Daylight Photodynamic Therapy: An Update.

Daylight photodynamic therapy (dPDT) uses sunlight as a light source to treat superficial skin cancer. Using sunlight as a therapeutic device has been present for centuries, forming the basis of photodynamic therapy in the 20th century. Compared to conventional PDT, dPDT can be a less painful, more convenient and an effective alternative. The first clinical uses of dPDT on skin cancers began in Copenhagen in 2008. Currently, aminolevulinic acid-mediated dPDT has been approved to treat actinic keratosis patients in Europe. In this review article, we introduce the history and mechanism of dPDT and focus on the pros and cons of dPDT in treating superficial skin cancers. The future applications of dPDT on other skin diseases are expected to expand as conventional PDT evolves.

Single Ablative Fractional Resurfacing Laser Treatment For Forearm Actinic Keratoses: 6-Month Follow-Up Data From An Intrapatient Comparison Between Treated and Untreated Sites.

BACKGROUND AND OBJECTIVES: Actinic keratoses (AK) are common pre-cancerous lesions, which are associated with ultraviolet light exposure and aging. Wounding therapies such as fractionated laser resurfacing (FLR) have been previously demonstrated to effectively treat facial AK. However, the effectiveness of FLR on other sites commonly afflicted with AK has not been studied in detail. Previously, our group has reported that treatment of aged skin with wounding therapies including dermabrasion and ablative fractionated resurfacing results in the removal of senescent fibroblasts and normalizing the pro-carcinogenic acute ultraviolet B radiation responses associated with aged skin. The current studies were designed to test the effectiveness of FLR of the forearm skin of subjects aged 60 and older to remove AKs. STUDY DESIGN/MATERIALS AND METHODS: Between February 2018 and March 2019, 30 subjects were enrolled in a study, in which they underwent a single FLR treatment of one extremity including the dorsal forearm, wrist, and dorsal hand. The number of AKs was recorded on both extremities at baseline, 3 and 6 months in a blinded fashion. Side effects of the FLR were documented. RESULTS: A single FLR treatment resulted in a 62% reduction in the absolute number of AK in the treated arm at 6 months post-treatment. The laser treatment was well-tolerated without major complications. CONCLUSIONS: These studies demonstrate that FLR using settings, which have demonstrated to remove senescent fibroblasts and normalize the pro-carcinogenic UVB-response of aged skin is a potentially effective and safe field therapy treatment that should be studied for long-term efficacy for use in treating upper extremity AKs. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.

Pain reduction in patients after applying a nitrous oxide/oxygen mixture (Livopan) during photodynamic therapy: study protocol for an observational study (Livopan study).

INTRODUCTION: Photodynamic therapy (PDT) is an effective treatment option for extensively photodamaged skin with multiple actinic kerastosis. However, the main drawback of PDT is the intensive pain experienced during its application, which makes it frequently necessary to interrupt or even terminate the process resulting in incomplete treatment. Several strategies for controlling pain during PDT have been studied but few effective methods are currently available. Alternative options are urgently needed. Livopan, a nitrous oxide/oxygen mixture, is indicated for the treatment of short-term pain conditions when rapid analgesic onset and offset effects are wanted. But so far, there are no studies evaluating the effect of Livopan on pain intensity during PDT. Therefore, it remains unclear whether patients benefit from this inhalation analgesia. Within the Livopan study, this issue will be evaluated for the first time. METHODS AND ANALYSIS: The Livopan study is a prospective, single-centre, explorative, controlled, observational study to investigate the pain reduction in patients after applying a nitrous oxide/oxygen mixture (Livopan) during PDT according to the visual analogue scale in 60 patients. ETHICS AND DISSEMINATION: Ethics approval was provided by the ethics committee of the medical faculty of the University of Heidelberg. Ethics approval number S-169/2014. TRIAL REGISTRATION NUMBER: German Clinical Trial Register (DRKS): DRKS00006054.

Nonablative fractional photothermolysis for facial actinic keratoses: 6-month follow-up with histologic evaluation.

BACKGROUND: A number of epidermal and papillary dermal skin conditions can be treated safely and effectively with fractional photothermolysis (FP). OBJECTIVE: We sought to evaluate the effectiveness of FP with a 1550-nm fractionated erbium-doped fiber laser for the treatment of facial actinic keratoses (AKs). METHODS: Fourteen men, ages 59 to 79 years, underwent 5 laser treatments (2- to 4-week intervals) at an energy fluence of 20 to 70 mJ and treatment level of 11 (8-10 passes), corresponding to 32% to 40% surface area coverage. AK counts and photographs were taken at baseline, before each treatment, and at 1-, 3-, and 6-month follow-ups after the last treatment. Biopsies were performed at baseline and at the 3-month follow-up. The clinical improvement of the actinic lesions was evaluated by a dermatologist using digital photography and lesion counts at all 3 follow-up visits. RESULTS: The AK count for each patient was reduced on average by 73.1% (67.5%-77.7%) at the 1-month, 66.2% (60.0%-71.5%) at the 3-month, and 55.6% (43.9%-64.8%) at the 6-month follow-up visit. Excluding two cases, all biopsy specimens (baseline and at the 3-month follow-up) were positive for histologic features of AK and/or squamous cell carcinoma. LIMITATIONS: This study is limited by a small number of patients; therefore further clinical studies are warranted. CONCLUSIONS: FP decreases the number of clinical AKs; however, posttreatment biopsy specimens indicate the histologic persistence of AKs (epidermal tumors). FP is not an adequate single-treatment modality for AKs.

Reversing precancerous actinic damage by mixing wavelengths (1064 nm, 532 nm).

BACKGROUND: Premalignancies resulting from photodamage, such as actinic keratosis and carcinoma in situ, can be treated with various modalities. Most of these treatments may reverse or treat these conditions although they often involve considerable skin irritation over a long period of time, are very uncomfortable for the patients or they need many office visits and sometimes are very expensive, such as photodynamic therapy (PDT). OBJECTIVE: To study the effectiveness of a mixed session of Q-switched KTP 532 nm and Nd:YAG 1064 nm laser treatment on precancerous lesions resulting from solar damage. METHODS: Ten patients with long-standing actinic damage/keratosis or carcinoma in situ were subjected to only one session of mixed Q-switched KTP 532 nm and Nd:YAG 1064 nm laser treatment. Lesions were evenly and repeatedly scanned with both wavelengths until light pain or purpura presented. RESULTS: All patients responded extremely well within a period of 20 days, with just one session, with virtually no pain, minimum irritation, no down time at all and excellent cosmetic outcome. CONCLUSION: The use of a mixed Q-switched 532 nm and Nd:YAG 1064 nm laser session seems to be ideal for treating precancerous lesions resulting from photodamage since it can be a fast, painless and simple office procedure with no down time and minimum discomfort for the patient. This method proves to be much more selective than traditional intense pulse light (IPL) photorejuvenation.

Validation of a non-invasive fluorescence imaging system to monitor dermatological PDT.

BACKGROUND: Methyl-aminolevulinate (MAL) photodynamic therapy (PDT) involves selective accumulation of a photosensitiser, protoporphyrin IX (PpIX), primarily in tumour tissue, which in combination with visible light and tissue oxygen results in reactive oxygen species (ROS) production and thus cellular destruction. METHODS: A non-invasive fluorescence imaging system (Dyaderm, Biocam, Germany) has been employed to acquire colour (morphological) and fluorescent (physiological) images simultaneously during dermatological PDT. This system had been previously utilised for fluorescence diagnosis, however, here changes in PpIX concentration within the skin lesions and normal tissue were followed after MAL application. Measurements were also recorded from a synthetic PpIX standard. RESULTS: Results indicated that imaging distance, imaging angle, position of the region of interest and light conditions all altered the PpIX levels acquired from the synthetic PpIX standard. The imaging system was therefore adapted and a standard operating procedure developed allowing reproducible images of dermatological lesions to be acquired. Different concentrations of synthetic PpIX were analysed with the system and a linear relationship was observed between the PpIX concentration and the mean greyscale value calculated for the images acquired up to 10 microM. CONCLUSIONS: The Dyaderm imaging system can now be used reproducibly with confidence to semi-quantify PpIX (within the range of 0-10 microM) within dermatological lesions using the standard operating procedure derived from this work.

Therapeutic Hotline: Facial skin rejuvenation in a patient treated with photodynamic therapy for actinic keratosis.

The aim of the most used treatments of actinic keratoses (AKs) is to avoid the conversion into invasive squamous cell carcinoma through the destruction of the lesion; a lot of therapeutic modalities (imiquimod, 5-fluorouracil, electrosurgery with curettage, cryosurgery) are effective and safe in this field, but not many can do it with excellent cosmetic results like treatment with photodynamic therapy (PDT). We have treated with this technique an old patient, whose AK was resistant to other treatments; the most interesting feature of our case comes from the esthetic effects of the PDT employing a methyl-ester of 5-aminolevulinic acid as topical photosensitizer. This kind of therapy has removed not only the lesion but also the photoaging manifestations like the wrinkles and the ugly lines, leaving a smooth skin, as we have proved with 3D-profilometry technique.

Erosive pustular dermatosis of the scalp. A chronic recalcitrant dermatosis developed upon CO2 laser treatment.

Erosive pustular dermatosis of the scalp (EPDS) is a rare, chronic inflammatory dermatosis that mostly affects elderly patients, who develop erosions, pustulation, crusting and scarring on the scalp. Its aetiology remains elusive, although the role of local trauma is being emphasized. Treatment is difficult, with several topical and systemic agents being reported to induce improvement. A 63-year-old Caucasian male had been suffering from persistent painful pustules, erosions and crusts on his scalp for 2 years. The onset of the lesions followed a CO2 laser vaporization procedure to treat multiple actinic keratoses. Different topical and systemic treatments had unsuccessfully been tried. A 4-month course of bid 0.1% tacrolimus ointment, along with strict external photoprotection, resulted in dramatic improvement, sustained after careful tapering of tacrolimus. This case is interesting in that the scalp eruption followed CO2 laser treatment. Other cases have been associated with cryosurgery, radiotherapy, surgery, and 5-FU. In fact, to our knowledge, ours is the fourth reported case of EPDS following CO2 laser treatment. Our case also strengthens previous observations as to the efficacy and safety of topical calcineurin inhibitors in this dermatosis. This is noteworthy bearing in mind the atrophic character of the skin in EPDS, which limits the usefulness of chronically administered topical steroids.