5-Aminolevulinic acid photodynamic therapy with and without Er:YAG laser for actinic keratosis: Changes in immune infiltration

Gellén, Emese; Fidrus, Eszter; Janka, Eszter Anna; Kollár, Sándor; Paragh, György; Emri, Gabriella; Remenyik, Éva

doi:10.1016/j.pdpdt.2019.04.010

Cited by 7 publications

(5 citation statements)

References 37 publications

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“…2 and 3 suggest that immediate PDT‐induced cell death is not the primary mechanism responsible for the similar lesion clearance rates after c‐PDT and p‐PDT. Because the literature has clearly shown that tumor cell damage caused by c‐PDT can trigger an acute inflammatory response, with activation of the innate immune system (24,50–52) as described in several recent studies of murine and human pre‐SCC and SCC of the skin (53–55), we focused our attention here on the immune responses induced by p‐PDT only. AK lesions were harvested at immediate (1 and 4 h), intermediate (24, 48, and 72 h) and late (1 and 2 weeks) times after p‐PDT, and tissue sections stained using antibodies specific for neutrophils, macrophages, and dendritic cells.…”

Section: Resultsmentioning

confidence: 99%

Painless Photodynamic Therapy Triggers Innate and Adaptive Immune Responses in a Murine Model of UV‐induced Squamous Skin Pre‐cancer

Anand

Govande

Yasinchak

et al. 2020

Photochem & Photobiology

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Painless photodynamic therapy (p-PDT), which involves application of photosensitizer and immediate exposure to light to treat actinic keratosis (AK) in patients, causes negligible pain on the day of treatment but leads to delayed inflammation and effective lesion clearance (Kaw et al., J Am Acad Dermatol 2020). To better understand how p-PDT works, hairless mice with UV-induced AK were treated with p-PDT and monitored for 2 weeks. Lesion clearance after p-PDT was similar to clearance after conventional PDT (c-PDT). However, lesion biopsies showed minimal cell death and less production of reactive oxygen species (ROS) in p-PDT treated than in c-PDT-treated lesions. Interestingly, p-PDT triggered vigorous recruitment of immune cells associated with innate immunity. Neutrophils (Ly6G+) and macrophages (F4/ 80+) appeared at 4 h and peaked at 24 h after p-PDT. Damage-associated molecular patterns (DAMPs), including calreticulin, HMGB1, and HSP70, were expressed at maximum levels around 24 h post-p-PDT. Total T cells (CD3+) were increased at 24 h, whereas large increases in cytotoxic (CD8+) and regulatory (Foxp3+) T cells were observed at 1 and 2 weeks post-p-PDT. In summary, the ability of p-PDT to eliminate AK lesions, despite very little overt cellular damage, appears to involve stimulation of a local immune response.

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Section: Resultsmentioning

confidence: 99%

Painless Photodynamic Therapy Triggers Innate and Adaptive Immune Responses in a Murine Model of UV‐induced Squamous Skin Pre‐cancer

Anand

Govande

Yasinchak

et al. 2020

Photochem & Photobiology

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“…Hierfür eignen sich beispielsweise ablative Laserverfahren, welche die oberste physikalische Barriere der Haut, das Stratum corneum, entfernen und mikroskopisch kleine vertikale Penetrationskanäle in der Epidermis schaffen 70 . Hierbei sind vor allem die Anwendung des Er:YAG‐ und des CO 2 ‐Lasers in Kombination mit ALA/MAL‐PDT zu nennen, die in vielen Anwendungsstudien eine signifikante Reduktion der AK‐Läsionen sowie eine geringere Rezidivrate zeigen konnten, auch bei schwer zu behandelnden Patienten unter Immunsuppression 72–76 . In einer Metaanalyse von Pei et al 61 .…”

Section: Therapie Von Aktinischen Keratosenunclassified

“…70 Hierbei sind vor allem die Anwendung des Er:YAG-und des CO 2 -Lasers in Kombination mit ALA/MAL-PDT zu nennen, die in vielen Anwendungsstudien eine signifikante Reduktion der AK-Läsionen sowie eine geringere Rezidivrate zeigen konnten, auch bei schwer zu behandelnden Patienten unter Immunsuppression. [72][73][74][75][76] In einer Metaanalyse von Pei et al 61 wurde eine signifikant höhere Rate an vollständig abgeheilten AK nach Anwendung einer ablativen Lasertherapie in Kombination mit PDT gegenüber der PDT alleine berichtet. Jedoch wurde der Metaanalyse nur ein niedriges Evidenzlevel zugesprochen.…”

Section: Therapie Von Aktinischen Keratosenunclassified

Diagnose und Therapie aktinischer Keratosen

Thamm,

Welzel,

Schuh

2024

J Deutsche Derma Gesell

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ZusammenfassungAktinische Keratosen (AK) sind frühe kutane Plattenepithelkarzinome (PEK) in situ. Chronische UV‐Exposition der Haut und weitere individuelle Faktoren wie anhaltende Immunsuppression sind Risikofaktoren für ihre Entwicklung und maligne Transformation. Weniger das klinische Erscheinungsbild (Olsen I–III) der AK als vielmehr histologische Kriterien wie basale Zellatypien (AK I) und basale Keratinozytenproliferation (PRO‐Score) scheinen das Risiko einer malignen Transformation zu bestimmen. Allerdings werden auf Grund der Invasivität der Probebiopsie diese histologischen Kriterien nicht regelhaft bestimmt. Nichtinvasive bildgebende Verfahren, wie die optische Kohärenztomographie (OCT) und die konfokale Lasermikroskopie (KLM), können bei der klinischen Differenzierung zwischen AK, Morbus Bowen und PEK helfen. Die konfokale Line‐Field‐OCT (LC‐OCT) ermöglicht darüber hinaus bei zellulärer Auflösung die nichtinvasive Bestimmung des PRO‐Score. Zur Therapie der AK sind sowohl läsions‐ als auch feldgerichtete Verfahren zugelassen. Sie müssen unter Berücksichtigung individueller Risikofaktoren und Präferenzen des Patienten ausgewählt werden. Allerdings treten in bis zu 85% der Fälle behandelter AK innerhalb eines Jahres Rezidive auf. Inwieweit diese bildgebenden Technologien geeignet sind, die nichtinvasive Nachsorge von AK zu ermöglichen und Rezidive beziehungsweise invasiven Progress frühzeitig zu erkennen, muss in weiteren klinischen Studien evaluiert werden.

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“…: F, field-directed; L, lesion-directed; RCT, randomized controlled trial in difficult-to-treat patients on immunosuppression. [72][73][74][75][76] In a meta-analysis by Pei et al 61 , a significantly higher rate of completely cleared AKs was reported after application of ablative laser therapy in combination with PDT compared to PDT alone. However, this meta-analysis was given only a low evidence level.…”

Section: Therapy Of Actinic Keratosismentioning

confidence: 99%

“…Suitable methods are, for example, ablative laser techniques that remove the uppermost physical skin barrier, the stratum corneum, and create microscopic vertical penetration channels in the epidermis 70 . In this context, the use of Er:YAG and CO 2 lasers in combination with ALA/MAL‐PDT is particularly notable, given that this approach achieved a significant reduction of AK lesions and a lower recurrence rate in many application studies even in difficult‐to‐treat patients on immunosuppression 72–76 . In a meta‐analysis by Pei et al 61 ,.…”

Section: Clinical Manifestation and Diagnosis Of Actinic Keratosismentioning

confidence: 99%

Diagnosis and therapy of actinic keratosis

Thamm,

Welzel,

Schuh

2024

J Deutsche Derma Gesell

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SummaryActinic keratosis (AK) is considered a chronic and recurring in situ skin neoplasia, with a possible transformation into invasive squamous cell carcinoma (SCC). Among others, predominant risk factors for development of AK are UV‐light exposure and immunosuppression. Basal epidermal keratinocyte atypia (AK I) and proliferation (PRO score) seem to drive malignant transformation, rather than clinical appearance of AK (Olsen I–III). Due to the invasiveness of punch biopsy, those histological criteria are not regularly assessed. Non‐invasive imaging techniques, such as optical coherence tomography (OCT), reflectance confocal microscopy (RCM) and line‐field confocal OCT (LC‐OCT) are helpful to distinguish complex cases of AK, Bowen's disease, and SCC. Moreover, LC‐OCT can visualize the epidermis and the papillary dermis at cellular resolution, allowing real‐time PRO score assessment. The decision‐making for implementation of therapy is still based on clinical risk factors, ranging from lesion‐ to field‐targeted and ablative to non‐ablative regimens, but in approximately 85% of the cases a recurrence of AK can be observed after a 1‐year follow‐up. The possible beneficial use of imaging techniques for a non‐invasive follow‐up of AK to detect recurrence or invasive progression early on should be subject to critical evaluation in further studies.

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5-Aminolevulinic acid photodynamic therapy with and without Er:YAG laser for actinic keratosis: Changes in immune infiltration

Cited by 7 publications

References 37 publications

Painless Photodynamic Therapy Triggers Innate and Adaptive Immune Responses in a Murine Model of UV‐induced Squamous Skin Pre‐cancer

Painless Photodynamic Therapy Triggers Innate and Adaptive Immune Responses in a Murine Model of UV‐induced Squamous Skin Pre‐cancer

Diagnose und Therapie aktinischer Keratosen

Diagnosis and therapy of actinic keratosis

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