1
|
Lavin L, Erlendsson AM, Aleissa S, Aleisa A, Menzer C, Dusza S, Cordova M, Alshaikh H, Shah R, Pan A, Ketosugbo K, Hosein S, Lee E, Nehal K, Togsverd-Bo K, Haedersdal M, Rossi A. Jet-injection assisted photodynamic therapy for superficial and nodular basal cell carcinoma: A pilot study. Lasers Surg Med 2024; 56:446-453. [PMID: 38804170 DOI: 10.1002/lsm.23793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/02/2024] [Accepted: 04/21/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Photodynamic therapy (PDT) with topical δ-Aminolevulinic acid (ALA) has efficacy in treating basal cell carcinoma (BCC) but is limited by incomplete penetration of ALA into the deeper dermis. This prospective open-label pilot trial investigated the safety and efficacy of photosensitizer jet injection for PDT (JI-PDT) for BCC treatment. It was performed with 15 patients (n = 15) with histologically confirmed, untreated, low-risk nodular BCCs at a single institution. METHODS For the intervention, JI-PDT patients (n = 11) received two sessions of jet-injected ALA with PDT separated by four to 6 weeks. To further understand treatment technique, another group of patients (n = 4) received jet-injected ALA followed by tumor excision and fluorescence microscopy (JI-E). Treatment tolerability was assessed by local skin responses (LSR) score at five distinct time intervals. Fluorescence microscopy assessed protoporphyrin IX penetration depth and biodistribution within the tumor. At the primary endpoint, tumor clearance was evaluated via visual inspection, dermoscopy and reflectance confocal microscopy. Postinjection and postillumination pain levels, and patient satisfaction, were scored on a 0-10 scale. RESULTS Fifteen participants with mean age of 58.3, who were 15/15 White, non-Hispanic enrolled. The median composite LSR score immediately after JI-PDT was 5 (interquartile range [IQR] = 3) which decreased to 0.5 (IQR = 1) at primary endpoint (p < 0.01). Immunofluorescence of excised BCC tumors with jet-injected ALA showed photosensitizer penetration into papillary and reticular dermis. Of the 13 JI-PDT tumors, 11 had tumor clearance confirmed, 1 recurred, and 1 was lost to follow-up. 1/11 patients experienced a serious adverse event of cellulitis. 70% of patients had local scarring at 3 months. Patients reported an average pain level of 5.6 (standard deviation [SD] = 2.3) during jet injection and 3.7 (SD = 1.8) during light illumination. CONCLUSIONS Jet injection of ALA for PDT treatment of nodular low-risk BCC is tolerable and feasible and may represent a novel modality to improve PDT.
Collapse
Affiliation(s)
- Leore Lavin
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Andrés M Erlendsson
- Department of Dermatology, Karolinska University Hospital, Stockholm, Sweden
| | - Saud Aleissa
- Department of Dermatology, King Abdulaziz University and University Hospital, Jeddah, Saudi Arabia
| | - Abdullah Aleisa
- Department of Dermatology, King Saud University, Riyadh, Saudi Arabia
| | - Christian Menzer
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Stephen Dusza
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Miguel Cordova
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Hesham Alshaikh
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Rohan Shah
- Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Alexander Pan
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kwami Ketosugbo
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Sharif Hosein
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Erica Lee
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Dermatology, Weill Cornell Medical College, New York, New York, USA
| | - Kishwer Nehal
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Dermatology, Weill Cornell Medical College, New York, New York, USA
| | - Katrine Togsverd-Bo
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg, Copenhagen, Denmark
| | - Merete Haedersdal
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anthony Rossi
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Rutgers New Jersey Medical School, Newark, New Jersey, USA
| |
Collapse
|
2
|
Mørk E, Mjønes P, Foss OA, Mørk C, Bachmann IM, Kroon S, Dotterud LK, Helsing P, Vatne Ø, Christensen E. Clinical versus Histological Assessment of Basal Cell Carcinoma Subtype and Thickness of Tumours Selected for Photodynamic Therapy. Acta Derm Venereol 2024; 104:adv18308. [PMID: 38751175 PMCID: PMC11110808 DOI: 10.2340/actadv.v104.18308] [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: 08/04/2023] [Accepted: 04/11/2024] [Indexed: 05/24/2024] Open
Abstract
Photodynamic therapy is an approved treatment for primary, superficial, and small nodular basal cell carcinomas with a thickness of < 2 mm located on low-risk sites. Histologically verified basal cell carcinomas clinically assessed as suited for photodynamic therapy were included. The study aimed to investigate the agreement between clinical and histological assessments of basal cell carcinoma subtypes and thickness of tumours selected for photodynamic therapy with histopathological evaluation as a reference. A total of 343 tumours were included. The agreement between clinical and histological diagnosis of basal cell carcinoma subtype was 72% (p < 0.001). Clinical assessment of subtype had a sensitivity of 93% and specificity of 55% for superficial tumours and a sensitivity of 55% and specificity of 85% for nodular tumours. The mean ± SD thickness values by clinical and histological assessments were 0.95 ± 0.53 and 0.86 ± 0.75. The difference of 0.09 mm was statistically significant (p = 0.017), but not considered to be clinically relevant, although the differences between specific subgroups could be relevant. Among basal cell carcinomas clinically diagnosed as superficial, 91% were histologically consistent with the current photodynamic therapy criteria. The main results suggest that histopathological evaluation should precede photodynamic therapy to ensure selection of suitable basal cell carcinomas. In selected cases, the clinical diagnosis alone may be adequate before proceeding with photodynamic therapy.
Collapse
Affiliation(s)
- Erik Mørk
- Department of Clinical and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
| | - Patricia Mjønes
- Department of Clinical and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Pathology, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Olav A Foss
- Department of Orthopaedic Surgery, Clinic of Orthopaedics, Rheumatology and Dermatology, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Cato Mørk
- Akershus Dermatology Centre, Lørenskog, Norway
| | - Ingeborg M Bachmann
- Institute of Medical Science, University of Bergen, Bergen, Norway; Department of Dermatology, Haukeland University Hospital, Bergen, Norway
| | - Susanne Kroon
- Department of Dermatology and Venerology, Stavanger University Hospital, Stavanger, Norway
| | | | - Per Helsing
- Department of Dermatology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Øystein Vatne
- Department of Dermatology, Førde Central Hospital, Førde, Norway
| | - Eidi Christensen
- Department of Clinical and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Dermatology, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| |
Collapse
|
3
|
Aebisher D, Rogóż K, Myśliwiec A, Dynarowicz K, Wiench R, Cieślar G, Kawczyk-Krupka A, Bartusik-Aebisher D. The use of photodynamic therapy in medical practice. Front Oncol 2024; 14:1373263. [PMID: 38803535 PMCID: PMC11129581 DOI: 10.3389/fonc.2024.1373263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 04/16/2024] [Indexed: 05/29/2024] Open
Abstract
Cancer therapy, especially for tumors near sensitive areas, demands precise treatment. This review explores photodynamic therapy (PDT), a method leveraging photosensitizers (PS), specific wavelength light, and oxygen to target cancer effectively. Recent advancements affirm PDT's efficacy, utilizing ROS generation to induce cancer cell death. With a history spanning over decades, PDT's dynamic evolution has expanded its application across dermatology, oncology, and dentistry. This review aims to dissect PDT's principles, from its inception to contemporary medical applications, highlighting its role in modern cancer treatment strategies.
Collapse
Affiliation(s)
- David Aebisher
- Department of Photomedicine and Physical Chemistry, Medical College of The Rzeszów University, Rzeszów, Poland
| | - Kacper Rogóż
- English Division Science Club, Medical College of The Rzeszów University, Rzeszów, Poland
| | - Angelika Myśliwiec
- Center for Innovative Research in Medical and Natural Sciences, Medical College of The University of Rzeszów, Rzeszów, Poland
| | - Klaudia Dynarowicz
- Center for Innovative Research in Medical and Natural Sciences, Medical College of The University of Rzeszów, Rzeszów, Poland
| | - Rafał Wiench
- Department of Periodontal Diseases and Oral Mucosa Diseases, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Grzegorz Cieślar
- Department of Internal Medicine, Angiology and Physical Medicine, Center for Laser Diagnostics and Therapy, Medical University of Silesia, Bytom, Poland
| | - Aleksandra Kawczyk-Krupka
- Department of Internal Medicine, Angiology and Physical Medicine, Center for Laser Diagnostics and Therapy, Medical University of Silesia, Bytom, Poland
| | - Dorota Bartusik-Aebisher
- Department of Biochemistry and General Chemistry, Medical College of The Rzeszów University, Rzeszów, Poland
| |
Collapse
|
4
|
Koumprentziotis IA, Rompoti N, Liopyris K, Nicolaidou E, Stratigos A. Photodynamic Therapy for the Treatment of Basal Cell Carcinoma: A Comprehensive Review of Randomized Controlled Trials. Dermatol Pract Concept 2024; 14:dpc.1402a105. [PMID: 38810046 PMCID: PMC11136039 DOI: 10.5826/dpc.1402a105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2024] [Indexed: 05/31/2024] Open
Abstract
INTRODUCTION Basal cell carcinoma (BCC) is the most common skin cancer worldwide and has been reported to have a rising incidence in the last years. Multiple therapeutic modalities are approved for the treatment of BCC, making it difficult for physicians to choose the most suitable option for every patient. Photodynamic therapy (PDT) using either 5-aminolevulinic acid (ALA) or methyl aminolevulinate (MAL) as photosensitizing agents is an established treatment option for low-risk BCC. OBJECTIVES This review aims to summarize the available evidence from randomized clinical trials (RCTs) that utilize either ALA or MAL PDT and compare it with other treatment modalities. The main outcomes related to the effectiveness, adverse events, cosmetic outcomes and pain sensation, along with data from long-term follow-ups will be presented and discussed. METHODS Thorough literature searches were conducted through the electronic databases ClinicalTrials. gov and Pubmed/MEDLINE from inception up to 28 March 2023. Only studies in English were included. All relevant data were extracted accordingly from the eligible studies. RESULTS Eight RCTs included superficial BCC (sBCC) alone, 7 included nodular BCC (nBCC), 2 included both sBCC and nBCC and 1 included BCC of unspecified subtype. Follow-up duration ranged from 3 months to 5 years. Both ALA-PDT and MAL-PDT demonstrated acceptable efficacy, adverse events, cosmetic outcomes and pain sensation while no major differences were observed between them. PDT was less effective than surgery but with better reported cosmetic outcomes. CONCLUSIONS PDT is a safe and efficacious treatment option for sBCC and to a lesser extent nBCC.
Collapse
Affiliation(s)
- Ioannis-Alexios Koumprentziotis
- 1 Department of Dermatology and Venereology, Andreas Sygros Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Natalia Rompoti
- 1 Department of Dermatology and Venereology, Andreas Sygros Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Liopyris
- 1 Department of Dermatology and Venereology, Andreas Sygros Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Electra Nicolaidou
- 1 Department of Dermatology and Venereology, Andreas Sygros Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexander Stratigos
- 1 Department of Dermatology and Venereology, Andreas Sygros Hospital, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
5
|
Salvio AG, Stringasci MD, Requena MB, Fregolenti BA, Medeiro MMDC, Santos RG, Bagnato VS. Long-term follow-up results of a pilot study for nodular basal cell carcinoma with PDT using partial home treatment protocol. Photodiagnosis Photodyn Ther 2024; 45:103930. [PMID: 38103584 DOI: 10.1016/j.pdpdt.2023.103930] [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: 10/28/2023] [Revised: 12/08/2023] [Accepted: 12/08/2023] [Indexed: 12/19/2023]
Abstract
SIGNIFICANCE Evaluate a photodynamic therapy (PDT) protocol for low-risk basal cell carcinoma (BCC) treatment that requires less time spent at the hospital and is less painful. APPROACH Eight BCCs were selected, debulked, and received 20 % methyl aminolevulinate cream. After 3 h, the first irradiation was performed at the hospital (20 min, 150 J/cm2). Then, the cream was re-applied, and a portable irradiation prototype was fixed to the skin around the lesion. After 1.5 h, the patients turned on the prototype for irradiation at home (for 2 h, totalizing 312 J/cm2). Disease-free survival rate and pain score during irradiations were evaluated. RESULTS The clearance at 30 days after PDT was 87.5 % by histological analysis. The mean follow-up was 21.5 months and the recurrence-free survival at 22 months was 75 %. The pain score was significantly lower at home. CONCLUSIONS A potentially less painful and more comfortable PDT treatment protocol with proven long-term efficiency is presented. A randomized clinical trial has been conducted to confirm these results.
Collapse
Affiliation(s)
- Ana Gabriela Salvio
- Skin Department of Amaral Carvalho Hospital, Jaú, Brazil; Sao Carlos Institute of Physics, University of Sao Paulo, Sao Carlos, Brazil.
| | - Mirian D Stringasci
- Sao Carlos Institute of Physics, University of Sao Paulo, Sao Carlos, Brazil
| | - Michelle B Requena
- Sao Carlos Institute of Physics, University of Sao Paulo, Sao Carlos, Brazil
| | | | | | | | - Vanderlei Salvador Bagnato
- Sao Carlos Institute of Physics, University of Sao Paulo, Sao Carlos, Brazil; Department of Biomedical Engineering, Texas A&M University, TX, USA
| |
Collapse
|
6
|
Reburn C, Gawthorpe G, Perry A, Wood M, Curnow A. Novel Iron-Chelating Prodrug Significantly Enhanced Fluorescence-Mediated Detection of Glioma Cells Experimentally In Vitro. Pharmaceutics 2023; 15:2668. [PMID: 38140009 PMCID: PMC10747273 DOI: 10.3390/pharmaceutics15122668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/10/2023] [Accepted: 11/20/2023] [Indexed: 12/24/2023] Open
Abstract
(1) Background: The protoporphyrin IX (PpIX)-mediated fluorescence-guided resection and interoperative photodynamic therapy (PDT) of remaining cells may be effective adjuvants to the resection of glioma. Both processes may be enhanced by increasing intracellular PpIX concentrations, which can be achieved through iron chelation. AP2-18 is a novel combinational drug, which ester-links a PpIX precursor (aminolaevulinic acid; ALA) to an iron-chelating agent (CP94). (2) Methods: Human glioma U-87 MG cells were cultured in 96-well plates for 24 h and incubated for 3 or 6 h with various test compound combinations: ALA (±) CP94, methyl aminolevulinate (MAL) (±) CP94 and AP2-18. PpIX fluorescence was measured at 0, 3 or 6 h with a Bio-tek Synergy HT plate reader, as well as immediately after irradiation with a 635 nm red light (Aktilite CL16 LED array), representing the PDT procedure. Cell viability post-irradiation was assessed using the neutral red assay. (3) Results: AP2-18 significantly increased PpIX fluorescence compared to all other test compounds. All treatment protocols effectively achieved PDT-induced cytotoxicity, with no significant difference between test compound combinations. (4) Conclusions: AP2-18 has potential to improve the efficacy of fluorescence-guided resection either with or without the subsequent intraoperative PDT of glioma. Future work should feature a more complex in vitro model of the glioma microenvironment.
Collapse
Affiliation(s)
| | | | | | | | - Alison Curnow
- Knowledge Spa, Royal Cornwall Hospital, University of Exeter, Truro TR1 3HD, UK; (C.R.); (G.G.); (A.P.); (M.W.)
| |
Collapse
|
7
|
Hasan N, Nadaf A, Imran M, Jiba U, Sheikh A, Almalki WH, Almujri SS, Mohammed YH, Kesharwani P, Ahmad FJ. Skin cancer: understanding the journey of transformation from conventional to advanced treatment approaches. Mol Cancer 2023; 22:168. [PMID: 37803407 PMCID: PMC10559482 DOI: 10.1186/s12943-023-01854-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 08/30/2023] [Indexed: 10/08/2023] Open
Abstract
Skin cancer is a global threat to the healthcare system and is estimated to incline tremendously in the next 20 years, if not diagnosed at an early stage. Even though it is curable at an early stage, novel drug identification, clinical success, and drug resistance is another major challenge. To bridge the gap and bring effective treatment, it is important to understand the etiology of skin carcinoma, the mechanism of cell proliferation, factors affecting cell growth, and the mechanism of drug resistance. The current article focusses on understanding the structural diversity of skin cancers, treatments available till date including phytocompounds, chemotherapy, radiotherapy, photothermal therapy, surgery, combination therapy, molecular targets associated with cancer growth and metastasis, and special emphasis on nanotechnology-based approaches for downregulating the deleterious disease. A detailed analysis with respect to types of nanoparticles and their scope in overcoming multidrug resistance as well as associated clinical trials has been discussed.
Collapse
Affiliation(s)
- Nazeer Hasan
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062, India
| | - Arif Nadaf
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062, India
| | - Mohammad Imran
- Frazer Institute, Faculty of Medicine, University of Queensland, Brisbane, 4102, Australia
| | - Umme Jiba
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062, India
| | - Afsana Sheikh
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062, India
| | - Waleed H Almalki
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Umm Al-Qura University, 24381, Makkah, Saudi Arabia
| | - Salem Salman Almujri
- Department of Pharmacology, College of Pharmacy, King Khalid University, 61421, Asir-Abha, Saudi Arabia
| | | | - Prashant Kesharwani
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062, India.
- Center for Global Health Research, Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Kuthambakkam, India.
| | - Farhan Jalees Ahmad
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062, India.
| |
Collapse
|
8
|
Peris K, Fargnoli MC, Kaufmann R, Arenberger P, Bastholt L, Seguin NB, Bataille V, Brochez L, Del Marmol V, Dummer R, Forsea AM, Gaudy-Marqueste C, Harwood CA, Hauschild A, Höller C, Kandolf L, Kellerners-Smeets NWJ, Lallas A, Leiter U, Malvehy J, Marinović B, Mijuskovic Z, Moreno-Ramirez D, Nagore E, Nathan P, Stratigos AJ, Stockfleth E, Tagliaferri L, Trakatelli M, Vieira R, Zalaudek I, Garbe C. European consensus-based interdisciplinary guideline for diagnosis and treatment of basal cell carcinoma-update 2023. Eur J Cancer 2023; 192:113254. [PMID: 37604067 DOI: 10.1016/j.ejca.2023.113254] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 07/18/2023] [Indexed: 08/23/2023]
Abstract
Basal cell carcinoma (BCC) is the most common malignant tumour in white populations. Multidisciplinary experts from European Association of Dermato-Oncology (EADO), European Dermatology Forum, European Society for Radiotherapy and Oncology (ESTRO), Union Européenne des Médecins Spécialistes, and the European Academy of Dermatology and Venereology developed updated recommendations on diagnosis and treatment of BCC. BCCs were categorised into 'easy-to-treat' (common) and 'difficult-to-treat' according to the new EADO clinical classification. Diagnosis is based on clinico-dermatoscopic features, although histopathological confirmation is mandatory in equivocal lesions. The first-line treatment of BCC is complete surgery. Micrographically controlled surgery shall be offered in high-risk and recurrent BCC, and BCC located on critical anatomical sites. Topical therapies and destructive approaches can be considered in patients with low-risk superficial BCC. Photodynamic therapy is an effective treatment for superficial and low-risk nodular BCCs. Management of 'difficult-to-treat' BCCs should be discussed by a multidisciplinary tumour board. Hedgehog inhibitors (HHIs), vismodegib or sonidegib, should be offered to patients with locally advanced and metastatic BCC. Immunotherapy with anti-PD1 antibodies (cemiplimab) is a second-line treatment in patients with a progression of disease, contraindication, or intolerance to HHI therapy. Radiotherapy represents a valid alternative in patients who are not candidates for or decline surgery, especially elderly patients. Electrochemotherapy may be offered when surgery or radiotherapy is contraindicated. In Gorlin patients, regular skin examinations are required to diagnose and treat BCCs at an early stage. Long-term follow-up is recommended in patients with high-risk BCC, multiple BCCs, and Gorlin syndrome.
Collapse
Affiliation(s)
- Ketty Peris
- Institute of Dermatology, Catholic University of the Sacred Heart, Rome, Italy; Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.
| | - Maria Concetta Fargnoli
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Roland Kaufmann
- Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt, Germany
| | - Petr Arenberger
- Department of Dermatovenereology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Lars Bastholt
- Department of Oncology, Odense University Hospital, Denmark
| | | | - Veronique Bataille
- Twin Research and Genetic Epidemiology Unit, School of Basic & Medical Biosciences, King's College London, London SE1 7EH, UK
| | - Lieve Brochez
- Department of Dermatology, University Hospital Ghent, Ghent, Belgium
| | - Veronique Del Marmol
- Department of Dermatology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zurich and University Zurich, Switzerland
| | - Ana-Marie Forsea
- Department of Oncologic Dermatology, Elias University Hospital Bucharest, Carol Davila University of Medicine and Pharmacy Bucharest, Bucharest, Romania
| | | | - Catherine A Harwood
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Axel Hauschild
- Department of Dermatology, University of Kiel, Kiel, Germany
| | - Christoph Höller
- Department of Dermatology, Medical University of Vienna, Austria
| | - Lidija Kandolf
- Department of Dermatology, Faculty of Medicine, Military Medical Academy, Belgrade, Serbia
| | - Nicole W J Kellerners-Smeets
- GROW-School for Oncology and Reproduction, Maastricht University, Maastricht, Netherlands; Department of Dermatology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Aimilios Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - Ulrike Leiter
- Centre for Dermatooncology, Department of Dermatology, Eberhard-Karls University, Tuebingen, Germany
| | - Josep Malvehy
- Department of Dermatology, Hospital Clínic de Barcelona (Melanoma Unit), University of Barcelona, IDIBAPS, Barcelona & CIBERER, Barcelona, Spain
| | - Branka Marinović
- Department of Dermatology and Venereology, University Hospital Center Zagreb, Croatia
| | - Zeljko Mijuskovic
- Department of Dermatology, Faculty of Medicine, Military Medical Academy, Belgrade, Serbia
| | - David Moreno-Ramirez
- Dermatology. Medicine School, University of Seville, University Hospital Virgen Macarena, Seville-Spain
| | - Eduardo Nagore
- Department of Dermatology, Instituto Valenciano de Oncologia, Valencia, Spain
| | | | - Alexander J Stratigos
- First Department of Dermatology-Venereology, National and Kapodistrian University of Athens, School of Medicine, Andreas Sygros Hospital, Athens, Greece
| | - Eggert Stockfleth
- Department of Dermatology, Skin Cancer Center, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Luca Tagliaferri
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Rome, Italy
| | - Myrto Trakatelli
- Second Department of Dermatology, Aristotle University Medical School, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Ricardo Vieira
- Coimbra Hospital and Universitary Centre, Coimbra, Portugal
| | - Iris Zalaudek
- Dermatology Clinic, University of Trieste, Trieste, Italy
| | - Claus Garbe
- Centre for Dermatooncology, Department of Dermatology, Eberhard-Karls University, Tuebingen, Germany
| |
Collapse
|
9
|
Mørk E, Mjønes P, Foss OA, Bachmann IM, Christensen E. Expression of β-Catenin, E-Cadherin, and α-Smooth Muscle Actin in Basal Cell Carcinoma Before Photodynamic Therapy in Non-recurrent and Recurrent Tumors: Exploring the Ability of Predicting Photodynamic Therapy Outcome. J Histochem Cytochem 2023; 71:111-120. [PMID: 36961748 PMCID: PMC10084567 DOI: 10.1369/00221554231161396] [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: 11/04/2022] [Accepted: 02/10/2023] [Indexed: 03/25/2023] Open
Abstract
Photodynamic therapy (PDT) is an effective and cosmetically beneficial treatment of low-risk basal cell carcinomas (BCCs). To optimize PDT response, it is important to correctly select tumors. We sought to find markers that could identify such tumors beyond contributions from clinical and histological examination. Studies have shown that β-catenin, E-cadherin, and α-smooth muscle actin (SMA) expression can indicate BCC aggressiveness/BCC invasiveness. We wanted to use these markers in an explorative study to investigate whether they were differently expressed among non-recurring compared with recurring BCCs, to evaluate their ability of predicting PDT outcome. Fifty-two BCCs were stained with antibodies against β-catenin, E-cadherin, and α-SMA, and evaluated using immunoreactive score (IRS), subcellular localization, and stromal protein expression. Results showed that IRS of E-cadherin was significantly different among recurring compared with non-recurring BCCs and with area under a receiver operating characteristic curve of 0.71 (95% confidence interval: 0.56-0.86, p=0.025). Stromal β-catenin expression significantly increased among recurring BCCs. Some recurring BCCs had intense expression in the deep invading tumor edge. In conclusion, E-cadherin, and stromal and deep edge β-catenin expression were most prominent in BCCs that recurred post-PDT, suggesting they could potentially predict PDT outcome. Further studies are needed to investigate whether these results are of clinical value.
Collapse
Affiliation(s)
- Erik Mørk
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Patricia Mjønes
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Pathology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Olav A. Foss
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Orthopaedic Surgery, Clinic of Orthopaedics, Rheumatology and Dermatology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Ingeborg M. Bachmann
- Institute of Medical Science, University of Bergen, Bergen, Norway
- Department of Dermatology, Haukeland University Hospital, Bergen, Norway
| | - Eidi Christensen
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Dermatology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| |
Collapse
|
10
|
Farberg AS, Marson JW, Soleymani T. Advances in Photodynamic Therapy for the Treatment of Actinic Keratosis and Nonmelanoma Skin Cancer: A Narrative Review. Dermatol Ther (Heidelb) 2023; 13:689-716. [PMID: 36662422 PMCID: PMC9984667 DOI: 10.1007/s13555-023-00888-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 01/03/2023] [Indexed: 01/21/2023] Open
Abstract
Photodynamic therapy (PDT) with photosensitization using 5-aminolevulinic acid (ALA) [including a nanoemulsion (BF-200 ALA)] is approved in the USA for the treatment of actinic keratoses (AKs); another derivative, methyl aminolevulinate, is not approved in the USA but is used in Europe. For AK treatment, the photosensitizer may be applied to individual AK lesions or, depending on treatment regimen, to broader areas of sun-damaged skin to manage field cancerization, although not all products are approved for field treatment. ALA-PDT and photosensitizers have also been used off-label for the treatment of nonmelanoma skin cancers, primarily basal cell carcinomas (BCCs) and cutaneous squamous cell carcinomas (cSCC). Advantages of PDT include potentially improved cosmesis and patient satisfaction; disadvantages include pain and duration of treatment. Alternative illumination approaches, including intense pulsed light as well as pulsed-dye lasers, have also been used successfully. Pretreating the affected tissue or warming during incubation can help to increase photosensitizer absorption and improve therapeutic efficacy. Combinations of multiple treatments are also under exploration. Reducing incubation time between photosensitizer application and illumination may significantly reduce pain scores without affecting treatment efficacy. Substituting daylight PDT for a conventional illumination source can also reduce pain without compromising efficacy. The objective of this narrative review is to describe current and ongoing research in the use of topical photosensitizers and modified light delivery regimens to achieve improved therapeutic outcomes with less toxicity in patients with AK, cSCC, BCC, and field cancerization.
Collapse
Affiliation(s)
- Aaron S. Farberg
- grid.486749.00000 0004 4685 2620Section of Dermatology, Baylor Scott & White Health System, Dallas, TX USA ,Bare Dermatology, Dallas, TX USA
| | - Justin W. Marson
- grid.262863.b0000 0001 0693 2202SUNY Downstate Health Sciences University, Brooklyn, NY USA
| | - Teo Soleymani
- grid.19006.3e0000 0000 9632 6718Division of Dermatologic Surgery, David Geffen School of Medicine at University of California, Los Angeles, CA USA
| |
Collapse
|
11
|
Efficacy of two different methods of cold air analgesia for pain relief in PDT of actinic keratoses of the head region - a randomized controlled comparison study. Photodiagnosis Photodyn Ther 2022; 40:103190. [PMID: 36336323 DOI: 10.1016/j.pdpdt.2022.103190] [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: 08/09/2022] [Revised: 10/18/2022] [Accepted: 11/02/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Photodynamic therapy (PDT) is an effective method for treating actinic keratosis (AK) with pain during illumination representing the major side effect. The efficacy of two different cooling methods for pain relief in PDT of AK in the head region was compared. METHODS Randomized, assessor-blinded, half side comparison study in 20 patients with symmetrically distributed AK on the head. Conventional PDT was performed on both halves of the scalp or face by applying 20% aminolevulinic acid cream (ALA) and subsequent illumination with incoherent red light. During illumination one side was cooled with a cold air blower (CAB) and the other with a standard fan (FAN) in a randomized fashion. Pain and skin temperature were recorded during and after PDT. The phototoxic skin reaction was evaluated up to seven days after PDT. The clearance rate of AK was assessed at 3 and 6 months after PDT. RESULTS Mean pain (VASmean), maximum pain intensity (VASmax) and the mean skin temperature during PDT were significantly lower with CAB as compared to FAN (VASmean: 2.7 ± 1.4 vs. 3.7 ± 2.1, p = 0.003; VASmax: 3.8 ± 2.0 vs. 4.8 ± 2.5, p = 0.002; 26.8 ± 2.0 °C vs. 32.1 ± 1.7 °C; p=<0.001). The severity of the phototoxic skin reaction and the clearance rate of AK did not differ between the two cooling methods. CONCLUSION Cooling with CAB during PDT has a greater analgesic effect than cooling with FAN. Patients with a lower skin temperature during illumination tended to experience less pain, however, this effect did not reach the level of statistical significance.
Collapse
|
12
|
Dey A, Singhvi G, Puri A, Kesharwani P, Dubey SK. An insight into photodynamic therapy towards treating major dermatological conditions. J Drug Deliv Sci Technol 2022; 76:103751. [PMID: 36159728 PMCID: PMC9495279 DOI: 10.1016/j.jddst.2022.103751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Photodynamic therapy (PDT), as the name suggests is a light-based, non-invasive therapeutic treatment method that has garnered immense interest in the recent past for its efficacy in treating several pathological conditions. PDT has prominent use in the treatment of several dermatological conditions, which consequently have cosmetic benefits associated with it as PDT improves the overall appearance of the affected area. PDT is commonly used for repairing sun-damaged skin, providing skin rejuvenation, curbing pre-cancerous cells, treating conditions like acne, keratosis, skin-microbial infections, and cutaneous warts, etc. PDT mediates its action by generating oxygen species that are involved in bringing about immunomodulation, suppression of microbial load, wound-healing, lightening of scarring, etc. Although there are several challenges associated with PDT, the prominent ones being pain, erythema, insufficient delivery of the photosensitizing agent, and poor clinical outcomes, still PDT stands to be a promising approach with continuous efforts towards maximizing clinical efficacy while being cautious of the side effects and working towards lessening them. This article discusses the major skin-related conditions which can be treated or managed by employing PDT as a better or comparable alternative to conventional treatment approaches such that it also brings about aesthetic improvements thereof.
Collapse
Affiliation(s)
- Anuradha Dey
- R&D Healthcare Division, Emami Ltd, 13, BT Road, Belgharia, Kolkata 700056, India
| | - Gautam Singhvi
- Department of Pharmacy, Birla Institute of Technology and Science, Pilani, Pilani Campus, Rajasthan, India-333031
| | - Anu Puri
- RNA Structure and Design Section, RNA Biology Laboratory (RBL), Center for Cancer Research, National Cancer Institute — Frederick, Frederick, MD, 21702, USA
| | - Prashant Kesharwani
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062, India
- University Institute of Pharma Sciences, Chandigarh University, Mohali, Punjab, India
| | - Sunil Kumar Dubey
- R&D Healthcare Division, Emami Ltd, 13, BT Road, Belgharia, Kolkata 700056, India
| |
Collapse
|
13
|
Modulation of Hedgehog Signaling for the Treatment of Basal Cell Carcinoma and the Development of Preclinical Models. Biomedicines 2022; 10:biomedicines10102376. [PMID: 36289637 PMCID: PMC9598418 DOI: 10.3390/biomedicines10102376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/17/2022] [Accepted: 09/20/2022] [Indexed: 11/17/2022] Open
Abstract
Basal Cell Carcinoma (BCC) is the most commonly diagnosed cancer worldwide. While the survivability of BCC is high, many patients are excluded from clinically available treatments due to health risks or personal choice. Further, patients with advanced or metastatic disease have severely limited treatment options. The dysregulation of the Hedgehog (Hh) signaling cascade drives onset and progression of BCC. As such, the modulation of this pathway has driven advancements in BCC research. In this review, we focus firstly on inhibitors that target the Hh pathway as chemotherapeutics against BCC. Two therapies targeting Hh signaling have been made clinically available for BCC patients, but these treatments suffer from limited initial efficacy and a high rate of chemoresistant tumor recurrence. Herein, we describe more recent developments of chemical scaffolds that have been designed to hopefully improve upon the available therapeutics. We secondly discuss the history and recent efforts involving modulation of the Hh genome as a method of producing in vivo models of BCC for preclinical research. While there are many advancements left to be made towards improving patient outcomes with BCC, it is clear that targeting the Hh pathway will remain at the forefront of research efforts in designing more effective chemotherapeutics as well as relevant preclinical models.
Collapse
|
14
|
Hamimed S, Jabberi M, Chatti A. Nanotechnology in drug and gene delivery. Naunyn Schmiedebergs Arch Pharmacol 2022; 395:769-787. [PMID: 35505234 PMCID: PMC9064725 DOI: 10.1007/s00210-022-02245-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/21/2022] [Indexed: 02/07/2023]
Abstract
Over the last decade, nanotechnology has widely addressed many nanomaterials in the biomedical area with an opportunity to achieve better-targeted delivery, effective treatment, and an improved safety profile. Nanocarriers have the potential property to protect the active molecule during drug delivery. Depending on the employing nanosystem, the delivery of drugs and genes has enhanced the bioavailability of the molecule at the disease site and exercised an excellent control of the molecule release. Herein, the chapter discusses various advanced nanomaterials designed to develop better nanocarrier systems used to face different diseases such as cancer, heart failure, and malaria. Furthermore, we demonstrate the great attention to the promising role of nanocarriers in ease diagnostic and biodistribution for successful clinical cancer therapy.
Collapse
Affiliation(s)
- Selma Hamimed
- Laboratory of Biochemistry and Molecular Biology, Faculty of Sciences of Bizerte, University of Carthage, CP 7021, Jarzouna, Tunisia. .,Departement of Biology, Faculty of Exact Sciences, Natural and Life Sciences, Chaikh Larbi Tebessi University, Tebessa, Algeria.
| | - Marwa Jabberi
- Laboratory of Biochemistry and Molecular Biology, Faculty of Sciences of Bizerte, University of Carthage, CP 7021, Jarzouna, Tunisia.,Laboratory of Energy and Matter for Development of Nuclear Sciences (LR16CNSTN02), National Center for Nuclear Sciences and Technology (CNSTN), Sidi Thabet Technopark, 2020, Ariana, Tunisia
| | - Abdelwaheb Chatti
- Laboratory of Biochemistry and Molecular Biology, Faculty of Sciences of Bizerte, University of Carthage, CP 7021, Jarzouna, Tunisia
| |
Collapse
|
15
|
Shi L, Yang J, Zhang L, Zhang Y, Yan G, Zhang H, Yang J, Wang P, Zhang G, Zhou Z, Wang X. Adverse reactions of ALA-PDT for the treatment of cutaneous diseases: A retrospective study. Photodiagnosis Photodyn Ther 2022; 38:102783. [PMID: 35218941 DOI: 10.1016/j.pdpdt.2022.102783] [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: 11/21/2021] [Revised: 02/10/2022] [Accepted: 02/22/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND 5-Aminolaevulinic acid photodynamic therapy (ALA-PDT) is an effective therapy for cutaneous diseases, such as precancers, superficial non melanoma skin cancers and certain inflammatory or viral conditions. However, the absence of a complete picture of adverse reactions limits the promotion of ALA-PDT. OBJECTIVE To systemically investigate the detailed evidence of adverse reactions relating to ALA-PDT for skin diseases. METHODS A retrospective study performed at the Shanghai Skin Disease Hospital. RESULTS In the retrospective study, 439 patients were included. Incidences of adverse reactions, including in-treatment pain (98.8%), erythema (92.4%), edema (35.0%), exudation (23.0%), hyperpigmentation (27.3%) were clarified. Edema was more common in female patients (P<0.05). Patients with HPV-related skin diseases were more likely to suffer erythema, edema or exudation (P<0.05). Hyperpigmentation was more likely to occur in skin appendage disorders (P<0.05). Fever (2.4%) and hypopigmentation (1.9%) are two neglected adverse reactions analyzed in detail. Fever is more prevalent in female patients. Hypopigmentation occurred predominantly in elderly with skin cancer or precancerosis lesions. CONCLUSION The results outline detailed information about the adverse reactions, including systemic reactions following ALA-PDT, assisting dermatologists in predicting and managing adverse reactions for greater efficacy and higher patient satisfaction.
Collapse
Affiliation(s)
- Lei Shi
- Institute of Photomedicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai 200092, China
| | - Jiayi Yang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai 200092, China
| | - Linglin Zhang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai 200092, China
| | - Yunfeng Zhang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai 200092, China
| | - Guorong Yan
- Institute of Photomedicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai 200092, China
| | - Haiyan Zhang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai 200092, China
| | - Jin Yang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai 200092, China
| | - Peiru Wang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai 200092, China
| | - Guolong Zhang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai 200092, China
| | - Zhongxia Zhou
- Institute of Photomedicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai 200092, China
| | - Xiuli Wang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai 200092, China.
| |
Collapse
|
16
|
Shi L, Yang J, Zhang L, Zhang Y, Yan G, Zhang H, Liu X, Yang J, Wang P, Zhang G, Zhou Z, Wang X. A prospective study of adverse reactions of ALA-PDT for acne vulgaris. Photodiagnosis Photodyn Ther 2022; 38:102752. [PMID: 35176498 DOI: 10.1016/j.pdpdt.2022.102752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/26/2022] [Accepted: 02/04/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Acne vulgaris is a chronic inflammatory skin disease around pilosebaceous unit. 5-Aminolaevulinic acid photodynamic therapy (ALA-PDT) is an effective therapy for severe acne vulgaris. However, the lack of detailed information of adverse reactions limits the promotion of ALA-PDT in clinic. OBJECTIVE To systemically investigate the adverse reactions relating to ALA-PDT for acne vulgaris. METHODS A prospective study was performed at the Shanghai Skin Disease Hospital. RESULTS In the prospective study, 35 patients with acne vulgaris completed the trial. The adverse reactions were first divided into acute-phase adverse reactions, including erythema (94.3%), post-treatment pain (91.4%), burning skin (91.4%), dry skin (91.4%), itching (85.7%), pustule (82.9%), edema (20%) and blister (11.4%), or recovery-phase adverse reactions, which included crust (65.6%), exudation (48.6%) and hyperpigmentation (42.7%). Younger patients were more likely to have pustules (P<0.05). Male patients were represented itching more often than female patients (P<0.05). The efficacy of ALA-PDT for severe acne was positively related to the severity of acute-phase adverse reactions. The duration of pain was shortest. Crusting and hyperpigmentation lasted considerably longer. CONCLUSION In the present study, we recorded the relative incidence of various adverse reactions following ALA-PDT for acne vulgaris. The severity of adverse reactions tended to decrease with increased patient age, except for itching and hyperpigmentation. Light-to-moderate adverse reactions might be the inflammatory reactions of ALA-PDT, predicting a good efficacy. A form for evaluation of adverse reactions based on the present study could assist dermatologists in predicting and managing adverse reactions for greater efficacy and higher patient satisfaction.
Collapse
Affiliation(s)
- Lei Shi
- Institute of Photomedicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, 1278 Baode Road, Shanghai 200092, China
| | - Jiayi Yang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, 1278 Baode Road, Shanghai 200092, China
| | - Linglin Zhang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, 1278 Baode Road, Shanghai 200092, China
| | - Yunfeng Zhang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, 1278 Baode Road, Shanghai 200092, China
| | - Guorong Yan
- Institute of Photomedicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, 1278 Baode Road, Shanghai 200092, China
| | - Haiyan Zhang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, 1278 Baode Road, Shanghai 200092, China
| | - Xiaojing Liu
- Institute of Photomedicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, 1278 Baode Road, Shanghai 200092, China
| | - Jin Yang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, 1278 Baode Road, Shanghai 200092, China
| | - Peiru Wang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, 1278 Baode Road, Shanghai 200092, China
| | - Guolong Zhang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, 1278 Baode Road, Shanghai 200092, China
| | - Zhongxia Zhou
- Institute of Photomedicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, 1278 Baode Road, Shanghai 200092, China
| | - Xiuli Wang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, 1278 Baode Road, Shanghai 200092, China.
| |
Collapse
|
17
|
Daylight-PDT: everything under the sun. Biochem Soc Trans 2022; 50:975-985. [PMID: 35385082 PMCID: PMC9162453 DOI: 10.1042/bst20200822] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/28/2022] [Accepted: 03/11/2022] [Indexed: 12/18/2022]
Abstract
5-Aminolevulinic acid-based photodynamic therapy (ALA-PDT) was first implemented over three decades ago and has since been mainly part of clinical practice for the management of pre-cancerous and cancerous skin lesions. Photodynamic therapy relies on the combination of a photosensitizer, light and oxygen to cause photo-oxidative damage of cellular components. 5-Aminolevulinic acid (ALA) is a natural precursor of the heme biosynthetic pathway, which when exogenously administered leads to the accumulation of the photoactivatable protoporphyrin IX. Although, effective and providing excellent cosmetic outcomes, its use has been restricted by the burning, stinging, and prickling sensation associated with treatment, as well as cutaneous adverse reactions that may be induced. Despite intense research in the realm of drug delivery, pain moderation, and light delivery, a novel protocol design using sunlight has led to some of the best results in terms of treatment response and patient satisfaction. Daylight PDT is the protocol of choice for the management of treatment of multiple or confluent actinic keratoses (AK) skin lesions. This review aims to revisit the photophysical, physicochemical and biological characteristics of ALA-PDT, and the underlying mechanisms resulting in daylight PDT efficiency and limitations.
Collapse
|
18
|
The evolution of clinical guidelines for antimicrobial photodynamic therapy of skin. Photochem Photobiol Sci 2022; 21:385-395. [PMID: 35132604 PMCID: PMC8821777 DOI: 10.1007/s43630-021-00169-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 12/28/2021] [Indexed: 11/28/2022]
Abstract
Antimicrobial photodynamic therapy has become an important component in the treatment of human infection. This review considers historical guidelines, and the scientific literature to envisage what future clinical guidelines for treating skin infection might include. Antibiotic resistance, vertical and horizontal infection control strategies and a range of technologies effective in eradicating microbes without building up new resistance are described. The mechanism of action of these treatments and examples of their clinical use are also included. The research recommendations of NICE Guidelines on the dermatological manifestations of microbial infection were also reviewed to identify potential applications for PDT. The resistance of some microbes to antibiotics can be halted, or even reversed through the use of supplementary drugs, and so they are likely to persist as a treatment of infection. Conventional PDT will undoubtedly continue to be used for a range of skin conditions given existing healthcare infrastructure and a large evidence base. Daylight PDT may find broader antimicrobial applications than just Acne and Cutaneous Leishmaniasis, and Ambulatory PDT devices could become popular in regions where resources are limited or daylight exposure is not possible or inappropriate. Nanotheranostics were found to be highly relevant, and often include PDT, however, new treatments and novel applications and combinations of existing treatments will be subject to Clinical Trials.
Collapse
|
19
|
Wang D, Wang P, Li C, Zhou Z, Zhang L, Zhang G, Wang X. Efficacy and safety of HpD-PDT for Extramammary Paget's Disease refractory to conventional therapy: A prospective, open-label and single arm pilot study. Photodiagnosis Photodyn Ther 2021; 37:102670. [PMID: 34883272 DOI: 10.1016/j.pdpdt.2021.102670] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 11/28/2021] [Accepted: 11/29/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Extramammary Paget's Disease (EMPD) is an intraepithelial cancer that is prone to recurrence and sometimes refractory to therapy. A few EMPD cases have been treated with Photodynamic therapy (PDT), which reported high complete remission (CR) rates and low recurrence with hematoporphyrin derivatives (HpD) The aim of this study was to further explore the efficacy and safety of HpD-PDT for EMPD patients. METHODS Open-label, single arm, pilot study was designed to investigate the role of HpD-PDT in EMPD. The HpD sensitizer was given intravenously at a dose of 3 or 5 mg/kg 48 h before light irradiation with a laser 630 nm red light at a dose level of 150-200 J/cm2. Clinical parameters involving gender, age, disease course, previous treatment, tumor thickness, long diameter of lesion, TNM staging, EMPD staging, HpD dosage, Visual Analogue Scale (VAS) score, 1st month visit result, subsequent treatment, follow up period and endpoint outcomes were collected to evaluate efficacy and safety of the intervention. RESULTS Eleven patients with pathologic confirmed EMPD were treated with HpD-PDT. The thickness of skin lesions which were located in vulva, penis, scrotum, and perianal area is 0.8∼6.7 mm (mean thickness 2.9 mm). All patients were followed up for an average of 17.4 months (12∼27 months). Complete remission (CR) rate and partial remission (PR) rate at the 1st month were 90.1% (10/11) and 9.1% (1/11) respectively. At the end of follow-up, 72.7% of the subjects (8/11) showed CR. Pain, infection, photosensitivity and uroschesis are recorded as adverse events (AEs) in this population, and no event of hepatic impairment was reported. After treatment, all the eleven patients showed different degrees of scar in the treatment site, but none of them had any structural or functional abnormalities. CONCLUSIONS According to our study, HpD-PDT in EMPD is able to offer acceptable disease outcomes including relatively high CR rate, with good cosmetic and functional outcomes, and could be considered a potential recommended therapy for patients with EMPD. TRIAL REGISTRATION Chinese Clinical Trial Register (ChiCTR-1900024965).
Collapse
Affiliation(s)
- Dixin Wang
- 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
| | - Chunxiao Li
- 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
| | - Linglin Zhang
- 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
| | - Xiuli Wang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China.
| |
Collapse
|
20
|
Salvio AG, Veneziano DB, Moriyama LT, Inada NM, Grecco C, Kurachi C, Bagnato VS. A new photodynamic therapy protocol for nodular basal cell carcinoma treatment: Effectiveness and long-term follow-up. Photodiagnosis Photodyn Ther 2021; 37:102668. [PMID: 34863948 DOI: 10.1016/j.pdpdt.2021.102668] [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: 07/29/2021] [Revised: 11/25/2021] [Accepted: 11/29/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Photodynamic therapy (PDT) has been reported as an excellent option for the treatment of small nodular basal cell carcinomas (nBCC). The standard protocol consists of two sessions, one week apart. Sometimes, returning to the hospital after one week can be impractical for elderly patients, due to comorbidities and mobility issues. Therefore, a new technique performed in one day could be superior for those patients. OBJECTIVE Evaluate the effectiveness of a PDT Single-visit protocol comparing to the standard protocol, as well as pain and long-term recurrence-free follow-up for nBCC. METHODS A total of 120 nBCC were treated through a Standard PDT protocol(two sessions, one week apart), and 120 nBCC were treated through a Single-visit PDT(two sessions in one day). A 30-day-after biopsy was performed in order to evaluate the results after the treatment. The lesions that had successful treatment were clinically and dermoscopically evaluated every 6 months up to 60 months. The pain score was compared between the groups(assessed every 3 min during PDT). RESULTS A complete response at 30-days-after PDT biopsy was observed in 85% of Standard PDT and in 93.3% of Single-visit PDT. Regarding the pain during the illumination, less pain was observed during the second session of the Single-visit PDT. The recurrence-free follow up showed, after 60 months, an 69.0% cumulative probability of recurrence-free for Standard PDT and 80.6% for Single-visit PDT. CONCLUSIONS The suggested Single-visit PDT protocol resulted in better outcomes at 30-day-after PDT biopsy and in lower recurrence rates than the Standard PDT protocol. A more comfortable and more efficient treatment was offered for the patients, with lower pain.
Collapse
Affiliation(s)
| | | | - Lilian Tan Moriyama
- São Carlos Institute of Physics, University of São Paulo, São Carlos, São Paulo, Brazil
| | - Natalia Mayumi Inada
- São Carlos Institute of Physics, University of São Paulo, São Carlos, São Paulo, Brazil
| | | | - Cristina Kurachi
- São Carlos Institute of Physics, University of São Paulo, São Carlos, São Paulo, Brazil
| | - Vanderlei Salvador Bagnato
- São Carlos Institute of Physics, University of São Paulo, São Carlos, São Paulo, Brazil; Hagler Fellow, Texas A&M University, College Station Texas, United States of America
| |
Collapse
|
21
|
Yao Y, Shi L, Wang Y, Shen X, Ye S, Tang G, Wu L. Ablative fractional laser-assisted photodynamic therapy vs. ablative fractional laser for oral leukoplakia treatment: A randomized, controlled pilot study. Photodiagnosis Photodyn Ther 2021; 36:102523. [PMID: 34487871 DOI: 10.1016/j.pdpdt.2021.102523] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/26/2021] [Accepted: 08/30/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Ablative fractional laser-assisted photodynamic therapy (AFL-PDT) is explored as an effective method in some premalignant diseases, whereas the effect of AFL-PDT on oral leukoplakia (OL), the best-known precursor of oral squamous cell carcinoma, remains undetermined. METHODS Forty-eight patients, histologically diagnosed with OL, were randomized (1:1) to receive either AFL-PDT or ablative fractional laser (AFL) treatment. All patients were followed up at 1, 3, 6 and 12 months postoperatively. The primary endpoints of efficacy and clinical recurrence and the secondary endpoint of side effects were assessed. RESULTS Forty-four patients completed the study. The 100% effective cure rate in the AFL-PDT group was higher than that in AFL group (80.9%, P<0.05) with 19.1% difference (95%CI: 0.7-40.0%). Compared to AFL group, recurrence observed at 6 and 12 months post-treatment tended to occur in fewer patients in the AFL-PDT group (P<0.05). No severe adverse events or systemic side effects were observed in either group. CONCLUSIONS AFL-PDT may effectively reduce recurrence of OL with high clinical efficacy and good tolerability, suggesting it may be a promising treatment for OL.
Collapse
Affiliation(s)
- Yilin Yao
- Department of Oral Mucosal disease, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China; National Clinical Research Center for Oral Diseases, Shanghai 200011, China; Shanghai Key Laboratory of Stomatology, Shanghai 200011, China
| | - Linjun Shi
- Department of Oral Mucosal disease, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China; National Clinical Research Center for Oral Diseases, Shanghai 200011, China; Shanghai Key Laboratory of Stomatology, Shanghai 200011, China
| | - Yufeng Wang
- Department of Oral Mucosal disease, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China; National Clinical Research Center for Oral Diseases, Shanghai 200011, China; Shanghai Key Laboratory of Stomatology, Shanghai 200011, China
| | - Xuemin Shen
- Department of Oral Mucosal disease, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China; College of Stomatology, Shanghai Jiao Tong University, Shanghai 200011, China; National Center for Stomatology, Shanghai 200011, China
| | - Sai Ye
- Department of Oral Mucosal disease, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China; National Clinical Research Center for Oral Diseases, Shanghai 200011, China; Shanghai Key Laboratory of Stomatology, Shanghai 200011, China
| | - Guoyao Tang
- Department of Oral Mucosal disease, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China; College of Stomatology, Shanghai Jiao Tong University, Shanghai 200011, China; National Center for Stomatology, Shanghai 200011, China; National Clinical Research Center for Oral Diseases, Shanghai 200011, China; Shanghai Key Laboratory of Stomatology, Shanghai 200011, China..
| | - Lan Wu
- Department of Oral Mucosal disease, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China; National Clinical Research Center for Oral Diseases, Shanghai 200011, China; Shanghai Key Laboratory of Stomatology, Shanghai 200011, China..
| |
Collapse
|
22
|
Wenlong H, Qiunan Y, Wenhao C, Yumo L, Tingting Z, Hong R. The combination of photodynamic therapy and fractional CO 2 laser for mycobacterium marinum infection. Photodiagnosis Photodyn Ther 2021; 35:102391. [PMID: 34119710 DOI: 10.1016/j.pdpdt.2021.102391] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/16/2021] [Accepted: 06/07/2021] [Indexed: 11/18/2022]
Abstract
Mycobacterium marinum (M. marinum) can cause cutaneous infection. Therapy with active antibiotics for 3 to 6 months is one reasonable treatment. However, it is hard to provide an optimal balance with regard to efficacy and tolerability when the patient is complicated with other diseases. We reported two patients with cutaneous M. marinum infections who were successfully treated with 5-aminolevulinic acid-photodynamic therapy (5-ALA-PDT) combined with fractional CO2 laser ablation. The results of these two cases indicated that PDT in combination with fractional CO2 laser ablation of epidermis could be a therapeutic option for the treatment of skin infections caused by M. marinum.
Collapse
Affiliation(s)
- Hu Wenlong
- Department of Dermatology, The Affiliated Lianyungang Hospital of Xuzhou Medical University/The First People's Hospital of Lianyungang, Lianyungang, Jiangsu, China
| | - Yao Qiunan
- Department of Dermatology, The Affiliated Lianyungang Hospital of Xuzhou Medical University/The First People's Hospital of Lianyungang, Lianyungang, Jiangsu, China
| | - Cheng Wenhao
- Department of Dermatology, The Affiliated Lianyungang Hospital of Xuzhou Medical University/The First People's Hospital of Lianyungang, Lianyungang, Jiangsu, China
| | - Lu Yumo
- Department of Dermatology, The Affiliated Lianyungang Hospital of Xuzhou Medical University/The First People's Hospital of Lianyungang, Lianyungang, Jiangsu, China
| | - Zhang Tingting
- Department of Infectious Diseases, The Affiliated Lianyungang Hospital of Xuzhou Medical University/The First People's Hospital of Lianyungang, Lianyungang, Jiangsu, China
| | - Ren Hong
- Department of Dermatology, The Affiliated Lianyungang Hospital of Xuzhou Medical University/The First People's Hospital of Lianyungang, Lianyungang, Jiangsu, China.
| |
Collapse
|
23
|
Experimental investigation of a combinational iron chelating protoporphyrin IX prodrug for fluorescence detection and photodynamic therapy. Lasers Med Sci 2021; 37:1155-1166. [PMID: 34218351 PMCID: PMC8918167 DOI: 10.1007/s10103-021-03367-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 06/21/2021] [Indexed: 10/31/2022]
Abstract
Photodynamic therapy (PDT) is an oxygen-dependent, light-activated, and locally destructive drug treatment of cancer. Protoporphyrin IX (PpIX)-induced PDT exploits cancer cells' own innate heme biosynthesis to hyper-accumulate the naturally fluorescent and photoactive precursor to heme, PpIX. This occurs as a result of administering heme precursors (e.g., aminolevulinic acid; ALA) because the final step of the pathway (the insertion of ferrous iron into PpIX by ferrochelatase to form heme) is relatively slow. Separate administration of an iron chelating agent has previously been demonstrated to significantly improve dermatological PpIX-PDT by further limiting heme production. A newly synthesized combinational iron chelating PpIX prodrug (AP2-18) has been assessed experimentally in cultured primary human cells of bladder and dermatological origin, as an alternative photosensitizing agent to ALA or its methyl or hexyl esters (MAL and HAL respectively) for photodetection/PDT. Findings indicated that the technique of iron chelation (either through the separate administration of the established hydroxypyridinone iron chelator CP94 or the just as effective combined AP2-18) did not enhance either PpIX fluorescence or PDT-induced (neutral red assessed) cell death in human primary normal and malignant bladder cells. However, 500 µM AP2-18 significantly increased PpIX accumulation and produced a trend of increased cell death within epithelial squamous carcinoma cells. PpIX accumulation destabilized the actin cytoskeleton in bladder cancer cells prior to PDT and resulted in caspase-3 cleavage/early apoptosis afterwards. AP2-18 iron chelation should continue to be investigated for the enhancement of dermatological PpIX-PDT applications but not bladder photodetection/PDT.
Collapse
|
24
|
Scholz M, Croizat G, Pšenčík J, Dědic R, Nonell S, Wagnieres G. Understanding delayed fluorescence and triplet decays of Protoporphyrin IX under hypoxic conditions. Photochem Photobiol Sci 2021; 20:843-857. [PMID: 34216374 DOI: 10.1007/s43630-021-00044-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 04/16/2021] [Indexed: 01/24/2023]
Abstract
Photosensitizers of singlet oxygen exhibit three main types of reverse intersystem-crossing (RISC): thermally activated, triplet-triplet annihilation, and singlet oxygen feedback. RISC can be followed by delayed fluorescence (DF) emission, which can provide important information about the excited state dynamics in the studied system. An excellent model example is a widely used clinical photosensitizer Protoporphyrin IX, which manifests all three mentioned types of RISC and DF. Here, we estimated rate constants of individual RISC and DF processes in Protoporphyrin IX in dimethylformamide, and we showed how these affect triplet decays and DF signals under diverse experimental conditions, such as a varying oxygen concentration or excitation intensity. This provided a basis for a general discussion on guidelines for a more precise analysis of long-lived signals. Furthermore, it has been found that PpIX photoproducts and potential transient excited complexes introduce a new overlapping delayed luminescence spectral band with a distinct lifetime. These findings are important for design of more accurate biological oxygen sensors and assays based on DF and triplet lifetime.
Collapse
Affiliation(s)
- Marek Scholz
- Department of Chemical Physics and Optics, Faculty of Mathematics and Physics, Charles University in Prague, Prague, Czech Republic. .,Center for Imaging Medicine, Thayer School of Engineering, Dartmouth College, Hanover, USA. .,Faculty of Science, University of South Bohemia, České Budějovice, Czech Republic.
| | - Gauthier Croizat
- Laboratory for functional and metabolic imaging, LIFMET, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| | - Jakub Pšenčík
- Department of Chemical Physics and Optics, Faculty of Mathematics and Physics, Charles University in Prague, Prague, Czech Republic
| | - Roman Dědic
- Department of Chemical Physics and Optics, Faculty of Mathematics and Physics, Charles University in Prague, Prague, Czech Republic
| | - Santi Nonell
- Institut Químic de Sarrià, Universitat Ramon Llull, Via Augusta 390, 08017, Barcelona, Catalunya, Spain
| | - Georges Wagnieres
- Laboratory for functional and metabolic imaging, LIFMET, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| |
Collapse
|
25
|
Zhang L, Yang J, Liu X, Xu D, Shi L, Liu J, Zeng Q, Wang X. 5-Aminolaevulinic acid photodynamic therapy amplifies intense inflammatory response in the treatment of acne vulgaris via CXCL8. Exp Dermatol 2021; 30:923-931. [PMID: 33860562 DOI: 10.1111/exd.14357] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/12/2021] [Accepted: 04/01/2021] [Indexed: 12/12/2022]
Abstract
Acne vulgaris is a chronic inflammatory cutaneous disease. 5-Aminolaevulinic acid photodynamic therapy (ALA-PDT) is a novel and effective approach for severe acne vulgaris treatment. However, its specific treatment mechanism still remains unclear. In the present study, we investigated the potential mechanism of how ALA-PDT regulated intense inflammatory response in acne vulgaris. It appeared that ALA-PDT suppresses proliferation and lipid secretion of primary human sebocytes. Besides, ALA-PDT could up-regulate the expression of CXCL8 in vivo and in vitro, amplifying the inflammatory response by recruiting T cells, B cells, neutrophils and macrophages. We also found that ALA-PDT elevated the expression of CXCL8 via p38 pathway. SB203580, a p38 pathway inhibitor, decreased the expression of CXCL8 in sebocytes after ALA-PDT. These findings indicate that ALA-PDT amplifies the intense inflammatory response in the treatment of acne vulgaris via CXCL8. Our data decipher the mechanism of intense inflammatory response after ALA-PDT for acne vulgaris.
Collapse
Affiliation(s)
- Linglin Zhang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jiayi Yang
- 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
| | - Detian Xu
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lei Shi
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jia Liu
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China
| | - Qingyu Zeng
- 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
| |
Collapse
|
26
|
Nasr I, McGrath EJ, Harwood CA, Botting J, Buckley P, Budny PG, Fairbrother P, Fife K, Gupta G, Hashme M, Hoey S, Lear JT, Mallipeddi R, Mallon E, Motley RJ, Newlands C, Newman J, Pynn EV, Shroff N, Slater DN, Exton LS, Mohd Mustapa MF, Ezejimofor MC. British Association of Dermatologists guidelines for the management of adults with basal cell carcinoma 2021. Br J Dermatol 2021; 185:899-920. [PMID: 34050920 DOI: 10.1111/bjd.20524] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2021] [Indexed: 12/13/2022]
Affiliation(s)
- I Nasr
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, UK
| | - E J McGrath
- Royal Devon and Exeter NHS Foundation Trust, Exeter, EX2 5DW, UK
| | - C A Harwood
- Barts Health NHS Trust, London, E1 1BB, UK.,National Cancer Research Institute's Skin Cancer Clinical Studies Group and Non-Melanoma Skin Cancer Subgroup, London, UK
| | - J Botting
- Royal College of General Practitioners, London, UK
| | - P Buckley
- Independent Cancer Patients' Voice, London, UK
| | - P G Budny
- British Association of Plastic, Reconstructive & Aesthetic Surgeons, London, UK.,Buckinghamshire Healthcare NHS Trust, Aylesbury, HP21 8AL, UK
| | | | - K Fife
- Royal College of Radiologists, London, UK.,Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
| | - G Gupta
- NHS Lothian, Lauriston Building, Edinburgh, EH3 9EN, UK
| | - M Hashme
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, UK
| | - S Hoey
- Royal Victoria Hospital, Belfast, BT12 6BA, UK
| | - J T Lear
- British Society for Skin Care in Immunosuppressed Individuals, London, UK.,Salford Royal NHS Foundation Hospital, Salford, M6 8HD, UK.,Manchester Academic Health Science Centre, Manchester, M20 2LR, UK
| | - R Mallipeddi
- British Society for Dermatological Surgery, London, UK.,St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, UK
| | - E Mallon
- St Mary's Hospital, Imperial College Healthcare NHS Trust, London, W2 1NY, UK
| | - R J Motley
- University Hospital of Wales, Cardiff, CF14 4XW, UK
| | - C Newlands
- British Association of Oral and Maxillofacial Surgeons, London, UK.,Royal Surrey County Hospital NHS Foundation Trust, Guildford, GU2 7XX, UK
| | - J Newman
- British Dermatological Nursing Group, Belfast, Ireland.,King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - E V Pynn
- Nevill Hall Hospital, Abergavenny, NP7 7EG, UK
| | - N Shroff
- Primary Care Dermatology Society, Rickmansworth, UK
| | - D N Slater
- Royal College of Pathologists, London, UK
| | - L S Exton
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, UK
| | - M F Mohd Mustapa
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, UK
| | - M C Ezejimofor
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, UK
| | | |
Collapse
|
27
|
O'Mahoney P, Samuel IDW, Eadie E, Ibbotson S. Fluorescence and thermal imaging of non-melanoma skin cancers before and during photodynamic therapy. Photodiagnosis Photodyn Ther 2021; 34:102327. [PMID: 33962057 DOI: 10.1016/j.pdpdt.2021.102327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/19/2021] [Accepted: 04/30/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Photodynamic therapy (PDT) has been shown to be less effective on the extremities. Protoporphyrin-IX (PpIX) fluorescence and skin surface temperature are variables that have been implicated in the differences in efficacy with body site, but objective studies have not been undertaken. OBJECTIVES To further investigate observations from our previous study that temperature and fluorescence during pro-drug incubation are correlated, through a prospective objective investigation of the relationships between fluorescence and skin surface temperature before and during PDT and relationships with body site and efficacy. METHODS Eighteen patients with Bowen's disease or basal cell carcinoma, who had been referred for PDT, were recruited to this study. PpIX fluorescence and thermal measurements were recorded at intervals during the pro-drug incubation and irradiation phases of PDT. Pain immediately after irradiation, and outcome at 3- and 12-months were recorded. RESULTS Temperature and PpIX fluorescence were higher on the trunk than lower leg immediately before treatment (median temperature 32.7 °C vs. 27.8 °C, p < 0.05 and median fluorescence 16.5 vs. 6.7, p < 0.05). Higher pain levels were reported during PDT on the extremities (median 5.7 vs. 2.2, p < 0.05). Clearance rates at 12-months were 80 %. CONCLUSIONS The study supports a correlation between temperature and PpIX fluorescence during PDT, providing robust objective data to support our previous hypothesis and observations. The higher pain levels, lower PpIX fluorescence on the lower leg, and the high efficacy rates at all body sites irrespective of temperature and fluorescence indicates that relationships between PDT treatment conditions and parameters is likely to be multifactorial.
Collapse
Affiliation(s)
- P O'Mahoney
- Photobiology Unit, NHS Tayside, Ninewells Hospital and Medical School, Dundee, UK; The Scottish Photodynamic Therapy Centre, Dundee, UK; School of Medicine, University of Dundee, Dundee, UK.
| | - I D W Samuel
- School of Physics and Astronomy, University of St. Andrews, St. Andrews, UK
| | - E Eadie
- Photobiology Unit, NHS Tayside, Ninewells Hospital and Medical School, Dundee, UK; The Scottish Photodynamic Therapy Centre, Dundee, UK
| | - S Ibbotson
- Photobiology Unit, NHS Tayside, Ninewells Hospital and Medical School, Dundee, UK; The Scottish Photodynamic Therapy Centre, Dundee, UK; School of Medicine, University of Dundee, Dundee, UK
| |
Collapse
|
28
|
Ho B, Howard N, Howard S, Cochrane A, Ferguson J, Ibbotson S. A photodynamic therapy patient survey: Real-life experience from two regional services. PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2021; 37:226-229. [PMID: 33301621 DOI: 10.1111/phpp.12638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 11/19/2020] [Accepted: 12/06/2020] [Indexed: 06/12/2023]
Affiliation(s)
- Bernard Ho
- Dermatology Department, St George's University Hospitals NHS Foundation Trust, London, UK
- Dermatology Department, Queen Mary Hospital, Roehampton, UK
| | - Natasha Howard
- Dermatology Department, Queen Mary Hospital, Roehampton, UK
| | - Sandra Howard
- Dermatology Department, Queen Mary Hospital, Roehampton, UK
| | - Andrea Cochrane
- Photobiology Unit, Ninewells Hospital & Medical School, School of Medicine, University of Dunhdee, Dunhdee, UK
| | - John Ferguson
- Photodermatology Unit, St John's Institute, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Sally Ibbotson
- Photobiology Unit, Ninewells Hospital & Medical School, School of Medicine, University of Dunhdee, Dunhdee, UK
| |
Collapse
|
29
|
Yang D, Lei S, Pan K, Chen T, Lin J, Ni G, Liu J, Zeng X, Chen Q, Dan H. Application of photodynamic therapy in immune-related diseases. Photodiagnosis Photodyn Ther 2021; 34:102318. [PMID: 33940209 DOI: 10.1016/j.pdpdt.2021.102318] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 04/09/2021] [Accepted: 04/26/2021] [Indexed: 02/06/2023]
Abstract
Photodynamic therapy (PDT) is a therapeutic modality that utilizes photodamage caused by photosensitizers and oxygen after exposure to a specific wavelength of light. Owing to its low toxicity, high selectivity, and minimally invasive properties, PDT has been widely applied to treat various malignant tumors, premalignant lesions, and infectious diseases. Moreover, there is growing evidence of its immunomodulatory effects and potential for the treatment of immune-related diseases. This review mainly focuses on the effect of PDT on immunity and its application in immune-related diseases.
Collapse
Affiliation(s)
- Dan Yang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3, Renminnan Road, Chengdu, Sichuan 610041, China
| | - Shangxue Lei
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3, Renminnan Road, Chengdu, Sichuan 610041, China
| | - Keran Pan
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3, Renminnan Road, Chengdu, Sichuan 610041, China
| | - Ting Chen
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3, Renminnan Road, Chengdu, Sichuan 610041, China
| | - Jiao Lin
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3, Renminnan Road, Chengdu, Sichuan 610041, China
| | - Guangcheng Ni
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3, Renminnan Road, Chengdu, Sichuan 610041, China
| | - Jiaxin Liu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3, Renminnan Road, Chengdu, Sichuan 610041, China
| | - Xin Zeng
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3, Renminnan Road, Chengdu, Sichuan 610041, China
| | - Qianming Chen
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3, Renminnan Road, Chengdu, Sichuan 610041, China
| | - Hongxia Dan
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3, Renminnan Road, Chengdu, Sichuan 610041, China.
| |
Collapse
|
30
|
Bungărdean RM, Şerbănescu MS, Colosi HA, Crişan M. High-frequency ultrasound: an essential non-invasive tool for the pre-therapeutic assessment of basal cell carcinoma. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY = REVUE ROUMAINE DE MORPHOLOGIE ET EMBRYOLOGIE 2021; 62:545-551. [PMID: 35024743 PMCID: PMC8848273 DOI: 10.47162/rjme.62.2.21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Aim: While histology remains the “gold standard” for cutaneous tumoral pathology, high-frequency ultrasound (HFUS) was shown to play a significant role in the non-invasive, pre-therapeutic assessment of skin tumors. The aim of our study was to determine whether there is a significant correlation between the ultrasound (US) and histological measurements of basal cell carcinoma (BCC) tumor depth. Materials and Methods: The present study retrospectively analyzed clinical, dermoscopy, HFUS and histological examinations of 90 patients (52 men and 38 women) with histologically confirmed BCC, with focus on tumor depth index (DI). Results: On clinical examination, 54 lesions were nodular (32 presented ulcerations) and 36 superficial lesions. Dermoscopy showed suggestive signs of BCC, most frequently “in focus” arborising superficial vessels (n=81), blue-grey ovoid nests (n=48) and specks of brown pigment (n=7). HFUS revealed well-defined (n=88) or poorly defined (n=2) hypoechoic, vascularized lesions, with inhomogeneous structure (n=90) and characteristic hyperechoic dots (n=36). A strong correlation (Pearson’s r=0.92) between the HFUS (mean measured US depth = 1.33 mm) and histological (mean measured histological depth = 1.47 mm) DI of the investigated skin lesions was found, although significant differences (p<0.001 – t-test for paired samples) between the two measurements were observed. Conclusions: HFUS provides reliable information about BCC depth of invasion that cannot be otherwise obtained prior to surgery. In this manner, it completes the preclinical evaluation and can have an impact on the choice of the optimal therapeutic method.
Collapse
Affiliation(s)
- Raluca Maria Bungărdean
- Department of Medical Informatics and Biostatistics, University of Medicine and Pharmacy of Craiova, Romania;
| | | | | | | |
Collapse
|
31
|
Abstract
This article reviews the 2020 European Society for Photodynamic Therapy (Euro-PDT) Annual Congress. Cutting edge studies included assessment of immunohistochemical variables influencing response of basal cell carcinomas and Bowen's disease to PDT with p53, the only biomarker associated with good response in both conditions. A further study indicated that analysis of molecular markers, such as PIK3R1, could help select patients with actinic keratoses who demonstrate the best response to daylight PDT. Novel delivery protocols include artificial daylight, and laser-assisted and textile PDT. The meeting learnt of novel indications including antimicrobial PDT, as well as methods to optimise daylight PDT, including combination therapy for actinic keratoses. Adverse events were reviewed and options for painless and efficient PDT assessed, including the effect of reduced drug-light interval. A smartphone application was also evaluated which may be used to assist clinicians and patients in effective dosing and timing of daylight PDT via computational algorithms using data from earth observation satellites, to send light and ultraviolet dose information directly to patients' smart phones.
Collapse
|
32
|
Collier NJ, Rhodes LE. Photodynamic Therapy for Basal Cell Carcinoma: The Clinical Context for Future Research Priorities. Molecules 2020; 25:molecules25225398. [PMID: 33218174 PMCID: PMC7698957 DOI: 10.3390/molecules25225398] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/05/2020] [Accepted: 11/15/2020] [Indexed: 01/11/2023] Open
Abstract
Photodynamic therapy (PDT) is an established treatment option for low-risk basal cell carcinoma (BCC). BCC is the most common human cancer and also a convenient cancer in which to study PDT treatment. This review clarifies challenges to researchers evident from the clinical use of PDT in BCC treatment. It outlines the context of PDT and how PDT treatments for BCC have been developed hitherto. The sections examine the development of systemic and subsequently topical photosensitizers, light delivery regimens, and the use of PDT in different patient populations and subtypes of BCC. The outcomes of topical PDT are discussed in comparison with alternative treatments, and topical PDT applications in combination and adjuvant therapy are considered. The intention is to summarize the clinical relevance and expose areas of research need in the BCC context, ultimately to facilitate improvements in PDT treatment.
Collapse
|
33
|
Nassar A, Mostafa M, Khashaba SA. Photodynamic therapy versus candida antigen immunotherapy in plane wart treatment: a comparative controlled study. Photodiagnosis Photodyn Ther 2020; 32:101973. [PMID: 32841751 DOI: 10.1016/j.pdpdt.2020.101973] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/09/2020] [Accepted: 08/17/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Plane warts, mostly found on the face, present a challenge to treat as most destructive methods can lead to unpleasant cosmetic outcome. Alternative therapeutic methods should be evaluated. The aim of this study is to evaluate the clinical efficacy and adverse effects of photodynamic therapy with methylene blue and intense pulsed light in comparison to candida antigen immunotherapy in the treatment of plane warts. METHODS The study included 39 patients with plane warts assigned into 3 groups. Group I received photodynamic therapy using methylene blue followed by IPL illumination, group II received immunotherapy using 0.1 ml of candida albicans antigen and group III received 0.1 ml saline as a control. RESULTS Complete response was detected in (46.1%) of patients in group I compared to (61.5%) in group II and no response in group III. CONCLUSION Candida antigen immunotherapy is superior to photodynamic therapy in plane warts treatment with absence of recurrence and comparable side effects in both groups.
Collapse
Affiliation(s)
- A Nassar
- Dermatology, Venereology and Andrology Department, Faculty of Medicine, Zagazig University, 44519, Egypt.
| | - M Mostafa
- Dermatology, Venereology and Andrology Department, Faculty of Medicine, Zagazig University, 44519, Egypt.
| | - S A Khashaba
- Dermatology, Venereology and Andrology Department, Faculty of Medicine, Zagazig University, 44519, Egypt.
| |
Collapse
|
34
|
Croizat G, Gregor A, Gerelli E, Joniova J, Scholz M, Wagnières G. A general framework for non-exponential delayed fluorescence and phosphorescence decay analysis, illustrated on Protoporphyrin IX. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2020; 209:111887. [DOI: 10.1016/j.jphotobiol.2020.111887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 04/14/2020] [Accepted: 04/26/2020] [Indexed: 02/03/2023]
|
35
|
Batchelor J. Clinical trials in the
BJD
: reviewing the last decade and looking to the future. Br J Dermatol 2020; 183:195-196. [DOI: 10.1111/bjd.19142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- J.M. Batchelor
- King's College Hospital NHS Foundation Trust Beckenham Beacon, 379 Croydon Road Beckenham BR3 3QL UK
- Centre of Evidence Based Dermatology University of Nottingham Lenton Lane Nottingham NG7 2NR UK
| |
Collapse
|
36
|
Imaging of hypoxia, oxygen consumption and recovery in vivo during ALA-photodynamic therapy using delayed fluorescence of Protoporphyrin IX. Photodiagnosis Photodyn Ther 2020; 30:101790. [DOI: 10.1016/j.pdpdt.2020.101790] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/19/2020] [Accepted: 04/20/2020] [Indexed: 01/17/2023]
|
37
|
Misiak-Galazka M, Zozula J, Rudnicka L. Palmoplantar Pustulosis: Recent Advances in Etiopathogenesis and Emerging Treatments. Am J Clin Dermatol 2020; 21:355-370. [PMID: 32008176 PMCID: PMC7275027 DOI: 10.1007/s40257-020-00503-5] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Palmoplantar pustulosis (PPP) is a chronic, recurrent skin disease belonging to the spectrum of psoriasis. It is characterized by an eruption of sterile pustules on the palms and soles. Recent studies in PPP have focused on genetic differences between pustular phenotypes and the role of the innate immunological system and the microbiome in the etiopathogenesis of the disease. Mutations in IL36RN (a major predisposing factor for generalized pustular psoriasis) were found in selected patients with PPP and were associated with earlier disease onset. Studies have shown that the interleukin (IL)-17 and IL-36 pathways might be involved in the pathogenesis of PPP. A microbiome has been demonstrated in the vesicopustules of PPP, and an abundance of Staphylococcus appears to be increased by smoking. Improved understanding of the underlying etiopathogenesis of PPP has led to advances in treatment options, and targeted therapies for PPP have been evaluated or are under evaluation against more than 12 molecules in ongoing clinical trials. These targets include CXCR2 (IL-8 receptor type B), granulocyte colony-stimulating factor receptor, IL-1 receptor, IL-8, IL-12, IL-23, IL-17A, IL-17 receptor, IL-36 receptor, phosphodiesterase-4, and tumor necrosis factor-α.
Collapse
Affiliation(s)
| | - Joanna Zozula
- Department of Dermatology, Medical University of Warsaw, Koszykowa 82A, 02-008, Warsaw, Poland
| | - Lidia Rudnicka
- Department of Dermatology, Medical University of Warsaw, Koszykowa 82A, 02-008, Warsaw, Poland.
| |
Collapse
|
38
|
Morton CA, Szeimies RM, Basset-Seguin N, Calzavara-Pinton P, 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 1: treatment delivery and established indications - actinic keratoses, Bowen's disease and basal cell carcinomas. J Eur Acad Dermatol Venereol 2020; 33:2225-2238. [PMID: 31779042 DOI: 10.1111/jdv.16017] [Citation(s) in RCA: 105] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 10/04/2019] [Indexed: 12/29/2022]
Abstract
Topical photodynamic therapy (PDT) is a widely approved therapy for actinic keratoses, Bowen's disease (squamous cell carcinoma in situ), superficial and certain thin basal cell carcinomas. Recurrence rates when standard treatment protocols are used are typically equivalent to existing therapies, although inferior to surgery for nodular basal cell carcinoma. PDT can be used both as lesional and field therapies and has the potential to delay/reduce the development of new lesions. A protocol using daylight to treat actinic keratoses is widely practised, with conventional PDT using a red light after typically a 3-h period of occlusion employed for other superficial skin cancer indications as well as for actinic keratoses when daylight therapy is not feasible. PDT is a well-tolerated therapy although discomfort associated with conventional protocol may require pain-reduction measures. PDT using daylight is associated with no or minimal pain and preferred by patient. There is an emerging literature on enhancing conventional PDT protocols or combined PDT with another treatment to increase response rates. This guideline, published over two parts, considers all current approved and emerging indications for the use of topical PDT in dermatology, prepared by the PDT subgroup of the European Dermatology Forum guidelines committee. It presents consensual expert recommendations reflecting current published evidence.
Collapse
Affiliation(s)
- C A Morton
- Department of Dermatology, Stirling Community Hospital, Stirling, UK
| | - R-M Szeimies
- Department of Dermatology, University Hospital Regensburg, Regensburg, Germany.,Department of Dermatology & Allergology, Klinikum Vest GmbH, Recklinghausen, Germany
| | - N Basset-Seguin
- 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, Zurich University Hospital, Zürich, Switzerland
| | - R E Hunger
- Department of Dermatology Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - S Karrer
- Department of Dermatology, University Hospital Regensburg, Regensburg, Germany
| | - S Piaserico
- Unit of Dermatology, Department of Medicine, University of Padova, Padova, Italy
| | - C Ulrich
- Skin Cancer Centre, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - A-M Wennberg
- Department of Dermatology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | |
Collapse
|
39
|
Shi L, Liu P, Liu J, Yang Y, Chen Q, Zhang Y, Zhang H, Wang X. Application of 5‐aminolevulinic acid‐photodynamic therapy in common skin diseases. TRANSLATIONAL BIOPHOTONICS 2020. [DOI: 10.1002/tbio.201900028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Lei Shi
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine Shanghai China
| | - Pei Liu
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine Shanghai China
| | - Jia Liu
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine Shanghai China
| | - Yuling Yang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine Shanghai China
| | - Qi Chen
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine Shanghai China
| | - Yunfeng Zhang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine Shanghai China
| | - Haiyan Zhang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine Shanghai China
| | - Xiuli Wang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine Shanghai China
| |
Collapse
|
40
|
Gnerucci A, Faraoni P, Calusi S, Fusi F, Romano G. Influence of stomach mucosa tissue on the efficacy of intragastric antibacterial PDT. Photochem Photobiol Sci 2020; 19:34-39. [PMID: 31799583 DOI: 10.1039/c9pp00315k] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
In the field of photodynamic therapy (PDT), optimization of the in vivo therapeutic efficacy needs a comprehensive study of the photo-killing action spectrum that depends on both the photosensitizer (PS) absorption and the tissue optical properties. This is especially true in the case of gastric infections by Helicobacter pylori: PS absorption has been largely investigated in vitro, while the contribution of tissue optical properties and illumination geometry has been poorly studied, despite being parameters that reflect the specific in vivo conditions. To investigate their influence, we focussed on the case of a point-like light source positioned in the antrum. This models a therapeutic device developed by our team which consists of a LED-based ingestible pill. By a simple 3D illumination model, our approach mediates light-tissue interaction over the illuminated stomach wall surface, then calculates its average transmittance T by means of a 1D model representative of the mean gastric mucosa structure. Finally, by merging T(λ) with the photosensitizers' absorption we obtained the in vivo action spectrum. This shows two peaks at about 500 and 630 nm, indicating a noticeable influence of the tissue with respect to in vitro studies, where the action spectrum reflects PS absorption only. Our approach defines one average action spectrum for this specific therapeutic context, which reflects the need to choose one emission spectrum for the light source used. The proposed methodology could be applied to any other illumination geometry of cave organs, provided appropriate model modifications for the light source and tissue characteristics are made.
Collapse
Affiliation(s)
- A Gnerucci
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, viale Pieraccini 6, Florence, I-50139, Italy
| | - P Faraoni
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, viale Pieraccini 6, Florence, I-50139, Italy
| | - S Calusi
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, viale Pieraccini 6, Florence, I-50139, Italy
| | - F Fusi
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, viale Pieraccini 6, Florence, I-50139, Italy.
| | - G Romano
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, viale Pieraccini 6, Florence, I-50139, Italy
| |
Collapse
|
41
|
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.
Collapse
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
| | | |
Collapse
|
42
|
Yao Y, Shen X, Shi L, Tang G, Wu L. The combination of photodynamic therapy and fractional CO 2 laser for oral leukoplakia: Case series. Photodiagnosis Photodyn Ther 2019; 29:101597. [PMID: 31707101 DOI: 10.1016/j.pdpdt.2019.101597] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 10/21/2019] [Accepted: 11/04/2019] [Indexed: 02/04/2023]
Abstract
Oral leukoplakia (OL), a predominantly white change to the oral mucosa, is the most common potentially malignant lesion. Elimination of this condition, especially high risk OL, is advisable, even necessary as an attempt to avoid malignant transformation. Here we present three cases of OL successfully treated by ALA photodynamic therapy (PDT) following pretreatment with CO2 laser. After a series of one to three sessions the patients were monitored for 12 months. All lesions showed remission, but one recurred during follow-up. Side effects included mild edema, erosion and burning sensation. No severe side effects were observed. In summary, the combination of PDT and CO2 laser is safe and effective in the treatment of OL.
Collapse
Affiliation(s)
- Yilin Yao
- Department of Oral Mucosal Diseases, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China; National Clinical Research Center for Oral Diseases, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Xuemin Shen
- Department of Oral Mucosal Diseases, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China; National Clinical Research Center for Oral Diseases, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Linjun Shi
- Department of Oral Mucosal Diseases, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China; National Clinical Research Center for Oral Diseases, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Guoyao Tang
- Department of Oral Mucosal Diseases, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China; National Clinical Research Center for Oral Diseases, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Lan Wu
- Department of Oral Mucosal Diseases, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China; National Clinical Research Center for Oral Diseases, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China.
| |
Collapse
|
43
|
Morton CA. Come in from the cold - laser fabric photodynamic therapy offers an alternative to seasonal daylight therapy. Br J Dermatol 2019; 180:703-704. [PMID: 30933328 DOI: 10.1111/bjd.17618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- C A Morton
- Department of Dermatology, Stirling Community Hospital, Stirling, FK8 2AU, Scotland, U.K
| |
Collapse
|
44
|
Ibbotson S, Wong T, Morton C, Collier N, Haylett A, McKenna K, Mallipeddi R, Moseley H, Rhodes L, Seukeran D, Ward K, Mohd Mustapa M, Exton L. Adverse effects of topical photodynamic therapy: a consensus review and approach to management. Br J Dermatol 2018; 180:715-729. [DOI: 10.1111/bjd.17131] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2018] [Indexed: 12/21/2022]
Affiliation(s)
- S.H. Ibbotson
- Photobiology Unit Department of Dermatology University of Dundee Ninewells Hospital and Medical School Dundee U.K
| | - T.H. Wong
- Stirling Community Hospital StirlingU.K
| | | | - N.J. Collier
- Photobiology Unit Dermatology Centre University of Manchester and Salford Royal NHS Foundation Trust ManchesterU.K
| | - A. Haylett
- Photobiology Unit Dermatology Centre University of Manchester and Salford Royal NHS Foundation Trust ManchesterU.K
| | - K.E. McKenna
- Department of Dermatology Belfast City Hospital BelfastU.K
| | - R. Mallipeddi
- St John's Institute of Dermatology Guy's and St Thomas’ NHS Foundation Trust London U.K
| | - H. Moseley
- Photobiology Unit Department of Dermatology University of Dundee Ninewells Hospital and Medical School Dundee U.K
| | - L.E. Rhodes
- Photobiology Unit Dermatology Centre University of Manchester and Salford Royal NHS Foundation Trust ManchesterU.K
| | | | | | | | - L.S. Exton
- British Association of Dermatologists London U.K
| |
Collapse
|