Topical Photodynamic Therapy with Different Forms of 5-Aminolevulinic Acid in the Treatment of Actinic Keratosis.

Photodynamic therapy (PDT) is safe and effective in the treatment of patients with actinic keratosis (AK). The aim of the study was to assess the efficacy, tolerability and cosmetic outcome of topical PDT in the treatment of AKs with three forms of photosensitizers: 5-Aminolevulinic acid hydrochloride (ALA-HCl), 5-Aminolevulinate methyl ester hydrochloride (MAL-HCl) and 5-Aminolevulinate phosphate (ALA-P). The formulations were applied onto selected scalp/face areas. Fluorescence was assessed with a FotoFinder Dermoscope 800 attachment. Skin areas were irradiated with Red Beam Pro+, Model APRO (MedLight GmbH, Herford, Germany). Applied treatments were assessed during the PDT as well as 7 days and 12 weeks after its completion. Ninety-four percent of patients rated obtained cosmetic effect excellent. The efficacy of applied PSs did not differ significantly. However, pain intensity during the PDT procedure was significantly lower in the area treated with ALA-P (5.8 on average) in comparison to the areas treated with ALA-HCl or MAL-HCl (7.0 on average on 0-10 scale). Obtained results show that ALA-P may undergo more selective accumulation than ALA-HCl and MAL-HCl. Our promising results suggest that PDT with the use of ALA-P in AK treatment may be an advantageous alternative to the already used ALA-HCl and MAL-HCl.

Photodynamic therapy with the use of superluminescent diodes (sLED) in the treatment of actinic keratosis.

BACKGROUND: Superluminescent diodes (sLED) appear to be an innovative and promising light source in photodynamic therapy (PDT), especially in actinic keratosis (AK) lesions treatment. AIM: Assessment of tolerability and efficacy of sLED in topical 5-aminolevulinic acid (ALA) PDT of AK lesions. METHODS: 27 patients received ALA PDT with the use of sLED with "soft starter". RESULTS: Tolerability of sLED lamp depended on the treated lesions field (extension) rather than on their thickness. In contrast sLED lamp efficacy depended on AK lesions thickness. CONCLUSION: sLED PDT is highly effective in the treatment of grade I and II AK lesions. Grade III AK lesions require further treatment.

Interleukin-2 and its soluble receptor in selected drug-induced cutaneous reactions.

Plasma concentrations of interleukin-2 (IL-2) and its soluble receptor (sIL-2R) were examined in 126 patients with drug-induced skin reactions: maculopapular eruptions (ME), erythema multiforme (EM), erythema multiforme coexisting with erythema nodosum (EMN), drug-induced urticaria (DU), hyperergic vasculitis (HV), Stevens-Johnsson syndrome and toxic epidermal necrolysis (SJS/TEN). The activity of both proteins were measured using immunoenzymatic ELISA method: a) in the acute stage of disease, before treatment was administered, and b) after clearing of skin symptoms, after treatment. In the acute stage of disease highly elevated mean concentrations of IL-2 and sIL-2R in all 6 groups of patients were found (p<0.001) in comparison with the control. After clearing of skin lesions IL-2 mean concentrations were lowered to the level not different significantly from the control (p>0.05), but slL-2R mean plasma concentrations, despite the deep decrease, were still highly significantly elevated in comparison with control values (p<0.001).

Activity of Tumor Necrosis Factor-alpha (TNF-alpha) and its soluble type I receptor (p55TNF-R) in some drug-induced cutaneous reactions.

Plasma concentration of TNF-alpha and its type I receptor (p55TNF-R) was examined in 126 patients with drug-induced skin reactions using immunoenzymatic ELISA method. Patients were subdivided into 6 groups: maculopapular eruptions (ME), erythema multiforme (EM), erythema multiforme coexisting with erythema nodosum (EMN), hyperergic vasculitis (HV), Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN). In the acute clinical stage highly significant (p<0.001) or significant (p<0.01) elevation of mean plasma concentrations of the cytokine and its receptor was found in all examined groups in comparison with the control. Clearing of clinical symptoms was connected with considerable decrease (p<0.001, p<0.01) of mean plasma levels of the both proteins in comparison with the before treatment values. TNF-alpha concentrations still remained significantly more elevated than those observed in the control. The results indicate that plasma activity of TNF-alpha and its p55 receptor change with the clinical course of the examined drug-induced skin reactions, which suggests the partake of both proteins in the pathogenesis of these diseases.