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.

[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.

[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.

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.

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.

SHP-1 expression in peripheral T cells from patients with Sezary syndrome and in the T cell line HUT-78: implications in JAK3-mediated signaling.

SHP-1 is a key tyrosine phosphatase that acts as a negative regulator of signal transduction in lymphocytes, which has been found down-regulated in several T cell lines derived from human T cell malignancies. The standardization of a sensitive ELISA for the quantification of SHP-1 protein in peripheral T and B lymphocytes has enabled us to quantify the SHP-1 content of freshly isolated T cells from patients with Sezary syndrome and in the Sezary T cell line HUT-78. In all cases, a dramatic decrease in the content of this protein, when compared with the content in healthy volunteer controls, was observed. These results were corroborated when the expression of SHP-1 mRNA was analyzed. In order to study whether there was any correlation between SHP-1 protein expression and tyrosine phosphorylated state of JAK3, the state of phosphorylation of JAK3 was studied in the T cell line HUT-78, and found to be highly phosphorylated. These results suggest that SHP-1 might be involved in maintaining the IL-2R/JAK3 signaling pathway under control and point towards a role of SHP-1 in the pathogenesis of the disease.

An improved data acquisition method for electrical impedance tomography.

Isaacson, Cheney and Seager have demonstrated that simultaneously applying trigonometric patterns of current to a circular electrode array optimizes the sensitivity of EIT to inner structure. We have found that it is less desirable to measure voltage at an electrode that also applies a current due to variable contact impedance. In order to preserve the optimum sensitivity while minimizing the effect of electrode artefacts, we have devised an approach where we sequentially apply a current between each individual electrode and a separate, fixed ground while measuring voltages at all other electrodes for each consecutive current impulse. By adding weighted sums of both the applied currents and corresponding measured voltages from individual passes, we can synthesize trigonometric patterns of any spatial frequency. Since only one of the electrodes in any given acquired data set is used as a source, this approach significantly dilutes the effect of contact impedance on the resulting voltage measurements. We present simulated data showing the equivalency between the synthesized and actual trigonometric excitation patterns. In addition, we report experimental data, both in vitro and in vivo, that show improved results using this data acquisition technique.

Infrequent expression of protein p53 in epidermotropic variants of cutaneous T-cell lymphoma.

Although diverse types of lymphomas have been examined for immunohistochemical detection of p53 protein, little information is available with regard to p53 protein expression in CTCL. We analyzed cutaneous biopsy specimens of 22 patients with the diagnoses of mycosis fungoides or Sézary syndrome with polyclonal rabbit anti-p53 antiserum CM-1. Staining of neoplastic cells was observed only in two patients with advanced disease. Overexpression of p53 protein does not seem to be a major feature of either mycosis fungoides or Sézary syndrome.

Concurrent cytomegalovirus, M. tuberculosis and M. avium-intracellulare cutaneous infection in an HIV patient.

We report a 25-year-old HIV-positive man with a past medical history of disseminated cytomegalovirus (CMV) infection, who developed cutaneous lesions during a disseminated mycobacterium infection. The histological changes of CMV and acid-fast bacilli were seen on histopathology of the lesions. Cultures were positive for M. tuberculosis and M. avium-intracellulare (MAI). CMV is frequently isolated from HIV patients, but skin involvement is rare. The association of CMV and mycobacteria can occur in cutaneous lesions of AIDS patients, but concurrent cutaneous involvement of CMV, M. tuberculosis, and MAI is unusual. These findings emphasize the polymorphous presentation of infectious disorders in AIDS patients and the need for multiple biopsies and for special stains in such patients.

[Facial angioma and the Sturge-Weber syndrome: a study of 121 cases]. / Angioma plano facial y síndrome de Sturge-Weber: estudio de 121 casos.

BACKGROUND: We show a study in 121 patients with port-wine stain (PWS) over the areas of trigeminal nerve sensory innervation, and we analyzed the relations between this distribution, sex and the neuro-ocular disease. METHODS: The population included 68 women between 12 months and 73 years (mean, 23 years; standard deviation, 13.7 years) and 53 men between 12 months and 50 years (mean, 18 years; standard deviation, 12 years). Chi-square test and Fisher test were performed in order to assess statistical significance of our results. RESULTS: Facial port-wine stains (PWS) were predominantly distributed over the area of innervation of the maxillary branch (V2) of the trigeminal nerve (88% of patients), either isolated or simultaneously involving ophthalmic (V1) and/or mandibular branch (V3). Of the unilateral PWS (86%), 10% were also extrafacially distributed. However, bilateral PWS (14%) extended extrafacially in 53% of the patients. Moreover, the number of patients with extrafacial PWS was increased among those with PWS over V3 (50%). Glaucoma and epilepsy were present in 23 (17%) and 17 (14%) patients, respectively. In all of them PWS affected V1. Among the 19 patients with bilateral PWS, nine of them developed glaucoma and five, epilepsy. Epilepsy was more frequent in men (26%) than in women (4%). CONCLUSIONS: Statistical analysis showed: 1) the PWS is preferentially distributed over the maxillary branch of the trigeminal nerve, 2) bilateral PWS significantly increases the frequency of cutaneous extrafacial PWS, 3) the presence of PWS over the mandibular branch of trigeminal nerve carries a higher risk of cutaneous extrafacial presence of the angioma, 4) only those patients with PWS over the ophthalmic branch may develop glaucoma and/or epilepsy, 5) extrafacial PWS is associated with a higher frequency of glaucoma, 6) men have a higher risk of developing epilepsy than women.

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.