Heat shock protein 90-targeted photodynamic therapy enables treatment of subcutaneous and visceral tumors.

Photodynamic therapy (PDT) ablates malignancies by applying focused near-infrared (nIR) light onto a lesion of interest after systemic administration of a photosensitizer (PS); however, the accumulation of existing PS is not tumor-exclusive. We developed a tumor-localizing strategy for PDT, exploiting the high expression of heat shock protein 90 (Hsp90) in cancer cells to retain high concentrations of PS by tethering a small molecule Hsp90 inhibitor to a PS (verteporfin, VP) to create an Hsp90-targeted PS (HS201). HS201 accumulates to a greater extent than VP in breast cancer cells both in vitro and in vivo, resulting in increased treatment efficacy of HS201-PDT in various human breast cancer xenografts regardless of molecular and clinical subtypes. The therapeutic index achieved with Hsp90-targeted PDT would permit treatment not only of localized tumors, but also more diffusely infiltrating processes such as inflammatory breast cancer.

Periorbital skin cancers subjected to mTHPC-photodynamic therapy: A prospective study.

INTRODUCTION: Photodynamic therapy (PDT) is a relatively new method of treating skin cancers. This prospective study highlights the use of PDT in the management of basal cell carcinomas (BCCs) and T1N0 cutaneous squamous cell carcinomas (SCCs) involving the periorbital area. MATERIALS AND METHODS: Surface illumination PDT was offered under local anaesthesia. mTHPC was administered intravenously. A single-channel 652 nm diode laser was used for illumination, and light was delivered at 20 J/cm2 per site. Lesion response evaluation was carried out according to response evaluation criteria in solid tumours (RECIST). RESULTS: After the first round of treatment, all cutaneous T1N0 SCC patients had complete response (CR) and continued to be in remission until last clinic review. For BCC patients, 12/14 patients had CR. The two remaining patients underwent a second round of treatment and also achieved a CR. All BCC patients were in remission at the last clinic review. Using visual analogue scale (VAS), 15 patients reported that this treatment gave them "excellent" cosmetic outcome (VAS 9-10). CONCLUSION: Photodynamic therapy achieved high efficacy in the treatment of periorbital BCCs and cutaneous SCCs with greatly reduced morbidity and disfigurement.

Eficácia antimicrobiana da terapia fotodinâmica no tratamento da candidíase oral em pessoas vivendo com HIV/Aids / Antimicrobial efficacy of photodynamic therapy on the treatment of oral candidiasis in people living with HIV/Aids / Eficacia antimicrobiana de la terapia fotodinámica en el tratamiento de la candidiasis bucal en personas viviendo con VIH/Sida

Objetivo: avaliar a eficácia antimicrobiana da terapia fotodinâmica no tratamento da candidíase oral em pessoas vivendo com HIV/aids. Método: estudo experimental, qualitativo e descritivo com 18 pessoas vivendo com HIV/aids que manifestavam a candidíase oral, maiores de 18 anos, que estavam em tratamento no Hospital Universitário Gaffrée e Guinle. Este grupo subdividiu-se em um grupo controle, composto por sete pessoas, que recebeu tratamento com a terapia fotodinâmica e antifúngicos, e um grupo experimental, com 11, que recebeu apenas a terapia fotodinâmica. A evolução do tratamento de cada participante foi acompanhada por registros fotográficos em duas consultas, inicial e final. Esta pesquisa foi aprovada pelo Comitê de Ética em Pesquisa do hospital, parecer número 2.431.107. Resultados: a maioria dos participantes apresentou melhora clínica, ainda que discreta, e em apenas um houve piora clínica. Conclusão: a terapia fotodinâmica antimicrobiana pode ser eficaz no tratamento da candidíase oral em pessoas vivendo com HIV/Aids

Objective: evaluate the antimicrobial efficacy of photodynamic therapy in the treatment of oral candidiasis in people living with HIV/ aids. Method: experimental, qualitative and descriptive study with 18 people living with HIV/aids who presented oral candidiasis, over 18 years of age, who were being treated at the Gaffrée and Guinle University Hospital. This group was subdivided into a control group, composed of seven people, who received treatment with photodynamic and antifungal therapy, and an experimental group, with 11, who received only the photodynamic therapy. The evolution of the treatment of each participant was followed by photographic registers in two appointments, initial and final. This research was approved by the Research Ethics Committee from the hospital, dictum number 2.431.107. Results: most of the participants showed clinical improvement, albeit discrete, and in only one there was clinical worsening. Conclusion: antimicrobial photodynamic therapy may be effective in the treatment of oral candidiasis in people living with HIV/Aids

Objetivo: evaluar la eficacia antimicrobiana de la terapia fotodinámica en el tratamiento de la candidiasis bucal en personas que viven con VIH/sida. Método: estudio experimental, cualitativo y descriptivo con 18 personas viviendo con VIH/sida que manifestaban la candidiasis bucal, mayores de 18 años, que estaban en tratamiento en el Hospital Universitario Gaffrée y Guinle. Este grupo se subdividió en grupo control, compuesto por siete personas, que recibió tratamiento con la terapia fotodinámica y antifúngicos, y un grupo experimental, con 11, que recibió sólo la terapia fotodinámica. La evolución del tratamiento de cada participante fue acompañada por registros fotográficos en dos consultas, inicial y final. La investigación fue aprobada por el Comité de Ética en Investigación del lugar, dictamen número 2.431.107. Resultados: la mayoría de los participantes presentó mejoría clínica, aunque discreta, y en apenas uno hubo empeoramiento clínico. Conclusión: la terapia fotodinámica antimicrobiana puede ser eficaz en el tratamiento de la candidiasis bucal en personas que viven con el VIH/Sida

Daylight-Mediated Photodynamic Therapy With Methyl Aminolevulinate in Actinic Keratosis Treatment.

BACKGROUND: Research has shown daylight-mediated photodynamic therapy (PDT) for the treatment of actinic keratosis (AK) to be effective, tolerable, and convenient, with excellent patient satisfaction and cosmesis. Although success has been demonstrated in areas with similar latitudes to Switzerland and Scandinavia, this treatment has not been studied in a Canadian population. OBJECTIVES: The purpose of this study is to investigate the effectiveness, safety, and patient satisfaction of daylight-mediated methyl 5-aminolevulinate (MAL)-PDT to make recommendations for its use in Canadian practice. METHODS: A retrospective chart review of patients who received treatment of daylight-mediated MAL-PDT for the indication of AK at the Institute of Cosmetic and Laser Surgery in Oakville, Ontario, between 2009 and 2016. RESULTS: A total of 112 patients were included, consisting of 94 males and 18 females with a mean age of 63.79 years. A total of 177 sites were treated among all patients, mostly consisting of the face (n = 92) and scalp (n = 55). A total of 13.4% of patients experienced side effects, the most common being redness (n = 4) and scabbing (n = 4). Of the 42 patients who expressed their level of satisfaction, 83.3% reported being happy with the treatment, χ2(1) = 18.67, P ≤ .05; 6.3% of patients were noted to be completely clear, 86.6% had a good response, 0.9% had a mild response, and 0% had no response, χ2(1) = 101.04, P ≤ .05. CONCLUSIONS: Daylight-mediated MAL-PDT is a suitable treatment option for AK lesions in a Canadian population due to the demonstrated efficacy, patient satisfaction, tolerability, and convenience.

A importância da terapia fotodinâmica na descontaminação do sistema de canais radiculares: relatos de casos / The importance of photodynamic therapy for decontamination of the root canal system: case reports

Introdução: o tratamento endodôntico permite a descontaminação do sistema de canais radiculares por meio do preparo químico-mecânico, medicação curativa intracanal e obturação do sistema de canais radiculares. Porém, a literatura aponta que microrganismos podem ter desenvolvido meios de resistência às manobras do método tradicional. Como meio terapêutico adicional, a terapia fotodinâmica (também conhecida como PDT, ou Photodynamic therapy) foi incorporada no tratamento endodôntico convencional, para controle microbiano, sendo de fácil e rápida aplicação, podendo ser utilizada tanto em sessão única quanto em múltiplas sessões. Objetivo: esclarecer o uso da terapia fotodinâmica, bem como as vantagens do seu uso, por meio do relato de dois casos clínicos. Métodos: foram relatados dois casos que ­ segundo os exames clínicos, testes de sensibilidade pulpar e radiográficos realizados ­ apontaram para o diagnóstico pulpar de necrose pulpar e necrose periapical, respectivamente, sugestivo de abscesso perirradicular crônico, inclusive com presença de fístula extrabucal; e sugestivo de granuloma perirradicular. Após o estabelecimento do diagnóstico, foi indicada a terapia endodôntica convencional associada à terapia fotodinâmica. Resultados: as radiografias de um ano de acompanhamento demonstraram área de reparação. Conclusão: o plano de tratamento proposto e relatado demonstrou ser eficaz, uma vez que pôde-se observar cicatrização da fístula, regressão das lesões periapicais (radiograficamente) e restabelecimento de estrutura óssea.

Avaliação da capacidade de penetração do azul de metileno na dentina radicular de dentes humanos com e sem agitação sônica: um estudo piloto / Evaluation of methylene blue penetration capacity in root dentin of human teeth with and without sonication: a pilot study

Introdução: com a necessidade de terapêuticas antimicrobianas complementares, a terapia fotodinâmica (PDT) vem mostrando resultados promissores na inativação de microrganismos no interior dos canais radiculares. Objetivo: o objetivo deste trabalho foi analisar a capacidade de penetração do fotossensibilizante azul de metileno na massa dentinária nos níveis cervical, médio e apical dos canais radiculares de dentes humanos, comparando diferentes aplicações da solução. Métodos: a amostra foi composta de 20 dentes pré-molares unirradiculares, distribuídos em quatro grupos, preparados utilizando-se instrumentos rotatórios de NiTi e irrigação com HCT20. Cada grupo recebeu suas respectivas aplicações do fotossensibilizante, sendo de 5 minutos o tempo de ação da solução dentro do canal: Grupo 1 = azul de metileno a 2%; Grupo 2 = azul de metileno a 2% associado ao detergente lauril-sulfato de sódio a 0,125%; Grupo 3 = azul de metileno a 2% com agitação sônica; Grupo 4 = azul de metileno a 2% associado ao detergente lauril-sulfato de sódio a 0,125% com agitação sônica. Os dentes foram, então, seccionados transversalmente nos níveis cervical, médio e apical e observados em microscópio cirúrgico. Resultados: os resultados foram analisados estatisticamente pela aplicação do teste ANOVA, teste de Levene e teste de Tukey (p < 0,05). O valor médio da penetração no nível cervical variou de 0,55 a 0,75mm; no nível médio, variou de 0,30 a 0,48mm; e no nível apical, variou de 0,17 a 0,24mm entre os grupos. Conclusões: independentemente da natureza do solvente e do uso ou não da agitação sônica, nas condições testadas não houve diferenças estatisticamente significativas entre os grupos.

Clinical efficacy of photodynamic therapy adjunctive to scaling and root planing in the treatment of chronic periodontitis: A systematic review and meta-analysis.

PURPOSE: To evaluate the clinical efficacy of photodynamic therapy (PDT) adjunctive to scaling and root planing (SRP) in patients with untreated chronic periodontitis based on up-to-date evidence. METHODS: MEDLINE and the Cochrane Library were systematically searched to identify eligible randomized controlled trials (RCTs), supplemented by a manual literature search. Mean differences (MD) and the corresponding 95% confidence intervals (CI) of probing depth (PD) reduction and clinical attachment level (CAL) gain were synthesized. The I2 test and Q statistics were used to determine the inter-study heterogeneity. Subgroup analysis based on smoking status was performed. RESULTS: Eleven RCTs with a total of 243 subjects were included. Significant improvement in PD reduction (MD=0.13, CI:0.02-0.24, p=0.02) and marginal significant improvement in CAL gain (MD=0.18, CI:-0.005-0.363, p=0.056) were observed in favor of SRP+PDT at 3months. When evaluated at 6months after baseline, the association of PDT with SRP resulted in a significant benefit in PD reduction (MD=0.40, CI:0.05-0.74, p=0.03), but not in CAL gain (MD=0.37, CI:-0.18-0.93, p=0.18). Subgroup analysis revealed that the combined therapy produced no significant improvements in PD and CAL at neither 3months nor 6months for studies with smokers. No treatment-related adverse events or side effects had been reported by the included studies. CONCLUSIONS: Pooled analysis suggests a short-term benefit of PDT as an adjunct to SRP in clinical outcome variables. However, evidence regarding its long-term efficacy is still insufficient and no significant effect has been confirmed in terms of CAL gain at 6months. Future clinical trials of high methodological quality are needed to establish the optimal combination of photosensitizer and laser configuration.

Effect of laser-assisted scaling and root planing on the expression of pro-inflammatory cytokines in the gingival crevicular fluid of patients with chronic periodontitis: A systematic review.

BACKGROUND: The aim of the present systematic review was to assess the efficacy of laser-assisted (low level laser therapy [LLLT], high intensity laser therapy [HILT], or antimicrobial photodynamic therapy [aPDT]) scaling and root planing (SRP) compared with SRP alone on the expression of inflammatory cytokines in the gingival crevicular (GCF) of patients with chronic periodontitis (CP). METHODS: In order to address the focused question: "What is the efficacy of SRP with and without laser and/or aPDT on the expression of pro-inflammatory cytokines in the GCF of patients with CP?" an electronic search without time or language restrictions was conducted up to and including February 2017 in indexed databases using various key words. RESULTS: Twenty-two randomized control trials were included in the present systematic review. Nine studies and six studies assessed the efficacy of LLLT and HILT, as adjunct to SRP, respectively. Seven studies assessed the efficacy of aPDT as adjunct to SRP on down-regulating the expression of pro-inflammatory cytokines in the GCF among patients with CP. The outcomes of the studies included based upon the reduction in the levels of pro-inflammatory cytokines were inconsistent. CONCLUSION: The role of laser-assisted SRP on the expression of pro-inflammatory cytokines in the GCF of patients with CP remains unclear. Further long term and well-designed randomized clinical trials are needed in this regard.

Treatment of unresectable extrahepatic cholangiocarcinoma using hematoporphyrin photodynamic therapy: A prospective study.

BACKGROUND: The available evidence of Photodynamic therapy (PDT) combined with stent placement treatment for unresectable extrahepatic cholangiocarcinoma (EHCC) is still insufficient. It also remains unclear whether PDT influences systemic inflammatory response. AIM: To explore the clinical efficacy and safety of the combination treatment and the systemic inflammatory response in patients with EHCC. METHODS: Patients with unresectable EHCC underwent either the combined treatment using Hematoporphyrin PDT and stent placement (PDT+stent group, n=12) or stent-only (stent group, n=27). The primary end-point was overall survival. Tumor necrosis factor (TNF)-α and interleukin (IL)-6 levels were measured. Quality of life was assessed using the Karnofsky performance scale (KPS) every 3 months. RESULTS: Average survival time (13.8 vs. 9.6 months), and 6-month (91.7% vs. 74.1%), and 1-year (58.3% vs. 3.7%) survival rates of PDT+stent group were significantly increased compared with the stent group. KPS scores in the PDT+stent group were significantly improved. TNF-α and IL-6 levels were significantly increased in the PDT+stent group. CONCLUSION: Hematoporphyrin-PDT combined with stent placement is an effective and safe treatment for EHCC. The treatment might promote systemic inflammatory response.

Efficacy of periimplant mechanical debridement with and without adjunct antimicrobial photodynamic therapy in the treatment of periimplant diseases among cigarette smokers and non-smokers.

OBJECTIVE: The aim was to assess the efficacy of mechanical debridement (MD) with and without adjunct antimicrobial photodynamic therapy (aPDT) in reducing periimplant inflammation among cigarette-smokers and non-smokers. METHODS: Cigarette-smokers and non-smokers were randomly divided into 2 groups. In the test-group, participants underwent full mouth scaling and periimplant MD with adjunct aPDT; and in the control-group, the participants underwent full mouth scaling and periimplant MD alone. Periimplant bleeding on probing (BOP), probing depth (PD) and crestal bone loss (CBL) were measured at baseline and at 6- and 12-months follow-up. Statistical analysis was performed using the Kruskal-Wallis test. P-values<0.05 were considered statistically significant. RESULTS: Eighty-four smokers (41 patients in the test group and 43 in the control group) and 82 non-smokers (40 patients in the test group and 42 in the control group) were included. Among smokers and non-smokers, periimplant PD was significantly higher in the control-group compared with the test-group (P<0.05) at 6-months of follow-up. There was no statistically significant difference in BOP, PD and CBL among smokers and non-smokers in the test- and control-groups at 12-months of follow-up. BOP was comparable among smokers at all time intervals. CONCLUSION: In the short-term, MD with adjunct aPDT is more effective in reducing periimplant probing depth than MD alone in smokers and non-smokers. However, in the long-term outcomes of MD either with or without aPDT among smokers and non-smokers are comparable.

Retrospective analysis of therapeutic effect and prognostic factors on early glottic carcinoma.

OBJECTIVE: To investigate the therapeutic effect of surgery, radiotherapy and photodynamic therapy on early glottic carcinoma and prognostic factors. METHODS: Retrospective analysis of 202 cases with early glottic carcinoma (Tis-T2N0M0) underwent surgery (n=152), radiotherapy (n=20) and PDT (n=30) from 2000 to 2013 The KPS score, the disease-free survival (DFS), overall survival (OS), local control (LC), larynx preservation rate, laryngeal function were evaluated. The methods of χ (2)test or Fisher's exact probability method, Kaplan Meier method, log-rank test of Kaplan-Meier method, Cox proportional hazards model were used to analyze the data. RESULTS: There was no statistical significance in OS, DFS and LC among the three groups. The laryngeal function preservation rate of RT group, PDT group and Surgery group were 90%, 86.7% and 65.1% respectively, with the former two groups significantly superior to Surgery group. While there is no statistical significance between RT group and PDT group. Single factor analysis showed that KPS score before treatment, vocal fold mobility limitation and differentiation degree could have an effect on prognosis. Multivariate regression analyses indicated that anterior commissure invasion, T stage and KPS score before treatment were independent adverse prognostic factors for OS. T stage and differentiation degree were adverse prognostic factors for DFS. T stage was also an adverse factor of LC. Thirty-three cases experienced local recurrence or cervical lymph node metastasis. Three groups showed no statistical difference in local recurrence or lymph node metastasis, with twenty-two cases in Surgery group, four in RT group and seven in PDT group. CONCLUSIONS: The therapeutic effect was approximate in surgery group, radiotherapy group and photodynamic group, and all three treatment regimens achieved good clinical effect. Radiotherapy and photodynamic therapy may be the first or very important treatment on early stage glottic squamous cell cancer (Tis∼T2N0M0). However only 6 patients underwent PDT for T2 disease, making definitive treatment conclusions for this subgroup unclear.

Is mechanical curettage with adjunct photodynamic therapy more effective in the treatment of peri-implantitis than mechanical curettage alone?

BACKGROUND: The aim of the present study was to review the pertinent literature on the effects of mechanical curettage (MC) with and without adjunct photodynamic therapy (PDT) for the management of peri-implantitis. METHODS: The addressed focused question was "Is PDT effective in the treatment of peri-implantitis?" A search without language or time restrictions up to March 2016 was conducted using various key words. The exclusion criteria included; review papers, in vitro Studies, case reports, commentaries, interviews, and letters to the editors. RESULTS: In total 9 studies were included. Among them 5 studies were clinical and 4 were experimental. All the studies used PDT as an adjunctive to MC in their test groups. The laser wavelengths used ranged from 660nm to 830nm. One study showed significant reduction of the bleeding scores, inflammatory exudates and Aggregatibacter actinomycetemcomitans count in group with PDT as an adjunctive when compared to MC and 0.2% chlorhexidine. However, in four clinical studies comparable periodontal parameters were reported when PDT is used as an adjunct to MC was compared to MC in treatment of peri-implantitis. In three experimental studies, outcomes were significantly better in group with PDT as an adjunct to MC when compared to MC alone at follow-up. CONCLUSION: The role of PDT as an adjunct to MC in the treatment of peri-implantitis is debatable. Further longterm randomised control trails are needed to justify the role PDT as an adjunct to MC in treatment of peri-implantitis.

Actinic keratosis: a cross-sectional study of disease characteristics and treatment patterns in Danish dermatology clinics.

OBJECTIVES: The incidence of actinic keratosis (AK) is increasing, and several treatment options are available. The aim of this study was to describe clinical characteristics and treatment patterns in patients with AK treated by Danish dermatologists. METHODS: A multicenter, non-interventional, cross-sectional study was conducted. Three dermatology hospital departments and seven private dermatology clinics enrolled eligible AK patients consecutively during one week. RESULTS: A total of 312 patients were included. Non-melanoma skin cancer (NMSC) was previously reported in 51.0% of patients and currently suspected in 9.4% of AK-affected anatomical regions. Lesions of AK were located primarily on the face (38.6%), scalp (12.8%), and hands (11.2%). Actinic keratosis commonly presented with multiple AK lesions (38.6%) and field cancerization (38.5%). The treatments used most frequently were cryotherapy (57.7%) and photodynamic therapy (PDT) with methyl aminolevulinate (17.1%) and imiquimod (11.2%). The likelihood of receiving cryotherapy was higher for men (odds ratio [OR] 1.65, 95% confidence interval [CI] 1.10-2.47) and increased with age (2.2% per year, 0.4-4.0%). PDT represented the most frequently applied treatment for severe actinic damage and was more likely to be prescribed to women (OR 4.08, 95% CI 2.22-7.47) and young patients (OR 0.97 per year, 95% CI 0.95-0.99). The prevalence of severe actinic damage (17.3% versus 9.6%) and intake of immunosuppressive medication (29.0 versus 2.0) were higher among hospital patients compared with those treated in private practices (P < 0.0001). CONCLUSIONS: The majority of AK patients in Danish dermatology clinics have a history of skin cancer, and NMSC is suspected in almost 10% of AK-affected regions. Cryotherapy is the most frequently used treatment overall, except in instances of severe actinic damage, in which PDT is the first-choice treatment.

Role of antimicrobial photodynamic therapy in the treatment of aggressive periodontitis: A systematic review.

BACKGROUND: The aim was to assess the efficacy of antimicrobial photodynamic therapy (aPDT) in the treatment of aggressive periodontitis (AgP). METHODS: The addressed focused question was "Is aPDT effective in the treatment of AgP?" MEDLINE/PubMed, EMBASE, Scopus, ISI Web of knowledge and Google-Scholar databases were searched from 1977 till May 2015 using combinations of the following keywords: antimicrobial; photochemotherapy; photodynamic therapy; photosensitizing agents; AgP; scaling and root-planing (SRP). Reviews, case reports, commentaries, and articles published in languages other than English were excluded. RESULTS: Seven studies were included. In 5 studies, aPDT was performed as an adjunct to SRP. Laserwavelengths and duration of irradiation ranged between 660-690 nm and 60-120 s, respectively. Laser power output as reported in 2 studies was 75 mW. One study showed significant improvement in periodontal parameters for subjects receiving aPDT as an adjunct to SRP as compared to treatment with SRP alone at follow up. However, comparable periodontal parameters were reported when aPDT as an adjunct to SRP was compared to SRP alone in the treatment of AgP in one study. One study showed comparable outcomes when aPDT was compared to SRP in the treatment of AgP. In two studies, adjunctive antibiotic administration to SRP showed significantly better outcomes when compared to application of adjunctive use of aPDT to SRP. CONCLUSION: aPDT is effective as an adjunct to SRP for the management of AgP, however, further randomized clinical trials with well defined control groups are needed in this regard.

Medical error analysis in dermatology according to the reports of the North Rhine Medical Association from 2004-2013.

BACKGROUND: Patient safety is a central issue of health care provision. There are various approaches geared towards improving health care provision and patient safety. By conducting a systematic retrospective error analysis, the present article aims to identify the most common complaints brought forth within the field of dermatology over a period of ten years. METHODS: The reports of the Expert Committee for Medical Malpractice Claims of the North Rhine Medical Association (from 2004 to 2013) on dermatological procedures were analyzed (n =  247 reports in the field of dermatology). RESULTS: Expert medical assessments in the field of dermatology are most frequently commissioned for nonsurgical therapies (e.g. laser therapy, phototherapy). While suspected diagnostic errors constitute the second most common reason for complaints, presumed dermatosurgery-related errors represent the least common reason for commissioning expert medical assessments. CONCLUSIONS: The most common and easily avoidable sources of medical errors include failure to take a biopsy despite suspicious clinical findings, or incorrect clinicopathological correlations resulting in deleterious effects for the patient. Furthermore, given the potential for incorrect indications and the inadequate selection of devices to be used as well as their parameter settings, laser and phototherapies harbor an increased risk in the treatment of dermatological patients. The fourth major source of error leading to complaints relates to incorrect indications as well as incorrect dosage and administration of drugs. Analysis of expert medical assessment reports on treatment errors in dermatology as well as other medical specialties is helpful and provides an opportunity to identify common sources of error and error-prone structures.

Efficacy of photodynamic therapy in the management of oral premalignant lesions. A systematic review.

OBJECTIVE: The aim was to systematically review the efficacy of photodynamic therapy (PDT) in the management of oral premalignant lesions. METHODS: The addressed focused question was "Is PDT effective in the management of oral premalignant lesions?" PubMed/Medline, Google-Scholar, EMBASE and ISI Web of Knowledge databases were searched from 1984 till June 2014 using different combinations of the following keywords: photodynamic therapy; oral premalignant lesions; leukoplakia; erythroplakia; erythro-leukoplakia; verrucous hyperplasia; and submucous fibrosis. Review articles, experimental studies, case-reports, commentaries, letters to the Editor, unpublished articles and articles published in languages other than English were not sought. The pattern of the present study was customized to mainly summarize the relevant information. RESULTS: Thirteen studies were included. In these studies, the number of patients ranged between 5 patients and 147 individuals with mean ages ranging between 51 years and 62.2 years. Oral premalignant lesions, which were investigated were leukoplakia, erythroplakia, erythro-leukoplakia and verrucous hyperplasia. Reported number of premalignant lesions ranged between 5 and 225. Laser wavelength, duration of irradiation and power density were 585-660nm, 60s to 16.6min and 100-150mW/cm(2), respectively. Aminolevulinic acid, chlorine-e6, meta-tetrahydroxyphenylchlorin and photofrin were used as photosensitizer. The frequency of PDT application ranged between once and 12 times. Complete, partial and no response to PDT was shown by 27-100%, 5-50% and 0-25% of pre-malignant lesions, respectively. The recurrence rate of pre-malignant lesions was up to 36%. CONCLUSION: PDT is effective in the overall management of oral premalignant lesions.

Tratamiento de hemangiomas coroideos con terapia fotodinámica / Choroidal hemangiomas treatment with photodynamic therapy

Objetivo: reportar tres casos de pacientes con hemangioma de coroides tratados con terapia fotodinámica (TFD) y realizar una revisión de la literatura sobre el tema. Diseño del estudio: estudio retrospectivo intervencionista, tipo serie de casos. Pacientes y metodología: revisión de historias clínicas y de exámenes complementarios de 3 pacientes con diagnóstico de hemangioma de coroides pre y post tratamiento con TFD en la Fundación Oftalmológica Nacional. Resultados: de los 3 casos presentados, dos se presentaron como hemangiomas de coroides circunscritos y uno difuso en un paciente con síndrome de Sturge ­ Weber. En todos los casos se observó mejoría de la agudeza visual, resolución del desprendimiento seroso de retina y regresión del tumor, sin efectos secundarios a la TFD. Conclusiones: el hemangioma coroideo es una patología con una baja incidencia, de evolución variable y difícil de predecir. La terapia fotodinámica es una alternativa no invasiva, de elección para hemangiomas coroideos sintomáticos, ya que no produce daño a las estructuras vecinas y presenta pocos efectos colaterales.

Objective: to report three cases of patients with choroidal hemangioma treated with photodynamic therapy (PDT) and review of the literature. Study design: retrospective interventional study, cases reports. Patients and methods: review of medical records and ancillary tests were performed in 3 patients with choroidal hemangioma pre and post PDT treatment. Results: of the 3 cases reported, two had a circumscribed choroidal hemangioma and one a diffuse hemangioma associated with Sturge ­ Weber syndrome. All cases had improvement in visual acuity, resolution of serous retinal detachment and tumor regression without PDT side eff ects after follow-up. Conclusions: choroidal hemangiomas have a low incidence and an uncertain prognosis. Photodynamic therapy remains as a noninvasive alternative for symptomatic choroidal hemangiomas, without damage to surrounding structures and few side effects.

Physicians' opinions and clinical practice patterns for actinic keratosis management in Italy.

AIM: We report dermatologists' opinions and clinical practice patterns about clinical factors driving decision making in the management of actinic keratosis (AK) in Italy. METHODS: We carried out a cross-sectional survey among 33 Italian dermatologists. Physicians were asked to report their management choices in consecutive patients with AK seen at their practice within 2 weeks since study initiation. We collected patients' clinical and socio-demographic characteristics with a standardized data collection form and assessed physicians' opinions on AK management with a self-reported questionnaire. RESULTS: Six hundred fifty-seven patients with new, single AK lesions without evidence of photo-damaged skin in the surrounding areas, were predominantly treated with lesion-directed therapies (primarily cryotherapy). In contrast, physicians preferentially prescribed field-directed therapies to patients with multiple lesions and evidence of photo-damaged skin in AK surrounding areas. However we observed a wide variation in treatment choices and physicians' opinions on AK management. Dermatologists underlined the importance of fostering patients' adherence and minimize therapy side effects. CONCLUSION: Overall, our results show that current guidelines regarding management of AK are only partially integrated in dermatology practice. The active dissemination of up-to-date national guidelines might help harmonize clinical decision making in this complex and fast growing therapeutic area.

Physicians' concerns towards prescription adherence and treatment effectiveness in the clinical management of actinic keratosis.

AIM: We report concerns toward prescription adherence and treatment effectiveness in the clinical management of actinic keratosis (AK) in Italy. METHODS: We carried out a cross-sectional web-based survey among Italian dermatologists across Italy. Physicians were asked to answer a self-administered questionnaire about their concerns around AK therapy and barriers to patients' adherence. Each physician also profiled his last patient and answered items concerning his experience with topical treatments and the suitability of current and future treatment options for the profiled patient. RESULTS: Fifty practitioners answered the survey. Most dermatologists agreed that field-therapy is a key element for the management of AK in most patients, and 76% (N.=38) agreed that topical treatments were the best option in such cases given their ability to target subclinical lesions. However most interviewee underlined the importance of fostering patients' adherence and minimizing side effects in order to maximize benefits from therapy. CONCLUSION: We showed that features of current therapeutic options for field-directed therapy (namely long duration of treatment, intensity and duration of local skin reaction) raise practitioners' concerns toward patients' prescription adherence and real-world effectiveness.