Alternatives to Outdoor Daylight Illumination for Photodynamic Therapy—Use of Greenhouses and Artificial Light Sources

Lerche, Catharina M.; Heerfordt, Ida M.; Heydenreich, Jakob; Wulf, Hans Christian

doi:10.3390/ijms17030309

Cited by 78 publications

(77 citation statements)

References 15 publications

(24 reference statements)

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“…Within 30 min of application, patients are exposed to daylight for 2.0 h with licensed approvals for AK and field cancerization . Alternative methods of delivering light equivalent to daylight, but avoiding the limitations of climate considerations, are emerging, including simple use of a glasshouse and attempting to simulate daylight indoors . The potential to deliver daylight MAL‐PDT at home has demonstrated high levels of patient satisfaction, effectiveness and tolerability …”

Section: Treatment Protocolsmentioning

confidence: 99%

European Dermatology Forum guidelines on topical photodynamic therapy 2019 Part 1: treatment delivery and established indications – actinic keratoses, Bowen's disease and basal cell carcinomas

Morton¹,

Szeimies

Basset-Séguin

et al. 2019

Acad Dermatol Venereol

138

146

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Topical photodynamic therapy (PDT) is a widely approved therapy for actinic keratoses, Bowen's disease (squamous cell carcinoma in situ), superficial and certain thin basal cell carcinomas. Recurrence rates when standard treatment protocols are used are typically equivalent to existing therapies, although inferior to surgery for nodular basal cell carcinoma. PDT can be used both as lesional and field therapies and has the potential to delay/reduce the development of new lesions. A protocol using daylight to treat actinic keratoses is widely practised, with conventional PDT using a red light after typically a 3‐h period of occlusion employed for other superficial skin cancer indications as well as for actinic keratoses when daylight therapy is not feasible. PDT is a well‐tolerated therapy although discomfort associated with conventional protocol may require pain‐reduction measures. PDT using daylight is associated with no or minimal pain and preferred by patient. There is an emerging literature on enhancing conventional PDT protocols or combined PDT with another treatment to increase response rates. This guideline, published over two parts, considers all current approved and emerging indications for the use of topical PDT in dermatology, prepared by the PDT subgroup of the European Dermatology Forum guidelines committee. It presents consensual expert recommendations reflecting current published evidence.

show abstract

Section: Treatment Protocolsmentioning

confidence: 99%

European Dermatology Forum guidelines on topical photodynamic therapy 2019 Part 1: treatment delivery and established indications – actinic keratoses, Bowen's disease and basal cell carcinomas

Morton¹,

Szeimies

Basset-Séguin

et al. 2019

Acad Dermatol Venereol

138

146

View full text Add to dashboard Cite

show abstract

“…The spectral measurements are shown in Fig. A, where for comparison purposes the intensities were uniformly scaled such that the indoor irradiance is 75% of the corresponding total outdoor irradiance, which is similar to reports by others . The actual reduction is dependent on the transmission of the glass or acrylic barrier, which is concisely summarized by O’Mahoney et al for many common materials .…”

Section: Resultsmentioning

confidence: 64%

Weather‐informed Light–tissue Model–Based Dose Planning for Indoor Daylight Photodynamic Therapy

LaRochelle

Chapman

Maytin

et al. 2019

Photochem & Photobiology

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Daylight activation for photodynamic therapy (PDT) of skin lesions is now widely adopted in many countries as a less painful and equally effective treatment mechanism, as compared to red or blue light activation. However, seasonal daylight availability and transient weather conditions complicate light dose estimations. A method is presented for dose planning without placing a large burden on clinical staff, by limiting spectral measurements to a one‐time site assessment, and then using automatically acquired weather reports to track transient conditions. The site assessment tools are used to identify appropriate treatment locations for the annual and daily variations in sunlight exposure for clinical center planning. The spectral information collected from the site assessment can then be integrated with real‐time daily electronic weather data. It was shown that a directly measured light exposure has strong correlation (R2: 0.87) with both satellite cloud coverage data and UV index, suggesting that the automated weather indexes can be surrogates for daylight PDT optical dose. These updated inputs can be used in a dose‐planning treatment model to estimate photodynamic dose at depth in tissue. A simple standardized method for estimating light dose during daylight‐PDT could help improve intersite reproducibility while minimizing treatment times.

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“…Protoporphyrin IX fluorescence was measured in arbitrary units in each treatment field with a hand‐held fluorescence photometer (FluoDerm; Dia‐Medico, Gentofte, Denmark) just before MAL application, and just before the start of the illumination. The difference in fluorescence reflected accumulated PpIX …”

Section: Methodsmentioning

confidence: 99%

Daylight photodynamic therapy of actinic keratosis without curettage is as effective as with curettage: a randomized clinical trial

Heerfordt

Wulf

2019

Acad Dermatol Venereol

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Background Guidelines for photodynamic therapy (PDT) of actinic keratosis (AK) recommend pretreatment with curettage. The impact of curettage on cure rate is, however, not well established. Objective The present study aimed to evaluate whether daylight PDT without curettage could be as effective as daylight PDT with curettage. Methods Twenty‐five patients with multiple AKs were treated in two even‐sized areas on the face and scalp. One area was treated with standard daylight PDT starting with curettage followed by incubation with methyl aminolevulinate (MAL) for 30 min before 2 h of daylight exposure. The other area was incubated with MAL for 1 h without prior curettage before 2 h of daylight exposure. The longer incubation time was used to obtain a sufficiently high protoporphyrin IX concentration in the non‐curettaged area. Results There was no difference in cure rate 3 months after daylight PDT in areas pretreated with curettage (86%) compared to non‐curettaged areas (84%) (P = 0.1). Neither was there any difference between reported pain during daylight exposure (P > 0.7) or clinically evaluated erythema the day after treatment (P = 1.0). Conclusion Daylight PDT without curettage but with 1 h of MAL incubation before daylight exposure was shown to be as effective in treatment of thin AKs on the face and scalp as standard daylight PDT with curettage. This modification of daylight PDT eases the task for the clinic and makes it more convenient for the patients as well, creating the possibility of performing daylight PDT as an entirely home‐based treatment for AKs of the face and scalp without training the patients to perform pretreatment.

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Alternatives to Outdoor Daylight Illumination for Photodynamic Therapy—Use of Greenhouses and Artificial Light Sources

Cited by 78 publications

References 15 publications

European Dermatology Forum guidelines on topical photodynamic therapy 2019 Part 1: treatment delivery and established indications – actinic keratoses, Bowen's disease and basal cell carcinomas

European Dermatology Forum guidelines on topical photodynamic therapy 2019 Part 1: treatment delivery and established indications – actinic keratoses, Bowen's disease and basal cell carcinomas

Weather‐informed Light–tissue Model–Based Dose Planning for Indoor Daylight Photodynamic Therapy

Daylight photodynamic therapy of actinic keratosis without curettage is as effective as with curettage: a randomized clinical trial

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