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Topical photodynamic therapy has become an established therapy option for superficial non-melanoma skin cancers with a substantial evidence base. In this update the increased choice in photosensitizers and light sources are reviewed as well as novel protocols to move beyond lesional treatment and address field therapy. Daylight PDT is emerging as an alternative to conventional office/hospital-based PDT that offers the advantage of much reduced pain. Although most studies have assessed efficacy of PDT in immune-competent patients, there is accumulating evidence for topical PDT being considered an option to assist in reducing the skin cancer burden in organ transplant recipients. The fluorescence associated with photosensitizer application can help delineate lesions prior to full treatment illumination and offers a useful adjunct to treatment in patients where diagnostic uncertainty or poor lesion outline complicates clinical care. PDT may also offer significant benefit in delaying/preventing new cancer development and combined with its recognized photo-rejuvenating effects, is emerging as an effective therapy capable of clearing certain superficial skin cancers, potentially preventing new lesions as well as facilitating photo-rejuvenating effects in treated areas.

Acne vulgaris is a common chronic inflammatory skin disease, typically affecting young adults and adolescents. Acne vulgaris can leave the patient with severe skin scarring and psychological effects. Photodynamic therapy (PDT) is an increasingly used therapeutic modality for various diseases in dermatology. In this study we used PDT to treat acne vulgaris, which developed resistance to conventional treatments. A 25-years old female patient presented with facial acne vulgaris. The patient had received conventional treatments for the last 7 years, with no satisfactory outcome. The patients was treated with methyl aminolaevulinate based PDT in three sessions; the first two sessions were repeated at two weeks interval, while the third session was given at one month interval. After 3 months of treatment, the patient response to the treatment was assessed at 95%. The patient was followed up to 6 months and no recurrence has been observed. MAL-PDT has a rapid response, excellent cosmetic outcomes and significantly effective for improving acne lesions. [ABSTRACT FROM AUTHOR]

• Bowen´s disease (BD) is an intraepidermal squamous cell carcinoma (SCC). • There are several alternatives for treatment of BD, including photodynamic therapy (PDT). • Photosensitizer precursors used in Europe include methyl-5-aminolaevulinate (MAL) and 5-aminolaevulinic acid (BF-200 ALA). • We designed a study with 171 patients to investigate the efficacy and safety of PDT in BD. • PDT is an effective and safe treatment option in BD. Our analysis suggests a higher rate of healing with ALA-PDT over MAL-PDT. An observational study was carried out in the photodynamic therapy (PDT) section of Fuenlabrada's hospital (Madrid, Spain). Our goal was to investigate the efficacy and safety of PDT in Bowen's disease (BD). Between June 2011-June 2017 171 patients (191 lesions) with diagnosis of BD were enrolled in the study (95 women and 76 men; average age of 74.31 years). Lesions were treated with one 5-aminolaevulinic acid (BF-200 ALA)-PDT or methyl-5-aminolaevulinate (MAL)-PDT cycle of two sessions in one week. A second treatment cycle was performed in cases of clinical persistence at 12 weeks. Our results showed that 47/55 lesions were resolved (84.75%) after one or two ALA-PDT cycle and 75/136 lesions (55.15%) after one or two MAL-PDT cycles, in the 12-month follow-up. In conclusion PDT is a safe and non-invasive treatment option in BD. In addition, our results suggest a better response with ALA-PDT over MAL-PDT. Limits: observational study with a limited number of patients. [ABSTRACT FROM AUTHOR]

• Superficial basal cell carcinoma (sBCC) is, after nodular, the second subtype in frequency of basal cell carcinoma. • In the last years PDT is being used as an effective alternative, especially in sBCC unsuitable for surgical treatment. • We design an observational study to investigate the efficacy and security of BF-200 ALAMAL in the treatment of sBCC. • Our results suggest a better response with BF-200 ALA-PDT over MAL-PDT in the treatment of sBCC, at 12 months of follow-up. Background: There is limited literature on efficacy in 5-aminolaevulinic acid (BF-200 ALA) and methyl-5-aminolaevulinate (MAL) for superficial basal cell carcinoma (sBCC). Aims: To investigate the efficacy and safety of PDT in sBCC. Methods: Analytical observational study between January 2014 and January 2017. Follow-up at 12, 24 and 52 weeks. Lesions were treated with one BF-200 ALA-PDT or MAL-PDT cycle of two sessions in one week. A second treatment cycle, with the same photosensitizer precursor, was performed in cases of clinical persistence at 12 weeks. Results: A total of 22 patients (30 lesions) were enrolled in the study. By sex, 13 men and 9 women. Average age of 72,14 years. In the 12-month follow-up 15/16 lesions were resolved (93,75%) after one or two BF-200 ALA-PDT cycle and 7/14 lesions (50%) after one or two MAL-PDT cycles. In most patients, tolerance to the therapy was good or regular, with no differences between the two groups. No long-term adverse effects were reported. Limitations: The observational nature and the low number of patients. Conclusion: PDT is a safe and non-invasive treatment option in sBCC. Our results suggest a better response with BF-200 ALA-PDT over MAL-PDT, at 12 months of follow-up. [ABSTRACT FROM AUTHOR]

Background/Objectives Solar (actinic) keratosis ( AK) is an emergent concern worldwide and is associated with an increased risk of development of non-melanoma skin cancer, especially squamous cell carcinoma. Daylight-mediated photodynamic therapy ( DL-PDT) using methyl aminolaevulinate cream has proved to be an effective, nearly painless, and more convenient alternative to conventional PDT for the treatment of AK. In a phase III, randomised, controlled trial performed in Australia, the mean irradiance (light intensity) received by patients during DL-PDT treatment, assessed via a spectroradiometer, was 305 W/m2 (min. 40 to max. 585 W/m2) with similar efficacy irrespective of intensity or dose. The objective of the present meteorological study was to assess the suitability of natural daylight to perform DL-PDT for the treatment of face and scalp AK during different periods of the year and different geographical locations and latitudes across Australia. Methods To determine daylight irradiance during a complete year in eight different geographical locations throughout Australia, we used meteorological software ( Meteonorm, Meteotest, Bern, Switzerland), and available solar radiation and weather data from 1986-2005. Results The average daily irradiance remained within the levels (40-585 W/m2) measured during the clinical DL-PDT study in Australia, throughout the year and in all geographical locations investigated (yearly average from Darwin 548 W/m2 to Hobart 366 W/m2). Conclusions DL-PDT for the treatment of face and scalp AK in Australia can be performed effectively throughout the entire year as long as weather conditions permit daylight exposure and allow participants to remain under direct light for 2 h. [ABSTRACT FROM AUTHOR]

Summary: Background: Although discovered over a century ago it is only in the last 25 years that photodynamic therapy (PDT) has been the focus of intense research. This versatile treatment modality has been shown to be effective in treating a wide variety of malignancies, and with the increasing incidence of non-melanoma skin cancer (NMSC) is a recognised treatment in dermatology clinics worldwide. There is little known as to whether different body sites influence the uptake and conversion of 5-aminolaevulinic acid (ALA) or methyl aminolaevulinate (MAL) to protoporphyrin IX (PpIX). In this study we investigated the characteristics of PpIX fluorescence within normal skin following the application of both ALA and MAL to four different body sites and the effect of tape stripping. Methods: A total of 17 healthy volunteers were recruited, and both ALA and MAL were applied to the inner forearm, outer forearm, lower leg and back for 4h. PpIX fluorescence was detected using a non-invasive spectroscopy system. Results and conclusions: PpIX fluorescence (following the application of either ALA or MAL) does vary significantly at different body sites with the lower leg producing the least. Following the application of ALA, peak fluorescence was noted at all body sites at 24h, except the lower leg, which peaked at 7h. In contrast MAL induced fluorescence at all body sites, peaked earlier at 7h and had significantly decreased by 24h. Removal of the stratum corneum by tape stripping was also shown to significantly increase PpIX fluorescence but did not alter the time course. [Copyright &y& Elsevier]

Abstract: Background: Photodynamic therapy (PDT) with aminolevulinic acid (ALA) or methyl aminolaevulinate (MAL) has been shown to enhance treatment of photoaged skin. However, there is little information about the molecular changes involved in dermal matrix remodeling following MAL-PDT for photorejuvenation. Objective: We sought to analyze the molecular changes of the epidermal and dermal matrix after MAL-PDT in mouse skin. Methods: Serial biopsy specimens were obtained at baseline and at various times after treatments with MAL-PDT, MAL alone and LED alone. To evaluate the molecular changes in the epidermal and dermal matrix, primary cytokines such as interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α), transforming growth factor-β1 (TGF-β1), matrix metalloproteinases (MMPs), procollagen type I and III were evaluated by reverse transcriptase polymerase chain reaction, Western blot analysis, and immunohistochemistry assays. Results: Elevation of primary cytokines and MMPs occurred at early points in time after one treatment with MAL-PDT based on the levels of mRNA and protein. On the other hand, procollagen type I protein increased later after MAL-PDT treatment. Conclusions: MAL-PDT activates more quantifiable alterations in the molecules associated with epidermal and dermal remodeling compared to treatment with MAL or LED alone. MAL-PDT significantly induced the epidermal and dermal matrix molecules required for photorejuvenation. [Copyright &y& Elsevier]

Background Visible light irradiation after application of a photosensitizer (topical photodynamic therapy; PDT) is increasingly used to treat nonmelanoma skin cancers and premalignant actinic keratoses. PDT can provide a cosmetically superior alternative to surgery, but carries failure rates of 10–40%. While some murine studies have suggested immune enhancement by PDT, others reported immunosuppressive effects, which may indicate impaired antitumour immunity and thus compromised tumour clearance. Objectives This study aimed to determine the in vivo immune effects of PDT in humans. Methods Using healthy, Mantoux-positive volunteers, we irradiated discrete areas of the back with narrowband red light (630 nm; 37 J cm−2), with and without prior application of 5-aminolaevulinic acid (ALA) or methyl aminolaevulinate (MAL). Adjacent, untreated areas served as immunologically intact control sites. Delayed-type hypersensitivity responses to tuberculin purified protein derivative (Mantoux reactions) were then elicited in each of the irradiated, unirradiated and control sites, and the intensity of the reactions was quantitated with an erythema meter and by measurement of Mantoux diameter. By comparing Mantoux intensity at treated and control sites, immunosuppression was determined in each volunteer for each intervention. Results We found that both MAL-PDT and ALA-PDT significantly suppressed Mantoux erythema (by 30% and 50%, respectively) and diameter (41% and 38%). Red light alone significantly suppressed diameter (22%) but not erythema (13%). Conclusions Topical PDT induced significant immune suppression, which could impair local antitumour immune responses and may thus contribute to treatment failure. [ABSTRACT FROM AUTHOR]

Background Photodynamic therapy (PDT) has been described for photoageing treatment, but its mechanism of action is not clarified. Although PDT-induced matrix metalloproteinase (MMP) expression and collagen production have been studied in normal skin and in inflammatory disease, there is no report about the effect of PDT on the extracellular matrix in photodamaged skin. Objectives To evaluate skin remodelling induced by methyl aminolaevulinate (MAL)-PDT in photodamaged skin by histological and immunohistochemical studies. Methods Fourteen patients were treated with two sessions of MAL-PDT. The light source was a light-emitting diode (635 nm, 37 J cm−2). Skin biopsies were performed in all patients before and at 3 and 6 months after treatment. Immunohistochemical studies evaluated collagen types I and III, MMP-1, MMP-3, MMP-7, MMP-9, MMP-12 and tissue inhibitor of metalloproteinases-1. Results Global improvement in photodamaged skin was observed. A significant increase in expression of MMP-9 in the dermis was detected at 3 months after treatment ( P = 0·002). Significant increases in the expression of collagen type I at 3 months ( P = 0·002) and at 6 months after treatment ( P = 0·001) were also observed. Conclusions Skin remodelling induced by MAL-PDT was demonstrated in photodamaged skin. Two sessions of MAL-PDT increases immunohistochemical expression of MMP-9 in the dermis at 3 months after treatment, and also of collagen type I. [ABSTRACT FROM AUTHOR]

Background: Allergic contact dermatitis to methyl aminolaevulinate (Metvix™) after topical application in photodynamic therapy (PDT) has previously been described in case reports. Objective: To compare the frequency of sensitization to Metvix® cream in a group of patients previously treated at least five times with Metvix-PDT with the frequency observed in an unexposed control group. Methods: Twenty patients treated five times or more with Metvix-PDT and 60 controls with no prior exposure to Metvix® were patch tested with Metvix® cream and Metvix® placebo cream. Subsequently, the patients were interviewed to determine the relevance of a positive patch test reaction to Metvix®. Results: Of 20 patients treated with Metvix-PDT, 7 were sensitized to Metvix® cream, giving a sensation risk of 35%. In the control group, 1 of 60 became sensitized after a single exposure to Metvix® cream (1.7%). There was no reaction to the placebo cream. The positive patch tests to Metvix® were considered relevant in four of seven patients (57%). Conclusions: This study demonstrates a considerable risk of sensitization after Metvix-PDT. We suggest that the patients are interviewed to detect late or persistent local reactions after PDT. These reactions are often considered to be local infections but may represent allergic contact dermatitis, and therefore, patients should be offered patch testing with Metvix® cream. [ABSTRACT FROM AUTHOR]

Background Photodynamic therapy (PDT) is an effective but time-consuming and often painful treatment for actinic keratosis (AK). Home-based daylight–PDT has the potential to facilitate treatment procedure and to reduce associated pain due to continuous activation of small amounts of porphyrins. Moreover, a reduced methyl aminolaevulinate (MAL) concentration may reduce associated inflammation, making the treatment more tolerable for the patients. Objectives To compare response rates and adverse effects after PDT using conventional 16% and 8% MAL with home-based daylight exposure in treatment of AK. Methods Thirty patients with mostly thin-grade AK of the face or scalp were treated with 16% and 8% MAL–PDT in two symmetrical areas after application of sunscreen. Immediately after, patients left the hospital with instructions to spend the remaining day outside at home in daylight. Patients scored pain during treatment and light exposure was monitored with an electronic wristwatch dosimeter. Results The complete response rate after 3 months was 76·9% for 16% MAL and 79·5% for 8% MAL ( P = 0·37). Patients spent a mean of 244 min outdoors and received a mean effective light dose of 30 J cm−2. Light doses of 8–70 J cm−2 induced similar response rates ( P = 0·25). Patients experienced mild to moderate pain during daylight exposure (mean maximal pain score of 3·7). No differences in pain scores and erythema were seen between the areas treated with 16% MAL and with 8% MAL. Conclusions Home-based daylight-mediated MAL–PDT was an effective and well-tolerated treatment for AK. No differences in response rates or adverse events were found between the areas treated with 16% MAL and with 8% MAL. [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]

Methyl aminolaevulinate–photodynamic therapy (MAL-PDT) has advanced the management of nonmelanoma skin cancer (NMSC), providing a treatment option for actinic keratosis (AK), basal cell carcinoma [both superficial (sBCC) and nodular (nBCC)] and Bowen's disease, with good clinical outcomes, low recurrence rates and enhanced cosmetic acceptability. Excellent results have been reported, with complete responses (CRs) in AK ranging from 69% to 93% at 3 months; CRs in Bowen's disease are 93% at 3 months and 68% at 24 months. In sBCC, CRs range from 85% to 93% at 3 months and are comparable with cryosurgery up to 60 months (75% vs. 74%). In nBCC, CRs range from 75–82% at 3 months to 77% at 60 months. MAL-PDT specifically targets diseased cells, leaving healthy tissue unharmed. This noninvasive treatment option is associated with minimal risk of scarring. Moreover, systemic uptake of MAL is negligible and the local phototoxic reactions that often occur during treatment rapidly heal to produce excellent cosmetic results. The side-effects of therapy, which are predominantly local phototoxic effects (burning, stinging and prickling sensations), are of mild-to-moderate intensity, of short duration and easily managed. Overall, the efficacy and low risk of side-effects afforded by this therapy have resulted in high patient preference in clinical trials. The current evidence base for MAL-PDT in the treatment of AK and NMSC is reviewed in this article. [ABSTRACT FROM AUTHOR]

Photodynamic therapy (PDT) is a two-step therapeutic technique in which the topical or systemic delivery of photosensitizing drugs is followed by irradiation with visible light. Activated photosensitizers transfer energy to molecular oxygen, generating reactive oxygen species (ROS). The subsequent oxidation of lipids, amino acids and proteins induces cell necrosis and apoptosis. In addition, ROS indirectly stimulate the transcription and release of inflammatory mediators. The photosensitizers are selective, in that they penetrate and accumulate in tumour cells or in the endothelium of newly formed vessels while generally avoiding the surrounding healthy tissue. The mechanisms of penetration through the cell membrane and the pattern of subcellular localization strongly influence the type of cellular effect. The photobiology and photoimmunology of the haematoporphyrin (Hp) derivative and its purified, lyophilized and concentrated form porfimer sodium have been investigated over the past 30 years. However, interest in PDT in dermatology was not raised until the 1990s with the availability of a simple and effective technique, the topical application of aminolaevulinic acid (ALA) and its methyl ester (methyl aminolaevulinate, MAL) followed by irradiation with broadband red light. At the same time, several new ‘second-generation’ synthetic sensitizers (e.g. benzoporphyrin derivatives, phthalocyanines, chlorins and porphycenes) became available. These compounds are chemically pure, highly efficient, selective and safe, while offering the advantage that the generalized skin photosensitivity they produce lasts for only a short time. They are currently under clinical evaluation but have not yet been approved for clinical use. This paper provides an overview of the chemistry of the photosensitizers, the photobiology and photoimmunology of the photodynamic reaction as well as the photophysical characteristics of the light sources available for PDT. [ABSTRACT FROM AUTHOR]

Background Photodynamic therapy using topical methyl aminolaevulinate (MAL) is a new treatment modality for skin disorders. MAL is metabolized into endogenous porphyrins, which act as photosensitizers when illuminated. Objectives To evaluate the severity and duration of skin photosensitivity after MAL application, and to investigate its relation to the presence of endogenous porphyrins. Methods Placebo and 160 mg g−1 MAL creams were randomly assigned to contralateral sites located at the forearms and fingertips of 16 healthy volunteers and were applied for 3 h. The porphyrin content in the skin was monitored by in situ fluorescence measurements following cream removal. Phototoxic reaction was evaluated after exposure to a high dose of red light. Results The porphyrin fluorescence in forearm skin peaked about 1 h after the cream removal, was halved after 8 h, and was reduced by > 90% within 24 h. Most forearm sites were photosensitive at 1 and 8 h following cream removal. Six subjects were still sensitive at 24 h, and at this time point the phototoxicity was coincidental with residual porphyrin fluorescence. In general, all reactions were mild or moderate, and included pain, erythema, oedema and transient hyperpigmentation. No photosensitivity or porphyrin fluorescence was detected at 48 h. At the fingertips photosensitivity was absent except for sporadic cases of mild pain. Conclusions Topical MAL application and exposure to red light induced mild and moderate phototoxicity. The photosensitivity ceased within 24–48 h after cream removal, and its duration was associated with the degradation of porphyrins. [ABSTRACT FROM AUTHOR]

Background Actinic keratosis (AK), the most common premalignant skin condition, can represent a management challenge. Treatment should not only be effective, but also well tolerated and allow for good cosmesis on typical sun-exposed highly visible body sites. Objectives The primary objective was to compare the lesion response and subject preference for topical methyl aminolaevulinate (MAL)-photodynamic therapy (PDT) vs. cryotherapy for the treatment of AK. Methods In this 24-week, multicentre, randomized, intraindividual (right–left) study, subjects received both one treatment session of MAL-PDT and a double freeze–thaw cryotherapy; the treatments were randomly allocated to either side of the face/scalp. Lesions with a noncomplete response were retreated after 12 weeks. The primary assessments were the subject's overall preference and lesion response at week 24. Secondary assessments included lesion response at week 12, cosmetic outcome, subject and investigator cosmetic outcome preference at week 24, and investigator overall preference at week 24. Skin discomfort and adverse events were also evaluated. Results In total, 119 subjects with 1501 lesions were included in the study. At week 12, treatment with MAL-PDT resulted in a significantly larger rate of cured lesions relative to cryotherapy (percentage lesion reduction from baseline: 86·9% vs. 76·2%; P < 0·001). At week 24, both treatment groups showed a high rate of cured lesions (89·1% for MAL-PDT vs. 86·1% for cryotherapy; P = 0·20; 95% confidence interval: −1·62 to 7·67). Results for subject and investigator preferences as well as cosmetic outcome favoured MAL-PDT. Both treatment regimens were safe and well tolerated. Conclusions The present study shows that, when treated with both MAL-PDT and cryotherapy, subjects significantly prefer MAL-PDT treatment for AK. MAL-PDT is an attractive treatment option for AK, with comparable efficacy and superior cosmetic outcomes compared with double freeze–thaw cryotherapy. [ABSTRACT FROM AUTHOR]

Background There is a need for alternative treatments for moderate to severe acne vulgaris. Preliminary experience suggests that topical methyl aminolaevulinate photodynamic therapy (MAL-PDT) may have potential. Objectives To investigate the efficacy and tolerability of MAL-PDT for treatment of moderate inflammatory facial acne. Patients/methods Thirty patients aged 15-28 years with moderate to severe acne were included in a blinded, prospective, randomized, placebo-controlled multicentre study. Each side of each patient's face was randomly assigned to treatment with MAL (160 mg g-1) or placebo cream, applied for 3 h prior to illumination. A second treatment was given 2 weeks later. On each occasion, patients assessed the intensity of pain using a 10-cm visual analogue scale. Inflammatory and noninflammatory acne lesions were counted at baseline and 4 and 10 weeks after the last PDT treatment. The investigator assessed the global severity of acne at baseline (seven patients had severe acne on at least one side of the face) and each study visit using a six-point rating scale. Data were analysed on an intention-to-treat basis, including all 30 patients. Results There was a statistically significant greater reduction in the total inflammatory lesion count with MAL-PDT compared with placebo PDT at week 12; median reduction 54% [95% confidence interval (CI) 35-64%] vs. 20% (95% CI 8-50%), P = 0.0006. MAL-PDT was associated with more pain than placebo PDT, although intensity varied across centres and was reduced with repeated treatment. Local adverse events were consistent with this treatment modality. Conclusions MAL-PDT is effective in the treatment of moderate to severe inflammatory facial acne. Further studies are warranted to optimize this promising procedure. [ABSTRACT FROM AUTHOR]

Background Inflammatory acne vulgaris is a very common condition, particularly in adolescents and young adults, and new effective and well-tolerated treatments are needed. Objectives To evaluate the efficacy and tolerability of methyl aminolaevulinate-based photodynamic therapy (MAL-PDT) in patients with moderate to severe facial acne vulgaris in a randomized, controlled and investigator-blinded trial. Methods Twenty-one patients were assigned to the treatment group and 15 patients to the control group. The treatment group received two MAL-PDT treatments, 2 weeks apart. Both groups were evaluated 4, 8 and 12 weeks after treatment. Efficacy evaluation included changes from baseline in numbers of noninflammatory and inflammatory lesions, changes from baseline in global acne severity grade and clinical assessments of clinical improvement by patient and evaluating dermatologist. Pain scores during treatment and local adverse effects were also evaluated. Results Twelve weeks after treatment the treatment group showed a 68% reduction from baseline in inflammatory lesions vs. no change in the control group ( P = 0·0023). We found no reduction in number of noninflammatory lesions after treatment. All patients experienced moderate to severe pain during treatment and developed severe erythema, pustular eruptions and epithelial exfoliation. Seven patients did not receive the second treatment due to adverse effects. Conclusions MAL-PDT proved to be an efficient treatment for inflammatory acne. The treatment was associated with severe pain during treatment and severe adverse effects after treatments. Efforts must be made to optimize the treatment regimen and to avoid adverse effects. [ABSTRACT FROM AUTHOR]

Background: Rosacea is a common disease, with an estimated prevalence of 5–10%. Established systemic and topical treatment is often effective but requires continuous medication. Aim: We report the outcome of photodynamic therapy (PDT) in 4 patients with rosacea. Methods: Prior treatment consisted of standard treatment with tetracycline and metronidazole. The treatment was however either ineffective or the patients were dissatisfied with the need for continuous treatment. The patients all received standard treatment with PDT. Results: The treated skin cleared in 3 of the 4 patients. Treatment with light alone did not appear to have any effect. In one of the patients there has been no relapse during a 9-month follow-up. In 2 patients, remissions lasted 3 months, during which time no additional or supplementary treatment was used. Conclusion: Our observation suggests that PDT may play a role in the future treatment of selected cases of rosacea. Copyright © 2005 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Basal cell carcinoma (BCC) may be difficult to treat by conventional means, particularly if the lesions are large or located in the mid-face (H-zone). Photodynamic therapy (PDT) using topical methyl aminolaevulinate (MAL) may be a good noninvasive option for these patients.To investigate the efficacy and safety of PDT using MAL for BCCs defined as‘difficult to treat’, i.e. large lesions, in the H-zone, or in patients at high risk of surgical complications.This was a prospective, multicentre, noncomparative study. Patients were assessed 3, 12 and 24 months after the last PDT treatment. One hundred and two patients with‘difficult-to-treat’ BCC were treated with MAL PDT, using 160 mg g−1 cream and 75 J cm−2 red light (570–670 nm), after lesion preparation and 3 h of cream exposure.Ninety-five patients with 148 lesions were included in the per protocol analysis. The histologically confirmed lesion complete response rate at 3 months was 89% (131 of 148). At 12 months, 10 lesions had reappeared, and therefore the cumulative treatment failure rate was 18% (27 of 148). At 24 months, an additional nine lesions had reappeared, resulting in a cumulative treatment failure rate of 24% (36 of 148). The estimated sustained lesion complete response rate (assessed using a time-to-event approach) was 90% at 3 months, 84% at 12 months and 78% at 24 months. Overall cosmetic outcome was judged as excellent or good in 79% and 84% of the patients at 12 and 24 months, respectively. Follow-up is continuing for up to 5 years.MAL PDT is an attractive option for‘difficult-to-treat’ BCC. Because of the excellent cosmetic results, the treatment is particularly well suited for lesions that would otherwise require extensive surgical procedures. [ABSTRACT FROM AUTHOR]

Transplant recipients have an increased propensity to develop multiple actinic keratoses, which demonstrate an increased transformation rate into invasive squamous cell carcinoma. To evaluate the efficacy and tolerability of topical photodynamic therapy with the new highly tumour-selective photosensitizer methyl aminolaevulinate vs. placebo in the treatment of actinic keratoses in transplant recipients. Seventeen transplant recipients with a total number of 129 mild to moderate actinic keratoses were enrolled in a prospective, randomized, double-blind, placebo-controlled study. Two lesional areas within a patient were randomized for two consecutive treatments of topical photodynamic therapy 1 week apart using either methyl aminolaevulinate or placebo cream. Sites were illuminated with 75 J cm−2 of visible light delivered at 80 mW cm−2 by a noncoherent light source. Complete resolution and reduction in the number or size of actinic keratoses within the lesional area relative to the initial findings were evaluated at weeks 4, 8 and 16 after treatment. The lesional areas treated with methyl aminolaevulinate were clinically cleared in 13 of 17 patients at 16 weeks. A partial response was recorded in a further three. No reduction in the size or number of actinic keratoses was observed in one area treated with methyl aminolaevulinate and in all placebo-treated areas. Adverse events, such as erythema, oedema and crust formation, were mild to moderate, and treatment was well tolerated by all patients. Photodynamic therapy using methyl aminolaevulinate is a safe and effective treatment for actinic keratoses in transplant recipients. It may also reduce the risk of transformation of actinic keratoses to invasive, potentially fatal, squamous cell carcinoma. [ABSTRACT FROM AUTHOR]