Peiru Wang

Evaluation of 5-aminolevulinic acid-mediated photorejuvenation of neck skin

OBJECTIVE To evaluate the outcomes of the combination of red light or intense pulsed laser (IPL) with 5-aminolevulinic acid (ALA)-mediated photodynamic therapy (PDT) in the treatment of photodamaged neck skin. METHODS The anterior of the neck was divided into four 2 cm × 2 cm sections and randomly assigned to red-light, red-light-PDT, IPL or IPL-PDT group. ALA cream of 5% was applied to PDT regions for 2h prior to light irradiation. Treatment was repeated once. The stratum corneum (SC) hydration, transepidermal water loss (TEWL), L(*), a(*), b(*) values, melanin index (MI), erythema index (EI), skin elasticity and skin thickness were examined by a blinded investigator. The function and volume of thyroid were also measured. RESULTS After red-light-PDT, IPL-PDT and IPL treatment, the appearance of photoaging lesion was improved. The SC hydration, L(*) value, elasticity and thickness increased, whereas the TEWL and MI value decreased. These changes in red-light-PDT and IPL-PDT group were more obvious than IPL group. The a(*) and EI value increased in red-light-PDT group. No significant change was noticed in red-light group. Partial irradiation of the thyroid did not affect the function and volume of the thyroid. CONCLUSION IPL-PDT and red-light-PDT showed better rejuvenation effect than IPL or red light alone on the neck skin.

Comparison of 5-aminolevulinic acid photodynamic therapy and red light for treatment of photoaging.

OBJECTIVE The aim of this pilot study was to compare the efficacy of ALA-PDT and red light alone in the treatment of photoaging. METHODS A total of 14 adults with photoaging skin were recruited. ALA-PDT or red light alone was applied to the forearm extensor. Before and after treatment, the treated sites were examined by dermoscopy, the changes in straum corneum (SC) hydration, transepidermal water loss (TEWL), and the L*a*b* values were measured, and microscopic examination of collagens and elastins was performed. RESULTS After ALA-PDT or red light illumination, the appearance of photoaging lesions improved, SC hydration increased and TEWL decreased. These changes in the ALA-PDT group were more obvious than those in the red light group. No significant change was noticed in the L*a*b* values in both groups. The signs of typical solar elastosis damage were improved in both groups. CONCLUSIONS ALA-PDT showed better skin rejuvenation effect than red light alone.

Treating cutaneous squamous cell carcinoma using 5-aminolevulinic acid polylactic-co-glycolic acid nanoparticle-mediated photodynamic therapy in a mouse model.

Background Squamous cell carcinoma (SCC) is a common skin cancer, and its treatment is still difficult. The aim of this study was to evaluate the effectiveness of nanoparticle (NP)-assisted 5-aminolevulinic acid (ALA) delivery for topical photodynamic therapy (PDT) of cutaneous SCC. Materials and methods Ultraviolet-induced cutaneous SCCs were established in hairless mice. ALA-loaded polylactic-co-glycolic acid (PLGA) NPs were prepared and characterized. The kinetics of ALA PLGA NP-induced protoporphyrin IX fluorescence in SCCs, therapeutic efficacy of ALA NP-mediated PDT, and immune responses were examined. Results PLGA NPs enhanced protoporphyrin IX production in SCC. ALA PLGA NP-mediated topical PDT was more effective than free ALA of the same concentration in treating cutaneous SCC. Conclusion PLGA NPs provide a promising strategy for delivering ALA in topical PDT of cutaneous SCC.

Treatment of cutaneous lichen planus with ALA-mediated topical photodynamic therapy

Purpose: To evaluate the effectiveness of topical 5-aminolevulinic acid (ALA)-mediated photodynamic therapy (PDT) for the treatment of cutaneous lichen planus (LP). Methods: A total of 17 symptomatic LP lesions in 7 Chinese patients were assessed. ALA cream (10%) was applied topically to LP lesions for 3 h. The lesions were irradiated with a 635 nm diode laser at the dose level of 100 J/cm2. The treatment was repeated at two-week intervals. Clinical assessment was conducted before each treatment. Follow-up was performed once a month for up to six months. Results: Lesions showed significant improvement after one to four courses of treatments. Complete response was achieved in 13 lesions (five patients) and partial remission in four lesions (two patients). The complete response rate was 71%. There was no significant side effects except the feeling of pain that most patients could tolerate. Follow-up of five patients who achieved complete response showed no signs of recurrence. Conclusion: Topical ALA PDT is effective in the treatment of cutaneous LP.

Clinical and Molecular Characterization of NF1 Patients: Single-Center Experience of 32 Patients From China.

AbstractNeurofibromatosis type 1 (NF1) is a hereditary disorder caused by mutations in the NF1 gene. Detecting mutation in NF1 is hindered by the genes large size, the lack of mutation hotspots, and the presence of pseudogenes.Our goal was to establish a sensitive, feasible, and comparatively economical protocol to detect NF1 mutations using blood samples.We developed a method to screen patients for mutations. Thirty-two NF1 patients from 32 unrelated families and 120 unrelated population-match controls were investigated in this study. Specific primers were designed for NF1 to avoid pseudogenes. NF1 mutations were detected by sequencing at the deoxyribonucleic acid (DNA) and complementary DNA (cDNA) levels, and multiplex ligation-dependent probe amplification (MLPA) and familial segregation analyses were used.Forty-four specific primers designed according to the NF1 structure were successfully used for polymerase chain reaction (PCR) and DNA sequencing, which was more feasible and useful than cDNA sequencing. Thirty distinct NF1 mutations were identified in 32 patients. Thirteen mutations were novel and most were frameshift mutations (33.3%). Mutations were detected at a rate of 93.8%.Our study suggests that this sensitive, feasible, and comparatively economical protocol is effective for the detection of NF1 mutations.

Plum-blossom needling promoted PpIX fluorescence intensity from 5-aminolevulinic acid in porcine skin model and patients with actnic keratosis

BACKGROUND AND OBJECTIVES Plum-blossom needling might enhance transdermal penetration of topically applied drugs by creating vertical channels. The purpose of this study was to evaluate drug delivery assisted by plum-blossom needling comparing with CO2 laser ablative fractional resurfacing (AFR) using 5-aminolevulinic acid (5-ALA), a porphyrin precursor, as a test drug. MATERIALS AND METHODS Ex vivo porcine skin was treated with plum-blossom needle(HWATO, Suzhou medical supplies factory Co., Ltd. China) or CO2 laser AFR before topical application of 20% 5-ALA(Sigma-Aldrich, Co., USA)cream, placebo cream and no cream. ALA-induced porphyrin fluorescence was measured by fluorescence microscopy at skin depths down to 1800μm. Needling was done by tapping the skin vertically from 5cm high above quickly. AFR was performed with a 10.6μm wavelength prototype CO2 laser, using stacked single pulses of 3 millisecond and 91.6mJ per pulse. Plum-blossom needling after ALA application was also done. Fluorescence intensity on lesion surface was examined by curalux spectrum analyzer (Laser Institute of Munich University, Germany) and VAS pain score was recorded in a randomized split-lesion clinical trial including 6 patients, 8 actinic keratosis lesions. RESULTS AFR created regular cone-shaped channels surrounded by a 70μm thin layer of thermally coagulated dermis, respectively. The cone is approximately 200μm in diameter at the opening and 1850μm in depth. Plum-blossom needle created irregular cone-shaped channels of approximately 180μm in diameter at the opening and it always drags a tail-which was shaped from the closed deeper channels. There was no porphyrin fluorescence in placebo cream or untreated skin sites. Plum-blossom needling followed by ALA application enhanced drug delivery with significantly higher porphyrin fluorescence at the edge of hole (P<0.005) and 100μm far from the hole (P=0.000) versus AFR followed by ALA application at skin depths of 120 and 500μm. Needling after ALA application presented higher porphyrin fluorescence at the edge of hole at skin depths of 120μm (P<0.005) and lower porphyrin fluorescence at 1000μm deep hole edge, and 100μm far from the hole at 120μm, 500μm and 1000μm depths versus AFR followed by ALA application (P<0.005). Skin massage after ALA application did not affect ALA-induced porphyrin fluorescence after pretreatment of plum-blossom needling or AFR. ALA application after plum-blossom needling was better than before plum-blossom needling. The clinical trial showed that the surface fluorescence intensity was stronger in needle-pretreated-lesion than in laser-pretreated-lesion. While the VAS pain score between needle treatment and laser treatment was almost the same. CONCLUSIONS Plum-blossom needling facilitates delivery of topical ALA into the dermis. It may help ALA to diffuse a little more broadly than AFR does in superficial dermis and obtain similar clinical effect with a much lower cost. Plum-blossom needling treatment appears to be a clinically practical and economical means for enhancing transdermal delivery of ALA, a photodynamic therapy drug, and presumably many other topical skin medications.

Treating cutaneous squamous cell carcinoma using ALA PLGA nanoparticle-mediated photodynamic therapy in a mouse model

Background: Squamous cell carcinoma (SCC) is a common skin cancer and its treatment is still difficult. The aim of this study was to evaluate the effectiveness of nanoparticle (NP)-assisted ALA delivery for topical photodynamic therapy (PDT) of cutaneous SCC. Methods: UV-induced cutaneous SCCs were established in hairless mice. ALA loaded polylactic-co-glycolic acid (PLGA) NPs were prepared and characterized. The kinetics of ALA PLGA NPs-induced protoporphyrin IX (PpIX) fluorescence in SCCs, therapeutic efficacy of ALA NP-mediated PDT, and immune responses were examined. Results: PLGA NPs could enhance PpIX production in SCC. ALA PLGA NP mediated topical PDT was more effective than free ALA of the same concentration in treating cutaneous SCC. Conclusion: PLGA NPs provide a promising strategy for delivering ALA in topical PDT of cutaneous SCC.

Preoperative asymmetry of upper eyelid thickness in young Chinese women undergoing double eyelid blepharoplasty

Asymmetry of the eyelid crease is a major complication following double eyelid blepharoplasty; the reasons are multivariate. This study presents, for the first time, a novel method, based on high-definition magnetic resonance imaging and high-precision weighing of tissue, for quantitating preoperative asymmetry of eyelid thickness in young Chinese women presenting for blepharoplasty. From 1 January 2008 to 1 October 2011, we studied 1217 women requesting double eyelid blepharoplasty. The patients ranged in age from 17 to 24 years (average 21.13 years). All patients were of Chinese Han nationality. Soft-tissue thickness at the tarsal plate superior border was 5.05 ± 1.01 units on the right side and 4.12 ± 0.96 units on the left. The submuscular fibro-adipose tissue area was 95.12 ± 23.27 unit(2) on the right side and 76.05 ± 21.11 unit(2) on the left. The pre-aponeurotic fat pad area was 112.33 ± 29.16 unit(2) on the right side and 91.25 ± 27.32 unit(2) on the left. The orbicularis muscle resected weighed 0.185 ± 0.055 g on the right side and 0.153 ± 0.042 g on the left; the orbital fat resected weighed 0.171 ± 0.062 g on the right side and 0.106 ± 0.057 g on the left. In conclusion, upper eyelid thickness asymmetry is a common phenomenon in young Chinese women who wish to undertake double eyelid blepharoplasty. We have demonstrated that the orbicularis muscle and orbital fat pad are consistently thicker on the right side than on the left.

Pemphigus vulgaris induced by 5-aminolaevulinic acid-based photodynamic therapy

Pemphigus vulgaris (PV) is an autoimmune disorder resulting from the interaction between autoantibodies and desmoglein. Here, we report a case of PV developed after 5-aminolaevulinic acid-based photodynamic therapy (ALA-PDT). The harmful and deleterious effects of UV radiation on the onset, during course, and perpetuation of PV have been observed for decades. Correlation between reactive oxygen species (ROS) and PV have also been reported. Oxidative proteins, which are modified by ROS, and subsequent production of antibodies by immune system seem to be responsible for PV developed following ALA-PDT. We emphasize that ALA-PDT should be added to the list of possible factors triggering PV and this condition should be considered if blistering arises following ALA-PDT.

Successful treatment of giant invasive cutaneous squamous cell carcinoma by plum-blossom needle assisted photodynamic therapy sequential with imiquimod: Case experience

Giant cutaneous squamous cell carcinoma (cSCC) in elderly people is difficult to treat. Herein, we report a case of 96-year-old male who was diagnosed to have giant facial invasive SCC (4cm*4.5cm*2 cm). He was successfully treated with plum-blossom needle assisted photodynamic therapy (PDT) sequential with imiquimod. The patient achieved complete remission after 9 sessions of PDT and 3 months of imiquimod but developed residual vitiligo-like hypopigmentation. There was no recurrence at 18 months of follow-up. This case suggests that plum-blossom needle pretreated PDT sequential by topical imiquimod is a viable treatment option for refractory and giant thick SCC.