bipolar radiofrequency-based intense pulsed light, infrared light, and diode laser in Chinese subjects with photoaged skin. J COSMET LASER THER 2016; 18:339-44. [PMID: 26963598 DOI: 10.3109/14764172.2016.1157608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To further evaluate the safety and effectiveness of bipolar RF-based optical therapy combining intense pulsed light (IPL), infrared light, and diode laser in the treatment of photoaged skin in Chinese subjects. METHODS Twenty-seven subjects received five treatments at 3-week intervals. Triple therapy was applied in one session to the face. Images and data were obtained 30 and 180 days after the last treatment. Objective measurements (including photometric analysis of skin pigmentation, texture and wrinkles, ultrasonic measurement of dermal thickness and dermal echo intensity, and public and self-assessment of apparent age), clinical assessment, and safety were evaluated. RESULTS Objective measurements of pigmentation, texture, wrinkles, and dermal echo intensity improved significantly, regardless of age. Self-assessment of apparent age at 30 and 180 days was reduced by an average of 2.7 and 2.2 years, respectively, and public assessment of apparent age was reduced by an average of 3.14 years and 2.95 years, respectively. Global scores for photoaging were improved in all patients. Adverse events were generally transient and mild. CONCLUSION Sequential combination treatment reported here could significantly reduce skin pigmentation, texture and wrinkles, improve dermal intensity, and reduce the self and publicly perceived age. This therapy is safe and well tolerated.
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Affiliation(s)
- Cuixia Yang
- a Southern Medical University , Guangzhou, Guangdong Province , China.,b BAB Aesthetic Medical Hospital , Chengdu, Sichuan Province , China
| | - Qin Li
- a Southern Medical University , Guangzhou, Guangdong Province , China.,c Department of Plastic Surgery , Guangzhou General Hospital of Guangzhou Military Command of PLA , Guangzhou, Guangdong Province , China
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Sanclemente G, Mancilla GA, Hernandez G. A double-blind randomized controlled trial to assess the efficacy of daylight photodynamic therapy with methyl-aminolevulinate vs. Placebo and daylight in patients with facial photodamage. ACTAS DERMO-SIFILIOGRAFICAS 2015; 107:224-34. [PMID: 26643786 DOI: 10.1016/j.ad.2015.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 10/02/2015] [Accepted: 10/12/2015] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Daylight PDT (dPDT) is easy to use and does not require light equipment. Such therapy has been exhaustively proved to be successful in the treatment of actinic keratosis, but its use in skin photodamage remains unclear. OBJECTIVE To evaluate dPDT's efficacy in skin facial photodamage. PATIENTS AND METHODS This was a parallel-group double-blind, randomized placebo-controlled trial. Sixty participants with symmetric facial photodamage were allocated to topical methyl aminolevulinate (MAL) and daylight vs. matching placebo and daylight. Primary outcome was global photodamage improvement/failure 1 month after the third session. Secondary outcomes included: pain evaluation; specific photodamage severity scores; sun irradiance quantification and Skindex-29 scores. Adverse events were also investigated. RESULTS Primary analysis included all randomized patients. All patients sun-exposed for 120min in 3 sessions. The risk of failure was lower in the MAL-dPDT group than in the placebo plus daylight group (RR: 0.18; 95% CI: 0.08-0.41). Mean solar irradiance (W/m(2)) during the first, second and third sessions was 480.82, 430.07 and 435.84, respectively. Items 5 and 14 of Skindex-29 in the MAL-dPDT group showed statistical significant differences. Two patients in the MAL-dPDT group had serious and non-serious events not directly related to the product. CONCLUSION dPDT with MAL was un-painful, effective and safe for the treatment of facial photodamage. Herpes simplex prophylaxis should be considered before sessions.
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Affiliation(s)
- G Sanclemente
- IPS Universitaria, Universidad de Antioquia, Medellín, Colombia; Grupo de Investigación Dermatológica (GRID), Instituto de Investigaciones Médicas, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.
| | - G A Mancilla
- Grupo de Investigación Dermatológica (GRID), Instituto de Investigaciones Médicas, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - G Hernandez
- Grupo de Investigación Dermatológica (GRID), Instituto de Investigaciones Médicas, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
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Tanaka Y, Tsunemi Y, Kawashima M. Objective assessment of intensive targeted treatment for solar lentigines using intense pulsed light with wavelengths between 500 and 635 nm. Lasers Surg Med 2015; 48:30-5. [PMID: 26462982 PMCID: PMC5396364 DOI: 10.1002/lsm.22433] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2015] [Indexed: 11/30/2022]
Abstract
Background and Objectives Solar lentigines are commonly found in sun‐exposed areas of the body including hands, neck, or face. This study evaluates the efficacy of an intense pulsed light (IPL) device, with wavelengths between 500 and 635 nm and delivered with a targeted tip, for the treatment of solar lentigines on Japanese skin. Study Design/Materials and Methods Forty Japanese patients with solar lentigines received one IPL treatment with a targeted treatment tip that emits wavelengths between 500 and 635 nm and contact cooling. Pulses were delivered through a targeted tip to each lentigo until mild swelling and a gray color were observed. Digital photographs and gray level histogram values were taken pre‐ and post‐treatment, and patient assessments were recorded post‐treatment. Results Significant improvement was observed for all patients in digital photographs and mean values of gray level histograms (P < 0.0001). Ninety percent of patients reported satisfaction with the improvement of the treatment area and convenience of the procedure. Complications were minor and transitory, consisting of a slight burning sensation and mild erythema which resolved within 5 hours of treatment. No serious adverse events were observed. Conclusions A short‐wavelength IPL, delivered with a targeted tip and contact cooling, offers a highly efficacious treatment for solar lentigines in Japanese skin with minimal downtime and complications. Lasers Surg. Med. 48:30–35, 2016. © 2015 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc.
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Affiliation(s)
- Yohei Tanaka
- Clinica Tanaka Plastic, Reconstructive Surgery and Anti-aging Center, Matsumoto, Nagano, 390-0874, Japan.,Department of Dermatology, Tokyo Women's Medical University, Tokyo, 162-8666, Japan
| | - Yuichiro Tsunemi
- Department of Dermatology, Tokyo Women's Medical University, Tokyo, 162-8666, Japan
| | - Makoto Kawashima
- Department of Dermatology, Tokyo Women's Medical University, Tokyo, 162-8666, Japan
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González-Rodríguez A, Lorente-Gual R. Current Indications and New Applications of Intense Pulsed Light. ACTAS DERMO-SIFILIOGRAFICAS 2015. [DOI: 10.1016/j.adengl.2015.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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González-Rodríguez A, Lorente-Gual R. Indicaciones actuales y nuevas aplicaciones de los sistemas de luz pulsada intensa. ACTAS DERMO-SIFILIOGRAFICAS 2015; 106:350-64. [DOI: 10.1016/j.ad.2014.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 08/26/2014] [Accepted: 10/03/2014] [Indexed: 10/24/2022] Open
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Tan J, Lei Y, Ouyang HW, Gold MH. The use of the fractional CO2
laser resurfacing in the treatment of photoaging in Asians: Five years long-term results. Lasers Surg Med 2014; 46:750-6. [DOI: 10.1002/lsm.22304] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Jun Tan
- The People's Hospital of Hunan Province; Department of Plastic & Laser Aesthetic Surgery; 1st Affiliated Hospital of Hunan Normal University; Chang-Sha Hunan 410005 P.R. China
| | - Ying Lei
- Attending Doctor of the People's Hospital of Hunan Providence
| | - Hua-Wei Ouyang
- Attending Doctor of the People's Hospital of Hunan Providence
| | - Michael H. Gold
- Tennessee Clinical Research Center; Nashville Tennessee
- Gold Skin Care Center; Department of Dermatology; Nashville Tennessee
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Effective blue light photodynamic therapy does not affect cutaneous langerhans cell number or oxidatively damage DNA. Dermatol Surg 2014; 40:979-87. [PMID: 25072126 DOI: 10.1097/01.dss.0000452624.01889.8a] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Photodynamic therapy (PDT) using aminolevulinic acid (ALA) with blue light or red light is effective for treating actinic keratoses (AKs). However, immunosuppression follows red light PDT, raising the spectre of skin cancer promotion in treated skin. OBJECTIVE To determine whether broad-area short incubation (BASI)-ALA-PDT using blue light immunosuppression immunosuppresses treated skin. METHODS Patients were evaluated clinically and by standardized facial biopsies of non-AK skin before, 24 hours and 1 month after customary blue light BASI-ALA-PDT. All biopsies were stained for markers of epidermal atypia and Langerhans cells (LCs); and at 24 hours to detect oxidative DNA damage. RESULTS Patients had an 81% reduction in AKs and slight improvement in clinical and histologic signs of photoaging after 1 month. The biopsied chronically photodamaged skin without clinically detectable AKs showed no effect of PDT on the LC number, distribution, or morphology; and no oxidative DNA damage, in contrast to the changes reported after customary red light PDT. CONCLUSION Customary blue light BASI-ALA-PDT does not affect the LC number or produce oxidative DNA damage, the sequelae of red light PDT responsible for immunosuppression in treated skin.
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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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Negosanti L, Pinto V, Sgarzani R, Negosanti F, Zannetti G, Cipriani R. Photodynamic therapy with topical aminolevulinic acid. World J Dermatol 2014; 3:6-14. [DOI: 10.5314/wjd.v3.i2.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 12/26/2013] [Accepted: 03/14/2014] [Indexed: 02/06/2023] Open
Abstract
Photodynamic therapy (PDT) is a relatively new therapy in dermatology that uses the topical application of a porphyrin derivative to selectively destroy a cutaneous target. The action is implemented by the application of a specific light frequency. The ability of porphyrin to selectively target tumor tissue has been known since the 1960s. In the late 1970s, the underlying mechanism was defined, and Dougherty’s discovery of the first chromophore led to the production and commercialization of Photofrin®. Many other chromophores that can act as photosensitizers have been studied since then, with aminolevulinic acid currently the most commonly used chromophore in clinical practice. PDT is simple, minimally invasive and can be administered on an outpatient basis. The efficacy of PDT has been proven for actinic keratosis, Bowen’s disease and basal cell carcinoma; another of its well-known applications is the treatment of photoaging. Indications for its use are continuously increasing, and promising results are reported for various skin diseases. In this paper we report the mechanism of action of PDT with aminolevulinic acid, the literature concerning the most common diseases treated with PDT and the subsequent level of evidence.
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Ji J, Zhang LL, Ding HL, Wang HW, Huang Z, Wang XX, Wang PR, Wang XL. Comparison of 5-aminolevulinic acid photodynamic therapy and red light for treatment of photoaging. Photodiagnosis Photodyn Ther 2014; 11:118-21. [PMID: 24568890 DOI: 10.1016/j.pdpdt.2014.02.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 02/12/2014] [Accepted: 02/13/2014] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The aim of this pilot study was to compare the efficacy of ALA-PDT and red light alone in the treatment of photoaging. METHODS A total of 14 adults with photoaging skin were recruited. ALA-PDT or red light alone was applied to the forearm extensor. Before and after treatment, the treated sites were examined by dermoscopy, the changes in straum corneum (SC) hydration, transepidermal water loss (TEWL), and the L*a*b* values were measured, and microscopic examination of collagens and elastins was performed. RESULTS After ALA-PDT or red light illumination, the appearance of photoaging lesions improved, SC hydration increased and TEWL decreased. These changes in the ALA-PDT group were more obvious than those in the red light group. No significant change was noticed in the L*a*b* values in both groups. The signs of typical solar elastosis damage were improved in both groups. CONCLUSIONS ALA-PDT showed better skin rejuvenation effect than red light alone.
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Affiliation(s)
- Jie Ji
- Shanghai Skin Diseases Hospital, Shanghai, China
| | | | - Hui-Lin Ding
- Shanghai Skin Diseases Hospital, Shanghai, China
| | - Hong-Wei Wang
- Department of Dermatology, Huadong Hospital, Shanghai, China
| | - Zheng Huang
- MOE Key Laboratory of OptoElectronic Science and Technology for Medicine, Fujian Normal University, Fuzhou, China; College of Engineering and Applied Science, University of Colorado Denver, CO, USA
| | | | - Pei-Ru Wang
- Shanghai Skin Diseases Hospital, Shanghai, China
| | - Xiu-Li Wang
- Shanghai Skin Diseases Hospital, Shanghai, China.
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Martínez-Carpio P, Alcolea-López J, Vélez M. Efficacy of photodynamic therapy in the short and medium term in the treatment of actinic keratosis, Basal cell carcinoma, acne vulgaris and photoaging: results from four clinical trials. Laser Ther 2014; 21:199-208. [PMID: 24511190 DOI: 10.5978/islsm.12-or-11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 08/31/2012] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To determine the clinical efficacy of methyl-aminolevulinate (MAL)-Photodynamic Therapy (PDT) in the treatment of actinic keratosis (AK), basal cell carcinoma (BCC), acne vulgaris (AV) and photoaging (PA), in the short and medium term. SUBJECTS AND METHODS Four separate prospective studies were designed on patients with AK (n=25), BCC (n=20), AV (n=20) and PA (n=25). Two PDT protocols were applied, and different clinical efficacy criteria were established, including lesion count and size. Two semi-quantitative and four analogue visual scales were completed for the evaluation of results according to the therapist, the patient and two independent experts. RESULTS In the AK and BCC studies, full clinical remission was observed in 84.7% and 75.7% of lesions, respectively. In the AV study, the number of inflammatory and non-inflammatory lesions fell significantly (p<0.001, p<0.05). In the PA study a reduction in Dover scale scores (3.19 vs. 2.14, p<0.001) was proven. The percentages of satisfied or very satisfied patients were: AK=88%, BCC=90%, AV=89% and PA=80%. A year later, none of the AK or BCC lesions had reappeared, and the cases of AV and PA remained stable, with a tendency towards improvement. CONCLUSION the MAL-PDT procedures used produced efficacious, safe and satisfactory results in KA, BCC, AV and PA in the short and medium term.
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Affiliation(s)
- Pa Martínez-Carpio
- IMC-Investiláser. Sabadell. Barcelona. Spain. ; Clínica Alcolea. Barcelona. Spain
| | | | - M Vélez
- Dermatology Department. Hospital Universitario del Mar. Barcelona. Spain
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Abstract
We review new developments in recent years in photodynamic therapy. Since 2009 two new photosensitizers, a self-adhesive 5-aminolevulinic acid (ALA) patch and a nanoemulsion formulation of 5-aminolevulinic acid have been approved for the treatment of actinic keratoses. Pretreatment with ablative fractional lasers enhances penetration of the photosensitizer and enables intensified PDT in acral lesions and in field-cancerized skin. Several clinical trials have demonstrated the skin-rejuvenating effects of photodynamic therapy, while the underlying mechanisms of action have been clarified. The efficacy of photodynamic therapy has been shown in the treatment and prophylaxis of actinic keratoses in organ transplant recipients at high risk for developing skin cancer. We also summarize the results of available studies on daylight-mediated photodynamic therapy.
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Affiliation(s)
- E Kohl
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93042 Regensburg, Germany
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Hassan KM, Benedetto AV. Facial skin rejuvenation: Ablative laser resurfacing, chemical peels, or photodynamic therapy? Facts and controversies. Clin Dermatol 2013; 31:737-40. [DOI: 10.1016/j.clindermatol.2013.05.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Prolonged Activation of ERK Contributes to the Photorejuvenation Effect in Photodynamic Therapy in Human Dermal Fibroblasts. J Invest Dermatol 2013; 133:2265-75. [DOI: 10.1038/jid.2013.25] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Revised: 12/11/2012] [Accepted: 12/14/2012] [Indexed: 12/19/2022]
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Clementoni MT, Lavagno R, Munavalli G. A new multi-modal fractional ablative CO2 laser for wrinkle reduction and skin resurfacing. J COSMET LASER THER 2013; 14:244-52. [PMID: 23057708 DOI: 10.3109/14764172.2012.738918] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The concept of fractional delivery modality of the energy with both ablative and non-ablative devices is now well known and accepted as an effective method to attain significant aesthetic improvements on facial aging skin. A new, multi-modal, fractional, ablative CO2 laser that can create, using same scanner/handpiece, deep columns in addition to superficial ablation has been recently proposed and therefore investigated. METHOD Twenty-four patients were enrolled in this evaluation. Each of them received one multi-modal, fractional ablative treatment. Patients were clinically and photographically evaluated at baseline and 6 months after the procedure. The degree of photoaging and the efficacy of treatment were evaluated using a VAS five-point scale of some skin features. A 3D images comparison was furthermore performed to objectify the improvements. RESULTS For all of the analysed skin features of photodamage a significant, statistical improvement was obtained. The data collected with the 3D system demonstrated an average improvement of 42% of the wrinkles and an average improvement of the melanin variation of 40.1%. CONCLUSIONS The multi-modal approach with a single handpiece allows obtaining good outcomes with a very low incidence of adverse effects and a short downtime.
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Szeimies RM, Lischner S, Philipp-Dormston W, Walker T, Hiepe-Wegener D, Feise K, Podda M, Prager W, Kohl E, Karrer S. Photodynamic therapy for skin rejuvenation: treatment options - results of a consensus conference of an expert group for aesthetic photodynamic therapy. J Dtsch Dermatol Ges 2013; 11:632-6. [PMID: 23650971 DOI: 10.1111/ddg.12119] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 03/26/2013] [Indexed: 11/29/2022]
Affiliation(s)
| | | | | | | | | | | | - Maurizio Podda
- Department of Dermatology; Darmstadt Hospital; Darmstadt-Eberstadt
| | | | - Elisabeth Kohl
- Department of Dermatology; University Clinic of Regensburg (all Germany)
| | - Sigrid Karrer
- Department of Dermatology; University Clinic of Regensburg (all Germany)
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Karrer S, Kohl E, Feise K, Hiepe-Wegener D, Lischner S, Philipp-Dormston W, Podda M, Prager W, Walker T, Szeimies RM. Photodynamic therapy for skin rejuvenation: review and summary of the literature--results of a consensus conference of an expert group for aesthetic photodynamic therapy. J Dtsch Dermatol Ges 2012. [PMID: 23190505 DOI: 10.1111/j.1610-0387.2012.08046.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Skin rejuvenating effects of photodynamic therapy (PDT) for photoaged skin has been well-documented in several clinical trials. Different photosensitizers (5-aminolevulinic acid, methyl aminolevulinate) and diverse light sources (light-emitting diodes, lasers, intense pulsed light) have been used with promising results. An improvement of lentigines, skin roughness, fine lines and sallow complexion has been achieved with PDT. These clinically evident effects are at least in part due to histologically proven increase of collagen and decrease of elastotic material in the dermis. Effective improvement of photoaged skin, simultaneous treatment and possibly also prevention of actinic keratoses, the possibility of repeated treatments and, in contrast to other procedures, limited and calculable side effects make PDT a promising procedure for skin rejuvenation.
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Affiliation(s)
- Sigrid Karrer
- Department of Dermatology, University Clinic of Regensburg, Franz-Josef-Strauss-Allee 11, Regensburg, Germany
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