PDF herunterladen
Aktuelle Dermatologie 2017; 43(10): 412-417
DOI: 10.1055/s-0043-112659
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Photodynamische Therapie – neue Wege, kritische Abwägung

New Applications in Photodynamic Therapy: A Critical Appraisal
H. Kurzen
1   Haut- und Laserzentrum Freising
2   Klinik für Dermatologie, Venerologie und Allergologie, Ruprecht-Karls Universität Heidelberg, Universitätsmedizin Mannheim
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
04. Oktober 2017 (online)

Auch verfügbar auf
   Lizenzen und Reprints

Zusammenfassung

In den letzten Jahren gewinnt die photodynamische Therapie (PDT) an Bedeutung in der Behandlung des chronischen Lichtschadens. Im Vordergrund steht die Behandlung der Feldkanzerisierung und damit von bösartigen, oberflächlichen epidermalen Karzinomen (aktinische Keratosen). Als Nebeneffekt wurde immer wieder ein positiver Effekt auf das Gesamterscheinungsbild und damit ein kosmetischer Effekt beschrieben. Untermauert wird dies durch Untersuchungen zur epidermalen Dicke und aktinischen Elastose nach PDT. In Kombination mit fraktionierten ablativen Lasern oder dem Mikroneedling kann eine synergistische Wirkungsverstärkung erzielt werden. Komplexe Behandlungsschemata, die PDT mit IPL, Farbstoff-Laser sowie Mikroneedling oder Mikrodermabrasion kombinieren, werden sowohl in der eigentlichen Verjüngungsbehandlung, jedoch auch zur Therapie der Akne oder auch infektiöser Hauterkrankungen eingesetzt. Die alleinige kosmetische Anwendung der PDT auf nicht sonnengeschädigter Haut steht auch aufgrund der hohen Kosten und besserer Konkurrenzmethoden nicht im Vordergrund.

Abstract

In recent years, photodynamic therapy (PDT) has gained increasing importance in the treatment of chronic light damage. The treatment of field cancerization which comprises malignant superficial epidermal carcinomas (actinic keratoses) plays the most important role. Many users have noted a pronounced positive effect of PDT on the cosmetic appearance of the treated patients. Recent studies have addressed this issue and have systematically examined PDT effects on epidermal thickness and dermal elastosis. The combination with fractional ablative lasers or microneedling can increase synergistically the observed effects. Complex treatment schemes combining PDT with IPL, pulsed dye lasers, microneedling or microdermabrasion are being used in rejuvenation and the treatment of acne or infectious diseases. The use of PDT for purely cosmetic purposes on non-sundamaged skin is currently not preferred due to high cost and better competing technologies.

 

  • Literatur

  • 1 Morton CA, Szeimies RM, Sidoroff A. et al. European guidelines for topical PDT part 1: treatment delivery and current indications – actinic keratoses, Bowen’s disease, basal cell carcinoma. J Europ Acad Dermatol Venerol 2013; 27: 536-544
    PubMedGoogle Scholar
  • 2 Tierney E, Barker A, Ahdout J. et al. Photodynamic therapy for the treatment of cutaneous neoplasia, inflammatory disorders, and photoaging. Dermatol Surg 2009; 35: 725-746
    CrossrefPubMedGoogle Scholar
  • 3 Morton CA, Szeimies RM, Sidoroff A. et al. European guidelines for topical PDT part 2: emerging indications – field cancerization, photorejuvenation and inflammatory/infective dermatoses. J Europ Acad Dermatol Venerol 2013; 27: 672-679
    PubMedGoogle Scholar
  • 4 Park MY, Sohn S, Lee ES. et al. Photorejuvenation induced by 5-aminolevulinic acid photodynamic therapy in patients with actinic keratosis: a histologic analysis. J Am Acad Dermatol 2010; 62: 85-95
    CrossrefPubMedGoogle Scholar
  • 5 Hong SB, Lee MH. Topical aminolevulinic acid-photodynamic therapy for the treatment of acne vulgaris. Photodermatol Photoimmunol Photomed 2005; 21: 322-325
    CrossrefPubMedGoogle Scholar
  • 6 Hongcharu W, Taylor CR, Chang Y. et al. Topical ALA-photodynamic therapy for the treatment of acne vulgaris. J Invest Dermatol 2000; 115: 183-192
    CrossrefPubMedGoogle Scholar
  • 7 Horfelt C, Funk J, Frohm-Nilsson M. et al. Topical methyl aminolaevulinate photodynamic therapy for treatment of facial acne vulgaris: results of a randomized, controlled study. Br J Dermatol 2006; 155: 608-613
    CrossrefPubMedGoogle Scholar
  • 8 Pollock B, Turner D, Stringer MR. et al. Topical aminolaevulinic acid-photodynamic therapy for the treatment of acne vulgaris: a study of clinical efficacy and mechanism of action. Br J Dermatol 2004; 151: 616-622
    CrossrefPubMedGoogle Scholar
  • 9 Wiegell SR, Wulf HC. Photodynamic therapy of acne vulgaris using 5-aminolevulinic acid versus methyl aminolevulinate. J Am Acad Dermatol 2006; 54: 647-651
    CrossrefPubMedGoogle Scholar
  • 10 Wiegell SR, Wulf HC. Photodynamic therapy of acne vulgaris using methyl aminolaevulinate: a blinded, randomized, controlled trial. Br J Dermatol 2006; 154: 969-976
    CrossrefPubMedGoogle Scholar
  • 11 Rojanamatin J, Choawawanich P. Treatment of inflammatory facial acne vulgaris with intense pulsed light and short contact of topical 5-aminolevulinic acid: a pilot study. Dermatol Surg 2006; 32: 991-996 discussion 996 – 997
    PubMedGoogle Scholar
  • 12 Haedersdal M, Togsverd-Bo K, Wiegell SR. et al. Long-pulsed dye laser versus long-pulsed dye laser-assisted photodynamic therapy for acne vulgaris: A randomized controlled trial. J Am Acad Dermatol 2008; 58: 387-394
    CrossrefPubMedGoogle Scholar
  • 13 Alexiades-Armenakas M. Long-pulsed dye laser-mediated photodynamic therapy combined with topical therapy for mild to severe comedonal, inflammatory, or cystic acne. J Drugs Dermatol 2006; 5: 45-55
    PubMedGoogle Scholar
  • 14 Ruiz-Rodriguez R, López L, Candelas D. et al. Enhanced efficacy of photodynamic therapy after fractional resurfacing: fractional photodynamic rejuvenation. J Drugs Dermatol 2007; 6: 818-820
    PubMedGoogle Scholar
  • 15 Le Pillouer-Prost A, Cartier H. Photodynamic Photorejuvenation: A Review. Dermatol Surg 2016; 42: 21-30
    CrossrefPubMedGoogle Scholar
  • 16 Szeimies RM, Radny P, Sebastian M. et al. Photodynamic therapy with BF-200 ALA for the treatment of actinic keratosis: results of a prospective, randomized, double-blind, placebo-controlled phase III study. Br J Dermatol 2010; 163: 386-394
    CrossrefPubMedGoogle Scholar
  • 17 Palm MD, Goldman MP. Safety and efficacy comparison of blue versus red light sources for photodynamic therapy using methyl aminolevulinate in photodamaged skin. J Drugs Dermatol 2011; 10: 53-60
    PubMedGoogle Scholar
  • 18 de Vijlder HC, Sterenborg HJ, Neumann HA. et al. Light fractionation significantly improves the response of superficial basal cell carcinoma to aminolaevulinic acid photodynamic therapy: five-year follow-up of a randomized, prospective trial. Acta DermVenereol 2012; 92: 641-647
    PubMedGoogle Scholar
  • 19 Philipp-Dormston WG, Sanclemente G, Torezan L. et al. Daylight photodynamic therapy with MAL cream for large-scale photodamaged skin based on the concept of ‘actinic field damage’: recommendations of an international expert group. J Eur Acad Dermatol Venereol 2016; 30: 8-15
    CrossrefPubMedGoogle Scholar
  • 20 Kellner C, Bauriedl S, Hollstein S. et al. Simulated-daylight photodynamic therapy with BF-200 aminolaevulinic acid for actinic keratosis: assessment of the efficacy and tolerability in a retrospective study. Br J Dermatol 2015; 172: 1146-1148
    CrossrefPubMedGoogle Scholar
  • 21 Clementoni MT, Roscher M, Munavalli GS. Photodynamic photorejuvenation of the face with a combination of microneedling, red light, and broadband pulsed light. Lasers Surg Med 2010; 42: 150-159
    CrossrefPubMedGoogle Scholar
  • 22 Torezan L, Chaves Y, Niwa A. et al. A pilot split-face study comparing methyl aminolevulinate-photodynamic therapy (PDT) with microneedling-assisted PDT on actinically damaged skin. Dermatol Surg 2013; 39: 1197-1201
    CrossrefPubMedGoogle Scholar
  • 23 Ruiz-Rodriguez R, Sanz-Sanchez T, Cordoba S. Photodynamic photorejuvenation. Dermatol Surg 2002; 28: 742-744
    PubMedGoogle Scholar
  • 24 Bay C, Lerche CM, Ferrick B. et al. Comparison of Physical Pretreatment Regimens to Enhance Protoporphyrin IX Uptake in Photodynamic Therapy: A Randomized Clinical Trial. JAMA Dermatol 2017; 153: 270-278
    CrossrefPubMedGoogle Scholar
  • 25 Sanclemente G, Correa LA, Garcia JJ. et al. Methyl aminolevulinate plus red light vs. placebo plus red light in the treatment of photodamaged facial skin: histopathological findings. Clin Exp Dermatol 2012; 37: 379-386
    CrossrefPubMedGoogle Scholar
  • 26 Karrer S, Kohl E, Feise K. et al. Photodynamic therapy for skin rejuvenation: review and summary of the literature – results of a consen- sus conference of an expert group for aesthetic photodynamic therapy. J Dtsch Dermatol Ges 2013; 11: 137-148
    PubMedGoogle Scholar
  • 27 Goldman MP, Weiss RA, Weiss MA. Intensepulsedlight as a nonablative approach to photoaging. Dermatol Surg 2005; 31: 1179-1187
    PubMedGoogle Scholar
  • 28 Marmur ES, Phelps R, Goldberg DJ. Ultrastructural changes seen after ALA-IPL photorejuvenation: a pilot study. J Cosmet Laser Ther 2005; 7: 21-24
    CrossrefPubMedGoogle Scholar
  • 29 Babilas P, Knobler R, Hummel S. et al. Variable pulsed light is less painful than LEDs for topical PDT of AKs: a prospective randomized controlled trial. Br J Dermatol 2007; 157: 111-117
    CrossrefPubMedGoogle Scholar
  • 30 Alster TS, Tanzi EL, Welsh EC. Photorejuvenation of facial skin with topical 20 % 5-aminolevulinic acid and intense pulsed light treatment: a split-face comparison study. J Drugs Dermatol 2005; 4: 35-38
    PubMedGoogle Scholar
  • 31 Dover JS, Bhatia AC, Stewart B. et al. Topical 5-aminolevulinic acid combined with intense pulsed light in the treatment of photoaging. Arch Dermatol 2005; 141: 1247-1252
    PubMedGoogle Scholar
  • 32 Gold MH, Bradshaw VL, Boring MM. et al. Split-face comparison of photodynamic therapy with 5-aminolevulinic acid and intense pulsed light versus intense pulsed light alone for photodamage. Dermatol Surg 2006; 32: 795-801 discussion 801 – 803
    PubMedGoogle Scholar
  • 33 Clementoni MT, B-Roscher M, Munavalli GS. Photodynamic photorejuvenation of the face with a combination of microneedling, red light, and broadband pulsed light. Lasers Surg Med 2010; 42: 150-159
    CrossrefPubMedGoogle Scholar
  • 34 Palm MD, Goldman MP. Safety and efficacy comparison of blue versus red light sources for photodynamic therapy using methyl aminolevulinate in photodamaged skin. J Drugs Dermatol 2011; 10: 53-60
    PubMedGoogle Scholar
  • 35 Friedmann DP, Goldman MP, Fabi SG. et al. Multiple sequential light and laser sources to activate aminolevulinic acid in the treatment of photodamage: a retrospective study. J Cosmet Laser Ther 2015; 17: 252-258
    CrossrefPubMedGoogle Scholar
  • 36 Friedmann DP, Goldman MP. Photodynamic Therapy for Cutaneous Photoaging: A Combination Approach. Dermatol Surg 2016; 42: S157-S160
    CrossrefPubMedGoogle Scholar
  • 37 Reinholz M, Heppt MV, Hoffmann FS. et al. Transient memory impairment and transient global amnesia induced by photodynamic therapy. Br J Dermatol 2015; 173: 1258-1262
    CrossrefPubMedGoogle Scholar
  • 38 Lehmann P. Nebenwirkungen der topischen photodynamischen Therapie. Hautarzt 2007; 58: 597-603
    CrossrefPubMedGoogle Scholar
  • 39 Zeitouni NC, Paquette AD, Housel JP. et al. A retrospective review of pain control by a two-step irradiance schedule during topical ALA-photodynamic therapy of non-melanoma skin cancer. Lasers Surg Med 2013; 45: 89-94
    CrossrefPubMedGoogle Scholar
  • 40 Grapengiesser S, Ericson M, Gudmundsson F. et al. Pain caused by photodynamic therapy of skin cancer. Clin Exp Dermatol 2002; 27: 493-497
    CrossrefPubMedGoogle Scholar
  • 41 Sandberg C, Stenquist B, Rosdahl I. et al. Important factors for pain during photodynamic therapy for actinic keratosis. Acta Derm Venereol 2006; 86: 404-408
    CrossrefPubMedGoogle Scholar