The variable response of plaque psoriasis after a single treatment with topical 5-aminolaevulinic acid photodynamic therapy

Collins, Paul M.; Robinson, Dominic J.; Stringer, Maurice; Stables, G.I.; Sheehan-Dare, R. A.

doi:10.1046/j.1365-2133.1997.19452060.x

Cited by 41 publications

(50 citation statements)

References 20 publications

(4 reference statements)

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“…Several authors have described clinical improvement of psoriasis after multiple PDT sessions, but an optimal treatment protocol has not yet been established (4)(5)(6)8,21,22). In the present study, six PDT treatments with a weekly interval induced significant clinical as well as histological improvement of psoriasis.…”

Section: Discussionmentioning

confidence: 44%

“…Besides the main oncological indications, other non-oncological indications have also been studied or are currently under evaluation (2). Psoriasis lesions accumulate PpIX selectively after application of 5-ALA and its susceptibility to photodynamic treatment has been previously studied by various authors (3)(4)(5)(6)(7)(8)(9). The clinical effects of photodynamic therapy (PDT) in psoriasis varied largely in these studies.…”

Section: Introductionmentioning

confidence: 99%

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The effects of keratolytic pretreatment prior to fluorescence diagnosis and photodynamic therapy with aminolevulinic acid-induced porphyrins in psoriasis

Kleinpenning

Kanis

Smits

et al. 2009

Journal of Dermatological Treatment

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Section: Discussionmentioning

confidence: 44%

Section: Introductionmentioning

confidence: 99%

The effects of keratolytic pretreatment prior to fluorescence diagnosis and photodynamic therapy with aminolevulinic acid-induced porphyrins in psoriasis

Kleinpenning

Kanis

Smits

et al. 2009

Journal of Dermatological Treatment

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“…On the ®rst day (day 1) of the treatment programme ALA (Department of Colour Chemistry, University of Leeds) dissolved (20% by weight) in a propriety oil-in-water emulsion (Unguentum Merck, Whitehall Laboratories Ltd, UK) was applied to the treatment sites in a quantity of approximately 25 mgcm À2 . Approximately 4 h after ALA application, each site received a single exposure to broad-band visible radiation from a modi®ed slide projector (12), at a ®xed dose-rate of 15 mWcm À2 . Considering the severe acute responses we observed in our previous study (12), the ®rst 3 patients in the study received light doses of 2 and 4 Jcm À2 , all subsequent patients were prescribed a light dose of 8 Jcm À2 .…”

Section: Treatmentmentioning

confidence: 99%

“…Approximately 4 h after ALA application, each site received a single exposure to broad-band visible radiation from a modi®ed slide projector (12), at a ®xed dose-rate of 15 mWcm À2 . Considering the severe acute responses we observed in our previous study (12), the ®rst 3 patients in the study received light doses of 2 and 4 Jcm À2 , all subsequent patients were prescribed a light dose of 8 Jcm À2 . Local analgesia was not used during treatment.…”

Section: Treatmentmentioning

confidence: 99%

“…In our previous therapeutic study (12) we established clinically effective values of light dose (Jcm À2 ) and dose-rate (mWcm À2 ) for the treatment of plaque psoriasis by ALA-PDT, although the response to a single treatment was variable. Of a total of 80 test sites, on 20 patients, 14 (17.5%) cleared, 6 (7.5%) showed a partial response and 60 (75%) showed little or no improvement.…”

mentioning

confidence: 99%

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Improved Response of Plaque Psoriasis after Multiple Treatments with Topical 5-Aminolaevulinic Acid Photodynamic Therapy

Robinson

Collins²,

Stringer³

et al. 1999

Acta Dermato-Venereologica

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We investigated the clinical response of 10 patients with plaque psoriasis to multiple treatments with photodynamic therapy, using topical application of 5-aminolaevulinic acid followed by exposure to broad-band visible radiation. Treatment was performed up to 3 times per week, with a maximum of 12 treatments, using a light dose of 8 Jcm(-2) delivered at a dose-rate of 15 mW cm(-2). Eight patients showed a clinical response. Out of 19 treated sites, 4 cleared, 10 responded but did not clear and 5 showed no improvement. Of the 4 sites that cleared only 1 did so fully, after 7 treatments, 45 days after the start of therapy. Of the 10 sites that responded partially, the greatest reduction in scale, erythema and induration index occurred after a minimum of 3 and a maximum of 8 treatments. The intensity of 5-aminolaevulinic acid-induced protoporphyrin IX fluorescence, recorded prior to the first treatment, varied between sites on the same patient as well as between patients. There was also a variation in fluorescence intensity recorded from the same site immediately prior to subsequent treatments, although the pretreatment levels generally decreased as the study progressed and then increased as psoriasis relapsed. Biopsies confirmed that fluorescence was localized throughout the epidermis and stratum corneum, but the level was not consistent between sections taken within the same biopsy. We also observed fluorescence at sites distant from the ones that received 5-aminolaevulinic acid, which was not present prior to the start of the treatment programme, but found no evidence of elevated levels of plasma porphyrins. The level of discomfort associated with this therapy increased with increasing values of the calculated photodynamic dose, defined as the product of the initial photosensitizer concentration and the percentage reduction in fluorescence following irradiation. Therefore, although clinical efficacy improved with multiple treatments, unpredictable response and patient discomfort make ALA-PDT unsuitable for the treatment of psoriasis.

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Artificial White Light vs Daylight Photodynamic Therapy for Actinic Keratoses

et al. 2016

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IMPORTANCE Daylight photodynamic therapy using topical methyl 5-aminolevulinic acid (MAL) for actinic keratoses (AKs) is as effective as conventional photodynamic therapy but has the advantage of being almost pain free. Daylight photodynamic therapy, however, requires dry and warm weather conditions. OBJECTIVE To establish if topical MAL photodynamic therapy using a white light light-emitting diode (LED) lamp is as effective and well-tolerated as daylight photodynamic therapy for the treatment of AKs. DESIGN, SETTING, AND PARTICIPANTS Overall, 22 men with significant photodamage and a high number of AKs were enrolled in this prospective, randomized, single-blind study, employing a split-scalp design, comparing the effectiveness and adverse effects of daylight photodynamic therapy and artificial white light (AWL) LED photodynamic therapy for the treatment of AKs on the forehead and scalp. Organ transplant recipients were excluded. Patients were treated and evaluated at an academic tertiary referral dermatology center. Treatment lasted from April 2014 to July 2014 and follow-up visits occurred for 9 months posttreatment. INTERVENTIONS Two symmetrical treatment fields were defined and AKs counted, mapped, and photographed at baseline, 1, 3, 6, and 9 months. Patients had half of their scalp treated with daylight photodynamic therapy and the other half treated with AWL photodynamic therapy 1 week apart and randomly allocated. MAL was applied, and treatment commenced 30 minutes later and lasted 2 hours. Irradiance, illuminance, and light spectra measurements were performed. The integrated dose in J/cm 2 was measured. The effective light dose, weighted to the absorption spectrum for protoporphyrin IX, was calculated. MAIN OUTCOMES AND MEASURES The primary end point was the reduction in total AK count per treatment field. Secondary end points included adverse effects and patient satisfaction. RESULTS We enrolled 22 men with a median age of 72 years (range, 47-85 years) at baseline, the total (median of AKs per field) were 469 (20.5) for the DPDT group and 496 (20.5) for the AWLPDT group (P = .34). The median number and percentage of reduction in AKs per field were 12 and 62.3% for DPDT and 14 and 67.7% for AWLPDT at 1 month (P = .21 and P = .13, respectively). There was no significant difference in the reduction percentage of AKs for either treatment at 1, 3, and 6 months. At 9 months, the median number and percentage of reduction in AKs per field was 9.0 and 48.4% for DPDT and 12.0 and 64.4% for AWLPDT (P = .13 and P = .05, respectively). Pain was reported by 14 patients with DPDT and 16 patients with AWLPDT (median maximum score [out of 100], 4 vs 6; P = .51). Moderate erythema was reported by 9 patients after DPDT and 14 patients after AWLPDT. On a scale of 0 (intolerable) to 10 (very tolerable) patients rated DPDT as 9.5 and AWLPDT as 9 (P = .37). CONCLUSIONS AND RELEVANCE Photodynamic therapy using an AWL source was as effective and well-tolerated as daylight photodynamic therapy. TRIAL REGISTRATION clinicaltrials.g...

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The variable response of plaque psoriasis after a single treatment with topical 5-aminolaevulinic acid photodynamic therapy

Cited by 41 publications

References 20 publications

The effects of keratolytic pretreatment prior to fluorescence diagnosis and photodynamic therapy with aminolevulinic acid-induced porphyrins in psoriasis

The effects of keratolytic pretreatment prior to fluorescence diagnosis and photodynamic therapy with aminolevulinic acid-induced porphyrins in psoriasis

Improved Response of Plaque Psoriasis after Multiple Treatments with Topical 5-Aminolaevulinic Acid Photodynamic Therapy

Artificial White Light vs Daylight Photodynamic Therapy for Actinic Keratoses

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