A controlled trial of photodynamic therapy of actinic keratosis comparing different red light sources

Abstract

A controlled trial of photodynamic therapy of actinic keratosis comparing different red light sourcesBackground: Photodynamic therapy (PDT) using 5-aminolevulinic acid (ALA) with red light is well established for actinic keratosis (AK). Differences have been observed concerning pain and efficacy rates with different red light sources. Objectives: To compare pain scores, shortand long-term efficacy rates of PDT of multiple AKs when employing different red light sources. Material and methods: In a controlled trial, 88 patients (310 AK lesions) received ALA-PDT in combination with either visible light (VIS) + water-filtered infrared A (wIRA) light (PhotoDyn ® 750 (PD750), 580-1400 nm) for 30 min or incoherent light (Waldmann ® 1200L (Wa1200L), 600-720 nm) for 10-11 min. Followup visits were performed after 1, 3, 6, and 12 months. If there was no complete cure after 1, 3 or 6 months, a second cycle of PDT was performed. Results: Pain scores were significantly lower in patients illuminated with PD750 rather than Wa1200L. Patient complete clearance rates were 85% and 91% after 1 month, 79% and 92% after 3 months, 97% and 92% after 6 months, and 69% and 85% after 12 months in the PD750 and Wa1200L groups, respectively. Lesion complete clearance rates were 94% and 92% after 1 month, 88% and 97% after 3 months, 96% and 95% after 6 months, and 81% and 89% after 12 months in the PD750 and Wa1200L group, respectively. The efficacy rates were not significantly different. Conclusion: A VIS + wIRA light source produced considerably less pain, while efficacy was not much affected in contrast to previously published studies, probably because the illumination time was longer in this study.

Comparison of 10 efficient protocols for photodynamic therapy of actinic keratosis: How relevant are effective light dose and local damage in predicting the complete response rate at 3 months?

“…With this irradiance, which is the mean irradiance measured for the CureLight 01 lamp in , the above light dose of 75 J/cm 2 is achieved using an irradiation time of 487 seconds. Gas discharge lampGas‐discharge lamps include many categories, such as metal halide lamps, xenon arc lamps, fluorescent lamps, mercury lamps, and sodium lamps. In this study, we investigate two protocols involving irradiation with commercial gas discharge lamps.The first protocol is the manufacturer‐recommended protocol for the Waldmann PDT 1200L (Waldmann Medizintechnik, VS‐Schwennigen, Germany) , which is a metal halide lamp widely investigated for PDT of AK . This protocol, which involves an incubation for 4 hours with ALA cream and removal of excess cream before irradiation at 160 mW/cm 2 for 625 seconds (the irradiation time required to achieve the recommended light dose of 100 J/cm 2 ), has been demonstrated to be clinically effective for ALA‐PDT of AK .…”

“…The first protocol is the manufacturer‐recommended protocol for the Waldmann PDT 1200L (Waldmann Medizintechnik, VS‐Schwennigen, Germany) , which is a metal halide lamp widely investigated for PDT of AK . This protocol, which involves an incubation for 4 hours with ALA cream and removal of excess cream before irradiation at 160 mW/cm 2 for 625 seconds (the irradiation time required to achieve the recommended light dose of 100 J/cm 2 ), has been demonstrated to be clinically effective for ALA‐PDT of AK .…”

Transient memory impairment and transient global amnesia induced by photodynamic therapy

“…Apart from local side-effects such as pain, erythema and oedema, PDT is regarded as a safe treatment modality. 12 Major adverse events or neurological disorders have not previously been associated with PDT. Here we report on a series of five patients with sudden onset of amnesia immediately following PDT.…”

“…The origin and nature of PDT-induced pain is not entirely clear. 12 It usually develops rapidly and peaks within the first few minutes of illumination. Densely innervated body sites such as the face, palms and perineum are more sensitive to pain, suggesting that direct nerve stimulation may contribute to the painful sensations, which are often characterized as burning, prickling or stinging.…”

“…Local skin reactions, such as erythema, oedema, pustules, erosions and haemorrhagic crusts, as well as pain and burning sensation, are the most common adverse events. The origin and nature of PDT‐induced pain is not entirely clear . It usually develops rapidly and peaks within the first few minutes of illumination.…”