Documento de consenso hispano-portugués para el uso de la terapia fotodinámica con metil aminolevulinato y luz de día en el tratamiento de las queratosis actínicas / Spanish-Portuguese Consensus Statement on Use of Daylight-Mediated Photodynamic Therapy With Methyl Aminolevulinate in the Treatment of Actinic Keratosis

INTRODUCCIÓN: La terapia fotodinámica con luz de día (TFDLD) es una nueva modalidad de terapia fotodinámica (TFD) que, manteniendo la misma eficacia en queratosis actínicas (QA) grado Iy II que la técnica convencional, disminuye sus efectos adversos y la hace más eficiente. Los condicionantes meteorológicos propios de la España y Portugal hacen necesario el establecimiento de un protocolo adecuado y consensuado por expertos adaptado a los mismos. OBJETIVO: Establecer un protocolo para la TFDLD con metil-aminolevulinato (MAL) para el tratamiento de las QA grado I y II adecuado y consensuado a las características epidemiológicas, meteorológicas y clínicas que se dan en España y Portugal. MÉTODO: Doce dermatólogos de diferentes áreas geográficas de ambos países, con experiencia en el tratamiento de las QA con TFD, se reunieron para elaborar un documento de consenso para la realización de TFDLD con MAL. De la revisión de la bibliografía y de su experiencia se elaboró el procedimiento recomendado para su realización. RESULTADOS: Las recomendaciones adoptadas establecen que los pacientes con QA grado I y II múltiples, especialmente en el contexto de campo de cancerización, son los candidatos a realizar este tratamiento. La TFDLD se puede realizar durante todo el año, siendo limitaciones las temperaturas menores de 10°C o las excesivamente elevadas, así como los días de lluvia, nieve o niebla. El procedimiento es sencillo y requiere la aplicación de un fotoprotector FPS>30 que solo contenga filtros orgánicos, la preparación adecuada de las lesiones, la aplicación del MAL sin oclusión y su activación con la luz del día durante 2h. CONCLUSIÓN: Este documento de consenso supone una guía práctica y detallada para la realización de la TFDLD con MAL en España y Portugal destinada a la consecución de la máxima efectividad con mínimos efectos adversos

INTRODUCTION: Daylight-mediated photodynamic therapy (PDT) is a new type of PDT that is as effective as conventional PDT in grade 1 and 2 actinic keratosis but with fewer adverse effects, resulting in greater efficiency. The climatic conditions in the Iberian Peninsula require an appropriately adapted consensus protocol. OBJECTIVE: We describe a protocol for the treatment of grade 1 and 2 actinic keratosis with daylight-mediated PDT and methyl aminolevulinate (MAL) adapted to the epidemiological and clinical characteristics of Spanish and Portuguese patients and the climatic conditions of both countries. METHODS: Twelve dermatologists from different parts of Spain and Portugal with experience in the treatment of actinic keratosis with PDT convened to draft a consensus statement for daylight-mediated PDT with MAL in these countries. Based on a literature review and their own clinical experience, the group developed a recommended protocol. RESULTS: According to the recommendations adopted, patients with multiple grade 1 and 2 lesions, particularly those at risk of developing cancer, are candidates for this type of therapy. Daylight-mediated PDT can be administered throughout the year, although it is not indicated at temperatures below 10°C or at excessively high temperatures. Likewise, therapy should not be administered when it is raining, snowing, or foggy. The procedure is simple, requiring application of a sunscreen with a protection factor of at least 30 based exclusively on organic filters, appropriate preparation of the lesions, application of MAL without occlusion, and activation in daylight for 2hours. CONCLUSION: This consensus statement represents a practical and detailed guideline to achieve maximum effectiveness of daylight-mediated PDT with MAL in Spain and Portugal with minimal adverse effects

Spanish-Portuguese consensus statement on use of daylight-mediated photodynamic therapy with methyl aminolevulinate in the treatment of actinic keratosis.

INTRODUCTION: Daylight-mediated photodynamic therapy (PDT) is a new type of PDT that is as effective as conventional PDT in grade 1 and 2 actinic keratosis but with fewer adverse effects, resulting in greater efficiency. The climatic conditions in the Iberian Peninsula require an appropriately adapted consensus protocol. OBJECTIVE: We describe a protocol for the treatment of grade 1 and 2 actinic keratosis with daylight-mediated PDT and methyl aminolevulinate (MAL) adapted to the epidemiological and clinical characteristics of Spanish and Portuguese patients and the climatic conditions of both countries. METHODS: Twelve dermatologists from different parts of Spain and Portugal with experience in the treatment of actinic keratosis with PDT convened to draft a consensus statement for daylight-mediated PDT with MAL in these countries. Based on a literature review and their own clinical experience, the group developed a recommended protocol. RESULTS: According to the recommendations adopted, patients with multiple grade 1 and 2 lesions, particularly those at risk of developing cancer, are candidates for this type of therapy. Daylight-mediated PDT can be administered throughout the year, although it is not indicated at temperatures below 10°C or at excessively high temperatures. Likewise, therapy should not be administered when it is raining, snowing, or foggy. The procedure is simple, requiring application of a sunscreen with a protection factor of at least 30 based exclusively on organic filters, appropriate preparation of the lesions, application of MAL without occlusion, and activation in daylight for 2hours. CONCLUSION: This consensus statement represents a practical and detailed guideline to achieve maximum effectiveness of daylight-mediated PDT with MAL in Spain and Portugal with minimal adverse effects.

Six years of experience in photodynamic therapy for Basal cell carcinoma: results and fluorescence diagnosis from 191 lesions.

Background. Photodynamic therapy (PDT) has become a therapeutic option for basal cell carcinoma (BCC) in the last decade. Objectives. To study the results and predictors of BCC response to treatment with PDT and to evaluate fluorescence diagnosis of BCC. Methods. A descriptive, retrospective, and observational study was carried out. Patients with biopsy-confirmed BCC who were treated with methyl aminolevulinate and red light according to standard treatment protocols (2 sessions separated by 2 weeks, 630 nm, 37 J/cm(2), 8 minutes, Aktilite) were selected. Response was scored as clinically complete and incomplete and the patients were followed up every three months. Results. Data from 191 BCC in 181 patients with a mean age of 69.55 years and a mean follow-up period of 34.4 months were collected. The overall response was 74% of the BCC treated, with the best response in superficial BCC with a 95% of complete response. The regression analysis revealed that the superficial histological type was the primary factor predictive of a complete response. Conclusions. In the treatment of BCC with PDT, the most significant factor for predicting response is the histological type.

Pulsed dye laser does not seem as effective as red light in Basal cell carcinoma mal-pdt: a small pilot study.

Multiple light sources can be used for photodynamic therapy (PDT) with good results, but there are few comparative studies. This study compares the efficacy of treatment of basal cell carcinoma with PDT and two light sources, the non-coherent red light and pulsed dye laser 595 nm. In this small pilot study red light is more effective, but many more studies are needed to draw definitive conclusions.

[Photodynamic therapy for acne: use of the pulsed dye laser and methylaminolevulinate]. / Estudio del empleo de láser de colorante pulsado y metilaminolevulinato en la terapia fotodinámica del acné.

Recent decades have seen the inclusion of acne vulgaris as a potential new indication for photodynamic therapy. Photodynamic therapy and light sources can be considered to be additional tools for primary or adjunctive therapy in patients with recurrent acne or those in whom it is not possible to use other treatments. We investigated the use of pulsed dye laser plus methylaminolevulinate for photodynamic therapy and have performed a comparative study of the use of this laser alone and as an element in photodynamic therapy.

[Plaque-phase mycosis fungoides treated with photodynamic therapy: results from 12 patients]. / Micosis fungoide en fase de placas tratada con terapia fotodinámica: resultados en 12 pacientes.

BACKGROUND: Recent years have seen an increase in the off-label use of photodynamic therapy for the treatment of a variety of skin diseases. Plaque-phase mycosis fungoides is among the most promising possibilities for the use of this treatment. OBJECTIVES: To evaluate the treatment of plaque-phase mycosis fungoides with photodynamic therapy and compare the results obtained using fluorescence photography. MATERIALS AND METHODS: We performed a prospective, descriptive, observational study. Twelve patients with 24 lesions were treated with topical methyl aminolevulinate (MAL) under an occlusive dressing for 3 h, followed by 8 min of red light (630 nm, 37 J/cm2; Aktilite). RESULTS: Six patients had a complete response, 5 a partial response, and 1 did not respond to treatment. A mean of 5.7 sessions was applied and no side effects were reported. Treatment tolerance was excellent. CONCLUSIONS: Photodynamic therapy with MAL appears to be a good treatment option for patients with plaque-phase mycosis fungoides with a small number of lesions.

Estudio del empleo de láser de colorante pulsado y metilaminolevulinato en la terapia fotodinámica del acné / Photodynamic Therapy for Acne: Use of the Pulsed Dye Laser and Methylaminolevulinate

La terapia fotodinámica (TFD) ha emergido en las últimas décadas en el estudio de potenciales nuevas indicaciones entre las que se encuentra el acné vulgar. La TFD y otras fuentes de luz pueden ser consideradas una herramienta adicional en el empleo, como tratamiento único o adyuvante, en pacientes con cuadros recidivantes o en los que no es posible la utilización de otras opciones terapéuticas. Planteamos la utilización de láser de colorante pulsado y metilaminolevulinato para la TFD. Realizamos un estudio comparativo entre el empleo aislado del láser de colorante pulsado frente a la terapia fotodinámica (AU)

Recent decades have seen the inclusion of acne vulgaris as a potential new indication for photodynamic therapy. Photodynamic therapy and light sources can be considered to be additional tools for primary or adjunctive therapy in patients with recurrent acne or those in whom it is not possible to use other treatments. We investigated the use of pulsed dye laser plus methylaminolevulinate for photodynamic therapy and have performed a comparative study of the use of this laser alone and as an element in photodynamic therapy (AU)

Micosis fungoide en fase de placas tratada con terapia fotodinámica: resultados en 12 pacientes / Plaque-Phase Mycosis Fungoides Treated with Photodynamic Therapy: Results from 12 Patients

Introducción: La terapia fotodinámica (TFD) está siendo desarrollada en los últimos años en dermatosis diferentes de las aprobadas para su uso. Entre todas ellas, la micosis fungoide (MF) en estadio de placas es una de las más prometedoras. Objetivos: Evaluar los resultados en el tratamiento de la MF en placas con TFD y correlacionarlos con la fotografía de fluorescencia. Material y métodos: Llevamos a cabo un estudio prospectivo, descriptivo y observacional. Se seleccionaron un total de 12 pacientes con 24 lesiones que fueron tratados con metilaminolevulinato (MAL) tópico ocluido tres horas y luz roja (630nm, 37J/cm2, 8min, Aktilite®). Resultados: Un total de 6 pacientes obtuvo respuesta completa, 5 pacientes alcanzaron respuesta parcial y uno no respondió al tratamiento. La media de sesiones aplicadas fue de 5,7 y no se recopilaron efectos secundarios. La tolerancia fue excelente. Conclusiones: La TFD con MAL parece una buena alternativa terapéutica para los pacientes con MF en placas con escaso número de lesiones (AU)

Background: Recent years have seen an increase in the off-label use of photodynamic therapy for the treatment of a variety of skin diseases. Plaque-phase mycosis fungoides is among the most promising possibilities for the use of this treatment. Objectives: To evaluate the treatment of plaque-phase mycosis fungoides with photodynamic therapy and compare the results obtained using fluorescence photography. Materials and methods: We performed a prospective, descriptive, observational study. Twelve patients with 24 lesions were treated with topical methyl aminolevulinate (MAL) under an occlusive dressing for 3h, followed by 8min of red light (630nm, 37J/cm2; Aktilite). Results: Six patients had a complete response, 5 a partial response, and 1 did not respond to treatment. A mean of 5.7 sessions was applied and no side effects were reported. Treatment tolerance was excellent. Conclusions: Photodynamic therapy with MAL appears to be a good treatment option for patients with plaque-phase mycosis fungoides with a small number of lesions (AU)

[Studies of methyl aminolevulinate photodynamic therapy for actinic keratosis]. / Terapia fotodinámica: estudios con metilaminolevulinato en queratosis actínicas.

Photodynamic therapy (PDT) for the treatment of actinic keratosis has been shown to be effective and safe in large clinical trials published in the last 5 years. However, evidence has since emerged that raises questions or that introduces new issues, such as the management of field cancerization, fluorescence diagnosis and results in transplant recipients. There also remains a need for more studies comparing PDT to additional treatments. We review the literature on these new topics in PDT.

Terapia fotodinámica: estudios con metilaminolevulinato en queratosis actínicas / Studies of Methyl Aminolevulinate Photodynamic Therapy for Actinic Keratosis

La terapia fotodinámica (TFD) se ha mostrado eficaz y segura en el tratamiento de las queratosis actínicas (QA) en importantes estudios en los últimos 5 años. Sin embargo, desde entonces, se han publicado varios trabajos con alguna evidencia contradictoria o añadiendo nuevos aspectos de esta terapia para su discusión, como es el tratamiento del campo de cancerización, el diagnóstico de fluorescencia, los resultados en pacientes trasplantados o la ausencia de estudios comparativos con otros tratamientos. En este trabajo revisamos estos nuevos aspectos de la TFD (AU)

Photodynamic therapy (PDT) for the treatment of actinic keratosis has been shown to be effective and safe in large clinical trials published in the last 5 years. However, evidence has since emerged that raises questions or that introduces new issues, such as the management of field cancerization, fluorescence diagnosis and results in transplant recipients. There also remains a need for more studies comparing PDT to additional treatments. We review the literature on these new topics in PDT (AU)

Pulsed dye laser vs. photodynamic therapy in the treatment of refractory nail psoriasis: a comparative pilot study.

BACKGROUND: Nail psoriasis is often refractory to traditional treatments, and patients with nail psoriasis usually demand a therapeutic option. Both photodynamic therapy (PDT) and pulse dye laser (PDL) have proved effective for plaque-type psoriasis, but they have not been evaluated in nail psoriasis. On the other hand, delta-aminolaevulinic acic has been shown to penetrate into the nail matrix and nail bed occluded with bioadhesive patches. OBJECTIVES: To compare the efficacy of PDT and PDL in the treatment of nail psoriasis. METHODS: We studied 61 nails treated with PDT and 60 nails treated with PDL in a group of 14 patients. The PDT used PDL as the light source. Sessions were applied monthly treating one hand with PDT and the other with PDL. The hand treated with PDT was occluded with methyl-aminolaevulinic acic (MAL, Metvix) for 3 h using a bioadhesive patch. The nails treated were evaluated at baseline, and after 3 and 6 months according to the Nail Psoriasis Severity Index (NAPSI) score. RESULTS: A decrease in NAPSI score was observed with both treatments and in both nail matrix and nail bed involvement. No statistical differences were found between PDT and PDL (P = 0.632, P = 0.084, P = 0.535, at baseline, and 3 and 6 months, respectively), and between nail matrix and nail bed NAPSI scores (P = 0.423 and P = 0.853, respectively). The subjective impression of the patients was good, especially regarding the decrease in the pain. CONCLUSIONS: PDL seems to be effective in the treatment of nail psoriasis and improves nail matrix and nail bed involvement. MAL does not seem to play role in the clinical response.

[Retrospective, descriptive, observational study of treatment of multiple actinic keratoses with topical methyl aminolevulinate and red light: results in clinical practice and correlation with fluorescence imaging]. / Estudio retrospectivo, descriptivo y observacional del tratamiento de queratosis actínicas múltiples con metilaminolevulinato tópico y luz roja: resultados en la práctica clínica y correlación con la imagen de fluorescencia.

BACKGROUND: Actinic keratosis (AK) is one of the most common skin diseases seen in clinical practice. In the last 5 years, several studies assessing the efficacy of photodynamic therapy in the treatment of multiple AKs have been published. OBJECTIVE: We aimed to assess the clinical outcomes of photodynamic therapy in patients with multiple AKs and the correlation of those outcomes with fluorescence imaging. MATERIAL AND METHODS: In this retrospective, descriptive, observational study of 57 patients treated in our hospital with photodynamic therapy for multiple AKs, we recorded age, sex, and lesion site (face, scalp, and dorsum of the hands). All patients were treated in the same way: methyl aminolevulinic acid (Metvix) was applied for 3 hours and the skin then irradiated with red light at 630 nm, 37 J/cm(2), for 7.5 minutes (Aktilite). The response, remission duration, tolerance, number of sessions, and fluorescence images were recorded by site. The chi(2) test was used to assess between-site differences and the correlation between fluorescence imaging and clinical response. RESULTS: The greatest improvements were obtained for facial lesions; these required fewer sessions and remission lasted longer than lesions at other sites. The treatment was best tolerated on the dorsum of the hands. The fluorescence area and the reduction in intensity on applying treatment were found to be strongly and significantly correlated with the extent of clinical response. CONCLUSIONS: Overall, the outcomes of treatment of multiple AKs with photodynamic therapy are better for the face than for the scalp and dorsum of the hands. Fluorescence imaging may be an effective tool for predicting response to treatment.

Estudio retrospectivo, descriptivo y observacional del tratamiento de queratosis actínicas múltiples con metilaminolevulinato tópico y luz roja: resultados en la práctica clínica y correlación con la imagen de fluorescencia / Retrospective, descriptive, observational study of treatment of multiple actinic keratoses with topical methyl aminolevulinate and red light: results in clinical practice and correlation with fluorescence imaging

Introducción. Las queratosis actínicas (QA) son una de las patologías cutáneas más frecuentes en la práctica clínica. En los últimos 5 años se han publicado varios estudios que evaluaban la eficacia de la terapia fotodinámica (TFD) en el tratamiento de múltiples QA. Objetivo. Evaluar los resultados de la TFD de múltiples QA por localizaciones y su correlación con la imagen de fluorescencia. Material y métodos. Realizamos un estudio retrospectivo, descriptivo y observacional de los pacientes tratados por múltiples QA con TFD en nuestro hospital. Se describe la edad, el sexo y la localización de las lesiones (cara, cuero cabelludo y dorso de las manos) de los 57 pacientes. Se trató a todos los pacientes usando los mismos parámetros: ácido metilaminolevulínico (MAL, Metvix®) ocluido tres horas e irradiación con luz roja de 630 nm, 37 J/cm2, 7,5 minutos (Aktilite®). Se describe la respuesta, período de remisión, tolerancia, número de sesiones y la fluorescencia según localizaciones. Con la prueba Chi-cuadrado se evalúan las diferencias entre localizaciones y la correlación de la imagen de fluorescencia con la respuesta clínica. Resultados. En la cara se obtiene mayor grado de mejoría, se requieren menor número de sesiones y mayores períodos de remisión que en el resto de las localizaciones. El dorso de las manos es la zona mejor tolerada. Existe una correlación alta y significativa entre el área de fluorescencia y su disminución al aplicar el tratamiento, con el grado de respuesta clínica. Conclusiones. Los resultados en el tratamiento de múltiples QA con TFD son mejores, globalmente, en la cara que en el cuero cabelludo y en el dorso de manos. El diagnóstico de fluorescencia puede ser una herramienta eficaz para predecir la respuesta al tratamiento (AU)

Background. Actinic keratosis (AK) is one of the most common skin diseases seen in clinical practice. In the last 5 years, several studies assessing the efficacy of photodynamic therapy in the treatment of multiple AKs have been published. Objective. We aimed to assess the clinical outcomes of photodynamic therapy in patients with multiple AKs and the correlation of those outcomes with fluorescence imaging. Material and methods. In this retrospective, descriptive, observational study of 57 patients treated in our hospital with photodynamic therapy for multiple AKs, we recorded age, sex, and lesion site (face, scalp, and dorsum of the hands). All patients were treated in the same way: methyl aminolevulinic acid (Metvix®) was applied for 3 hours and the skin then irradiated with red light at630 nm, 37 J/cm2, for 7.5 minutes (Aktilite®). The response, remission duration, tolerance, number of sessions, and fluorescence images were recorded by site. The X2 test was used to assess between-site differences and the correlation between fluorescence imaging and clinical response. Results. The greatest improvements were obtained for facial lesions; these required fewer sessions and remission lasted longer than lesions at other sites. The treatment was best tolerated on the dorsum of the hands. The fluorescence area and the reduction in intensity on applying treatment were found to be strongly and significantly correlated with the extent of clinical response. Conclusions. Overall, the outcomes of treatment of multiple AKs with photodynamic therapy are better for the face than for the scalp and dorsum of the hands. Fluorescence imaging may be an effective tool for predicting response to treatment (AU)

Failure to treat alopecia areata with photodynamic therapy.

We treated six patients with static alopecia areata (AA) with photodynamic therapy (PDT). All patients had received other treatment before starting PDT, but with no benefit. All previous treatments were stopped at least 3 months before beginning PDT, and no other treatment was given during the study period. PDT was used on only one of the affected areas, or if there was only one affected area, to only part of that area; untreated areas served as controls. For all patients methylaminolaevulinic acid was applied under occulsion 3 h after irradiation with red light at 630 nm (37 J/cm(2), 7.5 min). One session was carried out each month. Clinical and fluorescence photographs were taken with a digital camera connected to ultraviolet flashes, both before and after each treatment. None of the patients with AA of the scalp achieved complete hair regrowth, either in the treated or the untreated areas. Two of the patients showed growth of some thin hair over < 10 of the treated area. The remaining patients had no change. However, the patient with AA of the beard experienced complete regrowth after four sessions. To our knowledge, this is the first case of AA treated with PDT in this location. It may be that AA of beard hair responds better to PDT, but further studies are necessary.

Enfermedad de injerto contra huésped crónica tratada con fotoféresis: a propósito de un caso / A case of chronic graft vs host disease treated with photopheresis

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