Gain with no pain? Pain management in dermatological photodynamic therapy

Wang, B.; Shi, Lei; Zhang, Y.F.; Zhou, Qian; Zheng, Jia Wei; Szeimies, Rolf‐Markus; Wang, X.L.

doi:10.1111/bjd.15344

Cited by 71 publications

(64 citation statements)

References 120 publications

(309 reference statements)

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“…Pain during the illumination has received much attention in research and pain mechanisms were discussed in some detail elsewhere [57,86,87].…”

Section: Clinical Safetymentioning

confidence: 99%

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A review of BF-200 ALA for the photodynamic treatment of mild-to-moderate actinic keratosis

Reinhold¹

2017

Future Oncol.

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BF-200 ALA is a combination of a nanoscale-lipid vesicle formulation and the prodrug 5-aminolevulinic acid (5-ALA). The nanoemulsion stabilizes the prodrug and enhances its penetration through the stratum corneum. It has shown excellent therapeutic results in both lesion and field-directed photodynamic therapy of actinic keratosis (AK). AK is an early form of epidermal neoplasia and a precursor of invasive cutaneous squamous cell carcinoma. It is characterized by the combination of visible neoplastic lesions and surrounding tissue also harboring tumorigenic UV-induced mutations: a concept called field cancerization. A selective, field-directed treatment is ideal to meet the requirements of field change. Here, we review the clinical data on BF-200 ALA for AK along with a summary of molecular mechanisms and future perspectives. Actinic keratosis (AK), also known as solar keratosis, is caused by chronic exposure to sunlight or other ultraviolet light sources [1,2] and may progress to invasive squamous cell carcinoma (SCC) [3]. It is the most common lesion with malignant potential to arise on the skin. AK is mostly seen in Caucasians in skin areas that have extensive sun exposure throughout their lives [4]. Epidemiological data show a high occurrence rate of AK. Regions with higher ultraviolet exposure have a higher prevalence of AK. For the USA, the prevalence was estimated to range from 11 to 26%, while in Australia it ranged from 40 to 60%. In Europe, a prevalence of 15% in men and 6% in women has been documented [5]. Over the age of 70 years, 34% of men and 18% of women were found to have actinic keratotic lesions [6]. Next to fair skin type, an advanced age and lifelong sun exposure immunosuppression/-deficiency plays another important risk factor [5].Mostly, AK develops slowly and early in the disease process, they may disappear only to reappear later. Recurrence of the disease may include partial elimination of the initial lesion, subclinical lesion progression to visible status, or development of new lesions [7]. On top of this, an AK may progress to invasive SCC, the second-most common form of skin cancer [8,9]. The actual percentage of progress to invasive SCC remains unknown, and estimates vary from 5 to 20% within 10 to 25 years with reported annual transformation rates varying greatly from as low as 0.25% to as high as 16% [10]. The regression rate for a single untreated lesion is 15 to 63% after a year; recurrence rates range from 15 to 53% [11]. In general patients develop multiple AKs in one area and predicting which course each individual lesion will follow is impossible. Nonetheless, AK lesions are reliable markers for patients who are most predisposed to developing invasive SCC [4,[12][13].AK lesions typically appear in areas most frequently exposed to the sun such as the face, back of the hands, or bald scalp; 75% of lesions are found on the head, neck and forearms [14]. The lesions vary in appearance as well as size and can include erythematous scaly macules, rough pigmented patches and hyperker...

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“…Pain during the illumination has received much attention in research and pain mechanisms were discussed in some detail elsewhere [57,86,87].…”

Section: Clinical Safetymentioning

confidence: 99%

“…However, strategies to circumvent, reduce or cope with PDT-induced pain are of importance for the dermatological community [87][88]91]. During recent years, modified PDT protocols using natural or simulated daylight have been developed which can be implemented to manage pain in clinical routine.…”

Section: Clinical Safetymentioning

confidence: 99%

A review of BF-200 ALA for the photodynamic treatment of mild-to-moderate actinic keratosis

Reinhold¹

2017

Future Oncol.

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“…10,11 Infelizmente, a dor resultante deste procedimento é extremamente frequente (92% -97% 12 sendo grave em 16% 13 ), continuando a ser este o fator que mais limita o seu uso terapêutico. 14,15 A identificação dos doentes com risco de desenvolver dor intensa no decurso da PDT possibilitaria o emprego de estratégias analgésicas pré-procedimento. Foram identificados como possíveis preditores de dor: fototipo médio--baixo (I-III), 12,13,15 16,18 Outros, contudo, não são concordantes com esta observação.…”

Section: Terapêutica Fotodinâmicaunclassified

“…12,13 Estratégias para mitigar a dor relacionada com a PDT têm sido avaliadas em revisões sistemáticas recentes. 14,15,19 Várias intervenções demonstraram benefício: bloqueio regional, infiltração subcutânea de anestésico, estimulação transcutânea elétrica e por fim a analgesia pelo frio/arrefecimento cutâneo (com água gelada ou ar frio); esta última técnica, embora simples, parece ser globalmente mais eficaz. Os anestésicos tópicos demonstraram ser ineficazes.…”

Section: Terapêutica Fotodinâmicaunclassified

Abordagem da Dor em Dermatologia (Parte II)

Duarte

Roberto

Cruz

et al. 2018

SPDV

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RESUMO -A dor é um sintoma universal em Medicina; e na Dermatovenereologia é transversal ao seu domínio médico e cirúrgi-co. No domínio cirúrgico da especialidade temos a dor aguda peri-operatória, provavelmente mais frequente do que o esperado e cujo tratamento insuficiente implica morbilidade aguda e até potencialmente a longo prazo, dado o risco de cronificação. A dor crónica está associada a várias doenças cutâneas e é muitas vezes causa major de sofrimento para os doentes, dada a sua abordagem ser complexa, desafiante e por vezes infrutífera, agravada pela pouca evidência sobre como tratar apropriadamente o doente dermatológico com dor crónica. Este artigo é a segunda e última parte de uma revisão cujo objetivo é discutir os princípios gerais do tratamento da dor aguda peri--operatória e crónica no contexto da especialidade. Neste segundo capítulo será abordada a dor relacionada com procedimentos terapêuticos específicos. Por último, será discutida a dor crónica associada a entidades dermatológicas com quadros álgicos significativos. PALAVRAS-CHAVE - INTRODUÇÃOA dor é considerada o quinto sinal vital e o seu controlo é um indicador de qualidade dos serviços de saúde. Na primeira parte desta revisão, foi demonstrada a repercussão que a dor não controlada pode ter nas múltiplas esferas do domínio socioeconómico e familiar: sofrimento para os doentes e cuidadores, absentismo profissional, isolamento social e consumo significativo dos recursos de saúde. Observámos também que na Dermatologia e Venereologia, enquanto especialidade médico-cirúrgica, a dor não controlada é um sintoma frequentemente presente, quer por consequência de procedimentos cirúrgicos, quer devido a entidades clínicas com quadros fisiopatológicos complexos (como a úlcera de perna), e ao qual está associada uma perda major de qualidade de vida.Torna-se assim evidente a importância do tratamento eficaz da dor no doente dermatológico. Contudo, o controlo da dor, principalmente da dor crónica, continua a ser um desafio, havendo necessidade de delinear estratégias eficazes. A segunda parte deste artigo tem como objetivo colmatar esta necessidade, ao abordar o tratamento da dor aguda em procedimentos dermatológicos específicos e o tratamento da dor crónica associada a algumas entidades clínicas de gestão difícil.

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“…As PDT has become more widely practiced in clinics for these indications, translational clinical researchers have sought to optimize patient compliance and satisfaction, with a focus on pain reduction. PDT‐associated pain varies from patient to patient, but it can sometimes prove intolerable . In response to this, Wiegell et al .…”

Section: Introductionmentioning

confidence: 99%

Comparison of Blue and White Lamp Light with Sunlight for Daylight‐Mediated, 5‐ALA Photodynamic Therapy, in vivo

Marra

LaRochelle

Chapman

et al. 2018

Photochem & Photobiology

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Daylight-mediated photodynamic therapy (d-PDT) as a treatment for actinic keratosis (AK) is an increasingly common technique due to a significant reduction in pain, leading to better patient tolerability. While past studies have looked at different light sources and delivery methods, this study strives to provide equivalent PpIX-weighted light doses with the hypothesis that artificial light sources could be equally as effective as natural sunlight if their PpIX-weighted fluences were equalized. Normal mouse skin was used as the model to compare blue LED light, metal halide white light and natural sunlight, with minimal incubation time between topical ALA application and the onset of light delivery. A total PpIX-weighted fluence of 20 J cm was delivered over 2 h, and the efficacy of response was quantified using three acute bioassays for PDT damage: PpIX photobleaching, Stat3 crosslinking and quantitative histopathology. These bioassays indicated blue light was slightly inferior to both sunlight and white light, but that the latter two were not significantly different. The results suggest that metal halide white light could be a reasonable alternative to daylight PDT, which should allow a more controlled treatment that is independent of weather and yet should have similar response rates with limited pain during treatment.

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Gain with no pain? Pain management in dermatological photodynamic therapy

Cited by 71 publications

References 120 publications

A review of BF-200 ALA for the photodynamic treatment of mild-to-moderate actinic keratosis

A review of BF-200 ALA for the photodynamic treatment of mild-to-moderate actinic keratosis

Abordagem da Dor em Dermatologia (Parte II)

Comparison of Blue and White Lamp Light with Sunlight for Daylight‐Mediated, 5‐ALA Photodynamic Therapy, in vivo

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