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Daylight photodynamic therapy for prevention of new actinic keratosis and keratinocyte carcinomas in organ transplants. A cryotherapy‐controlled randomized clinical trial.
摘要： Background: Organ transplant recipients (OTR) have a higher risk of actinic keratosis (AK) and keratinocyte carcinomas (KC). There are no clinical trials assessing the effectiveness of daylight photodynamic therapy (DPDT) to prevent new AK and KC in OTR. Objectives: To determine whether repeated treatments of field cancerization with DPDT are effective in preventing new AK and KC in OTR. Methods: A randomized, intra-subject controlled, evaluator-blind, split-face and/or scalp trial, from April 2016 to October 2018. Participants were OTR older than 18 years, 1 year post-transplant, with at least 5 AK on each hemi-face/hemi-scalp. One side received 6 field-treatments with DPDT: two sessions 15 days apart at baseline, two at 3 months, and two at 9 months after baseline. Control side received lesion-directed treatment with cryotherapy (double freeze-thaw) at baseline, 3 and 9 months. Total number of lesions (AK and KC) at 21 months, number of new AK and KC at 3, 9, 15 and 21 months and treatment preferences were analysed. Results: Of 24 men included, 23 were analysed at 3 months; and 21, at 9, 15 and 21 months. Mean (SD) age was 69.8 years (9.2). Total number of lesions at 21 months were 4.7 (4.3) for DPDT and 5.8 (5.0) for control side; P= 0.09. DPDT showed significantly lower means [SD] of new lesions compared to control side at 3 months (4.2 [3.4] vs 6.8 [4.8]; P< 0.001), 9 months (3.0 [3.3] vs 4.3 [3.4]; P= 0.04) and 15 months (3.0 [4.6] vs 4.8 [5.0]; P= 0.02), and nonsignificant at 21 months (3.7 [3.5] vs 5.0 [4.5]; P= 0.06). Most participants preferred DPDT. Conclusion: DPDT showed potential effectiveness in preventing new AK and KC in OTR by consecutive treatments of field cancerization. The preference for DPDT could facilitate adherence to the long-term treatment necessary in these patients.
关键词： methyl aminolevulinate,daylight photodynamic therapy,keratinocyte carcinomas,actinic keratosis,organ transplant recipients
更新于2025-09-11 14:15:04
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Calcipotriol-assisted vs. conventional MAL-PDT in actinic keratosis
摘要： Actinic keratosis (AK) is a common pre-malignant lesion (affected patch) of the skin that affects many people worldwide, especially fair skin type people. It is more common after the age of 40 and in sun-exposed areas of the body. It can progress into a type of skin cancer named squamous cell carcinoma (SCC). For this reason, an adequate treatment of each AK lesion is recommended. This study aimed to treat these lesions with photodynamic therapy (PDT), which is a well-established option. Normally, topical PDT is a treatment that combines a drug (applied to the lesions) and illumination with light (blue or red). The final result is the massive killing of the cancer cells that will bring high cure rates to these patients. However, AKs on the scalp are sometimes hard to treat and the efficacy levels are lower when compared to facial lesions. Therefore, we aimed to find if the combination of PDT with a well-known drug named Calcipotriol would bring any benefit to the patients. So we compared: one half of the scalp with CAL and PDT and the other half with PDT alone. Patients were then followed (monitored) for 3 months. We found that the combination was safe and more effective for AK treatment, especially when the lesions were thicker. Side effects were more common, but well-tolerated by the patients. This is the first study of CAL and PDT for AKs.
关键词： scalp,Actinic keratosis,Calcipotriol,photodynamic therapy,treatment efficacy
更新于2025-09-10 09:29:36
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LOW-LEVEL LIGHT-ASSISTED PHOTODYNAMIC THERAPY USING A WEARABLE CAP-LIKE DEVICE FOR THE TREATMENT OF ACTINIC KERATOSIS OF THE SCALP
摘要： Background: Daylight photodynamic therapy (dlPDT) is a painless and increasingly cost-effective treatment for actinic keratosis (AK). New protocols avoid incubation minimizing pain and adverse events. However, it is time-consuming and dependent on specific weather conditions. In patients with AK of the scalp, we evaluated the efficacy of indoor photodynamic therapy (PDT) using a wearable low-level light therapy (LLLT) device, without pre-incubation with a photosensitizing agent. Methods: In this pilot study, 27 patients with thin and moderately thick AK (Olsen Grades I-II) underwent a single 15-minute session of LLLT using a wearable cap-like device immediately after application of methyl-aminolevulinate (MAL) cream, with no prior preparation of the affected area. Treatment efficacy was quantified by measuring the reduction in AK lesion number and the AK quality of life (AKQoL) score. All AK lesions were mapped at baseline for follow-up 2 months later. Paired pre/post scalp biopsies from 5 patients were analysed using histological and immunohistochemical techniques (p53, p27, cyclin D1, p63, and Ki67 expression). Data were analysed using the Wilcoxon signed-rank test. Results: In all patients we observed a global reduction in the number of AK lesions (71%; p<0.0001) and AKQoL score (from 5.6 to 4.4; p=0.034) 2 months after treatment. Histology and immunohistochemistry of skin biopsies from 5 patients also revealed marked improvements after LLLT. No patients reported any pain during treatment. Conclusion: PDT using LLLT is a rapid, painless, and efficacious modality for the treatment of AK.
关键词： helmet,skin cancer,low-level laser therapy,Actinic keratosis,photodynamic therapy,methylaminolevulinate
更新于2025-09-10 09:29:36
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Photomedicine - Advances in Clinical Practice || Photodynamic Therapy
摘要： Photodynamic therapy (PDT) employs light activation of tissue‐localized photosensitizer in an oxygen‐dependent process which initiates oxidative stress, inflammation, and cell death. Photodynamic therapy (PDT) involves the activation of a previously administered photosensitizing agent by visible light to induce tumor necrosis. Photosensitizers are topically applied in the treatment of skin tumors to avoid systemic side effects. The main dermatology indications for topical PDT are superficial nonmelanoma skin cancer and dysplasia, notably superficial basal carcinoma (BCC), Bowen's disease (BD), and actinic keratosis (AK). In this chapter, we evaluated the feasibility and efficacy of aminolevulinic acid (ALA) as a photosensitizer (ALA‐PDT) in combination with CO2 laser in the treat‐ment of dermatological disease from basics to clinic research.
关键词： photosensitizer,photodynamic therapy,Bowen's disease,actinic keratosis,aminolevulinic acid
更新于2025-09-09 09:28:46