Photodynamic Therapy in 2020: Lights in the Darkness

Abstract

Photodynamic therapy (PDT) is an integral treatment modality for treating the entire process of photodamage, based on what is understood about the pathogenesis of actinic keratosis and the consequences from treating only visible spots and not the underlying disease. Dermatologists must consider incorporation of treatment in combination with duration, frequency, and tolerability of local skin reactions. These considerations are important, along with the combination of topical therapies and intermittent cryotherapy of individual actinic keratoses. Aside from costs and patient demographics, adaptation by dermatologists can influence variability in long-term treatment algorithms. There are multiple published guidelines and consensus statements for the US and Europe to promote safe incorporation of both blueand red light along with the variable concentrations of ALA by dermatologists. However, there is a lack of head to head studies and comparative superiority as well as any evidence to support the use of topical agents. As management of local skin reactions becomes more commonplace, so will improved management of PDT to foster patient safety.