B. Pérez-García

Terapia fotodinámica: nuevas indicaciones

Photodynamic therapy (PDT) is approved for the treatment of actinic keratoses, superficial and nodular basal cell carcinomas, and recently, Bowens disease. In the last decade the advances experienced in the study of the photodynamic reaction have expanded the spectrum of application to other cutaneous diseases, neoplastic as well as inflammatory and infectious ones. The experience in psoriasis, acne, common warts and cutaneous T cell lymphoma starts to be broad and interesting, which permits to define its use in these entities. Photodynamic therapy is also been tested for a great variety of dermatoses with different photosensitizers and light sources with variable results. In this paper we review the treatment of Bowens disease and other indications different from non melanoma skin cancer with PDT, providing our experience.

Photodynamic Therapy: New Indications

Photodynamic therapy (PDT) is approved for the treatment of actinic keratoses, superficial and nodular basal cell carcinomas, and recently, Bowens disease. In the last decade the advances experienced in the study of the photodynamic reaction have expanded the spectrum of application to other cutaneous diseases, neoplastic as well as inflammatory and infectious ones. The experience in psoriasis, acne, common warts and cutaneous T cell lymphoma starts to be broad and interesting, which permits to define its use in these entities. Photodynamic therapy is also been tested for a great variety of dermatoses with different photosensitizers and light sources with variable results. In this paper we review the treatment of Bowens disease and other indications different from non melanoma skin cancer with PDT, providing our experience.

Experience with photodynamic therapy in Hailey‐Hailey disease

Hailey‐Hailey disease (HHD) is a rare genodermatosis that is often difficult to treat. This paper reports three patients with HHD treated with one session of photodynamic therapy (PDT) using topical methyl aminolevulinic acid applied under occlusion for 3 hours and red light at 37 J/cm2 for 7.5 minutes. Our results are not successful: all of the patients suffered discomfort during the 3–4 weeks following PDT and only one patient experienced clinical improvement. None of the patients would like to repeat the treatment. PDT is at an exploratory stage; further studies are necessary to determine whether PDT is useful in the treatment of HHD.

Hemangiomas infantiles tratados con aplicación secuencial de láser de colorante pulsado y Nd:YAG: estudio retrospectivo

BACKGROUND AND OBJECTIVES Infantile hemangiomas are the most common benign tumor in children. They have 3 phases of development: a proliferative phase, an involuting phase, and involution. Although active treatment is often not required, it is necessary in some cases. Of the possible treatments for hemangiomas, lasers have been shown to be effective in all phases of development. We report our experience with dual-wavelength sequential pulses from a pulsed dye laser and an Nd:YAG laser. MATERIAL AND METHODS This was a retrospective, descriptive study of patients with infantile hemangioma in different phases of development treated with pulsed dye laser pulses followed by Nd:YAG laser pulses. Four dermatologists assessed the effectiveness of treatment on a scale of 10 to 0. Adverse effects and incidents related to treatment were recorded. The median and interquartile range were calculated as descriptive statistics. Pretreatment and posttreatment comparisons were performed using the Wilcoxon test. RESULTS Twenty-two patients with hemangiomas in different phases of development were included. A statistically significant improvement was obtained both for the entire group and for different subgroups. Posttreatment events were reported in 4 patients, and included edema and ulceration, skin atrophy, and hyperpigmentation. CONCLUSIONS We believe that treatment with dual-wavelength light from a pulsed dye laser and a Nd:YAG laser is a viable treatment option for infantile hemangiomas when first-line therapies are ineffective or contraindicated.

Plaque-Phase Mycosis Fungoides Treated with Photodynamic Therapy: Results from 12 Patients

BACKGROUND Recent years have seen an increase in the off-label use of photodynamic therapy for the treatment of a variety of skin diseases. Plaque-phase mycosis fungoides is among the most promising possibilities for the use of this treatment. OBJECTIVES To evaluate the treatment of plaque-phase mycosis fungoides with photodynamic therapy and compare the results obtained using fluorescence photography. MATERIALS AND METHODS We performed a prospective, descriptive, observational study. Twelve patients with 24 lesions were treated with topical methyl aminolevulinate (MAL) under an occlusive dressing for 3 h, followed by 8 min of red light (630 nm, 37 J/cm2; Aktilite). RESULTS Six patients had a complete response, 5 a partial response, and 1 did not respond to treatment. A mean of 5.7 sessions was applied and no side effects were reported. Treatment tolerance was excellent. CONCLUSIONS Photodynamic therapy with MAL appears to be a good treatment option for patients with plaque-phase mycosis fungoides with a small number of lesions.

Estudio retrospectivo, descriptivo y observacional del tratamiento de queratosis actínicas múltiples con metilaminolevulinato tópico y luz roja: resultados en la práctica clínica y correlación con la imagen de fluorescencia

Resumen Introduccion Las queratosis actinicas (QA) son una de las patologias cutaneas mas frecuentes en la practica clinica. En los ultimos 5 anos se han publicado varios estudios que evaluaban la eficacia de la terapia fotodinamica (TFD) en el tratamiento de multiples QA. Objetivo Evaluar los resultados de la TFD de multiples QA por localizaciones y su correlacion con la imagen de fluorescencia. Material y metodos Realizamos un estudio retrospectivo, descriptivo y observacional de los pacientes tratados por multiples QA con TFD en nuestro hospital. Se describe la edad, el sexo y la localizacion de las lesions (cara, cuero cabelludo y dorso de las manos) de los 57 pacientes. Se trato a todos los pacientes usando los mismos parametros: acido metilaminolevulinico (MAL, Metvix®) ocluido tres horas e irradiacion con luz roja de 630 nm, 37 J/cm2, 7,5 minutos (Aktilite®). Se describe la respuesta, periodo de remision, tolerancia, numero de sesiones y la fluorescencia segun localizaciones. Con la prueba Chi-cuadrado se evaluan las diferencias entre localizaciones y la correlacion de la imagen de fluorescencia con la respuesta clinica. Resultados En la cara se obtiene mayor grado de mejoria, se requieren menor numero de sesiones y mayores periodos de remision que en el resto de las localizaciones. El dorso de las manos es la zona mejor tolerada. Existe una correlacion alta y significativa entre el area de fluorescencia y su disminucion al aplicar el tratamiento, con el grado de respuesta clinica. Conclusiones Los resultados en el tratamiento de multiples QA con TFD son mejores, globalmente, en la cara que en el cuero cabelludo y en el dorso de manos. El diagnostico de fluorescencia puede ser una herramienta eficaz para predecir la respuesta al tratamiento.

In situ production of ROS in the skin by photodynamic therapy as a powerful tool in clinical dermatology.

Photodynamic therapy (PDT) is a clinical modality of photochemotherapy based on the accumulation of a photosensitizer in target cells and subsequent irradiation of the tissue with light of adequate wavelength promoting reactive oxygen species (ROS) formation and cell death. PDT is used in several medical specialties as an organ-specific therapy for different entities. In this review we focus on the current dermatological procedure of PDT. In the most widely used PDT protocol in dermatology, ROS production occurs by accumulation of the endogenous photosensitizer protoporphyrin IX after treatment with the metabolic precursors 5-methylaminolevulinic acid (MAL) or 5-aminolevulinic acid (ALA). To date, current approved dermatological indications of PDT include actinic keratoses (AK), basal cell carcinoma (BCC) and in situ squamous cell carcinoma (SCC) also known as Bowen disease (BD). With regards to AKs, PDT can also treat the cancerization field carrying an oncogenic risk. In addition, an increasing number of pathologies, such as other skin cancers, infectious, inflammatory or pilosebaceous diseases are being considered as potentially treatable entities with PDT. Besides the known therapeutic properties of PDT, there is a modality used for skin rejuvenation and aesthetic purposes defined as photodynamic photorejuvenation. This technique enables the remodelling of collagen, which in turn prevents and treats photoaging stygmata. Finally we explore a new potential treatment field for PDT determined by the activation of follicular bulge stem cells caused by in situ ROS formation.

Necrotizing vasculitis due to gefitinib (Iressa

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Retrospective, Descriptive, Observational Study of Treatment of Multiple Actinic Keratoses With Topical Methyl Aminolevulinate and Red Light: Results in Clinical Practice and Correlation With Fluorescence Imaging

BACKGROUND Actinic keratosis (AK) is one of the most common skin diseases seen in clinical practice. In the last 5 years, several studies assessing the efficacy of photodynamic therapy in the treatment of multiple AKs have been published. OBJECTIVE We aimed to assess the clinical outcomes of photodynamic therapy in patients with multiple AKs and the correlation of those outcomes with fluorescence imaging. MATERIAL AND METHODS In this retrospective, descriptive, observational study of 57 patients treated in our hospital with photodynamic therapy for multiple AKs, we recorded age, sex, and lesion site (face, scalp, and dorsum of the hands). All patients were treated in the same way: methyl aminolevulinic acid (Metvix) was applied for 3 hours and the skin then irradiated with red light at 630 nm, 37 J/cm(2), for 7.5 minutes (Aktilite). The response, remission duration, tolerance, number of sessions, and fluorescence images were recorded by site. The chi(2) test was used to assess between-site differences and the correlation between fluorescence imaging and clinical response. RESULTS The greatest improvements were obtained for facial lesions; these required fewer sessions and remission lasted longer than lesions at other sites. The treatment was best tolerated on the dorsum of the hands. The fluorescence area and the reduction in intensity on applying treatment were found to be strongly and significantly correlated with the extent of clinical response. CONCLUSIONS Overall, the outcomes of treatment of multiple AKs with photodynamic therapy are better for the face than for the scalp and dorsum of the hands. Fluorescence imaging may be an effective tool for predicting response to treatment.

Dermatosis perforante por gefitinib

Resumen El gefitinib [Iressa®] es un nuevo agente antineoplasico que actua inhibiendo selectivamente la tirosina cinasa del factor de crecimiento epidermico [EGFR-TK]. Ha demostrado actividad frente a varios tumores solidos. Por su mecanismo de accion, el gefitinib y otros inhibidores de tirosina cinasa se han asociado a multiples efectos cutaneos dermatologicos, la mayoria de ellos leves y bien tolerados. Se presenta un caso de dermatosis perforante tras tratamiento con gefitinib.