Efficacy Of Daylight Photodynamic Therapy Research Articles

Conventional versus daylight photodynamic therapy for recalcitrant hand warts: Efficacy, safety and recurrence

BackgroundAcral warts appear as skin-colored, verrucous, hyperkeratotic papules most located on the dorsal hands, distal fingers, subungual skin, and feet. Conventional photodynamic therapy (C-PDT) has shown a good efficacy and safety profile in patients with viral warts, in both adults and children, with a good cure rate and excellent cosmetic results in front of few and light side effects. The efficacy of daylight photodynamic therapy (DL-PDT) has not yet been evaluated. Objectivesto investigate and assess the short- and long-term efficacy of PDT using 10 % aminolevulinic acid (ALA) in the treatment of multiple verrucae vulgaris of the hands. The second endpoint was to compare the efficacy and safety of C-PDT versus DL-PDT. Materials and methods68 patients (38 males and 30 females) aged between 6 and 80 years, affected by hand warts, were divided into two arms: group A was treated with C-PDT, and group B was treated with DL-PDT. Patients underwent treatments three times at 1-month intervals. The response was assessed 3 months after the last session (W24) and 1 year after the last session (W52) and scored as excellent (75–100 % reduction of total wart count), partial (74−25 % reduction), and none (< 25 % reduction or no response). Any adverse events occurring during or after ALA application or irradiation as well as pain intensity were recorded at each visit. Results48 patients (70.6 %) achieved excellent response at W24, while 6 patients (8.8 %) had a partial response and 14 (20.6 %) were resistant to treatment. Patients treated with DL-PDT were less likely to have an excellent response (66.7 %) than patients treated with C-PDT (73.7 %), although not statistically significant. Among patients with excellent or partial response (n=54), 37 % (n=20) had warts relapse at W52. Both treatment modalities were well tolerated, with transient pain as the main side effects. ConclusionPDT is effective in the treatment of verrucae vulgaris of the hands. An overall response rate of 70.6 % of excellent response was achieved. While C-PDT showed a trend towards better outcomes, DL-PDT offered a more patient-friendly approach, particularly in terms of comfort and compliance.

Pre-treatment with topical 5-fluorouracil increases the efficacy of daylight photodynamic therapy for actinic keratoses – A randomized controlled trial

BackgroundDaylight photodynamic therapy (dPDT) and topical 5-fluorouracil (5-FU) are each effective treatments for thin grade I actinic keratosis (AKs), but less so for thicker grade II-III AKs. Prolonged topical treatment regimens can be associated with severe skin reactions and low compliance.This study compares the efficacy of sequential 4 % 5-FU and dPDT with dPDT monotherapy for multiple actinic keratoses. MethodsSixty patients with a total of 1547 AKs (grade I: 1278; grade II: 246; grade III: 23) were treated in two symmetrical areas (mean size 75 cm2) of the face or scalp, which were randomized to (i) 4% 5-FU creme twice daily for 7 days before a single dPDT procedure and (ii) dPDT monotherapy. Daylight exposure was either outdoor or indoor daylight. ResultsTwelve weeks after treatment 87 % of all AKs cleared after 5-FU+dPDT compared to 74 % after dPDT alone (p<0.0001). For grade II AKs, the lesion response rate increased from 55 % with dPDT monotherapy to 79 % after 5-FU+dPDT (p<0.0056). Moderate/severe erythema was seen in 88 % 5-FU+dPDT areas compared to 41 % of dPDT areas two days after dPDT. Twelve weeks after treatment 75 % of the patients were very satisfied with both treatments. ConclusionsSequential 5-FU and dPDT was more effective than dPDT monotherapy in the treatment of AKs, especially for grade II AKs. Local skin reactions were more pronounced after combination treatment, but no patients discontinued the treatment. The combination of 5-FU and dPDT is an effective treatment of large treatment areas with high compliance and satisfaction.

Comparison of the safety and efficacy of daylight photodynamic therapy and conventional photodynamic therapy for actinic keratoses: A systematic review demonstrating noninferiority

Comparison of the safety and efficacy of daylight photodynamic therapy and conventional photodynamic therapy for actinic keratoses: A systematic review demonstrating noninferiority

Efficacy and safety of conventional versus daylight photodynamic therapy in children affected by multiple facial flat warts

facial flat warts (FFWs) are a superficial viral skin disease, extremely common in childhood. Recently, conventional photodynamic therapy (C-PDT) has been used for the treatment of FFWs with good outcome. The efficacy of daylight photodynamic therapy (DL-PDT) has not yet been evaluated. to investigate and assess the efficacy and safety of C-PDT versus DL-PDT using 10% aminolevulinic acid (ALA) in the treatment of recalcitrant FFWs in a paediatric setting. 30 consecutive patients aged <18 years with FFWs of the face were included and randomly divided into two groups: group A (15 patients) was treated with C-PDT and group B (15 patients) with DL-PDT. Patients underwent treatments for three times with 1-month intervals. The response was assessed on week 4,812 and 24 (T4,T8,T12,T24) and scored as excellent (75-100% reduction of total wart count), very good (74-50% reduction), good (49-25% reduction), poor (<25% reduction or no response). Any adverse event occurring during/after ALA application/irradiation as well as pain intensity were recorded at each visit. at T4 and T8 no excellent response was achieved in both groups. At week 12, excellent response was observed in 53.3% of group A patients vs 0% of group B patients, although in the latter 66.7% of patients achieved a very good response. Excellent outcome raised to 73.3% and 80% in group A and B, respectively, at week 24. Poor response to therapy was observed in 26.7% of patients in group A and 20% in group B. Both treatment modalities were well tolerated, with transient pain, irritation and hyperpigmentation as main side effects. ALA-PDT is effective and safe for FFWs, with striking cosmetic results and no recurrence. Compared with conventional modality, DL-PDT is better tolerated, time-saving, nearly painless and greatly appreciated by young patients.

Single versus two-treatment schedule of methyl aminolevulinate daylight photodynamic therapy for actinic keratosis of the face and scalp: An intra-patient randomized trial.

Efficacy of daylight-photodynamic therapy (DL-PDT) with methyl aminolaevulinate (MAL) has been reported to gradually decrease as the severity of actinic keratosis (AK) lesions increases. Repeated treatments have been suggested to increase the efficacy of DL-PDT. Aim of our pilot study was to evaluate the efficacy and tolerability of a single versus two-treatment schedule of MAL DL-PDT for the treatment of multiple AKs of the face/scalp in a prospective, intra-patient, comparison study. Patients with multiple AKs of the face/scalp received a single treatment of MAL DL-PDT or 2 treatments, 1 week apart, on either half-side. Weather conditions and outdoor temperature were recorded during daylight exposure. Visual analog scale for pain was assessed immediately after each session, and severity of local skin reactions after 2 days. Treatment efficacy was evaluated at 3 months. Thirty-one patients with multiple AKs of the face/scalp were enrolled and completed the study. No significant difference was observed between single and two-treatment schedule in the lesion complete response rate for total AKs (80.7% vs 85.6%, p = 0.28) and for AKs divided by grade (grade I: 88.5% vs 89.2%, p = 0.79; grade II: 67.3% vs 71.0%, p = 0.71; grade III: 50.0% vs 55.6%, p≈1.00). Pain was significantly higher during the second session (p = 0.04). Local skin reactions were generally mild, but more severe after the first treatment (p < 0.01). The two-treatment schedule did not improve significantly the efficacy of MAL DL-PDT for AKs of the face and scalp as compared to the single-treatment. Alternative strategies might be recommended to optimize the efficacy of DL-PDT.

Use of 5-Aminolevulinic Acid and Daylight Photodynamic Therapy for the Treatment of Actinic Keratoses.

Photodynamic therapy (PDT) is an effective modality for the treatment of actinic keratoses (AKs). The use of methyl aminolevulinate with daylight PDT (D-PDT) has quickly gained popularity internationally because of its tolerability and high levels of safety and efficacy. However, there is a paucity of studies on the use of D-PDT with 5-aminolevulinic acid (ALA). To study the safety and efficacy of D-PDT in treating AKs on the face and scalp using ALA. Thirty patients were recruited for this prospective, uncontrolled study. Patients were treated with topical ALA on either the scalp or face, incubated for 30 minutes, and then sat at home in a shady area for 2 hours. Weather conditions, lux measurements, and AK counts at 3 and 6 months were measured. Daylight PDT led to a median of 75% reduction in AK count at 6 months, with no significant adverse effects. Ninety-six percentage of patients were either moderately or very satisfied with the treatment, and the median peak pain score during treatment was 1. There was no correlation between weather or average lux received during treatment and 6-month outcomes. Daylight PDT with ALA is a safe and effective treatment modality for AKs on the head.

Efficacy and safety of daylight photodynamic therapy after tailored pretreatment with ablative fractional laser or microdermabrasion: a randomized, side-by-side, single-blind trial in patients with actinic keratosis and large-area field cancerization.

Physical pretreatments can potentiate the efficacy of daylight photodynamic therapy (dPDT), but clinical comparative studies remain limited. Performed in large skin areas with actinic keratoses (AKs) and photodamage, this blinded, randomized clinical trial compared the efficacy and safety of dPDT after tailored skin pretreatment using ablative fractional laser (AFL) or microdermabrasion (MD). Two ≥ 50-cm2 side-by-side skin areas were randomized to receive a single treatment with AFL-dPDT or MD-dPDT. Pretreatment parameters were tailored according to AK grade and skin constitution to ensure standardized immediate end points. Subsequently, methyl aminolaevulinate was applied, followed by 2-h daylight exposure. The primary outcome comprised blinded assessment of AK clearance at the 3-month follow-up. In 18 patients with 832 AKs, AFL-dPDT provided significantly higher AK clearance (81% vs. 60%, P < 0·001), led to fewer new AKs (P < 0·001) and showed superior improvement in dyspigmentation (P = 0·003) and skin texture (P = 0·001) vs. MD-dPDT. Peaking at days 3-6, AFL-PDT induced more intensified local skin responses (P = 0·004), including instances of Staphylococcus aureus infection (n = 3). Patients nonetheless preferred AFL-dPDT (P = 0·077), due to lower pretreatment-related pain (P = 0·002) and superior cosmesis (P = 0·035) and efficacy compared with MD-dPDT. AFL-dPDT is an effective treatment for patients with AK with extensive field cancerization, although AFL pretreatment is associated with intensified local skin reactions.

A double-blind randomized controlled trial to assess the efficacy of daylight photodynamic therapy with methyl-aminolevulinate vs. Placebo and daylight in patients with facial photodamage

BackgroundDaylight PDT (dPDT) is easy to use and does not require light equipment. Such therapy has been exhaustively proved to be successful in the treatment of actinic keratosis, but its use in skin photodamage remains unclear. ObjectiveTo evaluate dPDT's efficacy in skin facial photodamage. Patients and methodsThis was a parallel-group double-blind, randomized placebo-controlled trial. Sixty participants with symmetric facial photodamage were allocated to topical methyl aminolevulinate (MAL) and daylight vs. matching placebo and daylight. Primary outcome was global photodamage improvement/failure 1 month after the third session. Secondary outcomes included: pain evaluation; specific photodamage severity scores; sun irradiance quantification and Skindex-29 scores. Adverse events were also investigated. ResultsPrimary analysis included all randomized patients. All patients sun-exposed for 120min in 3 sessions. The risk of failure was lower in the MAL-dPDT group than in the placebo plus daylight group (RR: 0.18; 95% CI: 0.08–0.41). Mean solar irradiance (W/m2) during the first, second and third sessions was 480.82, 430.07 and 435.84, respectively. Items 5 and 14 of Skindex-29 in the MAL-dPDT group showed statistical significant differences. Two patients in the MAL-dPDT group had serious and non-serious events not directly related to the product. ConclusiondPDT with MAL was un-painful, effective and safe for the treatment of facial photodamage. Herpes simplex prophylaxis should be considered before sessions.

A double-blind randomized controlled trial to assess the efficacy of daylight photodynamic therapy with methyl-aminolevulinate vs. Placebo and daylight in patients with facial photodamage

BackgroundDaylight PDT (dPDT) is easy to use and does not require light equipment. Such therapy has been exhaustively proved to be successful in the treatment of actinic keratosis, but its use in skin photodamage remains unclear. ObjectiveTo evaluate dPDT's efficacy in skin facial photodamage. Patients and methodsThis was a parallel-group double-blind, randomized placebo-controlled trial. Sixty participants with symmetric facial photodamage were allocated to topical methyl aminolevulinate (MAL) and daylight vs. matching placebo and daylight. Primary outcome was global photodamage improvement/failure 1 month after the third session. Secondary outcomes included: pain evaluation; specific photodamage severity scores; sun irradiance quantification and Skindex-29 scores. Adverse events were also investigated. ResultsPrimary analysis included all randomized patients. All patients sun-exposed for 120min in 3 sessions. The risk of failure was lower in the MAL-dPDT group than in the placebo plus daylight group (RR: 0.18; 95% CI: 0.08–0.41). Mean solar irradiance (W/m2) during the first, second and third sessions was 480.82, 430.07 and 435.84, respectively. Items 5 and 14 of Skindex-29 in the MAL-dPDT group showed statistical significant differences. Two patients in the MAL-dPDT group had serious and non-serious events not directly related to the product. ConclusiondPDT with MAL was un-painful, effective and safe for the treatment of facial photodamage. Herpes simplex prophylaxis should be considered before sessions.