Photodynamic Therapy with Methyl 5-aminolevulinic Acid for Treatment of Toenail Onychomycosis: the Efficacy and Safety / 대한의진균학회지

BACKGROUND: The major limitations of the current therapeutic treatments for onychomycosis are the recurrence of the infection and the duration of the treatment. Recently, photodynamic therapy (PDT) is thought to be a novel alternative method for treatment of onychomycosis. OBJECTIVE: The aim of this study is to investigate the efficacy and safety of PDT with methyl 5-aminolevulinic acid (MAL) for the treatment of onychomycosis. METHODS: We performed MAL-PDT in eight patients with distal subungual onychomycosis on at least one great toenail. After the total three treatments, we observed the clinical and mycological courses for twelve months. RESULTS: For the twelve months of follow-up period, three patients (37.5%) showed continuous clinical improvement, two patients (25%) aggravation after transient improvement, and the rest, three patients (37.5%) resistance to treatment. All subjects complained of quite severe burning pain during irradiation of light source. CONCLUSION: In this study, we observed the highly variable clinical and mycological results of PDT in onychomycosis. We concluded that it is too difficult to consistently achieve the best fungicidal effect by PDT without strictly selected conditions.

Topical Photodynamic Therapy with Methyl-aminolevulinic Acid for the Treatment of Actinic Keratosis / 대한피부과학회지

BACKGROUND: Photodynamic therapy (PDT) is a treatment modality involving the use of a photosensitizer, oxygen and a light source to induce selective targeted cell death. It is used for various skin conditions, including actinic keratosis (AK). Both 5-aminolevulinic acid and methyl aminolevulinic acid (MAL) are currently available as photosensitizers. Although there are several studies on the treatment of AK using 5-aminolevulinic acid-PDT in Korea, there are few studies on using MAL-PDT for the treatment of AK. OBJECTIVE: The purpose of this study is to evaluate the efficacy and safety of MAL-PDT for the treatment of AK. METHODS: We performed a retrospective study and reviewed 64 AK lesions from 28 patients who were treated by MAL-PDT between January 2008 and April 2010. The data was collected through the medical records, the clinical photographs and the biopsy specimens. RESULTS: The patients were treated with either a single treatment or double treatments 1 week apart. The treatment results were assessed after 12 weeks. Overall, complete remission was achieved in 42/64 lesions (65.6%). Although a single treatment was effective for thin lesions, the complete response rates were significantly lower for the moderately thick and severely thick lesions (100% vs 71.3% vs 22.2%, respectively). Repeated treatment tended to improve the complete response rate of the severely thick lesions. A favorable cosmetic outcome was achieved and only tolerable local side effects were reported after MAL-PDT. The patients were followed up for an average period of 6 months and 4 lesions recurred. CONCLUSION: MAL-PDT is an effective and well-tolerated treatment option for thin and moderately thick AK. However, further study is required for determining the optimal regimen for thicker lesions and the long-term treatment results of MAL-PDT.

Efficacy of Photodynamic Therapy with Methyl 5-aminolevulinic Acid and Red Light for Actinic Keratosis / 대한피부과학회지

BACKGROUND: Actinic keratosis (AK) is a pre-cancerous skin lesion that has the potential to progress to squamous cell carcinoma, which generally occurs on long-term sun exposed and cosmetically sensitive areas of the face, scalp, ears and neck. Many treatment options such as surgical excision, electrosurgery, cryotherapy, topical therapy including 5-fluorouracil, imiquimod and diclofenacare are available for AK, but these can be inconvenient and unsatisfactory for patients. Recently, the efficacy of topical photodynamic therapy (PDT) has been demonstrated in a large number of clinical studies over the last several years. OBJECTIVE: The aim of this study was to evaluate the efficacy and adverse effects of methyl 5-aminolevulinic acid (MAL) and red light photodynamic therapy (PDT) in the treatment of actinic keratosis. METHODS: This study included 21 actinic keratosis lesions in 12 patients. After application of commercially available MAL cream (Metvix(R), Galderma, Hertfordshire, U.K.) under occlusion for 3 hours, the lesions were illuminated by red light from a light-emitting diode system (Aktilite lamp(R), PhotoCure ASA, Oslo, Norway). All patients were followed for 3 months after 2 MAL-PDT sessions. Therapeutic effectivenesswas assessed by clinical and histopathological findings. RESULTS: Complete remission was achieved in 18 of 21 lesions (85.7%). The local adverse effects were erythema, pain, burning sensation and edema. CONCLUSION: This study showed that MAL-PDT using red-light is a safe and effective treatment option for AK.