Photodynamic therapy in pediatric age: Current applications and future trends

Abstract

Photodynamic therapy (PDT) is a photochemotherapy based on local application of a photosensitive compound and subsequent exposure to a light source of adequate wavelength. It is a non-invasive therapeutic procedure widely used in oncodermatology for treatment of numerous skin cancers, but in the last years its use has been gradually extended to an increasing list of skin diseases of both infectious and inflammatory nature. Although PDT is proven as a safe and effective therapeutic option in adults, its use is not well standardized in the pediatric population. In this review, we will focus on clinical applications, mechanisms of action, protocols, and adverse events in children and adolescents. Most of pediatric experiences concerned treatment of skin cancers in Gorlin syndrome and xeroderma pigmentosum, acne vulgaris, and viral warts, but other applications emerged, such as cutaneous lymphoma and pseudo-lymphomas, necrobiosis lipoidica, hidradenitis suppurativa, dissecting cellulitis, leishmaniasis, angiofibromas, verrucous epidermal nevus, and linear porokeratosis. In these pediatric diseases, PDT appeared as an effective therapeutic alternative. The results on vitiligo were limited and not fully encouraging. Although highly versatile, PDT is not a therapy for all skin diseases, and a deeper knowledge of its mechanisms of action is required to better define its spectrum of action and safety in pediatric patients.

Phototherapy as a Treatment for Dermatological Diseases, Cancer, Aesthetic Dermatologic Conditions and Allergenic Rhinitis in Adult and Paediatric Medicine

“…This includes pre-cancerous and cancerous lesions [ 39 , 40 ] and photo aged skin [ 41 , 42 ]. PDT is also a suitable treatment for viral warts in children [ 43 ]. The efficacy of PDT for the treatment of Squamous cell carcinoma in situ (Bowen’s disease) using PDT and ALA as the photosensitizer has been reported [ 44 ].…”

“…ALA was applied topically four hours prior to PDT irradiation and resulted in clearance of all lesions after two treatments, which was a significant effect compared to a non PDT control treatment. No adverse events were associated with the use of PDT [ 43 ]. The relative efficacy of red and green light for the treatment of Bowen’s disease has been studied [ 45 ].…”

A Retrospective Review of Laser Therapy for Treatment of Hidradenitis Suppurativa

“…Hidradenitis suppurativa (HS), also known as acne inversa, 1–3 is an inflammatory disease of hair follicles that causes recurrent or chronic painful and suppurating lesions affecting apocrine gland-bearing regions 4 . It is most commonly observed in the axilla, groin, and perineum 5 . The prevalence of HS varies between literature and ranges between 0.05% and 4.10% 6–8 .…”

“…4 It is most commonly observed in the axilla, groin, and perineum. 5 The prevalence of HS varies between literature and ranges between 0.05% and 4.10%. [6][7][8] Hidradenitis suppurativa is usually diagnosed, on average, 7.2 years after its initial presentation, highlighting the high rates of misdiagnosis leading to erroneous treatment and disease progression.…”