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The article offers guidelines for topical photodynamic therapy (PDT) released by the British Association of Dermatologists and British Photodermatology Group. It offers overview of the purpose and scope of the guideline aimed at providing updated evidence-based recommendations for use of PDT. It also notes that the recommendation was developed for implementation in the National Health Service in Great Britain.

Summary: Background: Topical photodynamic therapy (PDT) is widely used to treat superficial nonmelanoma skin cancer and dysplasia, and is generally well tolerated. However, as with all treatments, adverse effects may occur and awareness may facilitate approaches to prevention and management. Objectives: To review the available evidence relating to the adverse effects of topical PDT, to help inform recommendations in updated clinical guidelines produced by the British Association of Dermatologists and British Photodermatology Group, and the efficacy of preventative and therapeutic approaches. Methods: This review summarizes the published evidence related to the adverse effects of topical PDT and attempts to interpret this evidence in the context of patient risk and management. Results: Pain and discomfort during PDT are acute adverse effects, which can be minimized through the use of modified and low‐irradiance PDT regimens and do not therefore usually limit successful treatment delivery. Other adverse effects include the risk of contact allergy to photosensitizer prodrugs, although this is rare but should be kept in mind, particularly for patients who have received multiple PDT treatments to larger areas. There are no other significant documented longer‐term risks and, to date, no evidence of cumulative toxicity or photocarcinogenic risk. Conclusions: Topical PDT is usually well tolerated, reinforcing the utility of this important therapeutic option in dermatology practice. The main acute adverse effect of pain can typically be minimized through preventative approaches of modified PDT regimens. Other adverse effects are uncommon and generally do not limit treatment delivery. What's already known about this topic? Photodynamic therapy (PDT) is widely used in dermatology.Pain is the most well documented adverse effect.Methods of effective pain relief are limited. What does this study add? This review scrutinizes the literature relating to adverse effects of PDT and management approaches.PDT‐induced pain can usually be effectively prevented and managed through adjustments to PDT regimens, such as using lower irradiance light delivery.Phototoxic reactions are to be expected.Other adverse effects are typically uncommon and not limiting. Linked Editorial:Wulf. Br J Dermatol 2019; 180:695–696. Plain language summary available online [ABSTRACT FROM AUTHOR]

Multicentre randomized controlled studies now demonstrate high efficacy of topical photodynamic therapy (PDT) for actinic keratoses, Bowen’s disease (BD) and superficial basal cell carcinoma (BCC), and efficacy in thin nodular BCC, while confirming the superiority of cosmetic outcome over standard therapies. Long-term follow-up studies are also now available, indicating that PDT has recurrence rates equivalent to other standard therapies in BD and superficial BCC, but with lower sustained efficacy than surgery in nodular BCC. In contrast, current evidence does not support the use of topical PDT for squamous cell carcinoma. PDT can reduce the number of new lesions developing in patients at high risk of skin cancer and may have a role as a preventive therapy. Case reports and small series attest to the potential of PDT in a wide range of inflammatory/infective dermatoses, although recent studies indicate insufficient evidence to support its use in psoriasis. There is an accumulating evidence base for the use of PDT in acne, while detailed study of an optimized protocol is still required. In addition to high-quality treatment site cosmesis, several studies observe improvements in aspects of photoageing. Management of treatment-related pain/discomfort is a challenge in a minority of patients, and the modality is otherwise well tolerated. Long-term studies provide reassurance over the safety of repeated use of PDT. [ABSTRACT FROM AUTHOR]

Photochemotherapy (psoralen/UVA (PUVA)) is an efficient therapeutic tool for a wide range of skin diseases. Concern, however, exists regarding the long-term carcinogenic effects of this treatment modality and, as a consequence, is being used less frequently. PUVA remains an important treatment in our therapeutic armamentarium but must be used with caution in those patients with risk factors and cumulative dose exposure must be limited. PUVA-induced cancers show features in common with skin cancers induced by immunosuppressed organ transplant recipients. Tumours in the latter group of individuals are, however, much more aggressive and difficult to manage. [ABSTRACT FROM AUTHOR]

Replies to comments on the evaluation of the effects of sildenafil dosages and treatment courses on phosphodiesterase type 6 gene expression in rat retina. Reverse transcription-polymerase chain reaction; Northern blot analyses.

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Presents a clinical case of eczematous reaction to hepatitis B vaccine. Presenting signs and symptoms; Variety of cutaneous reactions that have been reported as being associated with hepatitis B vaccination; Frequency of positive patch test reactions to thimerosal in patients with eczema.

We report a 19-year-old woman with psoriasis who developed a severe allergic reaction within 1 week of commencement of sulphasalazine; her skin becoming erythrodermic with associated lymphadenopathy, leucopenia and thrombocytopenia. Clinical signs and haematological abnormalities rapidly returned to normal on discontinuation of sulphasalazine. It is important to monitor carefully haematological indices in the early stages of treatment with this drug. [ABSTRACT FROM AUTHOR]

Two patients with psoriasis, whose skin condition deteriorated in association with disturbed liver function are reported; one case developed thrombocytopenia, following administration of mebhydrolin (Fabahistin, Bayer)—a commonly prescribed oral antihistamine. [ABSTRACT FROM AUTHOR]

Presents a review of literature on impotence. Protein and gene expression of nitric oxide synthase (NOS) isoforms I and III in the rat penile shaft; Use of quantitative reverse transcription-polymerase chain reaction techniques; Greater expression of NOS III than NOS I in the penile shaft.

Examines dermatitis from spinal cord stimulator implant. Pathophysiology of the complication; Conduction of patch test; Drug administration usage.