TY - JOUR
T1 - Counteracting Side-effects of Photodynamic Therapy for Actinic Keratoses
AU - Wulf, Hans Christian
AU - Heerfordt, Ida M
N1 - Copyright © 2022 International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.
PY - 2022/10
Y1 - 2022/10
N2 - BACKGROUND/AIM: Actinic keratoses (AKs) are precursors of squamous cell carcinomas and early intervention is important. Photodynamic therapy (PDT) is often first-choice treatment for widespread AKs. Classic PDT consists of: Superficial curettage, application of 5-aminolevulinic acid or methyl aminolevulinate, incubation and protoporphyrin IX (PpIX) accumulation under occlusion for 3 hours, followed by illumination with red light-emitting diode light (37 J/cm2). Classic PDT is effective in treating AKs, but side-effects include unpleasant pretreatment, severe pain during illumination, inflammation after treatment, and long waiting time in the clinic.MATERIALS AND METHODS: This targeted mini review describes efforts to counteract side-effects and simplify the procedure considering the clinic capacity. Changes are only acceptable if treatment effect is maintained.RESULTS: We introduce the following procedure changes: (i) reducing pre-treatment pain, bleeding, and oozing by omitting curettage; (ii) long-term illumination for 2 hours during PpIX formation (already in use as daylight PDT) and shortening of incubation time from 3 hours to 30 minutes to minimize pain and inflammation risk. In addition, options of timing, incubation, and illumination indoors and outdoors are discussed, focusing on advantages and disadvantages for patients and clinics.CONCLUSION: We report several options to counteract side-effects of classic PDT.
AB - BACKGROUND/AIM: Actinic keratoses (AKs) are precursors of squamous cell carcinomas and early intervention is important. Photodynamic therapy (PDT) is often first-choice treatment for widespread AKs. Classic PDT consists of: Superficial curettage, application of 5-aminolevulinic acid or methyl aminolevulinate, incubation and protoporphyrin IX (PpIX) accumulation under occlusion for 3 hours, followed by illumination with red light-emitting diode light (37 J/cm2). Classic PDT is effective in treating AKs, but side-effects include unpleasant pretreatment, severe pain during illumination, inflammation after treatment, and long waiting time in the clinic.MATERIALS AND METHODS: This targeted mini review describes efforts to counteract side-effects and simplify the procedure considering the clinic capacity. Changes are only acceptable if treatment effect is maintained.RESULTS: We introduce the following procedure changes: (i) reducing pre-treatment pain, bleeding, and oozing by omitting curettage; (ii) long-term illumination for 2 hours during PpIX formation (already in use as daylight PDT) and shortening of incubation time from 3 hours to 30 minutes to minimize pain and inflammation risk. In addition, options of timing, incubation, and illumination indoors and outdoors are discussed, focusing on advantages and disadvantages for patients and clinics.CONCLUSION: We report several options to counteract side-effects of classic PDT.
KW - Aminolevulinic Acid/adverse effects
KW - Drug-Related Side Effects and Adverse Reactions/drug therapy
KW - Humans
KW - Inflammation/drug therapy
KW - Keratosis, Actinic/drug therapy
KW - Pain/drug therapy
KW - Photochemotherapy/adverse effects
KW - Photosensitizing Agents/adverse effects
KW - Treatment Outcome
KW - Triazenes
UR - http://www.scopus.com/inward/record.url?scp=85139133568&partnerID=8YFLogxK
U2 - 10.21873/anticanres.16009
DO - 10.21873/anticanres.16009
M3 - Review
C2 - 36192011
SN - 0250-7005
VL - 42
SP - 5017
EP - 5020
JO - Anticancer Research
JF - Anticancer Research
IS - 10
ER -