Daylight photodynamic therapy for actinic keratosis: an international consensus

Wiegell, Stine Regin; Wulf, Hans Christian; Szeimies, Rolf‐Markus; Basset-Séguin, Nicole; Bissonnette, Robert; Gerritsen, Marinel; Gilaberte, Yolanda; Calzavara‐Pinton, Piergiacomo; Morton, C.A.; Sidoroff, A.; Braathen, Lasse R.

doi:10.1111/j.1468-3083.2011.04386.x

Cited by 201 publications

(209 citation statements)

References 23 publications

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“…Instead of a long incubation with a short illumination (c-PDT), daylight-PDT is performed with a short incubation and long illumination. More precisely, while during c-PDT a high amount of PpIX accumulates and is excited within short time, DL-PDT relies on the constant production and excitation of PpIX molecules within 2 h. Therefore a microphototoxic effect is postulated for DL-PDT, in contrast to a massive phototoxic effect induced by c-PDT [96,97].…”

Section: Pdt With Natural and Simulated Daylightmentioning

confidence: 99%

A review of BF-200 ALA for the photodynamic treatment of mild-to-moderate actinic keratosis

Reinhold¹

2017

Future Oncol.

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BF-200 ALA is a combination of a nanoscale-lipid vesicle formulation and the prodrug 5-aminolevulinic acid (5-ALA). The nanoemulsion stabilizes the prodrug and enhances its penetration through the stratum corneum. It has shown excellent therapeutic results in both lesion and field-directed photodynamic therapy of actinic keratosis (AK). AK is an early form of epidermal neoplasia and a precursor of invasive cutaneous squamous cell carcinoma. It is characterized by the combination of visible neoplastic lesions and surrounding tissue also harboring tumorigenic UV-induced mutations: a concept called field cancerization. A selective, field-directed treatment is ideal to meet the requirements of field change. Here, we review the clinical data on BF-200 ALA for AK along with a summary of molecular mechanisms and future perspectives. Actinic keratosis (AK), also known as solar keratosis, is caused by chronic exposure to sunlight or other ultraviolet light sources [1,2] and may progress to invasive squamous cell carcinoma (SCC) [3]. It is the most common lesion with malignant potential to arise on the skin. AK is mostly seen in Caucasians in skin areas that have extensive sun exposure throughout their lives [4]. Epidemiological data show a high occurrence rate of AK. Regions with higher ultraviolet exposure have a higher prevalence of AK. For the USA, the prevalence was estimated to range from 11 to 26%, while in Australia it ranged from 40 to 60%. In Europe, a prevalence of 15% in men and 6% in women has been documented [5]. Over the age of 70 years, 34% of men and 18% of women were found to have actinic keratotic lesions [6]. Next to fair skin type, an advanced age and lifelong sun exposure immunosuppression/-deficiency plays another important risk factor [5].Mostly, AK develops slowly and early in the disease process, they may disappear only to reappear later. Recurrence of the disease may include partial elimination of the initial lesion, subclinical lesion progression to visible status, or development of new lesions [7]. On top of this, an AK may progress to invasive SCC, the second-most common form of skin cancer [8,9]. The actual percentage of progress to invasive SCC remains unknown, and estimates vary from 5 to 20% within 10 to 25 years with reported annual transformation rates varying greatly from as low as 0.25% to as high as 16% [10]. The regression rate for a single untreated lesion is 15 to 63% after a year; recurrence rates range from 15 to 53% [11]. In general patients develop multiple AKs in one area and predicting which course each individual lesion will follow is impossible. Nonetheless, AK lesions are reliable markers for patients who are most predisposed to developing invasive SCC [4,[12][13].AK lesions typically appear in areas most frequently exposed to the sun such as the face, back of the hands, or bald scalp; 75% of lesions are found on the head, neck and forearms [14]. The lesions vary in appearance as well as size and can include erythematous scaly macules, rough pigmented patches and hyperker...

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Section: Pdt With Natural and Simulated Daylightmentioning

confidence: 99%

A review of BF-200 ALA for the photodynamic treatment of mild-to-moderate actinic keratosis

Reinhold¹

2017

Future Oncol.

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“…As daylight PDT requires exposure of the affected skin to daylight, the treatment is most suitable for lesions and areas of actinic damage on the face and scalp 12. Findings from a subgroup analysis of AK severity showed that following daylight PDT, lesion response rates of thin AK (76% [1572 lesions at baseline]) were higher than with moderate or thick AK (61% (974 lesions at baseline), 49% (222 lesions at baseline), as is also the case with c‐PDT and other topical treatments 14.…”

Section: Whom To Treat With Daylight Pdt With Methyl Aminolevulinate mentioning

confidence: 99%

“…International consensus recommendations for daylight PDT for treatment of AK have been developed primarily by and for dermatologists in Europe and Canada 12. Since this consensus, a phase III study has been performed in Australia confirming the efficacy and tolerability of daylight PDT 13.…”

Section: Introductionmentioning

confidence: 99%

Consensus recommendations on the use of daylight photodynamic therapy with methyl aminolevulinate cream for actinic keratoses in Australia

See¹,

Shumack

Murrell

et al. 2015

Aust J Dermatology

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Australia has the highest prevalence of actinic keratoses (AK) worldwide. Because of the risk of transformation of AK to invasive squamous cell carcinomas, consensus guidelines recommend that AK are removed using appropriate therapies to prevent progression to invasive disease. Daylight photodynamic therapy (PDT) is emerging as an efficacious treatment for AK, particularly for patients who require treatment of large areas of chronic actinic damage that can be exposed easily to daylight. Daylight PDT with methyl aminolevulinate (MAL) cream is a simple treatment for AK, almost painless, well tolerated and convenient, requiring minimal time in the clinic. Randomised controlled studies from northern Europe and Australia support the use of daylight PDT as an effective therapy for grade I and II AK on the face and scalp. There is sufficient daylight to conduct daylight PDT in Australia at any time of the year and during most weather conditions. Hence, daylight PDT with MAL can be included as an effective and well‐tolerated new treatment option for the treatment of AK in Australia. These consensus recommendations provide guidelines for Australian clinicians on the use of daylight PDT in the treatment of diagnosed AK.

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“…The daylight PDT allows patients to be active and under the sun during treatment, contrary to illumination with a fixed wavelength in clinical place [42,43]. Daylight PDT has a good efficiency and is less painful thanks to low light output compared to the conventional method.…”

Section: Photomedicine -Advances In Clinical Practicementioning

confidence: 99%

Light-Emitting Woven Fabric for Treatment with Photodynamic Therapy and Monitoring of Actinic Keratosis

Oguz¹,

Končar²,

Cochrane³

et al. 2017

Photomedicine - Advances in Clinical Practice

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A successful photodynamic therapy (PDT) requires a specific photosensitizer, oxygen and light of a specific wavelength and power. Today photodynamic therapy (PDT) is administered to patients with light-emitting diode (LED) panels. These panels deliver a non-uniform light distribution on the human body parts, as the complex human anatomy is not a flat surface (head vertex, hand, shoulder, etc.). For an efficient photodynamic therapy (PDT), a light-emitting fabric (LEF) was woven from plastic optical fibers (POF) aiming at the treatment of dermatologic diseases such as actinic keratosis (AK). Plastic optical fibers (POF) (Toray, PGR-FB250) have been woven in textile in order to create macro-bendings, and thus emit out the injected light directly to the skin. The light intensity and light-emitting homogeneity of the LEF were improved thanks to Doehlert Experimental Design. During the treatment with PDT, the photosensitizers were activated in the cancerous cells. These cells may be visualized, as they show a characteristic fluorescence under UV light, which is called fluorescence diagnosis (FD). Therefore, it is proposed to modify the developed LEF for PDT to measure the fluorescence amount. For this aim, a part of POFs was cut out to observe the quantity of light that could be collected while the LEF was connected to a light source. The first prototypes showed the possibility of the illumination with the same LEF without losing the efficiency but also imaging the collected light.

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Daylight photodynamic therapy for actinic keratosis: an international consensus

Cited by 201 publications

References 23 publications

A review of BF-200 ALA for the photodynamic treatment of mild-to-moderate actinic keratosis

A review of BF-200 ALA for the photodynamic treatment of mild-to-moderate actinic keratosis

Consensus recommendations on the use of daylight photodynamic therapy with methyl aminolevulinate cream for actinic keratoses in Australia

Light-Emitting Woven Fabric for Treatment with Photodynamic Therapy and Monitoring of Actinic Keratosis

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