Photodynamic therapy for cutaneous verrucous carcinoma

Cutaneous verrucous carcinoma is a low-grade and well-differentiated variant of squamous cell carcinoma. This rare neoplasm follows a seemingly indolent progression and exhibits a low metastatic potential. Photodynamic therapy relies on the selective intratumoral cell accumulation and photoactivation of a photosensitizer, leading to the generation of phototoxic compounds responsible for necrosis and apoptosis of the target cells. An 82-year-old man presenting with a large long-standing verrucous carcinoma on the leg was treated successfully by 6 photodynamic therapy sessions administered at weekly intervals using methyl-aminolevulinate and 57-J/cm(2) irradiations at 634-nm wavelength. The use of methyl-aminolevulinate-photodynamic therapy for treating cutaneous verrucous carcinoma had not been reported so far. It may represent a convenient therapeutic alternative in this setting.     

Photodynamic therapy as an alternative treatment for cutaneous sarcoidosis

Sarcoidosis is a systemic granulomatous disease. In more than 90% of the cases, sarcoidosis affects the lung with bilateral hilar adenopathy, while skin involvement occurs in about 25% of the cases. Whereas sarcoidosis of the lung is often successfully treated with oral corticosteroids, therapy of cutaneous sarcoidosis is frequently frustrating because some of the lesions may be refractory to treatment or recur quickly after resolution. We report two cases of cutaneous sarcoidosis successfully treated with photodynamic therapy, which represents an effective alternative therapy with fewer side effects.     

Photodynamic therapy with methylaminolevulinate as a valuable treatment option for unilesional cutaneous T-cell lymphoma

BACKGROUND: Mycosis fungoides (MF) is the most common primary cutaneous T-cell lymphoma (CTCL). Unilesional MF is characterized by a limited involvement of the skin and a chronical, though indolent course. If lesions are refractory to topical steroids, therapies such as localized chemotherapy, photochemotherapy and radiotherapy are available. However, they have several acute and chronic side-effects and toxicity may accumulate if repeated and protracted treatment cycles are delivered to refractory or relapsing lesions. The present study aims to assess the efficacy of photodynamic therapy (PDT) with topical methylaminolevulinate (MAL) in the treatment of unilesional MF. METHODS: Five patients were enrolled who had unilesional MF that did not respond to treatment with topical steroids, localized psoralen and UVA therapy or UVA1 phototherapies. A 20% MAL (Metvix cream) cream was applied under occlusive dressing for 3 h. Soon afterwards, skin was irradiated with 37.5 J/cm(2) of red light (635+/-18 nm) delivered by an Aktilite CL128 lamp (PhotoCure ASA) with an irradiance of 86 W/cm(2) at skin level. PDT was repeated once weekly until complete clearing of the lesions was obtained, or, in the case of partial clearing, the therapy was interupted when three successive treatments provided no further improvement. All patients underwent a skin biopsy before and after PDT. RESULTS: A complete remission was observed in four patients and a partial improvement in one. The median number of treatments was six (range 1-9). In no cases was recurrence seen at follow-up (ranging from 12 to 34 months). Treatments were well tolerated and local anesthesia was never requested. CONCLUSION: In conclusion, here, PDT was seen to be an effective and well-tolerated treatment option for unilesional MF.     

婴幼儿皮肤血管瘤和脉管畸形的诊断和治疗

皮肤血管瘤和脉管畸形是婴幼儿的常见疾病。但长期以来分类标准不统一，导致干预措施各异，无从评价干预效果。国际血管性疾病研究协会最新的分类方法将脉管病变分为有内皮细胞异常增生的血管瘤和只有管腔扩张的脉管畸形。同时又将血管瘤根据其起病时间和组织病理的不同表现进行进一步分类。根据这种分类方法介绍最常见的婴幼儿皮肤血管瘤和脉管畸形的临床表现、组织学表现及相应的干预措施。     

光动力疗法治疗18例皮肤肿瘤

目的 观察光动力疗法在不宜行手术治疗的皮肤肿瘤中的疗效.方法 8例光线性角化病、6例鳞状细胞癌、3例Bowen病和1例基底细胞癌患者行氨基酮戊酸光动力治疗.氨基酮戊酸配成20％溶液涂于皮损,4～6h后行635 nm红光照射,能量密度为80～ 100 J/cm2,时间20 min,每周照射1次,共3 ～6次,疗程结束后观察疗效.结果 8例光线性角化病,4例鳞状细胞癌,3例Bowen病得到完全缓解,2例鳞状细胞癌,1例基底细胞癌得到部分缓解.18例患者在治疗结束后1、2、3、6个月随访时皮损均无复发.结论 氨基酮戊酸光动力疗法对于不宜行手术治疗的皮肤肿瘤是一种无创、无明显瘢痕形成的治疗方法.     

Photodynamic therapy for solid tumors: A review of the literature

Photodynamic therapy (PDT) utilizes a sensitizer agent and light to produce selective cell death. Dermatologists are familiar with PDT for the treatment of actinic keratoses and early nonmelanoma skin cancers, and recent studies have elucidated that PDT has resulted in improved morbidity and secondary outcomes for the treatment of various cancerous and precancerous solid tumors. Light source and dosimetry may be modified to selectively target tissue, and novel techniques such as fractionation, metronomic pulsation, continuous light delivery, and chemophototherapy are under investigation for further optimization of therapy. This article aims to review the expanding indications for PDT and demonstrate the potential of this modality to decrease morbidity and increase quality of life for patients. To illustrate these new indications, we provide a focused review of the latest literature on PDT for dermatologic and other solid tumors including gastrointestinal, peritoneal, lung, genitourinary, brain, breast, and head and neck. Data on efficacy, survival, and side effects vary across tumor types but support PDT for the treatment of numerous solid tumors. With new advances in PDT, indications for this therapeutic modality may expand.     

无绿藻感染小鼠皮肤模型的构建

目的 构建无绿藻感染小鼠皮肤模型。方法 BALB/c小鼠分为4组,高浓度接种免疫抑制组为免疫抑制小鼠,腹部皮下接种1 × 109孢子/ml中型无绿藻波多黎各变种悬液组;低浓度接种免疫抑制组为免疫抑制小鼠,腹部皮下接种1 × 106孢子/ml悬液组;高浓度接种健康组为健康小鼠,腹部皮下接种1 × 109孢子/ml悬液组;对照组为健康小鼠腹部皮下接种生理盐水溶液,每个部位接种量均为200 μl。接种后第7、14、28天时观察各组小鼠腹部皮损变化,并进行腹部皮肤病理及真菌检查。结果 实验组小鼠接种处均出现丘疹、脓肿,部分出现溃疡、结痂,感染率均为100％。3组小鼠的腹部皮损直径,组内各时间点比较差异均有统计学意义（均P < 0.05）,均在第7天时最大,分别为（6.75 ± 1.09） mm、（5.88 ± 1.17） mm和（5.96 ± 0.99） mm;组间相比,在接种后第7、14天时差异无统计学意义（P > 0.05）,在第28天时差异有统计学意义（F = 8.91,P < 0.05）,高浓度接种免疫抑制组最大为（4.38 ± 0.86） mm。3个实验组基本病理改变为坏死、脓肿、肉芽肿形成,HE染色和过碘酸雪夫（PAS）染色均可见孢子,皮损直接镜检可见孢子,培养为无绿藻生长。对照组未感染无绿藻。结论 腹部皮下接种免疫抑制和健康小鼠均可构建无绿藻病皮肤感染模型。     

Port-wine-stain-associated dermatitis: implications for cutaneous vascular laser therapy

Abstract:  Port-wine stains are congenital vascular malformations affecting 0.3% to 0.5% of infants. Dermatitis occurring exclusively or most severely within port-wine stains has been described in the literature. Traditionally, topical corticosteroid therapy has been used for the treatment of dermatitis, while pulseddye laser treatment is considered a safe and effective means of lightening the appearance of congenital port-wine stains. To describe the development of port-wine stain-associated dermatitis as well as a rational treatment approach to these patients, we studied three children with facial, limb, or truncal port-wine stains who developed dermatitis within the congenital vascular malformation either prior to or during treatment with pulseddye laser. Laser therapy of dermatitis-affected areas was subsequently deferred pending resolution of the dermatitis with topical corticosteroid or topical calcineurin inhibitor treatment. While pulseddye laser therapy is an effective means of lightening port-wine stains and achieving lasting resolution of any associated dermatitis, this therapy to dermatitis-affected areas should be postponed until the inflammation resolves to minimize the risk of laser-associated adverse effects.     

Photodynamic therapy of murine skin tumors using Photofrin-II.

Photodynamic therapy (PDT) is a new experimental cancer therapy in which a photosensitizing chemical that selectively localizes within tumors is given to a tumor-bearing individual and the tumor is then irradiated by wavelengths within the visible spectrum of the photosensitizer. The only photosensitizer currently approved for human clinical trials is Photofrin-II (Pf-II). In most preclinical studies, the effectiveness of Pf-II has been assessed in implanted tumor models rather than in systems in which tumors are grown in their own connective tissue matrix. In this study, the pharmacokinetics, tumor ablation capability and cutaneous photosensitizing capacity of Pf-II were assessed in mice bearing chemically induced or ultraviolet B radiation (UVB)-induced benign skin neoplasms. Intraperitoneal administration of Pf-II (5 mg/kg body weight) to tumor-bearing animals showed maximum tumor: normal skin ratio of the photosensitizer at 72 h. When SENCAR mice bearing chemically induced tumors were irradiated with visible light corresponding to the absorption spectrum of the photosensitizer, up to 89% ablation in tumor volume at 20 d post-irradiation was observed. Animals treated with Pf-II and exposed to visible light showed significant cutaneous photosensitization for at least 6 d after-irradiation. Treatment of SKH-1 hairless mice bearing UVB-induced cutaneous neoplasms with Pf-II exhibited similar pharmacokinetics, skin tumor ablation effects and cutaneous photosensitivity. Our data indicate that Pf-II has significant activity towards the ablation of murine skin benign tumors grown in their own tissue matrix, suggesting that such a murine skin tumor model system could be valuable in evaluating the photodynamic effects of newly developed photosensitizers.     

Photodynamic therapy may be useful in debulking cutaneous lymphoma prior to radiotherapy

Photodynamic therapy (PDT) with topical 5-aminolaevulinic acid (5-ALA) is a promising new treatment for superficial malignant nonmelanoma tumours, including cutaneous malignant lymphoma. Here, we report a case of cutaneous anaplastic large cell lymphoma effectively treated by PDT with topical 5-ALA in combination with radiotherapy.     

Photodynamic therapy efficiently controls dermatophytosis caused by Trichophyton rubrum in a murine model

Hydroa vacciniforme (HV) is a rare photodermatosis that mainly affects children and manifests as vesiculopapular eruptions in sun‐exposed areas without systemic symptoms. HV‐like lymphoma (HVLL) is one of the Epstein–Barr virus (EBV)‐associated lymphoproliferative disorders (LPD) of childhood. Its diagnosis is based on monoclonal T‐cell proliferation; however, its degree of malignancy is controversial owing to its variable prognosis. Elderly‐onset cases of these diseases are extremely rare, and the clinical features remain unknown. It has been shown that late onset is closely associated with a severe phenotype in EBV‐associated LPD including atypical HV. Here we describe a case of elderly‐onset atypical HV accompanied by T‐cell monoclonality, but with a very indolent clinical course. Our patient indicates a possible case with elderly‐onset atypical HV manifesting a favourable course, and that T‐cell monoclonality and age of onset cannot always predict the disease severity, and highlights the difficulty of prognosis prediction in elderly‐onset atypical HV.     

Photodynamic therapy does not prevent cutaneous squamous-cell carcinoma in organ-transplant recipients: results of a randomized-controlled trial

A randomized-controlled trial with paired observations was performed with 40 organ-transplant recipients to assess the preventive effect of photodynamic therapy (PDT) on the development of new squamous-cell carcinomas and to evaluate the effect of PDT on the number of keratotic skin lesions. The treatment area consisted of a randomly assigned forearm and the corresponding hand, whereas the other forearm and hand served as the control area. After the initial visit, follow-up visits were scheduled at 3-monthly intervals during 2 years. No statistically significant difference was found in the occurrence of new squamous-cell carcinomas between the treated and untreated arms: after 2 years of follow-up, we observed 15 squamous-cell carcinomas in nine out of 40 PDT-treated arms and 10 squamous-cell carcinomas in nine out of 40 control arms. The number of keratotic skin lesions increased in both arms, but was less pronounced in the PDT-treated arm. After 1 year of follow-up, a trend in favor of the PDT-treated arm was observed, but statistical significance was not reached. Nearly 80% of the patients reported mild to severe adverse effects consisting of pain and a burning sensation, immediately after the treatment. No long-term adverse events were noted. In conclusion, PDT does not appear to prevent the occurrence of new squamous-cell carcinomas in organ-transplant recipients, but to some degree, reduces the increase of keratotic skin lesions.     

Photodynamic therapy for psoriasis?

Photodynamic therapy (PDT), the activation of a photosensitive compound by high intensity red light, is useful for Bowens' disease, thin basal carcinomata and as an adjunctive therapy for various internal malignancies. Its use in the treatment of psoriasis has been attempted only quite recently and some modest success achieved. These clinical experiences are reviewed and the rationale for using PDT for psoriasis is discussed.