Use Of Topical Photodynamic Therapy Research Articles

Topical photodynamic therapy in the treatment of benign oral mucosal lesions: A systematic review.

The introduction of photodynamic therapy (PDT) in various branches of the dental field such as endodontics, implantology, periodontology, and restorative dentistry and oral medicine has become useful in recent decades. This systematic review presents an overview of the literature to evaluate the usefulness of topical PDT for the treatment of benign oral soft tissue lesions and to identify limitations in prior studies to improve PDT applications. We performed a review of the literature using different search engines (PubMed, ISI Web of Science, and the Cochrane Library) employing MeSH terms such as "Photodynamic therapy" and "PDT" in conjunction with other terms. We utilized the Population, Intervention, Comparison, Outcomes, and Study design (PICOS) method to define our study eligibility criteria. Initial results were 1513. Finally, there were only 21 studies that met our selection criteria. We divided the 21 selected items into two groups: inflammatory diseases and infective diseases. Although topical PDT is an easy to perform and well-tolerated treatment and appears to be a valid method with promising results in the treatment of benign lesions of the oral cavity's soft tissues, further studies are needed to complete the current knowledge of this technique.

European Dermatology Forum guidelines on topical photodynamic therapy 2019 Part 2: emerging indications - field cancerization, photorejuvenation and inflammatory/infective dermatoses.

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.

European Dermatology Forum guidelines on topical photodynamic therapy 2019 Part 1: treatment delivery and established indications - actinic keratoses, Bowen's disease and basal cell carcinomas.

Topical photodynamic therapy (PDT) is a widely approved therapy for actinic keratoses, Bowen's disease (squamous cell carcinoma insitu), superficial and certain thin basal cell carcinomas. Recurrence rates when standard treatment protocols are used are typically equivalent to existing therapies, although inferior to surgery for nodular basal cell carcinoma. PDT can be used both as lesional and field therapies and has the potential to delay/reduce the development of new lesions. A protocol using daylight to treat actinic keratoses is widely practised, with conventional PDT using a red light after typically a 3-h period of occlusion employed for other superficial skin cancer indications as well as for actinic keratoses when daylight therapy is not feasible. PDT is a well-tolerated therapy although discomfort associated with conventional protocol may require pain-reduction measures. PDT using daylight is associated with no or minimal pain and preferred by patient. There is an emerging literature on enhancing conventional PDT protocols or combined PDT with another treatment to increase response rates. This guideline, published over two parts, considers all current approved and emerging indications for the use of topical PDT in dermatology, prepared by the PDT subgroup of the European Dermatology Forum guidelines committee. It presents consensual expert recommendations reflecting current published evidence.

A synthesis of the world's guidelines on photodynamic therapy for non-melanoma skin cancer.

Photodynamic therapy (PDT), using topically administered photosensitizing agents, is widely approved as a treatment for certain nonmelanoma skin cancers. As a tissue-sparing non-surgical modality, there is great potential for PDT to enhance the choice of therapies available to treat, and potentially prevent, skin cancer. Treatment-specific guidelines have assessed the evidence for various photosensitizing agents and light sources, dosimetry, and evaluate reported adverse effects. Discomfort is frequently experienced during treatment but no analgesia was required in most pivotal lesion-directed studies. Durability of response has been assessed with studies of PDT for basal cell carcinomas (BCC) extending to 5 years and beyond, 2 years for Bowen's disease and up to 1 year for actinic keratoses (AK). Disease-specific guidelines consider the place for topical PDT in routine clinical practice recognizing that PDT is typically office/clinic-based and usually initiated by specialists. Where updated guidelines are awaited, national and international consensus publications offer recommendations, including on the use of daylight to activate the photosensitizer for treating AK. Reviewed studies indicate equivalent efficacy of daylight PDT, but greatly reduced pain compared with conventional PDT. Guidelines and consensus publications also consider the place of PDT in treating skin lesions arising in organ transplant recipients and in the potential for PDT to delay/prevent the development of nonmelanoma skin cancers. There is now a substantial evidence-base to support the use of topical PDT in routine clinical practice with daylight PDT indicated for AK, providing suitable outside climate, whilst conventional PDT remains suitable for AK, Bowen's Disease, superficial and certain thin nodular BCC.

European Dermatology Forum Guidelines on topical photodynamic therapy.

Topical photodynamic therapy (PDT) is a widely approved therapy for actinic keratoses, squamous cell carcinoma in-situ, superficial and certain thin basal cell carcinomas. Recurrence rates are typically equivalent to existing therapies, although inferior to surgery for nodular basal cell carcinoma. PDT can be used both as a lesional or as a field therapy and has the potential to delay/reduce the development of new lesions. 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 immunocompetent individuals. Many additional indications have been evaluated, including photo-rejuvenation and inflammatory and infective dermatoses. This S2 guideline considers all current 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. An unabridged version of this guideline is available online at: http://www.euroderm.org/edf/index.php/edf-guidelines.

A prospective pilot study to evaluate combined topical photodynamic therapy and surgery for extramammary paget's disease

Extramammary Paget's disease (EMPD) is a rare intra-epithelial neoplasm. Surgical excision is the treatment of choice. The usefulness of topical photodynamic therapy (PDT) in the treatment of EMPD has been reported. The objective of this prospective pilot study was to investigate the feasibility of combined PDT and surgery in the treatment of EMPD. A total of 13 patients with 19 large EMPD lesions were recruited and assigned to surgery (n = 5) or PDT + surgery (n = 8) group. For the PDT + surgery group, four sessions of topical PDT mediated with 20% 5-aminolevulinic acid (ALA-PDT) were applied prior to surgery. Patients were followed up for 12 months. Treatment outcomes, adverse reactions and recurrence were compared. In the surgery group, recurrence was seen in 2 out of 8 lesions (25%). In the combination group, over 58% reduction in lesion size was achieved after 4-sessions of PDT and recurrence was seen in 1 out of 11 lesions (9.1%) after surgery. Multiple ALA-PDT could be applied to reduce the severity of EMPD lesion and improve the success of surgery.

Therapeutic and immune effects of 5‐aminolevulinic acid photodynamic therapy on UVB‐induced squamous cell carcinomas in hairless mice

The therapeutic effects of 5-aminolevulinic acid (ALA)-mediated photodynamic therapy (PDT) on cutaneous squamous cell carcinoma (SCC) are not fully understood, and the usefulness of topical PDT in the treatment of SCC is still debatable. The most interesting aspect in SCC PDT is perhaps its potential in inducing antitumor immune responses. In this study, cutaneous SCCs were established by UVB irradiation of hairless mice and treated with multiple ALA PDT. Immunohistochemistry assays showed that ALA PDT could induce quick apoptosis, overexpression of TNFα and marked increases in DCs, CD4(+) and CD8(+) cells in tumor interstitium and subcutaneous connective tissues. However, a complete response was only achieved for small SCCs. The clinical value of ALA PDT-induced specific antitumor immune responses in long-term control of SCCs deserves further study.

Local clinical phototreatment of herpes infection in São Paulo

The clinical use of topical photodynamic therapy in herpes simplex lesions in São Paulo is presented and discussed. Although previous attempts utilising this type of approach in the USA were discontinued in the early 1970s due to several presentations of post-treatment Bowen's disease, none of the cases from the clinic presented here have displayed any complications on follow-up. In addition, lesion recrudescence periods are generally much longer than with conventional approaches. This is thought to be due to improvements in the treatment protocol, viz. use of the non-toxic photosensitisers methylene blue and Hypericum perforatum extract in place of proflavine and neutral red in the original trials, differences in photosensitisation pathway and illumination of the treatment site with red rather than fluorescent/UV light. Post-treatment cosmesis is also excellent.

Topical photodynamic therapy with methylaminolevulinate for the treatment of actinic keratosis and reduction of photodamage in organ transplant recipients: A case-series of 16 patients

Organ transplant recipients (OTR) are at high risk of developing cutaneous neoplasms. Topical photodynamic therapy (PDT) has been used for the treatment of actinic keratosis (AK) in OTR. The objective was to evaluate the efficacy of PDT with methylaminolevulinate (MAL) in the treatment of facial AK in OTR. As a secondary objective, we wanted to evaluate the usefulness of topical PDT in the reduction of photodamage in OTR. A prospective, single center, single arm study was made. 16 OTR were included. Topical PDT was applied for 1 or 2 cycles depending on the patient's characteristics. An evaluation of AK was made at visits pre-treatment, at 12 weeks and at 24 weeks. Photodamage was measured with multispectral image technique (SkinCare). A complete response rate of 100% was achieved for AK in all patients; it persisted without change at 12 and 24 weeks of follow-up. 62.5% of patients improved their photodamage as measured by SkinCare®, but this result was not statistically significant (P = 0.12). All patients had high level of satisfaction at the end of the therapy. MAL-PDT is an effective therapy for the treatment of AK in OTRs. It can reduce photodamage in this group of patients, but these results were not statistically significant.

Oxygen saturation and perfusion changes during photodynamic therapy: use of noninvasive monitoring

Conflicts of interest S. Ibbotson has received travel expenses from Galderma, U.K. Photodynamic therapy (PDT) requires tissue‐localized photosensitizer, light of appropriate wavelength and the presence of oxygen. Indeed, the manipulation of oxygen tension can alter the efficacy of PDT in vitro, resulting in opportunities for optimization of treatment.1 The use of topical PDT in dermatology for dysplasia and superficial nonmelanoma skin cancer is well established,2 and its routine use in clinical practice has advanced beyond our understanding of what is happening at a cellular level in human skin. While topical PDT is highly effective in selected patients, relapse rates of approximately 20% can be expected by the 5‐year follow‐up.3 In addition, current PDT regimens are not maximally effective for lesions such as thicker nodular basal cell carcinomas, and pain during irradiation can sometimes be limiting. In view of this, there is a clinical need for optimization of PDT treatment parameters, and one approach has been to maximize PDT efficiency based on in vivo data,4 such as the use of lower irradiance or pulsed‐light delivery.

Photodynamic therapy in acne: can we achieve therapeutic gain without pain?

Conflicts of interest C.A.M. has acted as an adviser, lecturer and/or researcher for Galderma, Janssen and Leo Pharma. Impressive response rates have been observed following the use of topical photodynamic therapy (PDT) in acne, but the treatment remains little used in practice compared with its established indications in nonmelanoma skin cancer. Why? Therapy‐induced pain, erythema, sterile pustular reactions and hyperpigmentation, as well as the need for multiple treatments, have so far limited patient enthusiasm for PDT in acne. PDT, the interaction of a photosensitizer, light and oxygen to promote a targeted therapeutic effect, can promote improvement in acne via antibacterial activity against Propionibacterium acnes, as well as selective damage to sebaceous glands, reduction in follicular obstruction by keratinocyte shedding and via secondary host responses.1Propionibacterium acnes naturally produces small amounts of certain porphyrins, especially coproporphyrin III, hence the beneficial effects observed in light‐only studies, but application of an additional exogenous photosensitizer is necessary to maximize the effect of PDT in acne, facilitating its use even in moderate‐to‐severe disease.

Adverse effects of topical photodynamic therapy

Topical photodynamic therapy (PDT) is increasingly used in dermatology, particularly for the treatment of superficial non-melanoma skin cancer and dysplasia. Treatment is generally considered to be well tolerated, although pain during PDT can be a limiting factor. This review explores the adverse effects of topical PDT. A thorough search of the literature using Medline was undertaken and published data were evaluated and presented in conjunction with our own experience. Pain during PDT is the most commonly reported adverse effect and may prevent successful treatment delivery, although low-irradiance regimes and use of nerve blocks or cooling air can be used to reduce pain. Other acute and chronic adverse effects are reported but do not seem to be limiting factors in the use of topical PDT. To date, there is no convincing evidence for a carcinogenic effect of this treatment. Topical PDT is associated with few significant adverse effects, although methods to optimize regimes and minimize pain are required to improve the acceptability of this therapy for patients.

Guidelines for practical use of MAL‐PDT in non‐melanoma skin cancer

Methyl aminolaevulinate photodynamic therapy is increasingly practiced in the treatment of actinic keratoses, Bowen's disease and basal cell carcinomas. This method is particularly suitable for treating multiple lesions, field cancerization and lesions in areas where a good cosmetic outcome is of importance. Good treatment routines will contribute to a favourable result. The Norwegian photodynamic therapy (PDT) group consists of medical specialists with long and extensive PDT experience. With support in the literature, this group presents guidelines for the practical use of topical PDT in non-melanoma skin cancer.

An overview of topical photodynamic therapy in dermatology

This article is a review of the use of topical photodynamic therapy in dermatology and its current role in 2009 and future developments. The content of this article was presented at the EPPM in Wroclaw, September 2009.

How we treat Bowen's disease with topical photodynamic therapy in Dundee

We have more than 10 years experience in the Photobiology Unit, in the use of topical photodynamic therapy (PDT) for non-melanoma skin cancer and other skin diseases. During this time we have undertaken approximately 5000 treatments and this article details the practical aspects of how we treat Bowen's disease with topical PDT.

Guidelines for topical photodynamic therapy: update

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.

International guidelines for the use of topical photodynamic therapy in treating and preventing nonmelanoma skin cancers have been published.

International guidelines for the use of topical photodynamic therapy in treating and preventing nonmelanoma skin cancers have been published.

International guidelines for the use of topical photodynamic therapy in treating and preventing nonmelanoma skin cancers have been published.

International guidelines for the use of topical photodynamic therapy in treating and preventing nonmelanoma skin cancers have been published.

Guidelines on the use of photodynamic therapy for nonmelanoma skin cancer: An international consensus

Topical photodynamic therapy (PDT) is used to treat nonmelanoma skin cancers, such as actinic keratoses, Bowen's disease, and basal cell carcinoma (superficial and nodular). This article presents up-to-date, practical, evidence-based recommendations on the use of topical PDT using 5-aminolevulinic acid or methyl aminolevulinate for the treatment (and prevention) of nonmelanoma skin cancers. A systematic literature review was conducted (using MEDLINE), and recommendations were made on the basis of the quality of evidence for efficacy, safety/tolerability, cosmetic outcome, and patient satisfaction/preference. Topical PDT is highly effective in the treatment of actinic keratoses, Bowen's disease, superficial and thin nodular basal cell carcinomas, with cosmesis typically superior to that achieved with existing standard therapies. PDT may also be a means of preventing certain nonmelanoma skin cancers in immunosuppressed patients.

Photodynamische Therapie: Nichtonkologische Indikationen

While efficacy of photodynamic therapy (PDT) in the treatment of superficial, non-melanoma skin cancer has been proven in controlled clinical trials, there are only few controlled studies showing the usefulness of topical PDT for non-oncologic diseases of the skin. Several promising reports on PDT of inflammatory dermatoses, e. g. psoriasis vulgaris, localized scleroderma, lichen sclerosus et atrophicus or virus induced skin disorders offer promise that PDT will set up in this area also since it offers several advantages over established treatment modalities and is associated with only few side effects. In contrast to PDT of tumors, where the aim of therapy is tumor destruction, PDT of inflammatory disorders probably works by modulating cellular functions. Therapeutic protocols therefore differ markedly from those used for tumor destruction. For treatment of inflammatory dermatoses usually very low photosensitizer and light doses are sufficient (“low-dose PDT”), however multiple treatments are commonly necessary to achieve the desired effects. Most experiences are available with the endogenous topical photosensitizer 5-aminolevulinic acid. Only for the treatment of psoriasis also systemic photosensitizers have been used successfully. Controlled clinical trials are necessary to study the efficacy of PDT in this promising new field of inflammatory disorders, to establish treatment protocols and probabl y find new indications for PDT in dermatology. Originalarbeit