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Makuch S, Dróżdż M, Makarec A, Ziółkowski P, Woźniak M. An Update on Photodynamic Therapy of Psoriasis—Current Strategies and Nanotechnology as a Future Perspective. Int J Mol Sci 2022; 23:ijms23179845. [PMID: 36077239 PMCID: PMC9456335 DOI: 10.3390/ijms23179845] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/24/2022] [Accepted: 08/25/2022] [Indexed: 11/16/2022] Open
Abstract
Psoriasis (PS) is an immune-mediated skin disease with substantial negative effects on patient quality of life. Despite significant progress in the development of novel treatment options over the past few decades, a high percentage of patients with psoriasis remain undertreated and require new medications with superior long-term efficacy and safety. One of the most promising treatment options against psoriatic lesions is a form of phototherapy known as photodynamic therapy (PDT), which involves either the systemic or local application of a cell-targeting photosensitizing compound, followed by selective illumination of the lesion with visible light. However, the effectiveness of clinically incorporated photosensitizers in psoriasis treatment is limited, and adverse effects such as pain or burning sensations are frequently reported. In this study, we performed a literature review and attempted to provide a pooled estimate of the efficacy and short-term safety of targeted PDT in the treatment of psoriasis. Despite some encouraging results, PDT remains clinically underutilized. This highlights the need for further studies that will aim to evaluate the efficacy of a wider spectrum of photosensitizers and the potential of nanotechnology in psoriasis treatment.
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Affiliation(s)
- Sebastian Makuch
- Department of Clinical and Experimental Pathology, Wroclaw Medical University, 50-368 Wroclaw, Poland
- Correspondence:
| | - Mateusz Dróżdż
- Laboratory of RNA Biochemistry, Institute of Chemistry and Biochemistry, Freie Universität Berlin, Takustraße 6, 14195 Berlin, Germany
| | - Alicja Makarec
- Faculty of Biotechnology, University of Wroclaw, 50-383 Wroclaw, Poland
| | - Piotr Ziółkowski
- Department of Clinical and Experimental Pathology, Wroclaw Medical University, 50-368 Wroclaw, Poland
| | - Marta Woźniak
- Department of Clinical and Experimental Pathology, Wroclaw Medical University, 50-368 Wroclaw, Poland
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2
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Efendiev KT, Alekseeva PM, Shiryaev AA, Skobeltsin AS, Solonina IL, Fatyanova AS, Reshetov IV, Loschenov VB. Preliminary low-dose photodynamic exposure to the skin cancer with chlorin e6 photosensitizer. Photodiagnosis Photodyn Ther 2022; 38:102894. [PMID: 35490962 DOI: 10.1016/j.pdpdt.2022.102894] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND The study was aimed to investigate the chlorin e6 photosensitizer distribution in the tumor and tumor border (5 mm) during low-dose photodynamic treatment and to increase the effectiveness of the therapy for skin neoplasms. METHODS Sensitized boundaries of neoplasms were evaluated by video fluorescence imaging. The study of changes in the chlorin e6 distribution before/after photodynamic therapy and in the process of low-dose photodynamic exposure was carried out by the method of spectral fluorescence diagnostics. RESULTS All 19 patients with basal-cell skin cancer had a contrast of chlorin e6 accumulation compared to normal tissues. 3 hours after intravenous administration of the photosensitizer at a dose of 1 mg/kg, the chlorin e6 concentration was: in normal tissues - 0.18 mg/kg, in the tumor - 1.26 mg/kg, in the tumor border - 0.63 mg/kg. In most cases, the fluorescence indices of chlorin e6 in tumor tissues after low-dose photodynamic therapy increased and exceeded the values before light exposure. CONCLUSION Low-dose photodynamic therapy seems to be the optimal method for treating neoplasms, which does not cause severe pain in patients during the light exposure and allows locally increasing of the photosensitizer concentration in tumor tissues. This method of photodynamic therapy can improve the effectiveness of thе treatment.
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Affiliation(s)
- K T Efendiev
- Prokhorov General Physics Institute of the Russian Academy of Sciences, 119991 Moscow, Russia; National Research Nuclear University "MEPhI", 115409 Moscow, Russia.
| | - P M Alekseeva
- Prokhorov General Physics Institute of the Russian Academy of Sciences, 119991 Moscow, Russia; National Research Nuclear University "MEPhI", 115409 Moscow, Russia
| | - A A Shiryaev
- University Clinical Hospital No. 1, Levshin Institute of Cluster Oncology, Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation, 119435 Moscow, Russia
| | - A S Skobeltsin
- Prokhorov General Physics Institute of the Russian Academy of Sciences, 119991 Moscow, Russia; National Research Nuclear University "MEPhI", 115409 Moscow, Russia
| | - I L Solonina
- University Clinical Hospital No. 1, Levshin Institute of Cluster Oncology, Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation, 119435 Moscow, Russia
| | - A S Fatyanova
- University Clinical Hospital No. 1, Levshin Institute of Cluster Oncology, Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation, 119435 Moscow, Russia
| | - I V Reshetov
- University Clinical Hospital No. 1, Levshin Institute of Cluster Oncology, Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation, 119435 Moscow, Russia
| | - V B Loschenov
- Prokhorov General Physics Institute of the Russian Academy of Sciences, 119991 Moscow, Russia; National Research Nuclear University "MEPhI", 115409 Moscow, Russia
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Monfrecola G, Megna M, Rovati C, Arisi M, Rossi M, Calzavara-Pinton I, Fabbrocini G, Calzavara-Pinton P. A Critical Reappraisal of Off-Label Use of Photodynamic Therapy for the Treatment of Non-Neoplastic Skin Conditions. Dermatology 2020; 237:262-276. [PMID: 32554971 DOI: 10.1159/000507926] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 04/16/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In the past 30 years, topical photodynamic therapy (PDT) has been investigated for the treatment of a broad spectrum of cosmetic, inflammatory, and infectious skin conditions with variable, and often contrasting, results. However, the non-expert clinician may be in difficulty evaluating these results because different sensitizers, concentrations, formulations, light sources, and irradiation protocols have been used. In addition, many of these studies have poor quality design being case reports and uncontrolled studies of few cases. SUMMARY With the aim to clarify the potential usefulness of PDT for the treatment of infectious and inflammatory skin diseases as well as selected cosmetic indications, we searched for randomized controlled clinical trials, non-randomized comparative studies, retrospective studies, and case series studies with a number of at least 10 patients, published since 1990. Later, we reappraised the results in order to give a simple critical overview. Key Messages: Evidence from the literature seems to strongly support the use of ALA- and MAL-PDT for the treatment of common skin diseases such as acne, warts, condylomata, and Leishmania skin infection and for photorejuvenation, i.e., the correction of selected cosmetic changes of aging and photoaging. For other disorders, the level of evidence and strength of recommendation are lower, and controlled randomized studies with prolonged follow-ups are necessary in order to assess the clinical usefulness and other potential advantages over current treatment options.
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Affiliation(s)
- Giuseppe Monfrecola
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Matteo Megna
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Chiara Rovati
- Dermatology Department, University of Brescia, Brescia, Italy
| | | | | | | | - Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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4
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Lavaee F, Amanati A, Ramzi M, Naseri S, Shakiba Sefat H. Evaluation of the effect of photodynamic therapy on chemotherapy induced oral mucositis. Photodiagnosis Photodyn Ther 2020; 30:101653. [PMID: 31923632 DOI: 10.1016/j.pdpdt.2020.101653] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 12/27/2019] [Accepted: 01/06/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND In this study the effect of photodynamic therapy on chemotherapy induced mucositis was evaluated. METHODS This randomized single blind clinical pilot evaluation evaluated the effect of PDT with methylene blue on 15 patients with chemotherapy induced bilateral oral mucositis. They were divided into 2 groups (control side and intervention side). Methylene blue was applied on the lesions of both sides, after 10 min the lesion of intervention side was irradiated by a 660 nm diode laser InGaAlP(Azor-2 K) for 10 min (power: 25 mW, dose:19.23 J/CM2, probe diameter: 0.78 cm2) for three sessions (day1,3,5) and followed on day 12. In control side only sham laser was used. Data were analyzed by Wilcoxon and Mann-Whitney test using SPSS version 22. RESULTS Comparing the WCCNR and NCI difference in different sessions between intervention and control group, represented significant improvement in oral mucositis in photodynamic therapy group for sessions 1-0, 2-0, 3-0 (P.value<0.05). CONCLUSION Photodynamic therapy can improve chemotherapy induced oral mucositis.
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Affiliation(s)
- Fatemeh Lavaee
- Oral and Dental Disease Research Center, Assistant Professor of Oral and Maxillofacial Disease Department, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Ali Amanati
- Professor Alborzi Clinical Microbiology Research Center, Shiraz, Iran.
| | - Mani Ramzi
- Hematology Research Center, Department of Hematology, Oncology, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Setareh Naseri
- School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran.
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5
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De Annunzio SR, Costa NCS, Mezzina RD, Graminha MAS, Fontana CR. Chlorin, Phthalocyanine, and Porphyrin Types Derivatives in Phototreatment of Cutaneous Manifestations: A Review. Int J Mol Sci 2019; 20:ijms20163861. [PMID: 31398812 PMCID: PMC6719085 DOI: 10.3390/ijms20163861] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 06/13/2019] [Accepted: 06/18/2019] [Indexed: 12/13/2022] Open
Abstract
Recent scientific research has shown the use of chlorin, phthalocyanines, and porphyrins derivatives as photosensitizers in photodynamic therapy in the treatment of various pathologies, including some of the major skin diseases. Thus, the main goal of this critical review is to catalog the papers that used these photosensitizers in the treatment of acne vulgaris, psoriasis, papillomavirus infections, cutaneous leishmaniasis, and skin rejuvenation, and to explore the photodynamic therapy mechanisms against these conditions alongside their clinical benefits.
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Affiliation(s)
- Sarah Raquel De Annunzio
- School of Pharmaceutical Sciences, São Paulo State University (Unesp), Araraquara, Rod. Araraquara-Jaú, km 01, Campus Ville, Araraquara 14800-903, São Paulo, Brazil
| | - Natalia Caroline Silva Costa
- School of Pharmaceutical Sciences, São Paulo State University (Unesp), Araraquara, Rod. Araraquara-Jaú, km 01, Campus Ville, Araraquara 14800-903, São Paulo, Brazil
| | - Rafaela Dalbello Mezzina
- School of Pharmaceutical Sciences, São Paulo State University (Unesp), Araraquara, Rod. Araraquara-Jaú, km 01, Campus Ville, Araraquara 14800-903, São Paulo, Brazil
| | - Márcia A S Graminha
- School of Pharmaceutical Sciences, São Paulo State University (Unesp), Araraquara, Rod. Araraquara-Jaú, km 01, Campus Ville, Araraquara 14800-903, São Paulo, Brazil
| | - Carla Raquel Fontana
- School of Pharmaceutical Sciences, São Paulo State University (Unesp), Araraquara, Rod. Araraquara-Jaú, km 01, Campus Ville, Araraquara 14800-903, São Paulo, Brazil.
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Nguyen K, Khachemoune A. An update on topical photodynamic therapy for clinical dermatologists. J DERMATOL TREAT 2019; 30:732-744. [DOI: 10.1080/09546634.2019.1569752] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Khoa Nguyen
- College of Medicine, University of Central Florida, Orlando, FL, USA
| | - Amor Khachemoune
- Veterans Affairs Medical Center, Brooklyn, NY, USA
- Department of Dermatology, SUNY Downstate, Brooklyn, NY, USA
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7
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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
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8
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Wang B, Shi L, Zhang Y, Zhou Q, Zheng J, Szeimies R, Wang X. Gain with no pain? Pain management in dermatological photodynamic therapy. Br J Dermatol 2017; 177:656-665. [PMID: 28122416 DOI: 10.1111/bjd.15344] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2016] [Indexed: 12/30/2022]
Affiliation(s)
- B. Wang
- Department of Dermatology Ruijin Hospital School of Medicine Shanghai Jiaotong University Shanghai China
| | - L. Shi
- Institute of Photomedicine Shanghai Skin Disease Hospital Tongji University School of Medicine 1278 Baode Road Shanghai 200443 China
| | - Y.F. Zhang
- Institute of Photomedicine Shanghai Skin Disease Hospital Tongji University School of Medicine 1278 Baode Road Shanghai 200443 China
| | - Q. Zhou
- Institute of Photomedicine Shanghai Skin Disease Hospital Tongji University School of Medicine 1278 Baode Road Shanghai 200443 China
| | - J. Zheng
- Department of Dermatology Ruijin Hospital School of Medicine Shanghai Jiaotong University Shanghai China
| | - R.M. Szeimies
- Department of Dermatology and Allergology Vest Clinic Recklinghausen Germany
| | - X.L. Wang
- Institute of Photomedicine Shanghai Skin Disease Hospital Tongji University School of Medicine 1278 Baode Road Shanghai 200443 China
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9
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Slomp AM, Barreira SM, Carrenho LZ, Vandresen CC, Zattoni IF, Ló SM, Dallagnol JC, Ducatti DR, Orsato A, Duarte MER, Noseda MD, Otuki MF, Gonçalves AG. Photodynamic effect of meso -(aryl)porphyrins and meso -(1-methyl-4-pyridinium)porphyrins on HaCaT keratinocytes. Bioorg Med Chem Lett 2017; 27:156-161. [DOI: 10.1016/j.bmcl.2016.11.094] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 11/29/2016] [Accepted: 11/30/2016] [Indexed: 01/19/2023]
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10
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The potential of photodynamic therapy (PDT)-Experimental investigations and clinical use. Biomed Pharmacother 2016; 83:912-929. [PMID: 27522005 DOI: 10.1016/j.biopha.2016.07.058] [Citation(s) in RCA: 123] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 07/30/2016] [Accepted: 07/31/2016] [Indexed: 12/13/2022] Open
Abstract
Photodynamic therapy (PDT) is an intensively studied part of medicine based on free radicals. These reactive species, extremely harmful for whole human organism, are used for eradication numerous diseases. Specific structure of ill tissues causes accumulation free radicals inside them without attack remaining healthy tissues. A rapid development of medicine and scientific research has led to extension of PDT towards treatment many diseases such as cancer, herpes, acne and based on antimicrobials. The presented review article is focused on the aforementioned disorders with accurate analysis of the newest available scientific achievements. The discussed cases explicitly indicate on high efficacy of the therapy. In most cases, free radicals turned out to be solution of many afflictions. Photodynamic therapy can be considered as promising treatment with comparable effectiveness but without side effects characteristic for chemotherapy.
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11
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Nissen CV, Wiegell SR, Philipsen PA, Wulf HC. Short-term chemical pretreatment cannot replace curettage in photodynamic therapy. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2016; 32:146-52. [DOI: 10.1111/phpp.12236] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/07/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Christoffer V. Nissen
- Department of Dermatology; Bispebjerg Hospital; University of Copenhagen; Copenhagen NV Denmark
| | - Stine Regin Wiegell
- Department of Dermatology; Bispebjerg Hospital; University of Copenhagen; Copenhagen NV Denmark
| | - Peter Alshede Philipsen
- Department of Dermatology; Bispebjerg Hospital; University of Copenhagen; Copenhagen NV Denmark
| | - Hans Christian Wulf
- Department of Dermatology; Bispebjerg Hospital; University of Copenhagen; Copenhagen NV Denmark
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12
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Mahajan VK. Psoriasis treatment: Unconventional and non-standard modalities in the era of biologics. World J Dermatol 2016; 5:17-51. [DOI: 10.5314/wjd.v5.i1.17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 10/25/2015] [Accepted: 12/18/2015] [Indexed: 02/06/2023] Open
Abstract
Psoriasis is a potentially debilitating inflammatory dermatosis affecting 0.2%-4.8% of the population worldwide causing a significant occupational, personal or psychosocial morbidity to these patients for life. The basic aim of psoriasis therapy is to control the disease to maximum possible extent and improve the patient’s quality of life. Management of triggers for flare-ups, lifestyle modifications, and dietary supplements are often recommended. Intermittent or rotational therapy with frequent alterations in treatment options is usually needed to reduce toxicity of anti-psoriatic drugs in the absence of safer alternatives. Currently, several biological agents categorized as either T-cell targeted (e.g., Alefacept, Efalizumab) or cytokine modulating (e.g., Adalimumab, Infliximab, Etanercept) are available for treating severe psoriasis. However, their high cost is often precluding for most patients. The usefulness of systemic (methotrexate, cyclosporine, acitretin or several other therapeutic agents) or topical (tar, anthralin, corticosteroids or calcipotriol ointments, phototherapy with or without psoralens) therapies has been well established for the management of psoriasis. The literature is also replete with benefits of less used non-standard and unconventional treatment modalities (hydroxycarbamide, azathioprine, leflunomide, mycophenolate mofetil, isotretinoin, fumarates, topical calcineurin inhibitors, peroxisome proliferator-activated receptors agonists, statins, sulfasalazine, pentoxifylline, colchicine, grenz ray therapy, excimer laser, climatotherapy and balneophototherapy, peritoneal dialysis, tonsillectomy, ichthyotherapy, etc.). These can be used alternatively to treat psoriasis patients who have mild/minimal lesions, are intolerant to conventional drugs, have developed side effects or achieved recommended cumulative dose, where comorbidities pose unusual therapeutic challenges, or may be as intermittent, rotational or combination treatment alternatives.
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13
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de Souza TD, Ziembowicz FI, Müller DF, Lauermann SC, Kloster CL, Santos RCV, Lopes LQS, Ourique AF, Machado G, Villetti MA. Evaluation of photodynamic activity, photostability and in vitro drug release of zinc phthalocyanine-loaded nanocapsules. Eur J Pharm Sci 2016; 83:88-98. [DOI: 10.1016/j.ejps.2015.12.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 11/25/2015] [Accepted: 12/04/2015] [Indexed: 01/09/2023]
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Kim TI, Jeong KH, Shin MK. Verrucous epidermal nevus (VEN) successfully treated with indocyanine green (ICG) photodynamic therapy (PDT). JAAD Case Rep 2015; 1:312-4. [PMID: 27051764 PMCID: PMC4809274 DOI: 10.1016/j.jdcr.2015.07.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Tae In Kim
- Department of Dermatology, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Ki Heon Jeong
- Department of Dermatology, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Min Kyung Shin
- Department of Dermatology, School of Medicine, Kyung Hee University, Seoul, Korea
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Abstract
INTRODUCTION Photodynamic therapy for psoriasis showed promise in the early 1990s with reports of plaque clearance following topical aminolevulinic acid - photodynamic therapy (ALA-PDT). METHODS In December 2013, we conducted a systematic search of the PubMed Medline database using the keywords "psoriasis" and "photodynamic therapy". RESULTS Numerous clinical studies have failed to demonstrate a consistent, efficacious response to topical ALA-PDT. Furthermore, severe pain and burning sensations were repeatedly reported, many cases being intolerable for patients. DISCUSSION The variability in clinical response and the painful side effects have made topical ALA-PDT an unsuitable treatment option for chronic plaque psoriasis. Nonetheless, early clinical studies of other modalities such as topical hypericin and methylene blue, as well as systemic ALA and verteporfin, have shown that these photosensitizers are efficacious and much better tolerated than topical ALA. CONCLUSION With the current landscape of phototherapy dominated by psoralen combined with ultraviolet A (PUVA) and narrow-band ultraviolet B (NB-UVB), an alternative light therapy utilizing the visible spectrum is certainly promising and a worthwhile endeavor to pursue.
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Affiliation(s)
- Young M Choi
- David Geffen School of Medicine , UCLA, Los Angeles, CA , USA and
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16
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Yang MF, Baron ED. Update on the immunology of UV and visible radiation therapy: phototherapy, photochemotherapy and photodynamic therapy. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/17469872.3.1.85] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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17
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Almutawa F, Thalib L, Hekman D, Sun Q, Hamzavi I, Lim HW. Efficacy of localized phototherapy and photodynamic therapy for psoriasis: a systematic review and meta-analysis. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2013; 31:5-14. [DOI: 10.1111/phpp.12092] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/21/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Fahad Almutawa
- Department of Medicine, Faculty of Medicine; Kuwait University; Al-jabriya Kuwait
| | - Lukman Thalib
- Department of Community Medicine (Biostatistics); Faculty of Medicine; Kuwait University; Al-jabriya Kuwait
| | - Daniel Hekman
- Grand Rapids Medical Education Partners; Grand Rapids MI USA
| | - Qing Sun
- Department of Dermatology; Qilu Hospital of Shandong University; Jinan China
| | - Iltefat Hamzavi
- Department of Dermatology; Henry Ford Hospital; Detroit MI USA
| | - Henry W. Lim
- Department of Dermatology; Henry Ford Hospital; Detroit MI USA
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18
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Barge J, Glanzmann T, Zellweger M, Salomon D, van den Bergh H, Wagnières G. Correlations between photoactivable porphyrins' fluorescence, erythema and the pain induced by PDT on normal skin using ALA-derivatives. Photodiagnosis Photodyn Ther 2013; 10:683-93. [PMID: 24284128 DOI: 10.1016/j.pdpdt.2013.08.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 08/21/2013] [Accepted: 08/23/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Photodynamic therapy (PDT) with precursors of photoactivable porphyrins is a well-established treatment modality for skin pathologies as well as hair removal. Pain is a major side effect thereof, and it affects the treatment compliance and acceptance. METHODS Five male subjects underwent a PDT procedure on normal skin, either with a diode laser (635 nm) or a lamp (405 nm), 3 or 6h after application of various precursors of photoactivable porphyrins (ALA 1M; Metvix(®) 1M; ALA-DGME 1M; ALA-DGME 3.66 M). Light doses ranged from 30 to 150 J/cm(2) and irradiances were 100 or 180 mW/cm(2). Fluorescence measurements were performed just before PDT, pain was quantified during PDT, and erythema was determined 24h afterwards. RESULTS Because precursor ALA-DGME was very selective for the pilosebaceous apparatus vs. the epidermis, we solely carried out the PDTs using this precursor. In the absence of light, no pain was reported. An increase in pain was observed when increasing the irradiance. A correlation was observed between the follicular fluorescence and the maximal pain score during PDT. A correlation was observed between follicular fluorescence and skin erythema, and between pain score and skin erythema. CONCLUSIONS With our well-controlled PDT parameters and homogenous subjects' conditions, we showed that pain could be reduced by reducing irradiance during PDT procedures. With the various correlations observed, we conclude that both pain and PaP fluorescence are useful tools to predict the post-PDT tissue effects (side effects and outcome). We suggest that A∂ nerve fibres would be the best candidate as first generators of PDT-induced pain.
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Affiliation(s)
- Jérôme Barge
- Photoderma SA, Ch. du Raffort 6, 1055 Froideville, Switzerland.
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Calzavara-Pinton PG, Rossi MT, Aronson E, Sala R. A retrospective analysis of real-life practice of off-label photodynamic therapy using methyl aminolevulinate (MAL-PDT) in 20 Italian dermatology departments. Part 1: inflammatory and aesthetic indications. Photochem Photobiol Sci 2013; 12:148-57. [PMID: 22949035 DOI: 10.1039/c2pp25124h] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Experimental investigations have demonstrated that photodynamic therapy (PDT) with methyl aminolevulinate (MAL) may be a useful treatment in several inflammatory skin disorders and aesthetic indications. To assess the effectiveness, tolerability and safety of off-label MAL-PDT in daily clinical practice in 20 Italian hospital centers, a retrospective observational study of medical records of patients treated for off-label inflammatory and aesthetic indications was carried out. In all patients standard treatment options had been either ineffective, unacceptably toxic, or medically contraindicated. Clinical data regarding 221 patients affected by 22 different diseases were collected. The most common off-label indication was acne vulgaris, with >75% improvement in 72.8% of patients. Other disorders of the sebaceous gland, i.e. acne rosacea, hidradenitis suppurativa and sebaceous hyperplasia, were less responsive. Alopecia areata did not show any improvement. Granuloma annulare and necrobiosis lipoidica showed marked or moderate response in the majority of treated patients. The rate of patients with complete remission was lower for inflammatory skin disorders with hyperkeratosis, i.e. psoriasis (6/17) and porokeratosis (3/16). The efficacy for lichenoid dermatoses was dependent on the clinical variant (erosive and scleroatrophic were more responsive than hypertrophic). Only 1 of 6 patients with Zoon balanitis had a marked improvement. MAL-PDT of venous leg ulcers, photo-aging and hypertrophic scars led to a marked remission in 3/5, 3/6 and 5/8 patients, respectively. The treatment had to be interrupted because of strong pain and burning in 24 patients. Long term adverse events were not registered. Most patients with marked improvement had lasting remission with overall excellent cosmetic outcomes. The present findings demonstrate a high interest in off-label uses of MAL-PDT for inflammatory skin disorders. According to the observed clinical responses, safety, and favorable cosmetic results, MAL-PDT seems to have a potential therapeutic role for the treatment of granulomatous dermal disorders and follicular inflammatory diseases whereas results in other conditions are less encouraging.
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Zeitouni NC, Paquette AD, Housel JP, Shi Y, Wilding GE, Foster TH, Henderson BW. A retrospective review of pain control by a two-step irradiance schedule during topical ALA-photodynamic therapy of non-melanoma skin cancer. Lasers Surg Med 2013; 45:89-94. [PMID: 23390058 DOI: 10.1002/lsm.22118] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2013] [Indexed: 11/12/2022]
Abstract
BACKGROUND AND OBJECTIVE Photodynamic therapy (PDT) with topical δ-aminolevulinic acid (ALA) of non-melanoma skin cancers is often associated with treatment-limiting pain. A previous study on basal cell carcinomas (BCCs) at Roswell Park Cancer Institute evaluated a two-step irradiance scheme as a means of minimizing pain, preserving outcomes, and limiting treatment time. We used an initial low irradiance until 90% of the protoporphyrin IX was photobleached, followed by a high irradiance interval until the prescribed fluence was delivered. Success of this pilot investigation motivated integration of the protocol into routine practice. Here, we present a retrospective review of recent clinical experience in a broad patient population. STUDY DESIGN/MATERIALS AND METHODS This was a retrospective review of an existing dermatology database. Fourteen caucasion patients-nine men and five women, ages 18-80, with a total of 51 superficial and 73 nodular BCCs, and three Bowen's disease lesions-were included. ALA was applied to each lesion for approximately 4 hours. Lesions received an initial irradiance of 30-50 mW/cm(2) for 20 J/cm(2) , followed by 150 mW/cm(2) for a total fluence of 200-300 J/cm(2) . Pain was assessed using a visual analog scale (VAS). Clinical outcome was determined at 6-12 months. RESULTS Median VAS scores were 1.0 for both irradiances. Five of 127 lesions required pain control with 1% xylocaine. Pain was strongly influenced by lesion location but not by lesion type, number, or size. Complete responses were achieved in 84.1% of BCCs, which compares favorably with reported results for single ALA-PDT treatments. Two of three Bowen's disease lesions showed a complete response. Complete responses for nodular BCCs were 37%, which are also within the range of reported outcomes. CONCLUSIONS A two-step irradiance protocol in ALA-PDT effectively minimizes pain, maintains excellent clinical outcomes in superficial lesions, and adds minimal treatment time.
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Affiliation(s)
- Nathalie C Zeitouni
- Department of Dermatology, Roswell Park Cancer Institute, Buffalo, NY 14263, USA.
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21
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Morton C, Szeimies RM, Sidoroff A, Braathen L. European guidelines for topical photodynamic therapy part 2: emerging indications - field cancerization, photorejuvenation and inflammatory/infective dermatoses. J Eur Acad Dermatol Venereol 2012. [DOI: 10.1111/jdv.12026] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Maytin EV, Honari G, Khachemoune A, Taylor CR, Ortel B, Pogue BW, Sznycer-Taub N, Hasan T. Vitamin D Combined with Aminolevulinate (ALA)-Mediated Photodynamic Therapy (PDT) for Human Psoriasis: A Proof-of-Principle Study. Isr J Chem 2012; 52:767-775. [PMID: 23264699 DOI: 10.1002/ijch.201200005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
We previously showed that select agents (methotrexate or Vitamin D), when administered as a preconditioning regimen, are capable of promoting cellular differentiation of epithelial cancer cells while simultaneously enhancing the efficacy of 5-aminolevulinic acid (ALA)-mediated photodynamic therapy (PDT). In solid tumors, pretreatment with Vitamin D simultaneously promotes cellular differentiation and leads to selective accumulation of target porphyrins (mainly protoporphyrin IX, PpIX) within diseased tissue. However, questions of whether or not the effects upon cellular differentiation are inexorably linked to PpIX accumulation, and whether these effects might occur in hyperproliferative noncancerous tissues, have remained unanswered. In this paper, we reasoned that psoriasis, a human skin disease in which abnormal cellular proliferation and differentiation plays a major role, could serve as a useful model to test the effects of pro-differentiating agents upon PpIX levels in a non-neoplastic setting. In particular, Vitamin D, a treatment for psoriasis that restores (increases) differentiation, might increase PpIX levels in psoriatic lesions and facilitate their responsiveness to ALA-PDT. This concept was tested in a pilot study of 7 patients with bilaterally-matched psoriatic plaques. A regimen in which calcipotriol 0.005% ointment was applied for 3 days prior to ALA-PDT with blue light, led to preferential increases in PpIX (~130%), and reductions in thickness, redness, scaling, and itching in the pretreated plaques. The results suggest that a larger clinical trial is warranted to confirm a role for combination treatments with Vitamin D and ALA-PDT for psoriasis.
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Affiliation(s)
- Edward V Maytin
- Department of Dermatology, Cleveland Clinic, Cleveland, OH ; Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH ; Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA
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Chaves YN, Torezan LA, Niwa ABM, Sanches Junior JA, Festa Neto C. Pain in photodynamic therapy: mechanism of action and management strategies. An Bras Dermatol 2012; 87:521-6; quiz 527-9. [DOI: 10.1590/s0365-05962012000400001] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Accepted: 05/20/2011] [Indexed: 11/22/2022] Open
Abstract
Photodynamic therapy involves administration of a photosensitizing drug and its subsequent activation by irradiation with a light source at wavelengths matching the absorption spectrum of the photosensitizer. In many countries around the world, topical photodynamic therapy has been approved for treatment of cutaneous oncologic conditions such as actinic keratosis, Bowen's disease, and superficial basal cell carcinoma. Multicenter, randomized, controlled studies have confirmed its efficacy and superior cosmetic outcomes compared to conventional therapies. Nevertheless, this therapeutic method presents some adverse effects, such as erythema, edema, pigmentation, pustules, and pain. There is no doubt that pain is the most severe of the adverse effects, being sometimes responsible for definitive treatment interruption. The pain mechanism has not yet been fully understood, which makes complete pain control a challenge to be conquered. In spite of that, this literature review presents some useful pain management strategies as well as the most important pain-related factors in photodynamic therapy.
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Abstract
Localized resistant plaques of psoriasis often remain despite highly effective anti-psoriasis treatment. Intralesional therapy is often used to treat various malignant, infectious or inflammatory cutaneous diseases, including psoriasis. Despite the presence of many review articles on the treatment of psoriasis, no articles exist which review the use of intralesional therapy for psoriasis. In this article, we review the published literatures of intralesional therapy for psoriasis. Corticosteroids, methotrexate, cyclosporin, biologics, botulinum toxin type-A, 15-hydroxyeicosatetraenoic acid, and chemotherapy agents such as 5-fluorouracil are discussed. Also, agents which may be used intralesionally and have the potential to treat psoriasis will also be reviewed such as bleomycin, vincristine or vinblastine, mitomycin-C, aminophylline, 5-aminolevulinic acid, rituximab, bevacizumab and pentoxifylline are included.
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Affiliation(s)
- Ting-Shun Wang
- Department of Dermatology, National Taiwan University Hospital, Taipei, Taiwan, Republic of China
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Kwak SY, Lim DS, Bae SM, Kim YW, Lee JM, Namkoong SE, Han SJ, Kim JK, Lee CH, Chun HJ, Ahn WS. Photodynamic effects of Radachlorin® on cervical cancer model. J PORPHYR PHTHALOCYA 2012. [DOI: 10.1142/s1088424605000952] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Photodynamic therapy (PDT) has been reported to be effective for treating various tumors and induce apoptosis in many tumor cells. In this study, we examined a biological significance of PDT with a chlorin-based photosensitizer, Radachlorin®, in a cervical cancer model, TC-1 cells. When TC-1 cells were exposed to varied doses of Radachlorin® with light irradiation (6.25 J/cm2), PDT induced a dose-dependent growth inhibition of TC-1 cells. All of these cells were significantly damaged after light irradiation and categorized to be early and late apoptosis, as determined by annexin V staining. Radachlorin® localized primarily into the Golgi apparatus of cells in 12 h of the treatment, and weak fluorescence intensity was also detected in mitochondria. On the other hand, in the in vivo experiments, following light irradiation (100 J/cm2), retarded tumor growth was significant in mice treated with Radachlorin®, as compared to the control group. Taken together, we propose that PDT after the application of Radachlorin® may induce the Golgi apparatus-mediated apoptosis of cervical cancer cells in vitro, and also be effective in the mice system.
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Affiliation(s)
- Sun-Young Kwak
- Catholic Research Institutes of Medical Science, The Catholic University of Korea, Seoul 137-040, Korea
| | - Dae-Seog Lim
- Catholic Research Institutes of Medical Science, The Catholic University of Korea, Seoul 137-040, Korea
| | - Su-Mi Bae
- Catholic Research Institutes of Medical Science, The Catholic University of Korea, Seoul 137-040, Korea
| | - Yong-Wook Kim
- Department of Obstetrics and Gynecology, The Catholic University of Korea College of Medicine, Seoul 137-040, Korea
| | - Joon-Mo Lee
- Department of Obstetrics and Gynecology, The Catholic University of Korea College of Medicine, Seoul 137-040, Korea
| | - Sung-Eun Namkoong
- Department of Obstetrics and Gynecology, The Catholic University of Korea College of Medicine, Seoul 137-040, Korea
| | - Sei-Jun Han
- Department of Obstetrics and Gynecology, The Catholic University of Korea College of Medicine, Seoul 137-040, Korea
| | - Jong-Ki Kim
- Department of Radiology, Thoracic surgery, and Biomedical Engineering, Catholic University Hospital of Taegu, Taegu 705-718, Korea
| | - Chang-Hee Lee
- Department of Chemistry, Kangwon National University, Chuncheon 200-701, Korea
| | - Heung-Jae Chun
- Catholic Research Institutes of Medical Science, The Catholic University of Korea, Seoul 137-040, Korea
| | - Woong-Shick Ahn
- Department of Obstetrics and Gynecology, The Catholic University of Korea College of Medicine, Seoul 137-040, Korea
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Lee Y, Baron ED. Photodynamic Therapy: Current Evidence and Applications in Dermatology. ACTA ACUST UNITED AC 2011; 30:199-209. [DOI: 10.1016/j.sder.2011.08.001] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Accepted: 08/04/2011] [Indexed: 10/14/2022]
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Waters A, Ibbotson S. Parameters associated with severe pain during photodynamic therapy: results of a large Scottish series. Br J Dermatol 2011; 165:696-8. [DOI: 10.1111/j.1365-2133.2011.10429.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ibbotson SH. Adverse effects of topical photodynamic therapy. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2011; 27:116-30. [DOI: 10.1111/j.1600-0781.2010.00560.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kleinpenning MM, Kanis JH, Smits T, van Erp PEJ, van de Kerkhof P, Gerritsen RMJP. The effects of keratolytic pretreatment prior to fluorescence diagnosis and photodynamic therapy with aminolevulinic acid-induced porphyrins in psoriasis. J DERMATOL TREAT 2010; 21:245-51. [PMID: 19832289 DOI: 10.3109/09546630903271548] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Psoriasis lesions accumulate protoporphyrin IX (PpIX) with a variable distribution within plaques due to variations in hyperkeratosis causing differences in penetration of cream or light. OBJECTIVES To study the effects of different keratolytic pretreatments in PpIX-induced fluorescence diagnosis (FDAP) and during photodynamic therapy (PDT). METHODS Two psoriasis plaques of 10 patients were treated with either topical retinoic acid or with a hydrocolloid dressing. The hydrocolloid dressing gave the best results. Subsequently, two different contralateral plaques of eight patients were pretreated with a hydrocolloid dressing or the standard pretreatment, salicylic acid in petrolatum, during the 6 weeks of PDT. Biopsies were investigated with respect to stratum corneum thickness, proliferation, differentiation and inflammation. RESULTS Irritation and point bleedings were noticed after retinoic acid. A hydrocolloid dressing induced the best clinical improvement. Therefore, it was used as alternative pretreatment for psoriasis prior to PDT. We observed significant clinical and immunohistochemical improvement of psoriasis in the salicylic acid as well as the hydrocolloid dressing pretreated plaques. CONCLUSIONS Salicylic acid in petrolatum and a hydrocolloid dressing prior to FDAP and PDT induce improvement of hyperkeratosis. Thus, a hydrocolloid dressing is a good alternative to the current keratolytic pretreatment regime.
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Affiliation(s)
- Marloes M Kleinpenning
- Department of Dermatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Babilas P, Schreml S, Landthaler M, Szeimies RM. Photodynamic therapy in dermatology: state-of-the-art. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2010; 26:118-32. [DOI: 10.1111/j.1600-0781.2010.00507.x] [Citation(s) in RCA: 162] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Parera E, Gallardo F, Toll A, Gil I, Sánchez-Schmidt J, Pujol R. Inflammatory linear verrucous epidermal nevus successfully treated with methyl-aminolevulinate photodynamic therapy. Dermatol Surg 2010; 36:253-6. [PMID: 20402956 DOI: 10.1111/j.1524-4725.2009.01401.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Elisabet Parera
- Department of Dermatology, Hospital del Mar, IMAS, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Pain associated with aminolevulinic acid-photodynamic therapy of skin disease. J Am Acad Dermatol 2009; 61:1033-43. [PMID: 19925929 DOI: 10.1016/j.jaad.2009.03.048] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2008] [Revised: 03/02/2009] [Accepted: 03/16/2009] [Indexed: 12/21/2022]
Abstract
BACKGROUND Pain during topical aminolevulinic acid (ALA)-mediated photodynamic therapy (PDT) limits the use of this treatment of skin diseases. OBJECTIVE We sought to summarize the effectiveness of interventions to reduce ALA-PDT-related pain, and to explore factors contributing to pain induction. METHODS A PubMed search was performed to identify all clinical PDT trials (2000-2008) that used ALA or methyl-ALA, enrolled at least 10 patients per trial, and used a semiquantitative pain scale. RESULTS In all, 43 articles were identified for review. Pain intensity is associated with lesion size and location and can be severe for certain diagnoses, such as plaque-type psoriasis. Results are inconsistent for the correlation of pain with light source, wavelength of light, fluence rate, and total light dose. Cooling represents the best topical intervention. LIMITATIONS Pain perception differs widely between patients and can contribute to variability in the reported results. CONCLUSION Gamma-aminobutyric acid receptors, cold/menthol receptors (transient receptor potential cation channel, subfamily M, member 8), and vanilloid/capsaicin receptors (transient receptor potential cation channel, subfamily V, member 1) may be involved in pain perception during ALA-PDT and are therefore worthy of further investigation.
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Morsy H, Kamp S, Jemec GBE. Outcomes in randomized controlled trials in psoriasis: What has changed over the last 20 years? J DERMATOL TREAT 2009; 18:261-7. [DOI: 10.1080/09546630701487635] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
Multicentre randomized controlled studies now demonstrate high efficacy of topical photodynamic therapy (PDT) for actinic keratoses, Bowen's disease (BD) and superficial basal cell carcinoma (BCC), and efficacy in thin nodular BCC, while confirming the superiority of cosmetic outcome over standard therapies. Long-term follow-up studies are also now available, indicating that PDT has recurrence rates equivalent to other standard therapies in BD and superficial BCC, but with lower sustained efficacy than surgery in nodular BCC. In contrast, current evidence does not support the use of topical PDT for squamous cell carcinoma. PDT can reduce the number of new lesions developing in patients at high risk of skin cancer and may have a role as a preventive therapy. Case reports and small series attest to the potential of PDT in a wide range of inflammatory/infective dermatoses, although recent studies indicate insufficient evidence to support its use in psoriasis. There is an accumulating evidence base for the use of PDT in acne, while detailed study of an optimized protocol is still required. In addition to high-quality treatment site cosmesis, several studies observe improvements in aspects of photoageing. Management of treatment-related pain/discomfort is a challenge in a minority of patients, and the modality is otherwise well tolerated. Long-term studies provide reassurance over the safety of repeated use of PDT.
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Affiliation(s)
- C A Morton
- Department of Dermatology, Stirling Royal Infirmary, Stirling FK2 8AU, UK.
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36
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AKILOV OE, KOSAKA S, MAYTIN EV, HASAN T. Prospects for the use of differentiation-modulating agents as adjuvant of photodynamic therapy for proliferative dermatoses. J Dermatol 2008; 35:197-205. [DOI: 10.1111/j.1346-8138.2008.00445.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
While efficacy of topical photodynamic therapy (PDT) for the treatment of superficial non-melanoma skin cancer is already well-proven by several controlled clinical trials, there are only a few controlled studies showing efficacy of PDT for non-oncologic skin disorders. This report provides information on the use of PDT for inflammatory skin disorders, disorders of the pilosebaceous unit, infections of the skin, sclerotic skin diseases and cosmetic indications.
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Affiliation(s)
- S Karrer
- Klinik und Poliklinik für Dermatologie, Universität Regensburg, Franz-Josef-Strauss-Allee 11, 93042 Regensburg, Germany.
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Calzavara-Pinton PG, Venturini M, Sala R. Photodynamic therapy: update 2006. Part 2: Clinical results. J Eur Acad Dermatol Venereol 2007; 21:439-51. [PMID: 17373968 DOI: 10.1111/j.1468-3083.2006.02038.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In several randomized, controlled studies, the application of a standard preparation containing methyl-aminolevulinate (MAL; Metvix, Galderma, F), followed by red light irradiation proved effective and well tolerated in the treatment of actinic keratosis and basal cell carcinoma, and has now been approved for clinical use in European countries. A brand name aminolevulinic acid (ALA) solution (Levulan Kerastick, Dusa Pharmaceuticals Inc., Wilmington, MA) plus blue light exposure has been approved for the treatment of actinic keratosis in the USA. Randomized and controlled studies have shown that MAL as well as ALA are also effective in the treatment of Bowen's disease. In addition, a large and growing number of open studies or case reports have evaluated its use in the treatment of a broad range of other neoplastic, inflammatory and infectious skin diseases. However, efficacy and definite advantages over standard therapies remain to be clarified because the experimental design of these studies was often poor, the number of enrolled patients was generally low, and the follow-up was shorter than 12 months. However, these studies have suggested a few possible clinical applications worthy of further investigation. A growing number of laboratory and clinical findings suggest that several new synthetic sensitizers, besides ALA and MAL, may be helpful in the treatment of non-melanoma skin cancers, melanoma metastasis, and selected inflammatory and infective skin diseases. These compounds are deliverable intravenously, have short half-lives both in the blood and skin, and are highly efficient. However, they are as of yet not approved for clinical use.
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Affiliation(s)
- P G Calzavara-Pinton
- Department of Dermatology, Azienda Ospedaliera Spedali Civili and University of Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy.
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Fernández-Guarino M, García-Morales I, Harto A, Montull C, Pérez-García B, Jaén P. Terapia fotodinámica: nuevas indicaciones. ACTAS DERMO-SIFILIOGRAFICAS 2007. [DOI: 10.1016/s0001-7310(07)70091-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Huerta Brogeras M, Romero Mate A, Nieto Perea O, Borbujo Martínez JM. Complicaciones en la terapia fotodinámica. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/s0213-9251(07)73078-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
Mainstream uses for photodynamic therapy (PDT) in dermatology include nonmelanoma skin cancer and its precursors, acne vulgaris, photorejuvenation, and hidradenitis suppurativa. Many other dermatologic entities have been treated with PDT, including psoriasis, lichen planus, lichen sclerosus, scleroderma, cutaneous T cell lymphoma, alopecia areata, verruca vulgaris, Darier's disease and tinea infections. Nondermatologic applications include anal and vulva carcinoma, palliation of metastatic breast cancer to skin, Barrett's esophagus, and macular degeneration of the retina. PDT also has found to be useful in immunologic and inflammatory disorders, neoplasias other than skin cancer, and infections. The ability of this treatment to hone in on dysplastic epithelial and endothelial cells while retaining viability of surrounding tissue is its key feature because this leads to specific tumor destruction with cosmesis and function of the target organ intact.
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Affiliation(s)
- Amy Forman Taub
- Department of Dermatology, Northwestern University Medical School, 676 St. Clair Street, Chicago, IL 60611, USA.
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Schleyer V, Radakovic-Fijan S, Karrer S, Zwingers T, Tanew A, Landthaler M, Szeimies RM. Disappointing results and low tolerability of photodynamic therapy with topical 5-aminolaevulinic acid in psoriasis. A randomized, double-blind phase I/II study. J Eur Acad Dermatol Venereol 2007; 20:823-8. [PMID: 16898905 DOI: 10.1111/j.1468-3083.2006.01651.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Based on good results in the treatment of superficial skin tumours, since the early 1990s topical photodynamic therapy with aminolaevulinic acid (ALA PDT) has been used for disseminated, inflammatory dermatoses including psoriasis. However, there is still a lack of well-documented trials. OBJECTIVE A prospective randomized, double-blind phase I/II intrapatient comparison study was conducted in 12 patients to investigate whether topical ALA PDT is an effective treatment for chronic plaque-type psoriasis. METHODS In each patient three psoriatic plaques were randomly treated with a light dose of 20 J/cm(2) and 0.1%, 1% and 5% ALA, respectively. Treatment was conducted twice a week until complete clearance or for a maximum of 12 irradiations. Therapeutic efficacy was assessed by weekly determination of the psoriasis severity index (PSI). RESULTS The mean percentage improvement was 37.5%, 45.6% and 51.2% in the 0.1%, 1% and 5% ALA-treated groups, respectively. Irradiation had to be interrupted several times because of severe burning and pain sensation. CONCLUSION Topical ALA PDT did not prove to be an appropriate treatment option for plaque-type psoriasis due to disappointing clinical efficacy, the time-consuming treatment procedure and its unfavourable adverse event profile.
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Affiliation(s)
- V Schleyer
- Department of Dermatology, University of Regensburg, Regensburg, Germany
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Kleinpenning MM, Smits T, Ewalds E, van Erp PEJ, van de Kerkhof PCM, Gerritsen MJP. Heterogeneity of fluorescence in psoriasis after application of 5-aminolaevulinic acid: an immunohistochemical study. Br J Dermatol 2007; 155:539-45. [PMID: 16911278 DOI: 10.1111/j.1365-2133.2006.07341.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Psoriasis has been shown to highly accumulate protoporphyrin IX (PpIX), but a variable distribution within plaques after fluorescence diagnosis is seen. It is unknown what causes this heterogeneity of fluorescence in psoriatic skin, despite adequate keratolytic treatment. Variations in fluorescence might explain the variable and the mostly partial clinical response of psoriasis seen after photodynamic therapy (PDT). OBJECTIVES This study examines morphological and immunohistochemical differences in inhomogeneous PpIX-induced fluorescence in stable plaque psoriasis. MATERIALS AND METHODS Fourteen patients with stable plaque psoriasis were included in this study. In each patient one psoriatic plaque was incubated with 20% 5-aminolaevulinic acid (ALA) ointment for 3 h after keratolytic treatment. Fluorescence diagnosis with ALA-induced porphyrins (FDAP) was performed and subsequently high- and low-fluorescent psoriatic skin samples were biopsied. Biopsies were investigated with respect to histological hyperkeratosis (thickness of stratum corneum), proliferation (Ki-67 antigen), keratinization (K10, filaggrin) and inflammation (CD3). Digital images acquired with FDAP were analysed using image analysis software. RESULTS Inhomogeneous fluorescence was seen in 12 of the 14 plaques. A significantly thicker stratum corneum was found in low-fluorescent psoriatic skin compared with highly fluorescent skin. Fluorescence intensity and thickness of the stratum corneum proved to be negatively correlated. The variable-fluorescent parts of the lesional psoriatic skin showed no differences in epidermal proliferation, keratinization or inflammation. CONCLUSIONS Heterogeneous ALA-induced fluorescence in psoriasis plaques related to inhomogeneous distribution of PpIX in the epidermis may result from differences in penetration of ALA and/or light within a plaque caused by differences in stratum corneum thickness. The variable clinical response seen after PDT in psoriasis could be explained by this. These findings are consistent with the general assumption that optimal desquamation prior to FDAP or PDT is required for the most favourable results.
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Affiliation(s)
- M M Kleinpenning
- Department of Dermatology, Radboud University Nijmegen Medical Center, Rene Descartesdreef 1, 6525 GL Nijmegen, the Netherlands.
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Kim JY, Kang HY, Lee ES, Kim YC. Topical 5-aminolaevulinic acid photodynamic therapy for intractable palmoplantar psoriasis. J Dermatol 2007; 34:37-40. [PMID: 17204099 DOI: 10.1111/j.1346-8138.2007.00213.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Photodynamic therapy (PDT) has been reported to be useful in treating non-melanoma skin cancers and a variety of benign skin conditions including psoriasis. However, only two reports of palmoplantar pustular psoriasis (PPP) treated with PDT have been reported. We treated three intractable cases of PPP with PDT, using 20% 5-aminolaevulinic acid and a 630+/-50 nm light-emitting diode device. The power density was 30 mW/cm2 and the fluence was 15 J/cm2. After treatment, all cases showed mild to marked improvement. Topical PDT may be an alternative therapy in the treatment of PPP, but further study is necessary to confirm the effectiveness of topical PDT in PPP.
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Affiliation(s)
- Ji Yeon Kim
- Department of Dermatology, Ajou University School of Medicine, Suwon, Korea
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Fernández-Guarino M, García-Morales I, Harto A, Montull C, Pérez-García B, Jaén P. Photodynamic Therapy: New Indications. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/s1578-2190(07)70471-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Mitra A, Stables G. Topical photodynamic therapy for non-cancerous skin conditions. Photodiagnosis Photodyn Ther 2006; 3:116-27. [DOI: 10.1016/s1572-1000(06)00035-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2005] [Revised: 02/13/2006] [Accepted: 02/20/2006] [Indexed: 11/25/2022]
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Smits T, Kleinpenning MM, van Erp PEJ, van de Kerkhof PCM, Gerritsen MJP. A placebo-controlled randomized study on the clinical effectiveness, immunohistochemical changes and protoporphyrin IX accumulation in fractionated 5-aminolaevulinic acid-photodynamic therapy in patients with psoriasis. Br J Dermatol 2006; 155:429-36. [PMID: 16882185 DOI: 10.1111/j.1365-2133.2006.07290.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Topical 5-aminolaevulinic acid (ALA)-photodynamic therapy (PDT) for the treatment of psoriasis has been evaluated in a few studies. In these studies different treatment parameters were used, there was a variable clinical response, and a nonhomogeneous fluorescence was seen after irradiation with Wood's light. OBJECTIVES To study the clinical effectiveness, immunohistochemical changes and protoporphyrin IX accumulation in ALA-PDT in patients with psoriasis. Eight patients with stable plaque psoriasis with symmetrical involvement were included in the study. Two symmetrical plaques were randomly allocated to PDT either with 10% ALA or with placebo. Irradiation consisted of 2 and 8 J cm(-2) with a dark interval of 2 h (Waldmann PDT 1200 L, 600-750 nm, 40 mW cm(-2)) once weekly for 4 weeks. Before, during and after irradiation, fluorescence diagnosis was performed. Biopsies were taken at baseline, week 1 and week 6 for immunohistochemical assessment. Psoriatic plaques were clinically assessed using the plaque severity (sum) score. Fluorescence diagnosis was performed and expression of immunohistochemical markers for proliferation, differentiation and T-cell infiltration [Ki67, keratin 10 (K10), CD4, CD8 and CD45RO] was assessed. RESULTS From week 1 up to week 6, ALA-PDT gave a significant reduction in the number of Ki67+ nuclei, while the K10 expression increased. After 6 weeks significant improvement was observed for CD8 and CD45RO. These changes were absent in the placebo-treated lesions. The sum scores were also significantly lower in the ALA-treated plaques. Heterogeneity of macroscopic fluorescence was observed during treatment despite keratolytic treatment. CONCLUSIONS The present study shows that clinical improvement during fractionated ALA-PDT in psoriasis parallels histological improvement as seen in normalization of epidermal proliferation, differentiation and infiltration of relevant T-cell subsets. Optimizing the current treatment protocol may increase clinical efficacy further.
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Affiliation(s)
- T Smits
- Department of Dermatology, Radboud University Nijmegen Medical Centre, Rene Descartesdreef 1, 6525 GL Nijmegen, The Netherlands.
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Gilaberte Y, Serra-Guillén C, de las Heras ME, Ruiz-Rodríguez R, Fernández-Lorente M, Benvenuto-Andrade C, González-Rodríguez S, Guillén-Barona C. Terapia fotodinámica en dermatología. ACTAS DERMO-SIFILIOGRAFICAS 2006; 97:83-102. [PMID: 16595110 DOI: 10.1016/s0001-7310(06)73359-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Photodynamic therapy (PDT) is a therapeutic modality based on the photooxidation of biological materials induced by a photosensitizer, which selectively locates itself in certain tumorous cells or tissues, so that when illuminated by a light of the right length and at a sufficient dose, these cells are destroyed. In dermatology, PDT with topical 5-aminolevulinic acid or 5-methyl aminolevulinate is very effective in the treatment of actinic keratoses, basal cell carcinomas and Bowen's disease. In addition, very promising results have been obtained in inflammatory pathologies like morphea or sarcoidosis, infections like warts, and cosmetic processes such as photoaging, among others. This article reviews the most significant aspects of PDT in dermatology. First of all, we will review the basic fundamentals of photodynamic treatment. Next, we will outline its clinical applications in dermatology, both in oncological applications and all those dermatological processes in which PDT may play a role in their management. We will also discuss its promising cosmetic application in the treatment of photoaging. We will complete the review with photodiagnosis and the different non-invasive ways to monitor the effectiveness of PDT.
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Topical photodynamic therapy. ARCHIVE OF ONCOLOGY 2006. [DOI: 10.2298/aoo0602039p] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Topical photodynamic therapy is a therapeutic modality in development, thus arises grate interest among dermatologists worldwide. It is an effective therapy for actinic keratosis, superficial BCC and Bowenos disease. Treatment efficacy, good cosmetics, low risk of skin cancer, low invasiveness, low rate of adverse events, facility for treating multiple or large lesions, especially in poor healing sites and, for penile, digital and facial involvement, low general toxicity and possibility of repeating the treatments with the same efficiency, enable topical photodynamic therapy to become increasingly practiced treatment modality. Researching aimed topical photodynamic therapy to prove as a treatment modality for clinical use in other dermatoses, is in experimental phase. To answer the question when dermatologist should consider using topical photodynamic therapy treatment modatility, we are present available date.
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Abstract
ALA-PDT is a safe, well-tolerated, and effective treatment for many dermatologic conditions. Current data most strongly support its use in the treatment of actinic damage, but further investigation into alternative uses continues. Current efficacy is limited primarily by the depth of penetration of the photosensitizing agent and the activating light source. Even with this limitation, the potential applications of PDT are numerous. As new technology is developed to overcome current restraints, the future of PDT is wide open.
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