‘Photodynamic therapy light’: An enhanced treatment protocol for actinic keratoses with minimal pain and optimal clinical outcome by combining laser-assisted low irradiance PDT with shortened daylight PDT
Background: Between 2003 and 2016, 546 patients in our clinic discontinued outpatient treatment for actinic keratoses (AKs) using conventional photodynamic therapy (PDT) because of intolerable pain, thereby necessitating the use of a less painful procedure. Therefore, we developed a novel off-label...
Saved in:
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-02-01
|
| Series: | Photodiagnosis and Photodynamic Therapy |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1572100024004095 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832575499105206272 |
|---|---|
| author | Martin T. Braun Kelly Del Tredici Anna Wölling Luitgard Wiest |
| author_facet | Martin T. Braun Kelly Del Tredici Anna Wölling Luitgard Wiest |
| author_sort | Martin T. Braun |
| collection | DOAJ |
| description | Background: Between 2003 and 2016, 546 patients in our clinic discontinued outpatient treatment for actinic keratoses (AKs) using conventional photodynamic therapy (PDT) because of intolerable pain, thereby necessitating the use of a less painful procedure. Therefore, we developed a novel off-label PDT protocol: ‘PDT light’. Methods: Laser-assisted low irradiance PDT (li-PDT) was performed beginning in 2014. The dosage was gradually lowered to 8–12 J/cm² in 2018, so that we achieved considerable pain reduction while maintaining comparable therapeutic efficacy. A further considerable reduction in pain was achieved from 2018 onwards by combining the advantages of li-PDT with daylight PDT (DLPDT), thereby resulting in 2018 in the new technique ‘PDT light’. Patients with AK Olsen grades 1 or 2 and field cancerization initially received a mild-fractionated CO2 laser pretreatment prior to MAL-incubation (methyl aminolaevulinate, Metvix ®) under occlusion for 1.5–3 h. Then, patients were illuminated on average for 1.02 min with the Aktilite-LED and, after application of an UV-screen on the illuminated area, sent out into daylight for 1 h. Results: Between March and November 2019, we successfully treated 152 cases using the enhanced ‘PDT light’ procedure, with 137 cases achieving at follow-up 1 (on average after 8.14 months) good-to-excellent clearance rates (CLA and CLB together 90 %) and minimal adverse effects. Conclusions: The novel ‘PDT light’ protocol proved to be an excellent and nearly painless method with an average visual-analogue scale (VAS) score of 1.19. Additional advantages included reduced illumination time, shorter outpatient stays in the clinic, fewer adverse effects, and better patient compliance than with DLPDT alone. |
| format | Article |
| id | doaj-art-1c2660e3261249cf8028fc1974fee3bf |
| institution | Kabale University |
| issn | 1572-1000 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Photodiagnosis and Photodynamic Therapy |
| spelling | doaj-art-1c2660e3261249cf8028fc1974fee3bf2025-02-01T04:11:39ZengElsevierPhotodiagnosis and Photodynamic Therapy1572-10002025-02-0151104372‘Photodynamic therapy light’: An enhanced treatment protocol for actinic keratoses with minimal pain and optimal clinical outcome by combining laser-assisted low irradiance PDT with shortened daylight PDTMartin T. Braun0Kelly Del Tredici1Anna Wölling2Luitgard Wiest3Bodensee Laser Clinic Dr. Braun, Owinger Straße 2, Überlingen 88662, Germany; Corresponding author.Department of Neurology, University of Ulm, Ulm 89081, GermanyBodensee Laser Clinic Dr. Braun, Owinger Straße 2, Überlingen 88662, GermanyDermatology Unit, Über der Klause 1, Munich 81545, GermanyBackground: Between 2003 and 2016, 546 patients in our clinic discontinued outpatient treatment for actinic keratoses (AKs) using conventional photodynamic therapy (PDT) because of intolerable pain, thereby necessitating the use of a less painful procedure. Therefore, we developed a novel off-label PDT protocol: ‘PDT light’. Methods: Laser-assisted low irradiance PDT (li-PDT) was performed beginning in 2014. The dosage was gradually lowered to 8–12 J/cm² in 2018, so that we achieved considerable pain reduction while maintaining comparable therapeutic efficacy. A further considerable reduction in pain was achieved from 2018 onwards by combining the advantages of li-PDT with daylight PDT (DLPDT), thereby resulting in 2018 in the new technique ‘PDT light’. Patients with AK Olsen grades 1 or 2 and field cancerization initially received a mild-fractionated CO2 laser pretreatment prior to MAL-incubation (methyl aminolaevulinate, Metvix ®) under occlusion for 1.5–3 h. Then, patients were illuminated on average for 1.02 min with the Aktilite-LED and, after application of an UV-screen on the illuminated area, sent out into daylight for 1 h. Results: Between March and November 2019, we successfully treated 152 cases using the enhanced ‘PDT light’ procedure, with 137 cases achieving at follow-up 1 (on average after 8.14 months) good-to-excellent clearance rates (CLA and CLB together 90 %) and minimal adverse effects. Conclusions: The novel ‘PDT light’ protocol proved to be an excellent and nearly painless method with an average visual-analogue scale (VAS) score of 1.19. Additional advantages included reduced illumination time, shorter outpatient stays in the clinic, fewer adverse effects, and better patient compliance than with DLPDT alone.http://www.sciencedirect.com/science/article/pii/S1572100024004095Actinic keratosesPhotodynamic therapyPDTPDT lightPhototoxic side-effectsPain during illumination |
| spellingShingle | Martin T. Braun Kelly Del Tredici Anna Wölling Luitgard Wiest ‘Photodynamic therapy light’: An enhanced treatment protocol for actinic keratoses with minimal pain and optimal clinical outcome by combining laser-assisted low irradiance PDT with shortened daylight PDT Photodiagnosis and Photodynamic Therapy Actinic keratoses Photodynamic therapy PDT PDT light Phototoxic side-effects Pain during illumination |
| title | ‘Photodynamic therapy light’: An enhanced treatment protocol for actinic keratoses with minimal pain and optimal clinical outcome by combining laser-assisted low irradiance PDT with shortened daylight PDT |
| title_full | ‘Photodynamic therapy light’: An enhanced treatment protocol for actinic keratoses with minimal pain and optimal clinical outcome by combining laser-assisted low irradiance PDT with shortened daylight PDT |
| title_fullStr | ‘Photodynamic therapy light’: An enhanced treatment protocol for actinic keratoses with minimal pain and optimal clinical outcome by combining laser-assisted low irradiance PDT with shortened daylight PDT |
| title_full_unstemmed | ‘Photodynamic therapy light’: An enhanced treatment protocol for actinic keratoses with minimal pain and optimal clinical outcome by combining laser-assisted low irradiance PDT with shortened daylight PDT |
| title_short | ‘Photodynamic therapy light’: An enhanced treatment protocol for actinic keratoses with minimal pain and optimal clinical outcome by combining laser-assisted low irradiance PDT with shortened daylight PDT |
| title_sort | photodynamic therapy light an enhanced treatment protocol for actinic keratoses with minimal pain and optimal clinical outcome by combining laser assisted low irradiance pdt with shortened daylight pdt |
| topic | Actinic keratoses Photodynamic therapy PDT PDT light Phototoxic side-effects Pain during illumination |
| url | http://www.sciencedirect.com/science/article/pii/S1572100024004095 |
| work_keys_str_mv | AT martintbraun photodynamictherapylightanenhancedtreatmentprotocolforactinickeratoseswithminimalpainandoptimalclinicaloutcomebycombininglaserassistedlowirradiancepdtwithshorteneddaylightpdt AT kellydeltredici photodynamictherapylightanenhancedtreatmentprotocolforactinickeratoseswithminimalpainandoptimalclinicaloutcomebycombininglaserassistedlowirradiancepdtwithshorteneddaylightpdt AT annawolling photodynamictherapylightanenhancedtreatmentprotocolforactinickeratoseswithminimalpainandoptimalclinicaloutcomebycombininglaserassistedlowirradiancepdtwithshorteneddaylightpdt AT luitgardwiest photodynamictherapylightanenhancedtreatmentprotocolforactinickeratoseswithminimalpainandoptimalclinicaloutcomebycombininglaserassistedlowirradiancepdtwithshorteneddaylightpdt |