Stine Regin Wiegell

Continuous activation of PpIX by daylight is as effective as and less painful than conventional photodynamic therapy for actinic keratoses; a randomized, controlled, single-blinded study

Background Photodynamic therapy (PDT) is a highly effective treatment for actinic keratoses (AK); however, it is time consuming and often painful for the patient. Daylight‐PDT would make the treatment independent of the clinic and less painful due to the continuous activation of small amounts of porphyrins during its formation.

Photodynamic therapy of actinic keratoses with 8% and 16% methyl aminolaevulinate and home-based daylight exposure: a double-blinded randomized clinical trial

Background  Photodynamic therapy (PDT) is an effective but time‐consuming and often painful treatment for actinic keratosis (AK). Home‐based daylight–PDT has the potential to facilitate treatment procedure and to reduce associated pain due to continuous activation of small amounts of porphyrins. Moreover, a reduced methyl aminolaevulinate (MAL) concentration may reduce associated inflammation, making the treatment more tolerable for the patients.

Pain during photodynamic therapy is associated with protoporphyrin IX fluorescence and fluence rate

Background  Pain during photodynamic therapy (PDT) is a considerable problem that needs to be studied to improve this otherwise attractive treatment of skin diseases.

Long-pulsed dye laser versus long-pulsed dye laser-assisted photodynamic therapy for acne vulgaris: A randomized controlled trial

BACKGROUND Long-pulsed dye laser (LPDL)-assisted photodynamic therapy has been suggested to be superior to laser alone for acne vulgaris but no evidence is available. OBJECTIVE To evaluate the efficacy and safety of LPDL alone versus LPDL in photodynamic therapy with methylaminolevulinic acid (MAL-LPDL) for acne vulgaris. METHODS Fifteen patients received a series of 3 full-face LPDL treatments and half-face prelaser MAL treatments; the latter being randomly assigned to the left or right side. RESULTS Inflammatory lesions were reduced more on MAL-LPDL-treated than on LPDL-treated sides (week 4: 70% vs 50%, P = .003; week 12: 80% vs 67%, P = .004). Noninflammatory lesions reduced similarly. Patient satisfaction was slightly greater with MAL-LPDL versus LPDL treatments (scale 0-10: week 4: 7 vs 6, P = .034; week 12: 8 vs 7.5, P = .034). Fluorescence measurements detected photobleaching with MAL-LPDL (35.3%) and LPDL (7.3%) treatments (P < .001). Erythema, edema, and pustular eruptions intensified from MAL incubation. No patients experienced pigment changes or scarring. LIMITATIONS The sample size was limited. The split-face design in this randomized controlled trial does not allow us to draw conclusions about the efficacy of the LPDL, only about the efficacy of MAL-LPDL compared with LPDL alone. CONCLUSIONS MAL-LPDL is slightly superior to LPDL for the treatment of inflammatory acne.

Weather conditions and daylight‐mediated photodynamic therapy: protoporphyrin IX‐weighted daylight doses measured in six geographical locations

Background  Photodynamic therapy (PDT) is an attractive therapy for nonmelanoma skin cancers and actinic keratoses (AKs). Daylight‐mediated methyl aminolaevulinate PDT (daylight‐PDT) is a simple and painless treatment procedure for PDT. All daylight‐PDT studies have been performed in the Nordic countries. To be able to apply these results in other parts of the world we have to compare the daily protoporphyrin IX (PpIX) light dose in other countries with the PpIX light doses found in Nordic countries.

Morphine Gel 0.3% Does Not Relieve Pain During Topical Photodynamic Therapy: A Randomized, Double-blind, Placebo- controlled Study

There is a demand for pain relief during photodynamic therapy. We therefore investigated the efficacy and side-effects of topical morphine gel 0.3% for pain relief during topical photodynamic therapy in a randomized, double-blind, placebo-controlled study. The study involved 28 patients with actinic keratoses or basal cell carcinomas. Each patient was treated with photodynamic therapy after superficial curettage of 2 treatment areas that were randomized to morphine gel or placebo gel. The gels were applied 15 min before illumination. Pain was assessed pre-illumination, during, and immediately after illumination, using a numeric rating scale. Skin redness was determined by reflectance spectrophotometry and the size of the treated area by protoporphyrin IX fluorescence. There were no differences between the areas according to accumulation of protoporphyrin IX (p =0.34), size of fluorescence areas (p =0.84), or skin redness (p =0.95). There was no significant pain relief of topical morphine gel compared with placebo gel (p >0.23). This negative result suggests that opioid receptors may not be involved in the pain induced by photodynamic therapy.

Continuous ultra-low-intensity artificial daylight is not as effective as red LED light in photodynamic therapy of multiple actinic keratoses

Daylight‐mediated photodynamic therapy (PDT) is a simple and tolerable treatment of nonmelanoma skin cancer. It is of interest which light intensity is sufficient to prevent accumulation of protoporphyrin IX (PpIX) and effectively treat actinic keratoses (AKs). We compared the efficacy of PDT with light‐emitting diode (LED) to daylight‐mediated PDT with very low‐intensity artificial daylight (‘daylight’) in the treatment of multiple AKs in the face or scalp.

Light protection of the skin after photodynamic therapy reduces inflammation: an unblinded randomized controlled study

Photodynamic therapy (PDT) is followed by significant inflammation. Protoporphyrin (Pp)IX is still formed in the skin after PDT and patients are sensitive to daylight 24–48 h after treatment. Exposure to daylight after PDT may therefore increase inflammation.

Skin Pigmentation Kinetics after Exposure to Ultraviolet A

Multiple exposures to ultraviolet radiation (UVR) are the norm in nature and phototherapy. However, studies of the kinetics of pigmentation following UVA exposure have included only fair-skinned persons. The aim of this study was to investigate steady-state pigmentation and fading in 12 Scandinavians and 12 Indians/Pakistanis after 6 and 12 exposures on the back using broadband UVA and UVA1 with equal sub-minimal melanogenic doses (individually predetermined). Pigmentation was measured by skin reflectance at 555 and 660 nm. The UV dose to minimal pigmentation was higher in dark-skinned persons after a single broadband UVA exposure, but independent of pigmentation/skin type after single and multiple UVA1 exposures. To elicit minimal melanogenic doses after 6 and 12 exposures, every dose is lowered by a factor of 2 and 3, respectively, but the cumulative dose increases three- and four-fold, respectively. The absolute increase in pigmentation was independent of pre-exposure pigmentation; therefore the percentage increase in pigmentation was higher in fair-skinned subjects. The absolute increase in pigmentation was higher and it took 2-3 days longer to reach steady-state after 12 UV exposures compared with 6 UV exposures. Days to steady-state pigmentation and fading were independent of pre-exposure pigmentation, and fading took 5-6 months. Comparing data from a narrowband UVB source and a Solar Simulator, it was shown that pigmentation built up faster and increased more after 12 UVA exposures (16 days) than with the Solar Simulator (21 days).

Pulse photodynamic therapy reduces inflammation without compromising efficacy in the treatment of multiple mild actinic keratoses of the face and scalp: a randomized clinical trial.

The main side‐effects of photodynamic therapy (PDT) for actinic keratoses (AKs) are post‐treatment erythema and oedema, and pain during illumination. Severe erythema after PDT enhances the down time associated with the treatment.