- Daylight Photodynamic Therapy for Actinic Keratoses. [Review]
- AJAm J Clin Dermatol 2018 May 11
- Topical photodynamic therapy (PDT) using daylight is effective in the treatment of actinic keratoses (AKs), offering the potential for treatment of large fields such as full face and balding scalp, b...
Topical photodynamic therapy (PDT) using daylight is effective in the treatment of actinic keratoses (AKs), offering the potential for treatment of large fields such as full face and balding scalp, but with minimal therapy-associated pain. Comparison with conventional PDT indicates similar efficacy for thin and moderate-thickness AKs, but with significantly less discomfort/pain, driving a patient preference for daylight-mediated PDT (DL-PDT) compared with conventional PDT using high-intensity office/hospital-based light sources. Treatment protocol involves the application of a photosensitizing agent without occlusion and subsequent exposure to ambient daylight within 30 min, with patients exposed to daylight for 1.5-2.0 h. Pivotal randomized controlled trials in Europe and Australia have confirmed the efficacy of methyl aminolevulinic acid (MAL) DL-PDT in comparison with conventional MAL-PDT for mild and moderate-thickness lesions on the face and scalp. Initial clearance rates of 70-89% are reported. DL-PDT using a nanoemulsion aminolevulinic acid (ALA) has recently been shown to be at least as effective as MAL DL-PDT in treating mild and moderate-thickness AKs. DL-PDT may offer a better-tolerated method for treating patients with extensive AK disease. There is emerging literature on the potential for field PDT to reduce the number of new AKs developing, potentially preventing/slowing skin cancer development. Conventional PDT remains established as a therapy for Bowen's disease (squamous cell carcinoma in situ), superficial and certain thin basal cell carcinomas (BCCs), and AKs. The evidence for the use of DL-PDT beyond AK is limited, although has been reported in actinic cheilitis, superficial BCC, and acne and cutaneous leishmaniasis. There is emerging interest in combination therapy for AK, using one or more field therapies such as DL-PDT as an option to complement with localized treatment for residual lesions. We review current recommendations and consider the appropriate place for DL-PDT in our treatment armamentarium.
- Cutaneous Squamous Cell Carcinoma With Sclerosing Features: An Uncommon and Potentially Aggressive Variant. [Journal Article]
- AJAm J Dermatopathol 2018 May 08
- Sclerosing squamous cell carcinoma (SCC), also known as "desmoplastic" SCC, is a rare subtype of cutaneous malignancy. This variant is clinically significant because it is associated with an increase...
Sclerosing squamous cell carcinoma (SCC), also known as "desmoplastic" SCC, is a rare subtype of cutaneous malignancy. This variant is clinically significant because it is associated with an increased risk of local recurrence and metastasis. We herein present 16 examples of sclerotic SCC of the skin in 8 men and 3 women, with a median age of 66 years. The most common site of origin for this tumor is the skin of the head and neck, including the scalp (5 tumors in 2 different patients), forehead (3 cases), nasal ala (2 cases), neck (2 cases in the same patient), ear (2 cases), cheek (1 case), and chest (1 case). Microscopically, sclerosing SCCs are characterized by cellular cords, nests, and islands, as well as scattered single cells infiltrating densely desmoplastic and collagenized connective tissue. The differential diagnosis principally includes sclerosing basal cell carcinoma, microcystic adnexal carcinoma, and desmoplastic trichoepithelioma. The main goals of this study are to further characterize these lesions pathologically, and increase general awareness of this SCC subtype.
- Pain during topical photodynamic therapy - comparing methyl aminolevulinate (Metvix®) to aminolaevulinic acid (Ameluz®); an intra-individual clinical study. [Journal Article]
- PPPhotodiagnosis Photodyn Ther 2017; 20:6-9
- CONCLUSIONS: This intra-individual study demonstrate no significant difference between the pain response during PDT using methyl aminolevulinate and aminolaevulinic acid.
- Photodynamic Therapy Effectively Treats Actinic Keratoses Without Pre-Illumination Incubation Time. [Case Reports]
- JDJ Drugs Dermatol 2017 Mar 01; 16(3):275-278
- CONCLUSIONS: During PDT, the photosensitizer aminolevulinic acid (ALA), or in Europe methyl aminolevulinate (MAL), is utilized as a synthetic precursor that preferentially accumulates in dysplastic cells. The precursor then converts to PpIX via the heme pathway and causes apoptosis of the cells when excited, most commonly by either blue-violet (400-430 nm) or red (630-635 nm) light. Shorter incubation times are associated with reduced pain because less PpIX will have accumulated in the treated tissue by the start of the exposure to the light. The doubling of the light exposure time allows comparable levels of the photosensitizing molecule to accumulate and be activated so as to produce an equivalent reaction. The associated reduction in pain along with a more convenient treatment schedule makes this PDT protocol more tolerable and convenient to some patients.</p> <p><em>J Drugs Dermatol. 2017;16(3):275-278.</em></p>.
- Correlations between mercury concentration, and stable isotope ratios of carbon and nitrogen of amino acids in scalp hair from whale meat eaters and heavy fish eaters. [Journal Article]
- RCRapid Commun Mass Spectrom 2017 May 15; 31(9):745-752
- CONCLUSIONS: The difference in δ15 N values between Glx and Thr appears to be the best proxy for the estimation of Hg concentration in scalp hair. Copyright © 2017 John Wiley & Sons, Ltd.
- Randomized controlled trial comparing 35% trichloroacetic acid peel and 5-aminolaevulinic acid photodynamic therapy for treating multiple actinic keratosis. [Randomized Controlled Trial]
- BJBr J Dermatol 2017; 176(5):1155-1161
- CONCLUSIONS: ALA PDT provided better clinical results than TCA in the treatment of patients with extensive field cancerization and multiple AKs.
- Indole 3-acetic acid-photodynamic therapy in the treatment of multiple actinic keratoses: A proof of concept pilot study. [Clinical Trial]
- PPPhotodiagnosis Photodyn Ther 2016; 16:17-22
- CONCLUSIONS: Although larger studies are needed, this is a first "proof of concept" of IAA- PDT as a possible treatment for multiple AK on face/scalp.
- Relationship between manganese superoxide dismutase (MnSODAla-9Val) and glutathione peroxidase (GPx1 Pro 197 Leu) gene polymorphisms and alopecia areata. [Journal Article]
- IJInt J Clin Exp Med 2015; 8(11):21533-40
- CONCLUSIONS: This study is unique since an investigation to reveal the possible associations between the MnSOD Ala-9Val and GPx1 Pro 198 Leu polymorphisms and AA susceptibility and in Turkish population.
- Randomized Vehicle-Controlled Study of Short Drug Incubation Aminolevulinic Acid Photodynamic Therapy for Actinic Keratoses of the Face or Scalp. [Randomized Controlled Trial]
- DSDermatol Surg 2016; 42(3):296-304
- CONCLUSIONS: Short-incubation ALA-PDT was found to be superior to VEH-PDT for AK lesion clearance. A second treatment improves efficacy.
New Search Next
- Update on photodynamic treatment for actinic keratosis. [Journal Article]
- CPCurr Probl Dermatol 2015; 46:122-8
- Photodynamic therapy (PDT) is an attractive treatment option for actinic keratoses (AKs), as large skin areas can be treated with high response rates and superior cosmetic outcome. The efficacy of 5-...
Photodynamic therapy (PDT) is an attractive treatment option for actinic keratoses (AKs), as large skin areas can be treated with high response rates and superior cosmetic outcome. The efficacy of 5-aminolevulinic acid (ALA)-PDT and methyl aminolevulinate (MAL)-PDT for AK has been proven in multiple studies, and this treatment is recommended in numerous consensus works and therapy guidelines. Moreover, a self-adhesive ALA patch has been approved for the PDT of AK. In a phase III study, ALA-patch-PDT was superior to cryotherapy and placebo in the treatment of mild to moderate AK on the face and scalp, and pre-treatment of the lesions and additional light occlusion was unnecessary when using the patch. ALA with a proprietary nanoemulsion is another newly marketed ALA gel that has been approved for the treatment of mild to moderate AK on the head. ALA was combined with a nanoemulsion to achieve increased chemical stability of the active ingredient and to enhance skin penetration. One study found that ALA was superior to MAL in the treatment of AK on the face or scalp. Daylight-PDT is a simpler and more tolerable treatment procedure for PDT, and three randomised studies have shown that daylight-PDT is an effective and pain-free treatment for AK; however, the procedure is limited by the need for a sufficient light dose and outdoor temperature. Ablative fractional laser resurfacing prior to MAL has been used to improve the PDT response of thick AK. However, more intense acute skin reactions and long-term adverse events in ablative fractional laser resurfacing-PDT compared with PDT-treated skin were found, which might limit the use of the intensified treatment.