Short‐term chemical pretreatment cannot replace curettage in photodynamic therapy

Nissen, Claus; Wiegell, Stine Regin; Philipsen, Peter Alshede; Wulf, Hans Christian

doi:10.1111/phpp.12236

Cited by 18 publications

(18 citation statements)

References 35 publications

(54 reference statements)

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“…The amount of ALA-induced PpIX was at least threefold higher at any measured time point [53]. Two additional studies could reproduce the increased PpIX formation attributed to BF-200 ALA compared with MAL in healthy volunteers' skin, focusing on either different age groups or pretreatments [66,67].…”

Section: Enhancing Pdt With Nanoemulsion Technologymentioning

confidence: 83%

“…Interestingly, the nanoemulsion BF-200 seems to enhance penetration as well as epidermal PpIX formation [53,64,66,67]. In a porcine skin model in vitro, BF-200 ALA containing 7.8% ALA was shown to be superior compared with a 20% MAL formulation, containing 16% free MAL, in terms of penetration depth and PpIX formation in the deeper epidermal layers [64].…”

Section: Enhancing Pdt With Nanoemulsion Technologymentioning

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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Section: Enhancing Pdt With Nanoemulsion Technologymentioning

confidence: 83%

Section: Enhancing Pdt With Nanoemulsion Technologymentioning

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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“…In a recent study, we monitored PpIX fluorescence in 30 healthy individuals during a 24-h application of MAL and investigated the effect of pretreatment with curettage. 7 The results showed that PpIX accumulation after 21 h was > 300% higher than after the standard application time of 3 h. Furthermore, curettage in itself increased PpIX accumulation significantly. 7 In the present study, we used both methods to enhance PpIX accumulation and we investigated whether increased PpIX accumulation could improve PDT efficacy when treating AKs on the dorsal side of the hands.…”

Section: What Is the Translational Message?mentioning

confidence: 93%

“…It is possible to increase PpIX accumulation by extending the application time of MAL and/or pretreating the skin before MAL application. In a recent study, we monitored PpIX fluorescence in 30 healthy individuals during a 24‐h application of MAL and investigated the effect of pretreatment with curettage . The results showed that PpIX accumulation after 21 h was > 300% higher than after the standard application time of 3 h. Furthermore, curettage in itself increased PpIX accumulation significantly …”

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confidence: 99%

Increased protoporphyrin IX accumulation does not improve the effect of photodynamic therapy for actinic keratosis: a randomized controlled trial

et al. 2017

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“…Another study from the same group monitoring PpIX fluorescence in healthy individuals during 24‐h application of MAL demonstrated a 300% higher PpIX accumulation than after a 3‐h application, and that furthermore, curettage also increased PpIX accumulation significantly . The inferior efficacy rates obtained with PDT on acral parts of the upper extremities, which often have rather thick actinic keratosis (AK) lesions, have been believed to be caused by insufficient PpIX production and accumulation.…”

mentioning

confidence: 99%

Long methylaminolaevulinate application does not increase clinical efficacy of photodynamic therapy in actinic keratosis, but leads to collateral damage

Braathen¹

2017

Br J Dermatol

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Short‐term chemical pretreatment cannot replace curettage in photodynamic therapy

Abstract: Curettage significantly enhances PpIX fluorescence from 1 to 5 h and is superior to short-term chemical pretreatment. Our results support curettage as standard pretreatment in PDT.

Cited by 18 publications

References 35 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

Increased protoporphyrin IX accumulation does not improve the effect of photodynamic therapy for actinic keratosis: a randomized controlled trial

Long methylaminolaevulinate application does not increase clinical efficacy of photodynamic therapy in actinic keratosis, but leads to collateral damage

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