Pain associated with aminolevulinic acid-photodynamic therapy of skin disease

Warren, Christine; Karai, Laszlo; Vidimos, Allison; Maytin, Edward V.

doi:10.1016/j.jaad.2009.03.048

Cited by 119 publications

(112 citation statements)

References 77 publications

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“…Additionally, when indirectly comparing pain scores from lesion and field directed treatments using BF-200 ALA and an LED light source, there is no sign of increased pain during field treatment [68,78,80]. Nonetheless, an appropriate form of pain management has to be considered, whenever PDT is directed to larger fields, as treatment area size is a well-known predictor of PDT pain [88]. Since pain intensity is associated with light intensity, LED lamps have been developed that allow reduction of light intensity, but keep the fluence constant [89,90].…”

Section: Clinical Safetymentioning

confidence: 99%

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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: Clinical Safetymentioning

confidence: 99%

“…However, strategies to circumvent, reduce or cope with PDT-induced pain are of importance for the dermatological community [87][88]91]. During recent years, modified PDT protocols using natural or simulated daylight have been developed which can be implemented to manage pain in clinical routine.…”

Section: Clinical Safetymentioning

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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“…Cold air, cold ultrasound gel, and cool washcloths were used for pain relief as described in Ref. 9. After irradiation, photos were taken of the three previously marked areas.…”

Section: Treatment and Measurement Proceduresmentioning

confidence: 99%

Noninvasive fluorescence monitoring of protoporphyrin IX production and clinical outcomes in actinic keratoses following short-contact application of 5-aminolevulinate

et al. 2010

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Abstract. Topical 5-aminolevulinic acid ͑ALA͒ is widely used in photodynamic therapy ͑PDT͒ of actinic keratoses ͑AK͒, a type of premalignant skin lesion. However, the optimal time between ALA application and exposure to light has not been carefully investigated. Our objective is to study the kinetics of protoporphyrin IX ͑PpIX͒ accumulation in AK after short contact ALA and relate this to erythemal responses. Using a noninvasive dosimeter, PpIX fluorescence measurements ͑5 replicates͒ were taken at 20-min intervals for 2 h following ALA application, in 63 AK in 20 patients. Data were analyzed for maximal fluorescent signal obtained, kinetic slope, and changes in erythema. Our results show that PpIX accumulation was linear over time, becoming statistically higher than background in 48% of all lesions by 20 min, 92% of lesions by 1 h, and 100% of lesions by 2 h. PpIX accumulation was roughly correlated with changes in lesional erythema post-PDT. We conclude that significant amounts of PpIX are produced in all AK lesions by 2 h. The linear kinetics of accumulation suggest that shorter ALA application times may be efficacious in many patients. Noninvasive fluorescence monitoring of PpIX may be useful to delineate areas of high PpIX accumulation within precancerous areas of the skin. © 2010 Society of Photo-Optical Instrumentation Engineers.

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“…However, LEDs do not emit the same light dose over the entire treatment area and do not adapt to the irregularities of the body [13,18]. Another disadvantage of this method is pain due to the dose of pure light that effective treatment with LED panels [19,20]. Indeed, if the light output was less, we could limit the pain caused by the PDT.…”

Section: Introductionmentioning

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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Pain associated with aminolevulinic acid-photodynamic therapy of skin disease

Cited by 119 publications

References 77 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

Noninvasive fluorescence monitoring of protoporphyrin IX production and clinical outcomes in actinic keratoses following short-contact application of 5-aminolevulinate

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

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