5-ALA loaded self-adhesive patch-PDT is effective and safe in the treatment of actinic keratoses on hands and arms.

Photodynamic therapy (PDT) with 5-aminolevulinic acid hydrochloride (ALA) is an established method for the management of AK. PD P 506 A (brand name Alacare®) is an approved medicinal product for the treatment of AK located on scalp and face. It is a self-adhesive, light-proof patch loaded with 5-ALA HCl and was developed for easy handling. AK located on arms, hands or trunk do not respond as well to ALA-PDT as AK lesions on the head do. It has been reported that occlusion during ALA incubation can improve clinical outcome after ALA-PDT for AK on hands and arms. We present the results of a first explorative pilot study involving 20 participants with a total of 145 treated (122 evaluable) AK lesions. The trial investigated the conduct of two ALA-PDTs within 1-2 weeks and involved all severity grades of AK. The model-based percentage of complete clearance on lesion-basis was estimated being 78.0% (95%-CI: [64.6%, 87.3%]), and the by-participant calculation (patient-based clearance) led to similar results (78.7% with a 95%-CI of [67.0%, 90.3%]). The treatment was well tolerated. Local reactions during ALA patch incubation were rare whereas nearly all patients showed the expected reactions during or after the illumination, primarily erythema and pain. The study results indicate that two PD P 506 A-PDT sessions 1-2 weeks apart are an efficacious treatment for AK on hands and arms. Especially mild but also moderate lesions responded very well to PDT treatment involving ALA incubation under occlusion.

No room for pain: A prospective study showing effective and nearly pain-free treatment of actinic keratosis with simulated daylight photodynamic therapy (SDL-PDT) using the IndoorLux® System in combination with BF-200 ALA (Ameluz®).

BACKGROUND: Photodynamic therapy (PDT) with natural daylight is effective and less painful than conventional PDT when treating actinic keratosis (AK), however its weather dependency is restrictive. This prospective open-label observational single-arm study examined efficacy and safety of simulated daylight (SDL)-PDT using the IndoorLux® system in combination with 5-aminolevulinic acid gel (BF-200 ALA). METHODS: 12 patients with mild/moderate AK on the face or scalp received two SDL-PDTs. BF-200 ALA was applied prior to a 2 h illumination with the IndoorLux® System. Patients evaluated pain during and after SDL-PDT on visual analogue scales (VAS). Primary endpoint was lesion count reduction three months after the second SDL-PDT. Secondary endpoint was pain during and after illumination. RESULTS: Median individual clearance rate was 83.75% (66.7-100.0%); 33.3% of the patients and 84.9% of the lesions were completely cleared. Median size of the remaining partially cleared lesions decreased by 42.9%. The first SDL-PDT was pain-free for 7 patients (58.3%, VAS=0). Median VAS during and after the first treatment was 0 (0.0-0.3). For the second SDL-PDT, median VAS was 0.1 (0.0-5.5, during) and 0 (0.0-4.5, after). Both SDL-PDTs were pain-free for 6 patients. CONCLUSION: SDL-PDT was effective and nearly pain-free, emphasizing its advantages and potential for common practice.

Nutritional status and related factors in elderly nursing home residents: comparative cross-sectional study in migrants and native Germans.

Former guest workers in Germany who stayed on after retirement are now older than 70 years. Nursing homes (NH) are broadening their offer to meet specific requirements of this population. The nutritional status and related problems of the older ethnic minority group living in German NH has so far not been investigated. The aim of this study was, thus, to compare the nutritional situation of older migrants to that of native residents in two "multicultural" NH (cross-sectional study). All residents 65 years and older with a migration background were enrolled and compared to nonmigrants using frequency matching for age and gender. Nutritional status was assessed using body mass index (BMI; cut-off for undernourishment: BMI < 22 kg/m(2)) and calf circumference (CC; CC < 31 cm). Care staff completed a questionnaire on residents' health. Consecutive 3-day food records were evaluated to analyze the intake of energy, macro-, and micronutrients. Participants were n = 23 migrants (76 ± 6 years, 52% female) and n = 37 nonmigrants (78 ± 7 years, 59% female). Undernourishment was more prevalent in migrants according to BMI (39 vs. 11%; P < 0.05) and CC (57 vs. 22%; P < 0.05). Main nutritional problems in both groups were "loss of appetite" (56 vs. 19%; P < 0.05) and "refusal to eat" (56 vs. 25%; P < 0.05). Energy intake was low (6.4 ± 1.4, 6.8 ± 1.6 MJ/d). More than 50% of participants fell below recommended values for vitamin C, B1, B6, D, folate, calcium, and iron; 61% of the migrants had a low vitamin B12 intake. Migrant NH residents were more often undernourished than German NH residents.