Photodynamic Therapy in 2020: Lights in the Darkness

Main Article Content

Neal Bhatia

Keywords

Photodynamic therapy, PDT, COVID-19, COVID, Coronavirus, Updates

Abstract

Photodynamic therapy (PDT) is an integral treatment modality for treating the entire process of photodamage, based on what is understood about the pathogenesis of actinic keratosis and the consequences from treating only visible spots and not the underlying disease. Dermatologists must consider incorporation of treatment in combination with duration, frequency, and tolerability of local skin reactions. These considerations are important, along with the combination of topical therapies and intermittent cryotherapy of individual actinic keratoses. Aside from costs and patient demographics, adaptation by dermatologists can influence variability in long-term treatment algorithms. There are multiple published guidelines and consensus statements for the US and Europe to promote safe incorporation of both blue

and red light along with the variable concentrations of ALA by dermatologists. However, there is a lack of head to head studies and comparative superiority as well as any evidence to support the use of topical agents. As management of local skin reactions becomes more commonplace, so will improved management of PDT to foster patient safety.

References

1. Gold, M, “Photodynamic Therapy in Dermatology,” New York: Springer Science, 2011

2. Enk, CD. Levi A, “Low‐irradiance red LED traffic lamps as light source in PDT for actinic keratoses,” Photodermatology, Photoimmunology and Photomedicine, Dec 2012, Vol 28, Issue 6 Pages 332-334

3. Petukhova TA, Hassoun LA, Foolad N, Barath M, Sivamani RK, “Effect of Expedited Microneedle-Assisted Photodynamic Therapy for Field Treatment of Actinic Keratoses: A Randomized Clinical Trial.,” JAMA Dermatol. 2017;153(7):637–643. doi:10.1001/jamadermatol.2017.0849

4. Physician’s Insert, Levulan Kerastick®

5. Warren C. et al. “Noninvasive fluorescence monitoring of protoporphyrin IX production and clinical outcomes in actinic keratoses following short-contact application of 5-aminolevulinate,” Journal of Biomedical optics. 2010; 9/10 15(5)

6. Kaw U, Ilyas M, Bullock T, Rittwage L, Riha M, Vidimos A, Hu B, Warren CB, Maytin EV, “A regimen to minimize pain during blue light photodynamic therapy of actinic keratoses: Bilaterally controlled, randomized trial of simultaneous versus conventional illumination,” J Am Amer Dermatol (2019), doi: https://doi.org/10.1016/j.jaad.2019.09.010

7. https://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=128&ncdver=3&CoverageSelection=Both&ArticleType=All&PolicyType=Final&s=All&KeyWord=Photodynamic+Therapy&KeyWordLookUp=Title&KeyWordSearchType=And&bc=gAAAABAAAEAAAA%3D%3D&

8. Wiegell SR, Haedersdal M, Philipsen PA, et al: “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,” Br J Dermatol 2008; 158:740-746.

9. Wiegell SR, Haedersdal M, Eriksen P, Wulf HC, “Photodynamic therapy of actinic keratoses with 8% and 16% methyl aminolaevulinate and home-based daylight exposure: a double-blinded randomized clinical trial,” Br J Dermatol. 2009; 160(6):1308-1314.

10. Wiegell SR, Fabricius S, Stender IM, et al, “A randomized, multicentre study of directed daylight exposure times of 1½ vs. 2½ h in daylight-mediated photodynamic therapy with methyl aminolaevulinate in patients with multiple thin actinic keratoses of the face and scalp,” Br J Dermatol 2011;164:1083-1090.

11. Wiegell SR, Fabricius S, Gniadecka M, et al. “Daylight-mediated photodynamic therapy of moderate to thick actinic keratoses of the face and scalp: a randomized multicentre study. Br J Dermatol. 2012; 166(6):1327-1332.

12. Dirschka T, Ekanayake-Bohlig S, Dominicus R, et al, “A randomized, intraindividual, non-inferiority, Phase III study comparing daylight photodynamic therapy with BF-200 ALA gel and MAL cream for the treatment of actinic keratosis,” J Eur Acad Dermatol Venereol. 2019;33(2):288-297..

13. Levi, A et al, “Daylight photodynamic therapy for the treatment of actinic cheilitis,” Photodermatology, Photoimmunology & Photomedicine, January 201, Volume35, Issue1

14. Serra-Guillen C, Nagore E, Hueso L, et al, “A randomized comparative study of tolerance and satisfaction in the treatment of actinic keratosis of the face and scalp between 5% imiquimod cream and photodynamic therapy with methyl aminolaevulinate, “Br J Dermatol. 2011; 164(2):429-433.

15. Maytin EV, Anand S, Riha M, et al. “5-Fluorouracil Enhances Protoporphyrin IX Accumulation and Lesion Clearance during Photodynamic Therapy of Actinic Keratoses: A Mechanism-Based Clinical Trial,” Clin Cancer Res, 2018; 24(13):3026-3035. Table 2 Courtesy Lindsay Habeeb, MD Medical Affairs, Associate Director SunPharma Per Cleaning instructions from the BLU-U user manual (page 21): Cleaning/Disinfecting Table 3 Courtesy Jon Lyons, PhD MBA Director, Medical Affairs - U.S. Biofrontera, Inc. Communications regarding Ameluz/Rhodo-LED