Bringing the gentle properties of daylight photodynamic therapy indoors: A systematic review of efficacy and safety

Heerfordt, Ida M.; Philipsen, Peter Alshede; Wulf, Hans Christian

doi:10.1016/j.pdpdt.2022.102858

Cited by 12 publications

(15 citation statements)

References 37 publications

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“…It is important to note that this is in contrast with the suggested Ameluz® treatment protocol of 3‐h incubation with occlusion. However, the 30–60 min incubation, as well as simultaneous illumination, has been adopted in other clinical studies and has become common in clinical practice because it provides shorter visit times and lower reported pain of treatment 1,19,22–25 . The mean clearance rate and standard deviations reported in this study match the results of similar lamp‐based protocols 19,20 .…”

Section: Discussionsupporting

confidence: 65%

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Equivalent efficacy of indoor daylight and lamp‐based 5‐aminolevulinic acid photodynamic therapy for treatment of actinic keratosis

Ruiz

LaRochelle

Fahrner

et al. 2023

Skin Health and Disease

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Background Photodynamic therapy (PDT) is widely used as a treatment for actinic keratoses (AK), with new sunlight‐based regimens proposed as alternatives to lamp‐based treatments. Prescribing indoor daylight activation could help address the seasonal temperature, clinical supervision, and access variability associated with outdoor treatments. Objective To compare the AK lesion clearance efficacy of indoor daylight PDT treatment (30 min of 5‐aminolevulinic acid (ALA) pre‐incubation, followed by 2 h of indoor sunlight) versus a lamp‐based PDT treatment (30 min of ALA preincubation, followed by 10 min of red light). Methods A prospective clinical trial was conducted with 41 patients. Topical 10% ALA was applied to the entire treatment site (face, forehead, scalp). Patients were assigned to either the lamp‐based or indoor daylight treatment. Actinic keratosis lesion counts were determined by clinical examination and recorded for pre‐treatment, 1‐month, and 6‐month follow‐up visits. Results There was no statistical difference in the efficacy of AK lesion clearance between the red‐lamp (1‐month clearance = 57 ± 17%, 6‐month clearance = 57 ± 20%) and indoor daylight treatment (1‐month clearance = 61 ± 19%, 6‐month clearance = 67 ± 20%). A 95% confidence interval of the difference of the means was measured between −4.4% and 13.4% for 1‐month, and −2.2% and +23.6% for 6‐month timepoints when comparing the indoor daylight to the red‐lamp treatment, with a priori interval of equivalence of ±20%. Limitations Ensuring an equivalent dose between the indoor and lamp treatment cohorts limited randomisation since it required performing indoor daylight treatments only during sunny days. Conclusion Indoor‐daylight PDT provided equivalent AK treatment efficacy to a lamp‐based regimen while overcoming temperature limitations and UV‐block sunscreen issues associated with outdoor sunlight treatments in the winter. Clinical trial registration http://Clinicaltrials.gov listing: NCT03805737.

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Section: Discussionsupporting

confidence: 65%

“…lower reported pain of treatment. 1,19,[22][23][24][25] The mean clearance rate and standard deviations reported in this study match the results of similar lamp-based protocols. 19,20 The 2-h treatment for the indoor daylight cohort was based on standard practice in outdoor daylight protocols.…”

Section: Ofsupporting

confidence: 74%

Equivalent efficacy of indoor daylight and lamp‐based 5‐aminolevulinic acid photodynamic therapy for treatment of actinic keratosis

Ruiz

LaRochelle

Fahrner

et al. 2023

Skin Health and Disease

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“…The reduction of inflammation can be enhanced further by use of topical corticosteroids applied to the skin just before and just after end of treatment (15), with no change in cure rate, but complicates the procedure when not performed in the same session as the sunscreen. The light source used in classic PDT is most often red LED but may be exchanged with other lamp types or lasers emitting light corresponding to the absorption spectrum of PpIX (16)(17)(18). When LED light is substituted by daylight the illumination may take place outside the clinic and save time and space (19).…”

Section: Resultsmentioning

confidence: 99%

“…Daylight PDT cannot always be performed due to climate, low temperature, and rainy weather (24,25). Alternatives have been developed using lamps emitting wavelengths that can be absorbed by PpIX (18,26). To use these lamps for 2 hours of illumination the clinic must have staff, space and equipment and it may make treatment planning difficult, especially when the weather changes and planned daylight exposure becomes impossible.…”

Section: Discussionmentioning

confidence: 99%

Counteracting Side-effects of Photodynamic Therapy for Actinic Keratoses

Wulf¹,

Heerfordt²

2022

Anticancer Res

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Background/Aim: Actinic keratoses (AKs) are precursors of squamous cell carcinomas and early intervention is important. Photodynamic therapy (PDT) is often first-choice treatment for widespread AKs. Classic PDT consists of: Superficial curettage, application of 5-aminolevulinic acid or methyl aminolevulinate, incubation and protoporphyrin IX (PpIX) accumulation under occlusion for 3 hours, followed by illumination with red light-emitting diode light (37 J/cm 2 ). Classic PDT is effective in treating AKs, but side-effects include unpleasant pretreatment, severe pain during illumination, inflammation after treatment, and long waiting time in the clinic. Materials and Methods: This targeted mini review describes efforts to counteract sideeffects and simplify the procedure considering the clinic capacity. Changes are only acceptable if treatment effect is maintained. Results: We introduce the following procedure changes: (i) reducing pre-treatment pain, bleeding, and oozing by omitting curettage; (ii) long-term illumination for 2 hours during PpIX formation (already in use as daylight PDT) and shortening of incubation time from 3 hours to 30 minutes to minimize pain and inflammation risk. In addition, options of timing, incubation, and illumination indoors and outdoors are discussed, focusing on advantages and disadvantages for patients and clinics. Conclusion: We report several options to counteract side-effects of classic PDT.

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“…The challenge to find DNA binding molecules that do not interfere with the functions of normal cells and/or to overcome multidrug resistance to chemotherapeutics is the most desirable goal. In this direction, due to the high spatial and temporal control, photochemotherapy [22][23][24] and photodynamic therapy [25][26][27][28] allow the minimally invasive treatment of several kinds of cancer and other nonmalignant diseases. Such impressive selectivity is due to the role of light, which acts as a counterpart to small organic molecules that can be excited by the energy offered by light and affect the biological target.…”

Section: Introductionmentioning

confidence: 99%

Effect of Arylazo Sulfones on DNA: Binding, Cleavage, Photocleavage, Molecular Docking Studies and Interaction with A375 Melanoma and Non-Cancer Cells

Mikra

Mitrakas

Ghizzani

et al. 2023

IJMS

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A set of arylazo sulfones, known to undergo N–S bond cleavage upon light exposure, has been synthesized, and their activity in the dark and upon irradiation towards DNA has been investigated. Their interaction with calf-thymus DNA has been examined, and the significant affinity observed (most probably due to DNA intercalation) was analyzed by means of molecular docking “in silico” calculations that pointed out polar contacts, mainly via the sulfonyl moiety. Incubation with plasmid pBluescript KS II revealed DNA cleavage that has been studied over time and concentration. UV-A irradiation considerably improved DNA damage for most of the compounds, whereas under visible light the effect was slightly lower. Moving to in vitro experiments, irradiation was found to slightly enhance the death of the cells in the majority of the compounds. Naphthylazosulfone 1 showed photo-disruptive effect under UV-A irradiation (IC50 ~13 μΜ) followed by derivatives 14 and 17 (IC50 ~100 μΜ). Those compounds were irradiated in the presence of two non-cancer cell lines and were found equally toxic only upon irradiation and not in the dark. The temporal and spatial control of light, therefore, might provide a chance for these novel scaffolds to be useful for the development of phototoxic pharmaceuticals.

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Bringing the gentle properties of daylight photodynamic therapy indoors: A systematic review of efficacy and safety

Cited by 12 publications

References 37 publications

Equivalent efficacy of indoor daylight and lamp‐based 5‐aminolevulinic acid photodynamic therapy for treatment of actinic keratosis

Equivalent efficacy of indoor daylight and lamp‐based 5‐aminolevulinic acid photodynamic therapy for treatment of actinic keratosis

Counteracting Side-effects of Photodynamic Therapy for Actinic Keratoses

Effect of Arylazo Sulfones on DNA: Binding, Cleavage, Photocleavage, Molecular Docking Studies and Interaction with A375 Melanoma and Non-Cancer Cells

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