Low irradiance compared with conventional photodynamic therapy in the treatment of actinic keratoses.

BACKGROUND: Photodynamic therapy (PDT) is an effective therapy treating photodamaged areas with multiple actinic keratoses (AK). Still pain during therapy is one of the most challenging obstacles for patients. This retrospective study compares pain and efficacy intra-individual in patients using conventional PDT (c-PDT) compared to a low irradiance PDT protocol (li-PDT) with a reduced irradiance to 25% of c-PDT. METHODS: Thirty-one patients were enrolled into this retrospective analysis treated with li-PDT and c-PDT on comparable fields of actinic damage on the forehead or the cheek. Pain was scored by the patients using a VAS. Moreover, number and time to therapy interruptions were documented. For effectiveness number and grade of AK were counted before and 4 weeks after PDT. RESULTS: Maintaining a total light dose of 37 J/cm2 , a decrease in irradiation in li-PDT patients resulted in significant less pain (VAS score 2.8 vs 7.6) and fewer therapy interruptions compared to treatment with c- PDT (P < 0.0005). No significant difference in treatment outcome was found (P = 0.068). CONCLUSION: Our data shows that li-PDT can reduce pain with at least comparable clinical outcome compared to c-PDT. Therefore, it is an effective and well-tolerated treatment for patients with multiple AK.

Impact of red versus blue light on tolerability and efficacy of PDT: a randomized controlled trial.

Various light sources may be used for photodynamic therapy of actinic keratosis since photosensitizing agents are activated by different wavelengths. However, the relative impact of red and blue light irradiation on the efficacy and tolerability of therapy is controversial. OBJECTIVE: The aim of this study is to compare the efficacy and tolerability of therapy with red versus blue light sources, as well as the patients' evaluation of cosmetic results, clinical response, painfulness and preferred light source for future photodynamic treatments. METHODS: This is a prospective, single-center, randomized, controlled, open-label study with 28 patients undergoing elective photodynamic therapy. RESULTS: Red and blue light sources both showed very good results with a complete response rate of 84 % and 85 % respectively. Pain during photodynamic therapy was 6.1 vs. 5.4 (and 2.1 vs. 1.5 eight hours after therapy) on the visual analogue scale. Although these differences were statistically significant, the clinical relevance is low, since the number of therapy interruptions were equally distributed in both groups, and patients' subjective evaluation of the treatment showed no personal preference towards the light sources. CONCLUSION: Both light sources showed very good clinical results and satisfactory tolerability in this study.

Future treatment options for atopic dermatitis - small molecules and beyond.

Atopic dermatitis (AD) is a common eczematous skin disease with a chronic and relapsing course. Current therapeutic options for moderate to severe AD in children and adults are unsatisfactory. Along with the success of basic research to define pathogenesis-related targets, novel small molecule inhibitors and biologics for the treatment of AD have been developed. These compounds focus on the specific reduction of pruritus, interfere with the pro-allergic Th2-deviation of the immune system or inhibit inflammatory pathways in the skin. Based on studies registered at ClinicalTrials.gov we present novel treatment strategies of AD, their molecular mechanisms of action, and discuss the current status of the clinical results. As many of the new compounds target pathogenesis-related traits of the disease, we face a new era in the treatment and understanding of AD.