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Di Bartolomeo L, Altavilla D, Vaccaro M, Vaccaro F, Squadrito V, Squadrito F, Borgia F. Photodynamic therapy in pediatric age: Current applications and future trends. Front Pharmacol 2022; 13:879380. [PMID: 36052131 PMCID: PMC9424823 DOI: 10.3389/fphar.2022.879380] [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: 02/19/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
Photodynamic therapy (PDT) is a photochemotherapy based on local application of a photosensitive compound and subsequent exposure to a light source of adequate wavelength. It is a non-invasive therapeutic procedure widely used in oncodermatology for treatment of numerous skin cancers, but in the last years its use has been gradually extended to an increasing list of skin diseases of both infectious and inflammatory nature. Although PDT is proven as a safe and effective therapeutic option in adults, its use is not well standardized in the pediatric population. In this review, we will focus on clinical applications, mechanisms of action, protocols, and adverse events in children and adolescents. Most of pediatric experiences concerned treatment of skin cancers in Gorlin syndrome and xeroderma pigmentosum, acne vulgaris, and viral warts, but other applications emerged, such as cutaneous lymphoma and pseudo-lymphomas, necrobiosis lipoidica, hidradenitis suppurativa, dissecting cellulitis, leishmaniasis, angiofibromas, verrucous epidermal nevus, and linear porokeratosis. In these pediatric diseases, PDT appeared as an effective therapeutic alternative. The results on vitiligo were limited and not fully encouraging. Although highly versatile, PDT is not a therapy for all skin diseases, and a deeper knowledge of its mechanisms of action is required to better define its spectrum of action and safety in pediatric patients.
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Affiliation(s)
- Luca Di Bartolomeo
- Department of Clinical and Experimental Medicine, Dermatology, University of Messina, Messina, Italy
- *Correspondence: Luca Di Bartolomeo,
| | - Domenica Altavilla
- Department of Clinical and Experimental Medicine, Pharmacology, University of Messina, Messina, Italy
| | - Mario Vaccaro
- Department of Clinical and Experimental Medicine, Dermatology, University of Messina, Messina, Italy
| | - Federico Vaccaro
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Violetta Squadrito
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi, Pediatryˮ, University of Messina, Messina, Italy
| | - Francesco Squadrito
- Department of Clinical and Experimental Medicine, Pharmacology, University of Messina, Messina, Italy
| | - Francesco Borgia
- Department of Clinical and Experimental Medicine, Dermatology, University of Messina, Messina, Italy
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García-Oreja S, Álvaro-Afonso FJ, García-Álvarez Y, García-Morales E, Sanz-Corbalán I, Lázaro Martínez JL. Topical treatment for plantar warts: A systematic review. Dermatol Ther 2020; 34:e14621. [PMID: 33263934 DOI: 10.1111/dth.14621] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/08/2020] [Accepted: 11/23/2020] [Indexed: 01/08/2023]
Abstract
There are a wide variety of treatments for plantar warts, but none has been shown to be effective in all patients. We aimed to perform a systematic review of the efficacy of different topical treatments on plantar warts. Systematic electronic searches (Pubmed, Cochrane Library, Embase, and Web of Science) were conducted in April 2020. Meta-analyses, systematic reviews, and retrospective or prospective clinical trials of the effects of topical and nonsurgical treatments of plantar warts were included. Two authors performed the study selection and data extraction. Any discrepancies between the two reviewers were discussed with a third reviewer. Forty-four studies were included. The average cure rates of the most frequent treatments were variable across the studies: cryotherapy (45.61%), salicylic acid (13.6%), cantharidin-podophyllin-salicylic acid formulation (97.82%), laser (79.36%), topical antivirals (72.45%), intralesional bleomycin (83.37%), and intralesional immunotherapy (68.14%). Twenty-two studies (50%) had a level of evidence 1b and grade of recommendation A, five studies (11.4%) had a level of evidence 2b and grade of recommendation B, two studies (4.5%) had a level of evidence 3b and grade of recommendation B, and 15 studies (34,1%) with a level of evidence 4 and grade of recommendation C. First-choice treatments for common warts, such as cryotherapy and salicylic acid, have low-cure rates for plantar warts. Other treatments, such as CPA formulation, immunotherapy, and intralesional bleomycin, which have compassionate use, have higher cure rates. This review should stimulate future high-quality research to evaluate these specialized treatments.
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Affiliation(s)
- Sara García-Oreja
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Complutense University of Madrid, University Podiatric Clinic, Madrid, Spain
| | - Francisco Javier Álvaro-Afonso
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Complutense University of Madrid, University Podiatric Clinic, Madrid, Spain
| | - Yolanda García-Álvarez
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Complutense University of Madrid, University Podiatric Clinic, Madrid, Spain
| | - Esther García-Morales
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Complutense University of Madrid, University Podiatric Clinic, Madrid, Spain
| | - Irene Sanz-Corbalán
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Complutense University of Madrid, University Podiatric Clinic, Madrid, Spain
| | - Jose Luis Lázaro Martínez
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Complutense University of Madrid, University Podiatric Clinic, Madrid, Spain
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Huang K, Xie Y, Li M, Liu D, Su J, Li F, Deng B, Li J, Shi W, Zhang J, Chen X, Zhao S, Wu L. A Comparative Study: Superficial Shaving Combined With Photodynamic Therapy Versus Cryotherapy in the Treatment of Recalcitrant Plantar Warts. Lasers Surg Med 2020; 52:747-752. [PMID: 31922272 DOI: 10.1002/lsm.23212] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/25/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Kai Huang
- Hunan Engineering Research Center of Skin Health and Disease 87 Xiangya Road Changsha Hunan 410008 China
- Hunan Key Laboratory of Skin Cancer and Psoriasis 87 Xiangya Road Changsha Hunan 410008 China
- Department of Dermatology, Xiangya Hospital Central South University 87 Xiangya Road Changsha Hunan 410008 China
| | - Yang Xie
- Department of Dermatology The 3rd Affiliated Hospital of Sun Yat‐Sen University 600 Tianhe Road Guangzhou Guangdong 510630 China
| | - Mingjia Li
- Hunan Engineering Research Center of Skin Health and Disease 87 Xiangya Road Changsha Hunan 410008 China
- Xiangya School of Medicine Central South University 172 Tongzipo Road Changsha Hunan 410013 China
| | - Dihui Liu
- Hunan Engineering Research Center of Skin Health and Disease 87 Xiangya Road Changsha Hunan 410008 China
- Hunan Key Laboratory of Skin Cancer and Psoriasis 87 Xiangya Road Changsha Hunan 410008 China
- Department of Dermatology, Xiangya Hospital Central South University 87 Xiangya Road Changsha Hunan 410008 China
| | - Juan Su
- Hunan Engineering Research Center of Skin Health and Disease 87 Xiangya Road Changsha Hunan 410008 China
- Hunan Key Laboratory of Skin Cancer and Psoriasis 87 Xiangya Road Changsha Hunan 410008 China
- Department of Dermatology, Xiangya Hospital Central South University 87 Xiangya Road Changsha Hunan 410008 China
| | - Fangfang Li
- Hunan Engineering Research Center of Skin Health and Disease 87 Xiangya Road Changsha Hunan 410008 China
- Hunan Key Laboratory of Skin Cancer and Psoriasis 87 Xiangya Road Changsha Hunan 410008 China
- Department of Dermatology, Xiangya Hospital Central South University 87 Xiangya Road Changsha Hunan 410008 China
| | - Bo Deng
- Hunan Engineering Research Center of Skin Health and Disease 87 Xiangya Road Changsha Hunan 410008 China
- Hunan Key Laboratory of Skin Cancer and Psoriasis 87 Xiangya Road Changsha Hunan 410008 China
- Department of Dermatology, Xiangya Hospital Central South University 87 Xiangya Road Changsha Hunan 410008 China
| | - Jie Li
- Hunan Engineering Research Center of Skin Health and Disease 87 Xiangya Road Changsha Hunan 410008 China
- Hunan Key Laboratory of Skin Cancer and Psoriasis 87 Xiangya Road Changsha Hunan 410008 China
- Department of Dermatology, Xiangya Hospital Central South University 87 Xiangya Road Changsha Hunan 410008 China
| | - Wei Shi
- Hunan Engineering Research Center of Skin Health and Disease 87 Xiangya Road Changsha Hunan 410008 China
- Hunan Key Laboratory of Skin Cancer and Psoriasis 87 Xiangya Road Changsha Hunan 410008 China
- Department of Dermatology, Xiangya Hospital Central South University 87 Xiangya Road Changsha Hunan 410008 China
| | - Jianglin Zhang
- Hunan Engineering Research Center of Skin Health and Disease 87 Xiangya Road Changsha Hunan 410008 China
- Hunan Key Laboratory of Skin Cancer and Psoriasis 87 Xiangya Road Changsha Hunan 410008 China
- Department of Dermatology, Xiangya Hospital Central South University 87 Xiangya Road Changsha Hunan 410008 China
| | - Xiang Chen
- Hunan Engineering Research Center of Skin Health and Disease 87 Xiangya Road Changsha Hunan 410008 China
- Hunan Key Laboratory of Skin Cancer and Psoriasis 87 Xiangya Road Changsha Hunan 410008 China
- Department of Dermatology, Xiangya Hospital Central South University 87 Xiangya Road Changsha Hunan 410008 China
| | - Shuang Zhao
- Hunan Engineering Research Center of Skin Health and Disease 87 Xiangya Road Changsha Hunan 410008 China
- Hunan Key Laboratory of Skin Cancer and Psoriasis 87 Xiangya Road Changsha Hunan 410008 China
- Department of Dermatology, Xiangya Hospital Central South University 87 Xiangya Road Changsha Hunan 410008 China
| | - Lisha Wu
- Hunan Engineering Research Center of Skin Health and Disease 87 Xiangya Road Changsha Hunan 410008 China
- Hunan Key Laboratory of Skin Cancer and Psoriasis 87 Xiangya Road Changsha Hunan 410008 China
- Department of Dermatology, Xiangya Hospital Central South University 87 Xiangya Road Changsha Hunan 410008 China
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Morton CA, Szeimies RM, Basset-Séguin N, Calzavara-Pinton PG, Gilaberte Y, Haedersdal M, Hofbauer GFL, Hunger RE, Karrer S, Piaserico S, Ulrich C, Wennberg AM, Braathen LR. European Dermatology Forum guidelines on topical photodynamic therapy 2019 Part 2: emerging indications - field cancerization, photorejuvenation and inflammatory/infective dermatoses. J Eur Acad Dermatol Venereol 2019; 34:17-29. [PMID: 31805604 DOI: 10.1111/jdv.16044] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 10/24/2019] [Indexed: 12/12/2022]
Abstract
In addition to approved indications in non-melanoma skin cancer in immunocompetent patients, topical photodynamic therapy (PDT) has also been studied for its place in the treatment of, as well as its potential to prevent, superficial skin cancers in immune-suppressed patients, although sustained clearance rates are lower than for immune-competent individuals. PDT using a nanoemulsion of ALA in a daylight or conventional PDT protocol has been approved for use in field cancerization, although evidence of the potential of the treatment to prevent new SCC remained limited. High-quality evidence supports a strong recommendation for the use of topical PDT in photorejuvenation as well as for acne, refractory warts, cutaneous leishmaniasis and in onychomycosis, although these indications currently lack approvals for use and protocols remain to be optimized, with more comparative evidence with established therapies required to establish its place in practice. Adverse events across all indications for PDT can be minimized through the use of modified and low-irradiance regimens, with a low risk of contact allergy to photosensitizer prodrugs, and no other significant documented longer-term risks with no current evidence of cumulative toxicity or photocarcinogenic risk. The literature on the pharmacoeconomics for using PDT is also reviewed, although accurate comparisons are difficult to establish in different healthcare settings, comparing hospital/office-based therapies of PDT and surgery with topical ointments, requiring inclusion of number of visits, real-world efficacy as well as considering the value to be placed on cosmetic outcome and patient preference. This guideline, published over two parts, considers all current approved and emerging indications for the use of topical photodynamic therapy in Dermatology prepared by the PDT subgroup of the European Dermatology Forum guidelines committee. It presents consensual expert recommendations reflecting current published evidence.
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Affiliation(s)
- C A Morton
- Department of Dermatology, Stirling Community Hospital, Stirling, UK
| | - R-M Szeimies
- Department of Dermatology, Regensburg University Hospital, Regensburg, Germany.,Department of Dermatology & Allergology, Klinikum Vest GmbH, Recklinghausen, Germany
| | - N Basset-Séguin
- Department of Dermatology, Hôpital Saint Louis, Paris, France
| | | | - Y Gilaberte
- Department of Dermatology, Hospital Universitario miguel servet IIS Aragón, Zaragoza, Spain
| | - M Haedersdal
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - G F L Hofbauer
- Department of Dermatology, Zürich University Hospital, Zürich, Switzerland
| | - R E Hunger
- Department of Dermatology Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - S Karrer
- Department of Dermatology, Regensburg University Hospital, Regensburg, Germany
| | - S Piaserico
- Unit of Dermatology, Department of Medicine, University of Padova, Padova, Italy
| | - C Ulrich
- Skin Cancer Centre, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - A-M Wennberg
- Department of Dermatology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Yang YL, Sang J, Liao NX, Wei F, Liao W, Chen JH. Off-label photodynamic therapy for recalcitrant facial flat warts using topical 5-aminolevulinic acid. Lasers Med Sci 2016; 31:929-36. [PMID: 27059226 DOI: 10.1007/s10103-016-1925-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 03/18/2016] [Indexed: 11/25/2022]
Abstract
The facial flat wart (verruca plana) is one of the most common reasons for dermatology and primary care visits. Although there are many therapeutic modalities, no single therapy has been proven to be completely curative. Case reports and uncontrolled studies suggested that photodynamic therapy (PDT) with topical 5-aminolevulinic acid (ALA) can effectively treat recalcitrant facial flat warts. A total of 12 patients with recalcitrant facial flat warts were enrolled in the study. ALA gel (10 %) was applied topically to lesions and incubated for 3 h. The lesions were irradiated by an LED light of 630 ± 10 nm at dose levels of 60-100 mW/cm. Clinical assessment was conducted before and after every treatment for up to 24 weeks. Among the ten patients completing three sessions of ALA-PDT, five had complete lesions clearance, and the other five patients were significantly improved. At the 24-week follow-up, the average effective rate was 88.8 %, with no recurrences. No significant side effects were reported. A low-dose topical ALA-PDT regimen using 10 % ALA, 3 h incubation, and a red light source for three treatment sessions are suggested as the optimal scheme for the treatment of recalcitrant flat warts on the face in Chinese patients. Superior efficacy is found in elevated or active period lesions with mild side effects.
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Affiliation(s)
- Ya-Li Yang
- Department of Dermatology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
- Shanghai Key Laboratory of Molecular Medical Mycology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Junjun Sang
- Department of Dermatology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
- Shanghai Key Laboratory of Molecular Medical Mycology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Ning-Xin Liao
- Department of Dermatology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
- Shanghai Key Laboratory of Molecular Medical Mycology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Fang Wei
- Department of Dermatology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
- Shanghai Key Laboratory of Molecular Medical Mycology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Wanqin Liao
- Department of Dermatology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
- Shanghai Key Laboratory of Molecular Medical Mycology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jiang-Han Chen
- Department of Dermatology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
- Shanghai Key Laboratory of Molecular Medical Mycology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
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6
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Wan MT, Lin JY. Current evidence and applications of photodynamic therapy in dermatology. Clin Cosmet Investig Dermatol 2014; 7:145-63. [PMID: 24899818 PMCID: PMC4038525 DOI: 10.2147/ccid.s35334] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In photodynamic therapy (PDT) a photosensitizer – a molecule that is activated by light – is administered and exposed to a light source. This leads both to destruction of cells targeted by the particular type of photosensitizer, and immunomodulation. Given the ease with which photosensitizers and light can be delivered to the skin, it should come as no surprise that PDT is an increasingly utilized therapeutic in dermatology. PDT is used commonly to treat precancerous cells, sun-damaged skin, and acne. It has reportedly also been used to treat other conditions including inflammatory disorders and cutaneous infections. This review discusses the principles behind how PDT is used in dermatology, as well as evidence for current applications of PDT.
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Affiliation(s)
- Marilyn T Wan
- Melanoma Program, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jennifer Y Lin
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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7
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Pulsed dye laser versus Nd:YAG laser in the treatment of plantar warts: a comparative study. Lasers Med Sci 2013; 29:1111-6. [DOI: 10.1007/s10103-013-1479-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 10/22/2013] [Indexed: 10/26/2022]
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Kharkwal GB, Sharma SK, Huang YY, Dai T, Hamblin MR. Photodynamic therapy for infections: clinical applications. Lasers Surg Med 2012; 43:755-67. [PMID: 22057503 DOI: 10.1002/lsm.21080] [Citation(s) in RCA: 345] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVE Photodynamic therapy (PDT) was discovered over 100 years ago by its ability to kill various microorganisms when the appropriate dye and light were combined in the presence of oxygen. However it is only in relatively recent times that PDT has been studied as a treatment for various types of localized infections. This resurgence of interest has been partly motivated by the alarming increase in drug resistance amongst bacteria and other pathogens. This review will focus on the clinical applications of antimicrobial PDT. STUDY DESIGN/MATERIALS AND METHODS The published peer-reviewed literature was reviewed between 1960 and 2011. RESULTS The basics of antimicrobial PDT are discussed. Clinical applications of antimicrobial PDT to localized viral infections caused by herpes and papilloma viruses, and nonviral dermatological infections such as acne and other yeast, fungal and bacterial skin infections are covered. PDT has been used to treat bacterial infections in brain abscesses and non-healing ulcers. PDT for dental infections including periodontitis and endodontics has been well studied. PDT has also been used for cutaneous Leishmaniasis. Clinical trials of PDT and blue light alone therapy for gastric Helicobacter pylori infection are also covered. CONCLUSION As yet clinical PDT for infections has been mainly in the field of dermatology using 5-aminolevulanic acid and in dentistry using phenothiazinium dyes. We expect more to see applications of PDT to more challenging infections using advanced antimicrobial photosensitizers targeted to microbial cells in the years to come.
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Affiliation(s)
- Gitika B Kharkwal
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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Sparsa A, Blaise S, Tack B, Dalmay F, Leroy D, Bonnetblanc JM, Béani JC, Bédane C. Photodynamic therapy can improve warts' discomfort in renal transplant patients prospective multicenter study. Photochem Photobiol 2012; 88:1023-6. [PMID: 22332671 DOI: 10.1111/j.1751-1097.2012.01114.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Many studies have been conducted showing that aminolevulinic acid (ALA)-photodynamic therapy (PDT) can be an alternative treatment for recalcitrant warts. Recently, we performed a study evaluating methyl-aminolevulinic acid (MAL)-PDT for the treatment of hand warts in a population of renal transplant patients. Two symmetrical targets were selected on each hand and randomly assigned to chemical keratolytic treatment followed by three cycles of ALA-PDT (75 J cm(-2) red light). Patients were evaluated after 3 months and a second run of PDT was performed if the total area and number of warts decreased less than 50%, with evaluation every 3 months for 1 year. Twenty patients were included and 16 were evaluable (9 M, 7 F). After 6 months the reduction of warts' area was 48.4% on the treated side versus 18.4% in the control area (P = 0.021). The decrease in the total number of warts was 41%versus 19.4% (P = NS). The global tolerance of the treatment was good with acceptable pain during irradiation. These results suggest that ALA-PDT is a safe and efficient treatment for transplanted patient warts. The improvement between treated and control zone is 20% due to the decrease in untreated warts' area and number.
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Affiliation(s)
- Agnès Sparsa
- Department of Dermatology and Venereology, University Hospital, Limoges, France.
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Walker DP, Vollmer-Snarr HR, Eberting CLD. Ocular hazards of blue-light therapy in dermatology. J Am Acad Dermatol 2011; 66:130-5. [PMID: 21536341 DOI: 10.1016/j.jaad.2010.11.040] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Revised: 09/28/2010] [Accepted: 11/04/2010] [Indexed: 12/11/2022]
Abstract
Blue-light phototherapy has become important in the treatment of many dermatologic conditions and as a result continue to be developed. Although blue-light therapy is successful, research shows that excessive ocular blue-light exposure may contribute to age-related macular degeneration and other vision problems. As blue-light therapy becomes increasingly more popular for clinical and at-home use, patients and operators of blue-light devices should be aware of its associated ocular hazards. Protective eyewear should be carefully selected and implemented with each therapy session to guard against the development of retinal disease.
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Affiliation(s)
- Daniel P Walker
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Abstract
Warts remain one of the most common reasons for dermatology and primary care visits, yet no definitive therapy is available. Treatment of pediatric patients adds additional challenges, as the adept provider must effectively manage parents' expectations and patients' fears. This article provides an update on research in the field of viral cutaneous wart therapies with a focus on pediatric patients. Safety issues and potential complications of therapy are also addressed.
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Affiliation(s)
- Christina Boull
- Department of Medicine-Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA.
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12
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Caucanas M, Gillard P, Vanhooteghem O. Efficiency of photodynamic therapy in the treatment of diffuse facial viral warts in an immunosuppressed patient: towards a gold standard? Case Rep Dermatol 2010; 2:207-13. [PMID: 21537372 PMCID: PMC3085036 DOI: 10.1159/000323215] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
A 64-year-old man with a pulmonary transplant developed diffuse verrucae vulgares of the neck. After the failure of multiple cryotherapy treatments, 3 sessions of photodynamic therapy resulted in rapid therapeutic clinical success. This moderately painful and well-tolerated treatment is reproducible and can be very useful in treating papillomavirus infections in the immunosuppressed patient.
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Affiliation(s)
- M Caucanas
- Department of Dermatology, Sainte Elisabeth Hospital, Namur, Belgium
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Photodynamic therapy for localized infections--state of the art. Photodiagnosis Photodyn Ther 2010; 6:170-88. [PMID: 19932449 DOI: 10.1016/j.pdpdt.2009.10.008] [Citation(s) in RCA: 503] [Impact Index Per Article: 35.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Revised: 10/27/2009] [Accepted: 10/28/2009] [Indexed: 12/22/2022]
Abstract
Photodynamic therapy (PDT) was discovered over 100 years ago by observing the killing of microorganisms when harmless dyes and visible light were combined in vitro. Since then it has primarily been developed as a treatment for cancer, ophthalmologic disorders and in dermatology. However, in recent years interest in the antimicrobial effects of PDT has revived and it has been proposed as a therapy for a large variety of localized infections. This revival of interest has largely been driven by the inexorable increase in drug resistance among many classes of pathogen. Advantages of PDT include equal killing effectiveness regardless of antibiotic resistance, and a lack of induction of PDT resistance. Disadvantages include the cessation of the antimicrobial effect when the light is turned off, and less than perfect selectivity for microbial cells over host tissue. This review will cover the use of PDT to kill or inactivate pathogens in ex vivo tissues and in biological materials such as blood. PDT has been successfully used to kill pathogens and even to save life in several animal models of localized infections such as surface wounds, burns, oral sites, abscesses and the middle ear. A large number of clinical studies of PDT for viral papillomatosis lesions and for acne refer to its antimicrobial effect, but it is unclear how important this microbial killing is to the overall therapeutic outcome. PDT for periodontitis is a rapidly growing clinical application and other dental applications are under investigation. PDT is being clinically studied for other dermatological infections such as leishmaniasis and mycobacteria. Antimicrobial PDT will become more important in the future as antibiotic resistance is only expected to continue to increase.
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MacCormack MA. Photodynamic Therapy in Dermatology: An Update on Applications and Outcomes. ACTA ACUST UNITED AC 2008; 27:52-62. [DOI: 10.1016/j.sder.2007.12.001] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
Patients and clinicians experience the frustration of cutaneous viral warts caused by infection with the human papilloma virus (HPV).Warts appear in various forms on different sites of the body and include common warts (verruca vulgaris), plane or flat warts, myrmecia, plantar warts, coalesced mosaic warts, filiform warts, periungual warts, anogenital warts (venereal or condyloma acuminata), oral warts and respiratory papillomas. Cervical infection with HPV is now known to cause cervical cancer if untreated. A review of the medical literature reveals a huge armamentarium of wart monotherapies and combination therapies. Official evidence-based guidelines exist for the treatment of warts, but very few of the reported treatments have been tested by rigorous blinded, randomized controlled trials.Therefore, official recommendations do not often include treatments with reportedly high success rates, but they should not be ignored when considering treatment options. It is the purpose of this review to provide a comprehensive overview of the wart treatment literature to expand awareness of the options available to practitioners faced with patients presenting with problematic warts.
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Affiliation(s)
- Michelle M Lipke
- MPAS, PA-C, Department of Dermatology, Marshfield Clinic-Wausau Center, Wausau, WI 54401, USA.
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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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