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Bizoń M, Maślińska D, Sawicki W. Influence of Photodynamic Therapy on Lichen Sclerosus with Neoplastic Background. J Clin Med 2022; 11:jcm11041100. [PMID: 35207373 PMCID: PMC8877107 DOI: 10.3390/jcm11041100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/09/2022] [Accepted: 02/17/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Lichen sclerosus is the most common nonmalignant vulvar disease with morbidity in postmenopausal age. The first line of treatment is corticosteroid therapy. In case of insufficiency, tacrolimus or pimecrolimus can be provided. Photodynamic therapy (PDT) can be used as alternative way of treatment while symptoms recurrent despite other methods. Methods: the analyzed population of 182 women with diagnosis of lichen sclerosus treated using PDT was divided into three groups: patients with neoplastic disease or intraepithelial neoplasia; those with a positive family history of neoplastic disease; and a control group with no neoplastic disease and no familial history of neoplastic diseases. Results: Reduction of vulvar changes was assessed in the whole vulva in the groups as 21.9%, 21.2% and 21.8%, respectively. The most frequent symptom, itching, was reported to decrease in all groups, 39.3%, 35.5% and 42.5%, respectively. Improvement of quality of life was assessed in 91.3% of the whole group, stabilization of lichen sclerosus in 7.1% and progression in 1.6%. Conclusions: Photodynamic therapy gives positive results in most cases. Improvement after PDT is observed in objective vulvoscopic assessment and in subjective patients’ opinions. Neoplastic disease in the past can influence the effectiveness of PDT.
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Affiliation(s)
- Magdalena Bizoń
- Chair and Department of Obstetrics, Gynecology and Gynecological Oncology, Medical University of Warsaw, 02-091 Warszawa, Poland;
- Correspondence: ; Tel.: +48-697-722-894
| | - Danuta Maślińska
- Department of General and Experimental Pathology, Medical University of Warsaw, 02-091 Warszawa, Poland;
| | - Włodzimierz Sawicki
- Chair and Department of Obstetrics, Gynecology and Gynecological Oncology, Medical University of Warsaw, 02-091 Warszawa, Poland;
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Gerkowicz A, Szczepanik-Kułak P, Krasowska D. Photodynamic Therapy in the Treatment of Vulvar Lichen Sclerosus: A Systematic Review of the Literature. J Clin Med 2021; 10:5491. [PMID: 34884193 PMCID: PMC8658411 DOI: 10.3390/jcm10235491] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/14/2021] [Accepted: 11/17/2021] [Indexed: 11/16/2022] Open
Abstract
Vulvar lichen sclerosus (VLS) is a chronic inflammatory disease involving the genital skin and mucous membrane. Patients exhibit focal atrophy and destructive scarring, with an increased risk of malignant transformation. Due to objective symptoms as well as subjective complaints, patients with VLS experience emotional distress, lowered mood, and sexual dysfunction, which is reflected in impaired health-related quality of life. Thus, the necessity of implementing appropriate therapy at the earliest possible stage of the disease in order to avoid serious complications is highlighted. We presented the systematic review of available literature, performed with MEDLINE, Cinahl, Central, Scopus, and Web of Science databases. We identified a total of twenty relevant studies which indicate that photodynamic therapy (PDT) is a valuable therapeutic modality in the treatment of VLS.
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Affiliation(s)
| | - Paulina Szczepanik-Kułak
- Department of Dermatology, Venerology and Paediatric Dermatology, Medical University of Lublin, 20-081 Lublin, Poland; (A.G.); (D.K.)
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Zhang F, Li D, Shi L, Gu Y, Xu Y, Wu C. Efficacy of 5-Aminolevulinic Acid (ALA)-Photodynamic Therapy (PDT) in Refractory Vulvar Lichen Sclerosus: Preliminary Results. Med Sci Monit 2021; 27:e927406. [PMID: 33411697 PMCID: PMC7802375 DOI: 10.12659/msm.927406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background As a chronic inflammatory skin disease of unknown etiology, vulvar lichen sclerosus (VLS) mainly affects postmenopausal and perimenopausal women. The main clinical manifestations of VLS include itching, burning pain, and sexual dysfunction, which can lead to a decline in quality of life. The existing treatment options include topical corticosteroid ointment, estrogen, and traditional Chinese medicine; however, their therapeutic effects on VLS remain unsatisfactory. Material/Methods Thirty patients with VLS and routine treatment failure were treated with 5-aminolevulinic acid (ALA)-photodynamic therapy (PDT). A 20% ALA water-in-oil emulsion was applied to the vulvar lesions and sealed with plastic film for 3 h. Patients were irradiated at a power density of 60 to 90 mW/cm2 with a red light at a wavelength of 635±15 nm for 20 min, delivering a total dose of 100 to 150 J/cm2 per session. The treatment was repeated 3 times every 2 weeks. The objective parameters, female sexual function index (FSFI) and quality of life (QoL) scores, were used before and after treatment to evaluate the clinical curative effect. Results All patients completed 3 treatment cycles of ALA-PDT and follow-up visits. The clinical symptoms of pruritus completely disappeared in 27 cases, and itching improved from severe to mild in 3 cases. The pathological changes of all patients were objectively improved. FSFI score decreased significantly after treatment (P<0.001). The main adverse effects of ALA-PDT were pain, erythema, and swelling. These adverse effects were temporary and tolerable. The QoL score was significantly improved after treatment (P<0.001). Conclusions ALA-PDT is an effective and safe approach for the treatment of VLS.
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Affiliation(s)
- Fenghua Zhang
- Department of Gynecology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China (mainland)
| | - Daoyun Li
- Department of Gynaecology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China (mainland)
| | - Lijuan Shi
- Department of Gynaecology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China (mainland)
| | - Yijia Gu
- Department of Gynaecology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China (mainland)
| | - Yun Xu
- Department of Gynaecology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China (mainland)
| | - Changping Wu
- Department of Tumor Biological Treatment, Soochow University, Changzhou, Jiangsu, China (mainland).,Jiangsu Engineering Research Center for Tumor Immunotherapy, Soochow University, Changzhou, Jiangsu, China (mainland).,Institute of Cell Therapy, Soochow University, Changzhou, Jiangsu, China (mainland)
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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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Declercq A, Güvenç C, De Haes P. Proposition of standardized protocol for photodynamic therapy for vulvar lichen sclerosus. J DERMATOL TREAT 2020; 33:560-568. [PMID: 32420789 DOI: 10.1080/09546634.2020.1771260] [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] [Indexed: 01/31/2023]
Abstract
Background: Photodynamic therapy (PDT) is an alternative treatment modality for vulvar lichen sclerosus (VLS) which is a chronic inflammatory mucosal condition. In literature, no consensus of optimal parameters of PDT for VLS is reached so far.Objectives: The aim of this narrative review is to develop a standardized treatment protocol for PDT in VLS.Methods: A systematic literature search was conducted to identify studies reporting on PDT in VLS and used treatment parameters, side-effects, and clinical outcomes were summarized.Results: Thirteen studies used 5-aminolevulinic acid (5-ALA) with concentrations of 20%, 10%, 5% and three studies used methyl aminolevulinate (MAL). Generally, the light source was red light (median 630 nm). Light dose varied between 9 and 180 J/cm2 and light intensity between 40 and 700 mW/cm2. Incubation period with the photosensitizer ranged from 2 to 6 h. All studies showed a substantial improvement in VLS-related pruritus, burning and pain.Conclusions: Based on a literature review, we suggest the following protocol for PDT in VLS: 5% 5-ALA as a photosensitizer applied for 3 h under occlusion before irradiation at the dose of 120 J/cm2 with red light (590-760 nm) and intensity of 204 mW/cm2.
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Affiliation(s)
- Alicia Declercq
- Department of Dermatology, University Hospitals Leuven, Leuven, Belgium
| | - Canan Güvenç
- Department of Dermatology, University Hospitals Leuven, Leuven, Belgium
| | - Petra De Haes
- Department of Dermatology, University Hospitals Leuven, Leuven, Belgium
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Kawczyk-Krupka A, Bartusik-Aebisher D, Latos W, Cieślar G, Sieroń K, Kwiatek S, Oleś P, Kwiatek B, Aebisher D, Krupka M, Wiench R, Skaba D, Olek M, Kasperski J, Czuba Z, Sieroń A. Clinical Trials and Basic Research in Photodynamic Diagnostics and Therapies from the Center for Laser Diagnostics and Therapy in Poland. Photochem Photobiol 2020; 96:539-549. [PMID: 32112419 DOI: 10.1111/php.13243] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 01/09/2020] [Indexed: 12/29/2022]
Abstract
The purpose of this review is to present an overview of the development of photodiagnostic and photodynamic therapy (PDD and PDT) techniques in Poland. The paper discusses the principles of PDD, including fluorescent techniques in determining precancerous conditions and cancers of the skin, digestive tract, bladder and respiratory tract. Methods of PDT of cancer will be discussed and the current state of knowledge as well as future trends in the development of photodynamic techniques will be presented, including the possibility of using photodynamic antimicrobial therapy. Research pioneers in photodynamic medicine such as Thomas Dougherty are an inspiration for the development of methods of PDD and PDT in our Clinic. The Center for Laser Diagnostics and Therapy in Bytom, Poland, promotes the propagation of PDD and PDT through the training of clinicians and raising awareness among students in training and the general public. Physicians at the Center are engaged in photomedical research aimed at clinical implementation and exploration of new avenues in photomedicine while optimizing existing modalities. The Center promotes dissemination of clinical results from a wide range of topics in PDD and PDT and serving as representative authorities of photodynamic medicine in Poland and Europe.
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Affiliation(s)
- Aleksandra Kawczyk-Krupka
- Department of Internal Medicine, Angiology, and Physical Medicine, Center for Laser Diagnostics and Therapy, Medical University of Silesia in Katowice, Bytom, Poland
| | | | - Wojciech Latos
- Department of Internal Medicine, Angiology, and Physical Medicine, Center for Laser Diagnostics and Therapy, Medical University of Silesia in Katowice, Bytom, Poland
| | - Grzegorz Cieślar
- Department of Internal Medicine, Angiology, and Physical Medicine, Center for Laser Diagnostics and Therapy, Medical University of Silesia in Katowice, Bytom, Poland
| | - Karolina Sieroń
- Department of Internal Medicine, Angiology, and Physical Medicine, Center for Laser Diagnostics and Therapy, Medical University of Silesia in Katowice, Bytom, Poland.,Department of Physical Medicine, Chair of Physiotherapy, Medical University of Silesia, Katowice, Poland
| | - Sebastian Kwiatek
- Department of Internal Medicine, Angiology, and Physical Medicine, Center for Laser Diagnostics and Therapy, Medical University of Silesia in Katowice, Bytom, Poland
| | - Piotr Oleś
- Department of Internal Medicine, Angiology, and Physical Medicine, Center for Laser Diagnostics and Therapy, Medical University of Silesia in Katowice, Bytom, Poland
| | - Beata Kwiatek
- Department of Internal Medicine, Angiology, and Physical Medicine, Center for Laser Diagnostics and Therapy, Medical University of Silesia in Katowice, Bytom, Poland
| | - David Aebisher
- Faculty of Medicine, University of Rzeszów, Rzeszów, Poland
| | - Magdalena Krupka
- Department of Internal Medicine, Angiology, and Physical Medicine, Center for Laser Diagnostics and Therapy, Medical University of Silesia in Katowice, Bytom, Poland
| | - Rafał Wiench
- Department of Periodontal Diseases and Oral Mucosa Diseases, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Dariusz Skaba
- Department of Periodontal Diseases and Oral Mucosa Diseases, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Marcin Olek
- Department of Prosthetic Dentistry, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Jacek Kasperski
- Department of Prosthetic Dentistry, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Zenon Czuba
- Department of Microbiology and Immunology, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Aleksander Sieroń
- Department of Internal Medicine, Angiology, and Physical Medicine, Center for Laser Diagnostics and Therapy, Medical University of Silesia in Katowice, Bytom, Poland.,Department of Physiotherapy, Jan Dlugosz University in Częstochowa, Częstochowa, Poland
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Nguyen K, Khachemoune A. An update on topical photodynamic therapy for clinical dermatologists. J DERMATOL TREAT 2019; 30:732-744. [DOI: 10.1080/09546634.2019.1569752] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Khoa Nguyen
- College of Medicine, University of Central Florida, Orlando, FL, USA
| | - Amor Khachemoune
- Veterans Affairs Medical Center, Brooklyn, NY, USA
- Department of Dermatology, SUNY Downstate, Brooklyn, NY, USA
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Sharova A, Farrakhova D, Slovokhodov E, Arakelov S, Zykov A, Sarantsev A, Linkov K, Loschenov V. Evaluation of vulvar leukoplakia photodynamic therapy efficiency by fluorescent diagnostics method with local «Alasens®» photosensitizer application. Photodiagnosis Photodyn Ther 2019; 27:105-110. [PMID: 31116997 DOI: 10.1016/j.pdpdt.2019.05.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 04/19/2019] [Accepted: 05/17/2019] [Indexed: 11/17/2022]
Abstract
PURPOSE Using continuous-pulse irradiation mode application for performing photodynamic therapy sessions to introduce a new method, and conclude results of clinical research focused on vulvar leukoplakia photodynamic therapy efficiency in combination with topical aqueous «Alasens®» solution administration. METHOD Seventy patients (average age of 61 years) diagnosed with vulvar leukoplakia disease (2018 ICD-10-CM Diagnosis Code N90.4) were examined. The following values represent doses of combined mode photodynamic therapy session: 12 J/cm2 pulse radiation dose; 3.5 J/cm2 continuous radiation dose. Non-invasive spectroscopic and visual control of drug accumulation in real time was carried out by fluorescence diagnostic method before and after each therapy session. RESULTS Single-therapy session efficiency was estimated by a fluorescent signal reduction in the pathological region after irradiation, and the direct correlation between photosensitizer photobleaching and disease regression was registered. Photodynamic therapy course included three procedures, with each session applied in 24 -h intervals, and when necessary, an additional course of therapy was applied 60 days afterward. Significant post-treatment results took effect after 2-3 courses with symptom presence reduced or fully regressed depending on the initial severity of the disease. Additionally, side effects and sequelae remained absent in all cases. CONCLUSION The result of methods applied during the clinical research period indicate strong potential in utilizing such promising technology to contribute to the possible prevention of malignant transformation and the treatment of vulvar leukoplakia.
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Affiliation(s)
- Alina Sharova
- Prokhorov General Physics Institute of the Russian Academy of Sciences, Vavilova str.38, 119991, Moscow, Russia.
| | - Dina Farrakhova
- Prokhorov General Physics Institute of the Russian Academy of Sciences, Vavilova str.38, 119991, Moscow, Russia; National Research Nuclear University «MEPh», Kashirskoe shosse 31, 115409, Moscow, Russia.
| | - Egor Slovokhodov
- City Clinical Hospital № 40, Kasatkina str.7, 129301, Moscow, Russia.
| | - Sergey Arakelov
- City Clinical Hospital № 40, Kasatkina str.7, 129301, Moscow, Russia.
| | - Arkady Zykov
- City Clinical Hospital № 40, Kasatkina str.7, 129301, Moscow, Russia.
| | - Andrey Sarantsev
- City Clinical Hospital № 40, Kasatkina str.7, 129301, Moscow, Russia.
| | - Kirill Linkov
- Prokhorov General Physics Institute of the Russian Academy of Sciences, Vavilova str.38, 119991, Moscow, Russia.
| | - Victor Loschenov
- Prokhorov General Physics Institute of the Russian Academy of Sciences, Vavilova str.38, 119991, Moscow, Russia; National Research Nuclear University «MEPh», Kashirskoe shosse 31, 115409, Moscow, Russia.
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Lan T, Zou Y, Hamblin MR, Yin R. 5-Aminolevulinic acid photodynamic therapy in refractory vulvar lichen sclerosus et atrophicus: Series of ten cases. Photodiagnosis Photodyn Ther 2018; 21:234-238. [PMID: 29258952 PMCID: PMC5922423 DOI: 10.1016/j.pdpdt.2017.12.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 12/05/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Vulvar lichen sclerosus et atrophicus (VLSA) is a chronic inflammatory skin disease of unknown etiology that mainly affects postmenopausal and perimenopausal women. The primary clinical symptoms of VLSA are itching, burning pain, and dyspareunia that can results in decreased quality of life. Existing therapies including topical corticosteroid ointment, topical calcineurin inhibitors, estrogens, are not very effective for treatment of VLSA. OBJECTIVE To evaluate the effectiveness and safety of 5-aminolevulinic acid mediated photodynamic therapy (ALA-PDT) in the treatment of VLSA. MATERIALS AND METHODS Ten patients with VLSA who had failed conventional treatment received ALA-PDT. 10% 5-ALA in an oil-in-water emulsion was applied to the lesions and occluded with plastic film for 3 h, when the lesions were irradiated with 100 mW/cm2, 635 ± 15 nm red light for 20 min. Treatments were repeated three times at 2-week intervals. Objective and subjective symptoms and signs of the vulvar lesions based on horizontal visual analogue scales were recorded at each treatment and 1, 3, and 6 months after the last session. The quality of life was assessed using dermatology life quality index (DLQI) questionnaire. RESULTS All patients completed three ALA-PDT treatments and the follow-up visits. Clinical symptoms of itching disappeared completely in nine patients, one patient had itching decreased from severe to mild. All subjects showed objective improvement in lesions. The DLQI of all cases improved after treatment. The main side-effects of ALA-PDT were pain, erythema, and swelling. Side-effects were transient and tolerable. All patients reported being "satisfied" or "very satisfied" with their outcomes. CONCLUSIONS ALA-PDT is an effective and safe approach for the treatment of VLSA.
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Affiliation(s)
- Ting Lan
- Department of Dermatology, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Yongzhen Zou
- Department of Dermatology, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Michael R Hamblin
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA02114, United States; Department of Dermatology, Harvard Medical School, Boston, MA 02115, United States; Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA 02139, USA
| | - Rui Yin
- Department of Dermatology, Southwest Hospital, Third Military Medical University, Chongqing 400038, China.
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Belotto RA, Chavantes MC, Tardivo JP, Euzébio Dos Santos R, Fernandes RCM, Horliana ACRT, Pavani C, Teixeira da Silva DF. Therapeutic comparison between treatments for Vulvar Lichen Sclerosus: study protocol of a randomized prospective and controlled trial. BMC WOMENS HEALTH 2017; 17:61. [PMID: 28793884 PMCID: PMC5550930 DOI: 10.1186/s12905-017-0414-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 08/01/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Vulvar lichen sclerosus (VLS) is a lymphocyte-mediated disease of unknown etiology that can cause intense itching as well stenosis, hindering the evacuation and urination. It can also limit the sex life due to severe local pruritus, pain and dyspareunia (pain during sexual intercourse). The standard treatment for this disease is the use of topical corticosteroids to reduce the clinical symptoms and to try to increase disease-free intervals. Photodynamic therapy (PDT), a treatment that associates a light radiation with a photosensitizing agent and photobiomodulation (PBM) are therapies that can promote effective immunomodulatory responses at the application site by means of photophysical and photochemical phenomena from the molecular to the systemic level, which promote their use in chronic dermatoses. The aim is to compare the effects of PDT, PBM, and topical corticosteroid in VLS evaluating clinical, histological, immunohistochemical and spectroscopic responses. METHODS The study is prospective, randomized and controlled, in a population of 60 women with histological diagnoses of VLS. There will be 3 treatments groups: PDT, PBM and topical corticosteroid (control group), where will be allocated by randomization 20 patients in each one. The clinical course will be monitored by measuring local temperature, itching, atrophy, and the area of the lesion. Histologically, the slides will be classified and will have the ordering of collagen fibers quantified. Immunohistochemical analysis will be done using the markers IFN-γ, TGF-β, CD4, CD8, IL-1, p53 and Ki-67. Finally, the spectroscopic evaluation will be done by reflectance. Descriptive and inferential statistical analyses will be conducted to compare the groups and make associations between different responses. The study is an open-label for patients with active symptomatic disease with a period of 1 year follow-up to determine the rate of recurrence in each groups. DISCUSSION The immunological effects of PDT and PBM are described by several authors in inflammatory skin diseases, stimulating the production and organization of the associated collagen. Thus, it is reasonable to determine the efficacy and safety of these new treatments in VLS, in comparison to the control group, analyzing the recurrence time, the impact on the optical properties of the skin, and the benefit to patients. TRIAL REGISTRATION ClinicalTrials.gov: NCT02416531 .
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Affiliation(s)
- Renata A Belotto
- Postgraduate Program in Biophotonics Applied to Health Sciences, Nove de Julho University/UNINOVE, 249 Vergueiro Street, Liberdade, São Paulo, SP, 01504-001, Brazil.,Pérola Byington Hospital, 683 Brig. Luís Antônio Avenue, Bela Vista, São Paulo, SP, 01318-000, Brazil
| | - Maria Cristina Chavantes
- Postgraduate Program in Medicine, Nove de Julho University/UNINOVE, 249 Vergueiro Street, Liberdade, São Paulo, SP, 01504-001, Brazil
| | - João Paulo Tardivo
- ABC Medical School and Padre Anchieta Teaching Hospital, 470 Silva Jardim Street, Centre, São Bernardo do Campo, SP, 09715-090, Brazil
| | | | | | - Anna Carolina Ratto Tempestini Horliana
- Postgraduate Program in Biophotonics Applied to Health Sciences, Nove de Julho University/UNINOVE, 249 Vergueiro Street, Liberdade, São Paulo, SP, 01504-001, Brazil
| | - Christiane Pavani
- Postgraduate Program in Biophotonics Applied to Health Sciences, Nove de Julho University/UNINOVE, 249 Vergueiro Street, Liberdade, São Paulo, SP, 01504-001, Brazil
| | - Daniela Fátima Teixeira da Silva
- Postgraduate Program in Biophotonics Applied to Health Sciences, Nove de Julho University/UNINOVE, 249 Vergueiro Street, Liberdade, São Paulo, SP, 01504-001, Brazil.
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Olejek A, Gabriel I, Bilska-Janosik A, Kozak-Darmas I, Kawczyk-Krupka A. ALA-Photodynamic treatment in Lichen sclerosus-clinical and immunological outcome focusing on the assesment of antinuclear antibodies. Photodiagnosis Photodyn Ther 2017; 18:128-132. [PMID: 28219801 DOI: 10.1016/j.pdpdt.2017.02.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Revised: 01/22/2017] [Accepted: 02/10/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Lichen sclerosus (LS) is a difficult to treat, often relapsing disease with unknown background. Autoimmune diseases also coexist with LS. Over recent years photodynamic therapy (PDT) has been shown to be a noninvasive and successful therapeutic approach for the effective treatment of many conditions. However, the change of immune status of the patients based on ANA antibodies has not been yet reported. Our aim was to observe the clinical response followed by possible changes in autoimmune antibodies levels before and after PDT for LS. MATERIAL AND METHODS We enrolled 100 women with Lichen sclerosus with or without a concomitant autoimmune disease. All patients received 10 cycles of PDT (65 treated with DIOMED Light, 35 with PhotoDYN Light). We assessed autoimmune antibodies before and after PDT in addition to the clinical response evaluation.Two-year prospective controlled before-and-after study. RESULTS Following PDT, patients showed a significant attenuation in symptoms' intensity (itching, pruritus, vulvar discomfort). After therapy 41% of patients had partial response, 51% of patients had no symptoms and 8% had persistent or worsened symptoms. The most frequent autoimmune disease were thyroid disorders, followed by vitiligo and arthritis. 57% patients with an additional autoimmune disease before PDT had ANA antibodies. The mean level of ANA in this group diminished significantly after PDT treatment (261.74 IU/ml before vs. 123.20 IU/ml after treatment). CONCLUSION Based on our results, we assume that PDT may influence the immune status of patients with Lichen sclerosus.
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Affiliation(s)
- Anita Olejek
- School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Department of Gynecology, Obstetrics and Oncological Gynecology, Batorego 15, 41-902, Bytom, Poland
| | - Iwona Gabriel
- School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Department of Gynecology, Obstetrics and Oncological Gynecology, Batorego 15, 41-902, Bytom, Poland; Division of Urogynecology, Brigham and Women's Hospital, Boston, USA
| | - Anna Bilska-Janosik
- School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Department of Gynecology, Obstetrics and Oncological Gynecology, Batorego 15, 41-902, Bytom, Poland
| | - Iwona Kozak-Darmas
- School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Department of Gynecology, Obstetrics and Oncological Gynecology, Batorego 15, 41-902, Bytom, Poland
| | - Aleksandra Kawczyk-Krupka
- School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Department of Internal Medicine, Angiology and Physical Medicine, Center for Laser Diagnostics and Therapy, Batorego 15, 41-902, Bytom, Poland.
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13
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Imbernón-Moya A, Martínez-Pérez M, Churruca-Grijelmo M, Lobato-Berezo A, Vargas-Laguna E, Fernández-Cogolludo E, Aguilar-Martínez A, Gallego-Valdés MÁ. Photodynamic therapy as a therapeutic alternative in vulvar lichen sclerosus: series of 8 cases. PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2016; 32:307-310. [PMID: 27098754 DOI: 10.1111/phpp.12242] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/07/2016] [Indexed: 11/26/2022]
Affiliation(s)
| | | | | | | | - Elena Vargas-Laguna
- Department of Dermatology, Hospital Universitario Severo Ochoa, Leganés, Spain
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14
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Kim TI, Jeong KH, Shin MK. Verrucous epidermal nevus (VEN) successfully treated with indocyanine green (ICG) photodynamic therapy (PDT). JAAD Case Rep 2015; 1:312-4. [PMID: 27051764 PMCID: PMC4809274 DOI: 10.1016/j.jdcr.2015.07.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Tae In Kim
- Department of Dermatology, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Ki Heon Jeong
- Department of Dermatology, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Min Kyung Shin
- Department of Dermatology, School of Medicine, Kyung Hee University, Seoul, Korea
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15
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Sieroń A, Sieroń-Stołtny K, Kawczyk-Krupka A, Latos W, Kwiatek S, Straszak D, Bugaj AM. The role of fluorescence diagnosis in clinical practice. Onco Targets Ther 2013; 6:977-82. [PMID: 23935372 PMCID: PMC3735341 DOI: 10.2147/ott.s42074] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Fluorescence diagnosis is a fast, easy, noninvasive, selective, and sensitive diagnostic tool for estimation of treatment results in oncology. In clinical practice the use of photodynamic diagnosis is focused on five targets: detection for prevention of malignant transformation precancerous changes, detection of neoplasmatic tissue in the early stages for fast removal, prevention of expansion and detection of recurrence of the cancer, monitoring therapy, and the possibility of excluding neoplasmatic disease. In this article, selected applications of fluorescence diagnosis at the Center for Laser Diagnostics and Therapy in Bytom, Poland, for each of these targets are presented.
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Affiliation(s)
- Aleksander Sieroń
- Clinical Department of Internal Diseases, Angiology and Physical Medicine, Center for Laser Diagnostics and Therapy, Silesian Medical University, Bytom
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16
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Osiecka B, Nockowski P, Jurczyszyn K, Ziólkowski P. Photodynamic therapy of vulvar lichen sclerosus et atrophicus in a woman with hypothyreosis – Case report. Photodiagnosis Photodyn Ther 2012; 9:186-8. [DOI: 10.1016/j.pdpdt.2012.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Revised: 02/24/2012] [Accepted: 02/27/2012] [Indexed: 10/28/2022]
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17
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Parera E, Gallardo F, Toll A, Gil I, Sánchez-Schmidt J, Pujol R. Inflammatory linear verrucous epidermal nevus successfully treated with methyl-aminolevulinate photodynamic therapy. Dermatol Surg 2010; 36:253-6. [PMID: 20402956 DOI: 10.1111/j.1524-4725.2009.01401.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Elisabet Parera
- Department of Dermatology, Hospital del Mar, IMAS, Universitat Autònoma de Barcelona, Barcelona, Spain.
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18
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Twenty years of experience with PDD and PDT in Poland—Review. Photodiagnosis Photodyn Ther 2009; 6:73-8. [DOI: 10.1016/j.pdpdt.2009.07.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2009] [Accepted: 07/10/2009] [Indexed: 11/17/2022]
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19
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Mitra A, Stables G. Topical photodynamic therapy for non-cancerous skin conditions. Photodiagnosis Photodyn Ther 2006; 3:116-27. [DOI: 10.1016/s1572-1000(06)00035-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2005] [Revised: 02/13/2006] [Accepted: 02/20/2006] [Indexed: 11/25/2022]
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