Successful Sequential Treatment with Itraconazole and ALA-PDT for Cutaneous Granuloma by Candida albicans: A Case Report and Literature Review

Minimally Invasive Semiconductor Laser Surgery Combined with 5-ALA Photodynamic Therapy for a Chronic Hyperplastic Candidiasis Patient Who Is Ineffective to Antifungal Therapy

Background: Chronic hyperplastic candidiasis (CHC) is a chronic oral mucosal infection caused by Candida, which has potential for malignant transformation. Diagnosing CHC can be challenging due to its various manifestations. In addition, fungal treatments often prove to be ineffective, highlighting the urgent need for a new safe and efficient treatment approach. Given the potential of CHC to transform into malignancy, it is crucial to emphasize dynamic monitoring and follow-up after treatment. Objective: We attempted to investigate the effect of semiconductor laser pretreatment combined with 5-amino-levulinic acid (5-ALA) photodynamic therapy (PDT) for CHC. Methods: We presented the successful treatment of CHC with mild dysplasia in a 30-year-old man using semiconductor laser and 5-ALA PDT after antifungal therapy proved ineffective. Toluidine blue staining, autofluorescence imaging, and DNA image cytometry were combined to dynamically monitor the progress of the disease. Results: We have obtained positive outcomes with the use of laser combined with PDT treatment. The patients experienced only mild adverse reactions after the treatment, and there was no indication of recurrence or malignant transformation during the subsequent follow-up period, as observed through various auxiliary examinations. Conclusions: This case report suggests that semiconductor laser surgery combined with PDT could be a promising treatment option for patients with CHC who do not respond to antifungal therapy. In addition, the use of combined noninvasive examinations might provide a more accurate assessment of malignant transformation in patients with CHC.

Photodynamic therapy combined with antifungal drugs against kerion: A report of six cases and literature review

Kerion, a severe manifestation of tinea capitis caused by dermatophytes, is a fungal skin disease primarily affecting children. This report discusses six cases of pediatric kerion that were successfully treated with a combination of photodynamic therapy (PDT) and antifungal agents. Additionally, we conducted a literature review, identifying and analyzing six published reports on kerion and tinea capitis. The characteristics and efficacies of these cases are summarized. In summary, early combination therapy and proactive pre-treatment interventions proved effective in maximizing therapeutic outcomes, reducing disease duration and minimizing adverse reactions such as cicatricial alopecia. This approach has emerged as a favorable choice for the treatment of kerion.

Isolated Cutaneous Granuloma Caused by Candida Parapsilosis: Case Report and Literature Review

Candidal granuloma is an uncommon type of deep chronic cutaneous candidiasis. Candida albican is the most common causative pathogen for candidal granuloma. We report herein the original case of a 69-year-old Chinese woman presented with a 3-year of painful cutaneous lesion on the back of left hand. Physical examination revealed a 4 × 5 cm large infiltrative reddish plaque with unclear boundaries. The yellow-white crusts were observed on the uneven surface of plaque. Histopathological examination of biopsy tissue revealed that yeast cells and the horizontal section of hyphae in the dermis by hematoxylin eosin staining and periodic acid-Schiff staining. Finally, the pathogen was identified as Candida parapsilosis by mycological examination and molecular identification. The patient was treated with itraconazole oral 200 mg twice daily combined with topical terbinafine hydrochloride cream for 2 months. The lesions were fully resolved and no recurrence was observed. Since the cutaneous infection caused by C. parasilosis were rarely reported, we also reviewed all 11 cases of cutaneous infection caused by C. parapsilosis in the PubMed. Our study highlighted that chronic unilateral infiltrated plaques or ulcers should be aware of the occurrence of fungal granuloma including candidal granuloma especially in immunocompromised patients.

5-aminolevulinic acid-based photodynamic therapy in combination with antifungal agents for adult kerion and facial ulcer caused by Trichophyton rubrum

Dermatophytosis is the most common fungal infectious disease in the world, which is commonly caused by Trichophyton rubrum in China. The traditional therapies for treating dermatophytosis include topical and oral antifungal agents like terbinafine, griseofulvin, and azole antifungal drugs. However, 5-aminolevulinic acid-based photodynamic therapy (ALA-PDT) as a new alternative therapy avoids the side effects and drug resistance of traditional antifungal agents. We report two cases diagnosed as kerion and tinea faciei secondary to ulcers with CARD 9 deficiency, both of whom were infected by T.rubrum. They were both successfully treated by ALA-PDT combined with antifungal drugs, providing a feasible strategy for therapeutic choice for adult kerion and ulcer treatment.

Clinical efficacy of 5-aminolevulinic acid-mediated photodynamic therapy versus topical antifungal agent and surgical excision for the treatment of hyperplastic candidiasis

BACKGROUND

Hyperplastic candidiasis (HC) is a chronic infection of oral mucosa caused by Candida. Owing to its potential for malignant transformation, its intervention requires attention. Conventional surgical resection might lead to irreversible damage and impact the patient's quality of life. Hence, this study aimed to evaluate the clinical efficacy of 5-aminolevulinic acid (5-ALA)-mediated photodynamic therapy (PDT) alone and in combination with topical antifungal therapy (i.e., nystatin [combination therapy]) in comparison with nystatin and surgical resection for the treatment of HC.

METHODS

Forty subjects with clinical and histopathological diagnoses of HC were included in the study. Four study groups, with 10 participants each, were formed as follows: Group-I - receiving antifungal agent [nystatin]; Group-II - receiving surgical resection; Group-III - receiving PDT; and Group-IV - receiving 5-ALA-mediated PDT and nystatin [combination therapy]. Salivary and mucosal samples were collected for the quantification of Candida albicans and the treatment responses to different interventions were recorded at week-4, week-6, and week-8 after finishing therapies.

RESULTS

At the 3^rd follow-up (i.e., at end of the 8^th week after the interventions), complete improvement in 3 (30%), 2 (20%), 1 (10%), and 5 (50%) patients in group-I, group-II, group-III, and group-IV, respectively was observed. A statistically significant difference was obtained when the intervention responses were compared at week-4 (p<0.01), week-6 (p<0.01), and week-8 (p<0.0001) follow-ups in group-I, group-II, and group-IV subjects. At the 8-week follow-up regarding the salivary and mucosal samples, the lowest colony-forming units/milliliter score of C. albicans was observed in group-IV subjects.

CONCLUSION

The application of 5-ALA-mediated PDT in combination with nystatin gel possesses the potential as a well-tolerated and safe therapeutic modality for the treatment of patients with HC.

An insight into photodynamic therapy towards treating major dermatological conditions

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

Combination Treatment with Photodynamic Therapy and Laser Therapy in Chronic Hyperplastic Candidiasis: A Case Report

Chronic hyperplastic candidiasis (CHC) is a rare subtype of oral candidiasis. Due to the malignant transformation potential of this disease, its treatment deserves attention. Here we reported a refractory case of 85-year-old female with chronic hyperplastic candidiasis treated with combined photodynamic therapy and laser therapy with a superior clinical result. The patient had a two-months history of thick white plaque on her upper inner lip. Conventional antifungal therapy and repeated photodynamic therapy contributed slightly improvement to the hyperkeratosis lesion, and then it was removed by laser therapy. Recurrence was found at the follow-up visit of eighth- week, and the recurrent lesion was removed again by laser therapy and prophylactic photodynamic therapy was performed. The patient is still under follow-up.

Phototherapy and optical waveguides for the treatment of infection

With rapid emergence of multi-drug resistant microbes, it is imperative to seek alternative means for infection control. Optical waveguides are an auspicious delivery method for precise administration of phototherapy. Studies have shown that phototherapy is promising in fighting against a myriad of infectious pathogens (i.e. viruses, bacteria, fungi, and protozoa) including biofilm-forming species and drug-resistant strains while evading treatment resistance. When administered via optical waveguides, phototherapy can treat both superficial and deep-tissue infections while minimizing off-site effects that afflict conventional phototherapy and pharmacotherapy. Despite great therapeutic potential, exact mechanisms, materials, and fabrication designs to optimize this promising treatment option are underexplored. This review outlines principles and applications of phototherapy and optical waveguides for infection control. Research advances, challenges, and outlook regarding this delivery system are rigorously discussed in a hope to inspire future developments of optical waveguide-mediated phototherapy for the management of infection and beyond.

New Applications of Photodynamic Therapy in the Management of Candidiasis

The most important aetiological agent of opportunistic mycoses worldwide is Candida spp. These yeasts can cause severe infections in the host, which may be fatal. Isolates of Candida albicans occur with greater frequency and variable resistance patterns. Photodynamic therapy (PDT) has been recognised as an alternative treatment to kill pathogenic microorganisms. PDT utilises a photosensitizer, which is activated at a specific wavelength and oxygen concentration. Their reaction yields reactive oxygen species that kill the infectious microorganism. A systematic review of new applications of PDT in the management of candidiasis was performed. Of the 222 studies selected for in-depth screening, 84 were included in this study. All the studies reported the antifungal effectiveness, toxicity and dosimetry of treatment with antimicrobial PDT (aPDT) with different photosensitizers against Candida spp. The manuscripts that are discussed reveal the breadth of the new applications of aPDT against Candida spp., which are resistant to common antifungals. aPDT has superior performance compared to conventional antifungal therapies. With further studies, aPDT should prove valuable in daily clinical practice.

Successful treatment of chronic hyperplastic candidiasis with 5-aminolevulinic acid photodynamic therapy: A case report

Chronic hyperplastic candidiasis (CHC) is a chronic oral mucosal infection caused by Candida. Refractory hyperplastic lesions may lead to epithelial dysplasia and carcinogenesis. Traditional surgical resection may cause irreversible damage and effect the patient's quality of life. This paper reports the case of a 63-year-old man with CHC. After routine treatment, local hyperplastic lesions remained. Photodynamic therapy with ALA was applied to the hyperplastic lesions and yielded satisfactory results, with no recurrence at 1 year. This case report describes a promising, effective method for the treatment of CHC.

Photosensitizers Mediated Photodynamic Inactivation against Fungi

Superficial and systemic fungal infections are essential problems for the modern health care system. One of the challenges is the growing resistance of fungi to classic antifungals and the constantly increasing cost of therapy. These factors force the scientific world to intensify the search for alternative and more effective methods of treatment. This paper presents an overview of new fungal inactivation methods using Photodynamic Antimicrobial Chemotherapy (PACT). The results of research on compounds from the groups of phenothiazines, xanthanes, porphyrins, chlorins, porphyrazines, and phthalocyanines are presented. An intensive search for a photosensitizer with excellent properties is currently underway. The formulation based on the existing ones is also developed by combining them with nanoparticles and common antifungal therapy. Numerous studies indicate that fungi do not form any specific defense mechanism against PACT, which deems it a promising therapeutic alternative.

Photodynamic and antibiotic therapy in combination against bacterial infections: efficacy, determinants, mechanisms, and future perspectives

Antibiotic treatment, the mainstay for the control of bacterial infections, is greatly hampered by the global prevalence of multidrug-resistant (MDR) bacteria. Photodynamic therapy (PDT) is effective against MDR infections, but PDT-induced bacterial inactivation is often incomplete, causing the relapse of infections. Combination of PDT and antibiotics is a promising strategy to overcome the limitation of both antibiotic treatment and PDT, exerting increased disinfection efficacy on MDR bacterial pathogens versus either of the monotherapies alone. In this review, we present an overview of the therapeutic effects of PDT/antibiotic combinations that have been developed. We further summarize the influencing factors and the governing molecular mechanisms of the therapeutic outcomes of PDT/antibiotic combinations. In the end, we provide concluding remarks on the strengths, limitations, and future research directions of PDT/antibiotic combination therapy to guide its appropriate usage and further development.

5-Aminolevulinic acid-mediated photodynamic therapy has effective antifungal activity against Sporothrix globosa in vitro

BACKGROUND

An alternative therapy for sporotrichosis is necessary to reduce the treatment time and raise clinical efficacy. The 5-Aminolevulinic acid-mediated photodynamic therapy (ALA-PDT) is a promising platform with which to treat mycoses. However, despite the worldwide prevalence of Sporothrix globosa, a causative agent of sporotrichosis, the effect of ALA-PDT on this pathogen has not been validated.

OBJECTIVES

The aim of this study was to evaluate the effect of ALA-PDT on S globosa and the protection of melanin through an in vitro study. The mechanisms involved were also investigated.

METHODS

To estimate the survival rate of S globosa treated with ALA-PDT and the protection offered by melanin, the conidia and yeast cells of wild-type S globosa (Mel+), other clinical strains, tricyclazole-treated Mel+ and an albino mutant strain (Mel-) were incubated with and without ALA or irradiation. Reactive oxygen species generation by Mel+ conidia induced by ALA-PDT was assayed. SEM and TEM were conducted to obverse ultrastructural changes in the conidia. A comet assay was performed to evaluate DNA damage.

RESULTS

The survival rate of S globosa conidia and yeast cells significantly decreased following incubation with 1.19M ALA and 162 J/cm² irradiation in vitro. Melanin was not only capable of protecting the conidia against ALA-PDT, but also against ALA or irradiation alone. After induction by ALA-PDT, alterations in reactive oxygen species generation, DNA damage and ultrastructural changes were observed.

CONCLUSIONS

ALA-PDT inhibits the survival of S globosa conidia in vitro and therefore has potential for the treatment of sporotrichosis.

Successful Treatment of Refractory Candidal Granuloma by Itraconazole and Terbinafine in Combination with Hyperthermia and Cryotherapy

Candidal granuloma is a rare and refractory disease in clinical practice, usually reported in immunocompromised patients. We report a 57-year-old man who presented with candidal granuloma caused by Candida tropicalis. The diagnosis was confirmed according to histopathology and molecular identification. Prolonged duration of initial antifungal therapy did not obtain satisfactory improvement. Finally, the refractory disease was successfully treated by itraconazole and terbinafine in combination with hyperthermia and cryotherapy. The "blackish-red dot" dermoscopic sign of the verrucous granuloma gradually resolved during the treatment.

A combination of photodynamic therapy and antimicrobial compounds to treat skin and mucosal infections: a systematic review

BACKGROUND

Antimicrobial photodynamic therapy (aPDT) is a growing approach to treat skin and mucosal infections. Despite its effectiveness, investigators have explored whether aPDT can be further combined with antibiotics and antifungal drugs.

OBJECTIVE

To systematically assess the in vivo studies on the effectiveness of combinations of aPTD plus antimicrobials in the treatment of cutaneous and mucosal infections.

MATERIALS AND METHODS

Searches were performed in four databases (PubMed, EMBASE, Cochrane library databases, ClinicaTrials.gov) until July 2018. The pooled information was evaluated according to the PRISMA guidelines.

RESULTS

11 full-text articles were finally evaluated and included. The best aPDT combinations involved 5-aminolevulinic acid or phenothiazinium dye-based aPDT. In general, the combination shows benefits such as reducing treatment times, lowering drug dosages, decreasing drug toxicity, improving patient compliance and diminishing the risk of developing resistance. The mechanism of action may be that first aPDT damages the microbial cell wall or membrane, which allows better penetration of the antimicrobial drug.

LIMITATIONS

The number of studies was low, the protocols used were heterogeneous, and there was a lack of clinical trials.

CONCLUSIONS

The additive or synergistic effect of aPDT combined with antimicrobials could be promising to manage skin and mucosal infections, helping to overcome the microbial drug resistance.