Pain during topical photodynamic therapy of actinic keratoses with 5‐aminolevulinic acid and red light source: randomized controlled trial

Buinauskaitė, Evelina; Žalinkevičius, Rimantas; Buinauskienė, Jūratė; Valiukevičienė, Skaidra

doi:10.1111/phpp.12044

Cited by 17 publications

(17 citation statements)

References 33 publications

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“…No consistent, significant correlation was found between pain and age or sex . So far, no studies have explored the association between ethnicity and pain; however, there is plenty of evidence suggesting no correlation between Fitzpatrick skin type and pain experience during PDT . To conclude, these three patient‐specific characteristics do not strongly correlate with pain experiences.…”

Section: Intrinsic and Extrinsic Factors Of Painmentioning

confidence: 91%

“…These factors include the location, size and type of lesion. PDT of lesions on the face and scalp generates greater pain compared with lesions at other body sites, while larger lesions are more painful during PDT . It is likely that increased sensory nerve stimulation correlates with pain experience during PDT, as the face and scalp have the highest nerve innervation density .…”

Section: Intrinsic and Extrinsic Factors Of Painmentioning

confidence: 99%

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Gain with no pain? Pain management in dermatological photodynamic therapy

et al. 2017

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Pain during photodynamic therapy (PDT) is the main limiting adverse effect in its use in dermatology. Given its multifactorial nature, we reviewed both intrinsic and extrinsic factors that are involved in PDT pain. We propose a threshold theory for pain experience in PDT: it correlates positively with fluence rate and dose below a certain threshold (rate of ~60 mW cm , dose of ~50 J cm ); when the threshold is surpassed, pain intensity saturates. Additionally, we carefully compared recent updates on pain management strategies and we suggest that cold-air analgesia and low-irradiance light sources (such as variable pulsed light and daylight PDT) represent the current best analgesic options. Finally, we discuss the possible mechanisms of pain experience during PDT. Reactive oxygen species, transient receptor potential channels and inflammatory responses are key mediators in pain. Further investigation into these pathways should help with the development of more effective analgesic strategies. Taking these points together, for pain management in PDT, an individualized plan of analgesia is possible.

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Section: Intrinsic and Extrinsic Factors Of Painmentioning

confidence: 91%

Section: Intrinsic and Extrinsic Factors Of Painmentioning

confidence: 99%

Gain with no pain? Pain management in dermatological photodynamic therapy

et al. 2017

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“…Treatment of facial AKs may result in greater pain than scalp lesions [13]. Localised skin reactions causing oedema and erythema also commonly occur, although scarring is rare [5].…”

Section: Adverse Effectsmentioning

confidence: 99%

Photodynamic Therapy and Non-Melanoma Skin Cancer

Griffin

Lear

2016

Cancers

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Non-melanoma skin cancer (NMSC) is the most common malignancy among the Caucasian population. Photodynamic therapy (PDT) is gaining popularity for the treatment of basal cell carcinoma (BCC), Bowen’s disease (BD) and actinic keratosis (AK). A topical or systemic exogenous photosensitiser, results in selective uptake by malignant cells. Protoporphyrin IX (PpIX) is produced then activated by the introduction of a light source. Daylight-mediated MAL (methyl aminolaevulinate) PDT for AKs has the advantage of decreased pain and better patient tolerance. PDT is an effective treatment for superficial BCC, BD and both individual and field treatment of AKs. Excellent cosmesis can be achieved with high patient satisfaction. Variable results have been reported for nodular BCC, with improved outcomes following pretreatment and repeated PDT cycles. The more aggressive basisquamous, morphoeic infiltrating subtypes of BCC and invasive squamous cell carcinoma (SCC) are not suitable for PDT. Prevention of “field cancerization” in organ transplant recipients on long-term immunosuppression and patients with Gorlin syndrome (naevoid basal cell carcinoma syndrome) is a promising development. The optimisation of PDT techniques with improved photosensitiser delivery to target tissues, new generation photosensitisers and novel light sources may expand the future role of PDT in NMSC management.

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“…Although this study showed that placebo‐IPL treatment was mildly to moderately painful, pain levels were significantly higher for MAL‐IPL therapy. However, pain levels reported for MAL‐IPL in this clinical trial were lower than those for PDT with nonpulsed light sources . Moreover, the shorter treatment time of PDT with IPL makes treatment more comfortable and time‐efficient for both patients and medical personnel.…”

Section: Discussionmentioning

confidence: 71%