Use of Photodynamic Therapy for Treatment of Actinic Keratoses in Organ Transplant Recipients

Wlodek, Christina; Ali, Fahad; Lear, John T.

doi:10.1155/2013/349526

Cited by 23 publications

(19 citation statements)

References 81 publications

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“…Transplant procedures have also increased due to the ageing population and improved surgical techniques [77]. NMSC represents 95% of cutaneous malignancies in this patient group.…”

Section: Organ Transplant Recipientsmentioning

confidence: 99%

Photodynamic Therapy and Non-Melanoma Skin Cancer

Griffin

Lear

2016

Cancers

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Non-melanoma skin cancer (NMSC) is the most common malignancy among the Caucasian population. Photodynamic therapy (PDT) is gaining popularity for the treatment of basal cell carcinoma (BCC), Bowen’s disease (BD) and actinic keratosis (AK). A topical or systemic exogenous photosensitiser, results in selective uptake by malignant cells. Protoporphyrin IX (PpIX) is produced then activated by the introduction of a light source. Daylight-mediated MAL (methyl aminolaevulinate) PDT for AKs has the advantage of decreased pain and better patient tolerance. PDT is an effective treatment for superficial BCC, BD and both individual and field treatment of AKs. Excellent cosmesis can be achieved with high patient satisfaction. Variable results have been reported for nodular BCC, with improved outcomes following pretreatment and repeated PDT cycles. The more aggressive basisquamous, morphoeic infiltrating subtypes of BCC and invasive squamous cell carcinoma (SCC) are not suitable for PDT. Prevention of “field cancerization” in organ transplant recipients on long-term immunosuppression and patients with Gorlin syndrome (naevoid basal cell carcinoma syndrome) is a promising development. The optimisation of PDT techniques with improved photosensitiser delivery to target tissues, new generation photosensitisers and novel light sources may expand the future role of PDT in NMSC management.

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“…Transplant procedures have also increased due to the ageing population and improved surgical techniques [77]. NMSC represents 95% of cutaneous malignancies in this patient group.…”

Section: Organ Transplant Recipientsmentioning

confidence: 99%

Photodynamic Therapy and Non-Melanoma Skin Cancer

Griffin

Lear

2016

Cancers

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“…Photodynamic therapy (PDT) comprises the photodynamic reaction between a photosensitiser, light of a select wavelength (or band) and oxygen to generate reactive oxygen species that target microbes and malignant cells. PDT is most commonly used in dermatological practice to combat nonmelanoma skin cancer (NMSC) and acne vulgaris [7]. The two most commonly used photosensitisers are methyl aminolevulinate (MAL) and aminolevulinic acid (ALA).…”

Section: Pre-clinical Studies: Animal Modelsmentioning

confidence: 99%

“…AKs are the commonest pre-malignant skin condition, included in the larger population of NMSCs [7,15]. Treatments for AKs include physically destructive measures (cryotherapy, curettage, excision), chemically destructive means (including PDT and topical agents such as 5-FU and ingenol mebutate) and immunomodulatory agents (such as imiquimod).…”

Section: Actinic Keratosismentioning

confidence: 99%

“…Owing to high doses of immunosuppressants that have to be taken, organ transplant recipients are at higher risk of NMSCs, which exhibit a lower response rate to PDT [7]. Helsing and colleagues compared a single treatment of CO 2 -AFXL-PDT (30 W, 0.12-mm spot size, two passes) with CO 2 -AFXL alone for treatment of AKs and warty lesions on the dorsal hands of ten organ transplant recipients with over 1000 lesions [17].…”

Section: Actinic Keratosismentioning

confidence: 99%

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Laser-assisted drug delivery in dermatology: from animal models to clinical practice

Ali

Al‐Niaimi

2015

Lasers Med Sci

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Topical medicaments are the mainstay of the dermatologists' therapeutic arsenal. Laser-assisted drug delivery enhances the ability of topically applied medicaments to penetrate the skin. We discuss the mechanisms of laser-assisted drug delivery and animal models that have informed clinical practice. We review clinical studies that have employed laser-assisted drug delivery for a range of indications to date including non-melanoma skin cancer, vitiligo, scarring, vaccination, local anaesthesia, analgesia, viral warts, infantile haemangiomas and cosmetic uses. Studies thus far suggest that laser pre-treatment improves transepidermal absorption of topical agents and allows for a much deeper penetration of drugs than is possible with topical medicaments alone. This may allow more efficacious action of current treatments, such that conventional duration of treatment can be shortened or lower concentrations of active agents be used, potentially obviating side effects of treatment. The prospect of using laser technologies to facilitate transdermal vaccination and as an adjunct for inflammatory dermatoses and cosmetic indications remains in its infancy. As larger trials are published, involving greater numbers of patients and utilising various laser and topical medicament parameters, we will enhance our understanding of this nascent modality of treatment delivery.

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“…Field AKs are markedly increased in patients who are immunosuppressed, with 40% of patients who have undergone organ transplantation developing AKs within five years of the procedure (7) and a much greater risk (52-to 250-fold higher) of lesions progressing to invasive SCC in the immunocompromised population (5,8,9). AKs are a marker of significant UV exposure and thus total skin examination is recommended and patients should be educated regarding sun avoidance and protection.…”

Section: Introductionmentioning

confidence: 99%

A consensus on the use of daylight photodynamic therapy in the UK

Ibbotson

Stones

Bowling³

et al. 2016

Journal of Dermatological Treatment

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Background: Actinic keratoses (AKs) are a consequence of chronic exposure to ultraviolet radiation. Treatment of chronically photo-damaged skin and AKs is driven by risk of progression to squamous cell carcinoma, as well as for symptomatic relief. Conventional photodynamic therapy (c-PDT) is indicated when AKs are multiple or confluent and if patients respond poorly or are unable to tolerate other therapies. c-PDT is limited by the field size that can be treated in single sessions and can cause significant discomfort. Objective: Recent studies investigated daylight illumination to activate protoporphyrin IX and daylight-PDT (d-PDT) is now licensed in the UK for face and scalp AKs. A group of experts met to discuss application of d-PDT with methyl aminolevulinate (MAL) and develop a UK consensus statement, specific to UK weather conditions. Methods: The UK consensus recommendations were reached among eight experts, who reviewed recent studies on d-PDT, assessed UK meteorological data and discussed personal experiences of d-PDT for AKs. Results: Recommendations from these discussions provide guidance on d-PDT use, specifically regarding patient selection, therapeutic indications, when to treat, skin preparation, MAL application and daylight exposure for patients with AKs. Conclusions: This UK expert consensus provides practical guidance for UK application of d-PDT.

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Use of Photodynamic Therapy for Treatment of Actinic Keratoses in Organ Transplant Recipients

Cited by 23 publications

References 81 publications

Photodynamic Therapy and Non-Melanoma Skin Cancer

Photodynamic Therapy and Non-Melanoma Skin Cancer

Laser-assisted drug delivery in dermatology: from animal models to clinical practice

A consensus on the use of daylight photodynamic therapy in the UK

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