Photodynamic therapy includes the use of photochemical reactions with interaction of photosensitising agents, light source and oxygen for the treatment of malignant and benign diseases.
Photodynamic therapy includes two stages. During the first stage the photosensitising substance is administered to the patient in one or more ways (topical, intravenous, orally), and is absorbed by the target cells.
The second stage includes the activation of the photosensitising agent in the presence of oxygen through a light of specific wavelength.
Because the photosensitising substance is absorbed more by cells which proliferate more the treatment is selective, minimizing the tissue damage on healthy tissue.
The most commonly used photosensitisers in PDT are ALA (amino – levulinic acid) aand MAL (methyl – amino – levulinic acid).
Any light source with the adequate wavelength and high absorption in the spectrum of the photosensitising drug, can be used for the activation of the photosensitising agent.
Photodynamic therapy in Actinic Hyperkeratosis
For the treatment of Actinic Hyperkeratosis with MAL, the cream must be applied on the lesions after preparation of the skin. This includes removal of hyperkeratosis and scales in order for the drug to be absorbed better. Then MAL (Metvix) is applied with occlusion for about 3 hours and then follows exposure to 37J/cm2 or 75J/cm2 red light. Photodynamic therapies are done every 3 months or every week according to the treatment protocol.
Photodynamic therapy in Basal Cell Carcinoma
Metvix is the only substance which has been approved for use in basal cell carcinomas, in superficial or nodular basal cell carcinoma on the head or scalp. The reoccurrences and the effectiveness are comparable to that of surgical excision, cryotherapy and other forms of treatment but the but the aesthetic result is clearly superior
Photodynamic therapy for photoaging
The extensive use of photodynamic therapy, although not indicated, is widely used for the treatment of photoaging. The parameters concerning the application time, the light energy and the duration of the treatment can be diversified.
Photodynamic therapy for Acne
PDTwith use of Metvix has been used successfully for the treatment of acne because it achieves clinical reduction of the sebum production and of the size of the sebaceous glands. It is proven with biopsies the destruction of the sebaceous glands, leading to long term remission. The fact that red light has deeper penetrability makes it more suitable than blue light.
Photodynamic therapy for Bowen Disease
The use of MAL (metvix) is indicated in Europe for the treatment of Bowen disease, in case where surgical removal is less suitable. Bowen disease is one of the best indications for PDT because the lesions are big and surgery can lead to creation of scars.
Photodynamic therapy is applied in many other skin lesions such as actinic cheilitis, flat warts, genital warts etc.
Modern studies have shown that photodynamic therapy with the use of natural light has equal results to classic photodynamic therapy with use of artificial light sources.
Furthermore the use of photodynamic therapy with natural light is better tolerated by the patient as it is painless . Half hour after the application of the photosensitising cream the patient is exposed to the sun for 2.5 hours. The next days a mild redness is observed and exfoliation which lasts foe 5-7 days.
It is a particularly popular treatment in our clinic for the treatment of extensive areas such as the whole face, chest, upper limbs and legs.
For individual lesions usually traditional phototherapy is preferred .
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