5-Aminolevulinic acid photoactivated over planktonic and biofilm forms of Enterococcus faecalis as a pharmacological therapy alternative

The purpose of the study was to evaluate the antibacterial effect of protoporphyrin IX (PpIX) generated by the exogenous administration of 5-aminolevulinic acid or δ-ALA and activated with an argon laser over a planktonic and biofilm of Enterococcus faecalis (E. faecalis) as a pharmacological therapy alternative. A planktonic strain of E. faecalis was cultured with a solution of ∂-ALA (40 µg/mL)-thioglycolate solution for 13 min, and a biofilm of E. faecalis was cultured in a δ-ALA (80 µg/mL)-thioglycolate solution for 13 min. Then, both were irradiated with an argon laser. Finally, the antibacterial effect was evaluated by counting the CFU in planktonic form, and a LIVE/DEAD viability cell test. The production and accumulation of PpIX from exogenously administered δ-ALA on E. faecalis in planktonic and biofilm forms was confirmed by spectrofluorometry. The irradiation of PpIX with an argon laser produced an antibacterial effect on E. faecalis in planktonic and biofilm form, even without biofilm disruption, at a concentration of 40 µg/mL and 80 µg/mL of δ-ALA, respectively. The exogenous administration of δ-ALA in combination with laser irradiation on planktonic and biofilm forms of E. faecalis produces an effective antibacterial effect as complement or alternative to pharmacological therapies

A new optical intra-tissue fiber irradiation ALA-PDT in the treatment of acne vulgaris in rabbit model: improved safety and tolerability

Abstract Background: Photodynamic therapy with topical aminolevulinic acid (ALA-PDT) has been suggested to be effective in treatment of acne vulgaris. However, adverse events occur during and after treatment. Objectives: To compare the efficacy and tolerability of optical intra-tissue fiber irradiation (OFI) ALA-PDT versus traditional ALA-PDT in treatment of acne vulgaris in rabbit models. Methods: Twenty-five rabbits of clean grade were used. Twenty rabbits were randomly selected to establish acne model and the other five were used as control. Rabbits in model group (40 ears) were further divided into four groups (10 ears/group): I, OFI-ALA-PDT with the head of optical fiber inserted into the target lesion (intra-tissue); II, traditional ALA-PDT group; III, OFI group; IV, blank control group without any treatment. Uncomfortable symptoms, adverse events, and effectiveness rates were recorded on post-treatment day 14, 30, and 45. Results: On post-treatment day 14, the effectiveness rate in OFI-ALA-PDT group was obviously higher than that of the other three groups (P<0.05). However, no improved effects were observed in OFI-ALA-PDT group on day 30 and 45. During the period of treatment, the frequencies of uncomfortable symptoms in ALA-PDT group were obviously higher than those in the other three groups (P<0.05). The adverse event rate in OFI-ALA-PDT group was obviously lower than that of the ALA-PDT group (P<0.05) Study limitations: The unblindness of the study and temporary animal models of acne induced may hamper the assessment and monitoring of the results, and future studies are still needed to clarify it further. Conclusion: The OFI-ALA-PDT group (intra-tissue irradiation) showed no improved efficacy on treating rabbit ear acne but had higher safety and better tolerability.

Photodynamic therapy in actinic cheilitis: clinical and anatomopathological evaluation of 19 patients / Tratamento de queilite actínica com terapia fotodinâmica: avaliação clínica e anatomopatológica de 19 pacientes

BACKGROUND: Actinic cheilitis, a common disease caused by chronic solar exposure and tobacco use, is considered a premalignant lesion with potential to develop into squamous cell carcinoma. Some of the available treatments are invasive, have unaesthetic results and require multiple sessions. OBJECTIVE: To assess the efficacy of a therapy and its cosmetic results. METHODS: In this uncontrolled clinical trial a single photodynamic therapy (PDT) session using 16% methyl-aminolevulinate was performed on actinic cheilitis of the lower lip. A standardized questionnaire was applied in order to assess the clinical improvement from the patients' point of view and the satisfaction with the treatment. Anatomopathological evaluation was performed before the treatment and two months afterwards. RESULTS: The sample was composed of 19 patients (10 males and 9 females), phototypes I to III, with average age of 62 years. Main adverse effects were: sudden pain, scabs, herpes flare-up, and edema. The average score of pain during the procedure was 5,8+2,9. At the final assessment the patients reported improvement of 80% and satisfaction of 85% (p<0.01). Anatomopathological analysis showed a significant decrease of dysplasia (p=0.03) in spite of its presence in 84% of cases. There was no significant correlation between the level of dysplasia with either the subjective impression of clinical improvement (p=0.82) or with the patients' final satisfaction (p=0.96). CONCLUSION: PDT is effective in the treatment of actinic cheilitis, but it is associated with a significant level of pain. Due to the persistence of dysplasia, more research needs to be done in order to define the ideal number of sessions for the effective treatment of these lesions.

FUNDAMENTOS: Queilite actínica, afecção causada por exposição solar crônica e tabagismo, é considerada lesão pré-maligna com possibilidade de transformação para carcinoma espinocelular. Alguns tratamentos descritos são invasivos, têm resultados inestéticos e requerem múltiplas aplicações. OBJETIVO: Verificar o uso de tratamento efetivo com resultado esteticamente aceitável. MÉTODOS: Ensaio clínico não controlado, utilizando terapia fotodinâmica com cloridrato de aminolevulinato de metila creme 16%, única aplicação, na queilite actínica de lábio inferior. Aplicação de questionário padronizado para avaliar melhora clínica da lesão subjetiva do paciente e satisfação com tratamento. Avaliação anatomopatológica antes da aplicação e dois meses após. RESULTADOS: Amostra compreendeu 19 pacientes (10 homens e 9 mulheres), fototipos I a IH, idade média 62 anos. Principais efeitos adversos: dor imediata, crostas, herpes labial e edema. Escore médio de dor referida durante o procedimento foi 5,8±2,9. Na avaliação final, os pacientes referiram melhora de 80% das lesões e apresentaram mediana de 85% de satisfação (p<0,01). Análise anatomopatológica mostrou diminuição significativa de displasia (p=0,03), apesar da persistência em 84% dos casos. Não houve correlação significativa da redução no grau de displasia com impressão subjetiva de melhora clínica (p=0,82) ou com satisfação final do paciente (p=0,96). CONCLUSÃO: TFD é efetiva no tratamento da queilite actínica, porém associada a grau significativo de dor. Devido à persistência de displasia, mais estudos são necessários para definir o número ideal de aplicações para tratamento efetivo destas lesões.

Efecto de la terapia fotodinámica con metil-aminolevulinato (MAL) comparada con luz roja en el tratamiento de acné inflamatorio leve a moderado / Effectiveness of photodynamic therapy with methyl aminolevulinate (MAL) compared with red light alone in the treatment of acne

Introducción: El acné es una dermatosis inflamatoria frecuente. Habitualmente requiere tratamientos sistémicos no exentos de riesgos. La terapia fotodinámica (TFD) ha demostrado efectividad en el tratamiento del acné. Material y método: estudio prospectivo, aleatorizado, y controlado, comparando la TFD con metil-aminolevulinato (MAL) al 16 por ciento con la aplicación de luz roja sola en el tratamiento del acné inflamatorio leve a moderado. Se aleatorizaron los pacientes a dos grupos; en el primer grupo se realizó TFD con luz roja, previa aplicación de crema de metil-aminolevulinato 16 por ciento (MAL), a las semanas 0 y 2. Resultados: se incluyeron 36 pacientes con acné inflamatorio leve y moderado localizado en región facial. Se determinaron los cambios de grados de acné existiendo diferencias significativas en los cambios de grado a las semanas 2, 4 y 10 (p<0.001), siendo mayor la mejoría clínica del acné en el grupo TFD-MAL comparado con el grupo luz roja sola, pero observable en ambos grupos. Discusión: la fototerapia con luz roja, con o sin fotosensibilizante, representa una opción de tratamiento no invasivo, seguro y eficaz para el acné vulgar. Al combinar la fototerapia con sustancias tópicas, por ejemplo MAL, resulta de una acción sinérgica aditiva.

Introduction: Acne is a frequent inflammatory dermatoses. It usually requires systemic treatments that are not free of adverse events. Photodynamic therapy (PDT) had been shown to be effective in acne. Methods: a prospective, randomized controlled trial was done to evaluate the effectiveness of PDT with methyl aminolevulinate (MAL) compared with red light alone. Patients were randomized in two groups. In the first group PDT-MAL was applied at week 0and 2; and in the second groupred light alone was applied. Results: 36 patients were incluided with facial acne. Effectiveness was evaluated at weeks 2, 4 and 10 for both groups. A statistically significant difference (p<0.001) was found favoring PDT-MAL group. Both groups showed and improvement in cane severity. Discussion: PDT-MAL and red light therapy are an effective and safe treatment option for acne. Combining PDT with MAL is more effective than red light alone.

Terapia fotodinámica con metil aminolevulinato y ácido 5-aminolevulínico en acné inflamatorio leve y moderado: experiencia clínica / Photodynamic therapy with 5-aminolevulinic acid and methyl aminolevulinate for mild to moderate inflammatory acne: clinical experience

Introducción: La terapia fotodinámica (TFD) con ácido 5-aminolevulínico (ALA) y metil aminolevulinato (MAL) ha mostrado utilidad en el manejo del acné inflamatorio. Métodos: Dos grupos de cuatro pacientes cada uno, portadores de acné inflamatorio leve o moderado. Se realizaron dos sesiones de TFD separadas por dos semanas: un grupo fue tratado con MAL y luz roja y el otro, con ALA y luz azul. Se midió la severidad del acné con escala de 6 puntos y se consideró éxito clínico los grados 0 y 1. Resultados: En ambos grupos se observó éxito clínico a las 12 semanas post tratamiento, quedando con pigmentación residual, escasos comedones y menos de 10 pápulas. Se observaron efectos adversos tolerables, siendo los más importantes el eritema y la descamación. Conclusión: La TFD con ALA y MAL es una buena alternativa terapéutica para aquellos pacientes con acné inflamatorio leve y moderado que no responden o tienen contraindicación a los tratamientos convencionales.

Introduction: Photodynamic therapy with methyl aminolevulinate (MAL) and 5-aminolevulinic acid (ALA) has shown to be useful in the management of inflammatory acne. Methods: Two groups of 4 patients each with mild to moderate inflammatory acne. Two PDT sessions were performed within a 2 week interval; one group was treated with MAL and red light, and the other with ALA and blue light. Acne severity was measured with a 6-point scale and clinical success was considered between grades 0 and 1. Results: In both groups, clinical success was observed at 12 weeks post treatment, leaving residual pigmentation, scarce comedones and less than 10 papules. Tolerable side effects were observed, being the most important erythema and desquamation. Conclusion: PDT with ALA and MAL is a good therapeutic option for patients with mild to moderate inflammatory acne who do not respond or have contraindications to conventional treatments.

Tratamiento de verruga plantar recalcitrante con terapia fotodinámica / Treatment of recalcitrant verruca plantaris with photodynamic therapy

Se presenta el caso de un paciente de sexo masculino, de 55 años de edad, portador de una verruga plantar recalcitrante de casi dos años de evolución. El paciente fue tratado con terapia fotodinámica utilizando metil aminolevulinato y una fuente de luz roja de 630 mm, con una dosis de 37 J/cm2. Luego de tres sesiones de terapia fotodinámica, el paciente presentó una remisión completa de la verruga plantar, lo que ha persistido luego de ocho meses de seguimiento y con excelente resultado cosmético.

We present the case of a 55-year-old male patient with recalcitrant verruca plantaris for almost two years. The patient was treated with photodynamic therapy using aminolevulinic acid and a red light source (630 nm), with a 37 J/cm2 dose. After three photodynamic therapy sessions, the patient showed a complete remission and is still free of the lesion after 8 months of follow-up, evidencing an excellent cosmetic outcome.