Skip to main content

Advertisement

SpringerLink
Log in

The application of physical pretreatment in photodynamic therapy for skin diseases

  • Review Article
  • Published:
Lasers in Medical Science Aims and scope Submit manuscript

Abstract

Photodynamic therapy (PDT) is widely used in skin diseases; the response rate of PDT treatment varies widely. The limited penetration in the tissue of photosensitizers influenced the penetration depth of PDT, which obviously impacts the therapeutic effect. The studies have improved the efficacy of PDT through various pretreatment applications; especially, the physical pretreatment had achieved significant outcomes. We will review the physical pretreatment to optimize the efficacy of PDT in skin diseases by searching the literature on this topic. The types of physical pretreatment commonly used in the clinical practice are discussed: curettage, superficial shaving, laser, surgical resection, plum-blossom needles, and microneedles. Compared with PDT alone, the physical pretreatment before PDT application was generally improved the efficacy and reduced the recurrence, especially in actinic keratoses (AK), Bowen disease (BD), basal cell carcinoma (BCC), and viral warts. The application of the physical pretreatments before PDT may improve the efficacy of PDT in various skin diseases. However, each kind of physical pretreatment has the benefit and shortcoming, and the applicable situation is different.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Pogue BW, O'Hara JA, Demidenko E, Wilmot CM, Goodwin IA, Chen B et al (2003) Photodynamic therapy with verteporfin in the radiation-induced fibrosarcoma-1 tumor causes enhanced radiation sensitivity. Cancer Res 63(5):1025–1033

    PubMed  CAS  Google Scholar 

  2. Wen X, Li Y, Hamblin MR (2017) Photodynamic therapy in dermatology beyond non-melanoma cancer: an update. Photodiagn Photodyn Ther 19:140–152

    Article  CAS  Google Scholar 

  3. Daayana S, Winters U, Stern PL, Kitchener HC (2011) Clinical and immunological response to photodynamic therapy in the treatment of vulval intraepithelial neoplasia. Photochem Photobiol Sci 10(5):802–809

    Article  PubMed  CAS  Google Scholar 

  4. Piaserico S, Fortina AB, Rigotti P, Rossi B, Baldan N, Alaibac M et al (2007) Topical photodynamic therapy of actinic keratosis in renal transplant recipients. Transpl P 39(6):1847–1850

    Article  CAS  Google Scholar 

  5. Roozeboom MH, Aardoom MA, Nelemans PJ, Thissen MRTM, Kelleners-Smeets NWJ, Kuijpers DIM et al (2013) Fractionated 5-aminolevulinic acid photodynamic therapy after partial debulking versus surgical excision for nodular basal cell carcinoma: a randomized controlled trial with at least 5-year follow-up. J Am Acad Dermatol 69(2):280–287

    Article  PubMed  CAS  Google Scholar 

  6. Mu X, Wang L, Wang L, Ge R, Dang H, Mou K (2018) Plum-blossom needling enhanced the effect of photodynamic therapy on basal cell carcinoma. Photodiagn Photodyn Ther 23:339–341

    Article  CAS  Google Scholar 

  7. Smits T, Olthuis D, Blokx WA, Kleinpenning MM, van de Kerkhof PC, van Erp PE et al (2007) Aneuploidy and proliferation in keratinocytic intraepidermal neoplasias. Exp Dermatol 16(2):81–86

    Article  PubMed  CAS  Google Scholar 

  8. Kleinpenning MM, Smits T, Ewalds E, van Erp PE, van de Kerkhof PC, Gerritsen MJ (2006) Heterogeneity of fluorescence in psoriasis after application of 5-aminolaevulinic acid: an immunohistochemical study. Br J Dermatol 155(3):539–545

    Article  PubMed  CAS  Google Scholar 

  9. Smits T, Robles CA, van Erp PEJ, van de Kerkhof PCM, Gerritsen MJP (2005) Correlation between macroscopic fluorescence and protoporphyrin IX content in psoriasis and actinic keratosis following application of aminolevulinic acid. J Invest Dermatol 125(4):833–839

    Article  PubMed  CAS  Google Scholar 

  10. Morton CA, Szeimies RM, Sidoroff A, Braathen LR (2013) European guidelines for topical photodynamic therapy part 2: emerging indications--field cancerization, photorejuvenation and inflammatory/infective dermatoses. J Eur Acad Dermatol Venereol 27(6):672–679

    Article  PubMed  CAS  Google Scholar 

  11. Haedersdal M, Sakamoto FH, Farinelli WA, Doukas AG, Tam J, Anderson RR (2010) Fractional CO(2) laser-assisted drug delivery. Lasers Surg Med 42(2):113–122

    Article  PubMed  Google Scholar 

  12. Haedersdal M, Katsnelson J, Sakamoto FH, Farinelli WA, Doukas AG, Tam J et al (2011) Enhanced uptake and photoactivation of topical methyl aminolevulinate after fractional CO2 laser pretreatment. Lasers Surg Med 43(8):804–813

    Article  PubMed  CAS  Google Scholar 

  13. Bay C, Lerche CM, Ferrick B, Philipsen PA, Togsverd-Bo K, Haedersdal M (2017) Comparison of physical pretreatment regimens to enhance protoporphyrin IX uptake in photodynamic therapy: a randomized clinical trial. JAMA Dermatol 153(4):270–278

    Article  PubMed  Google Scholar 

  14. Christensen E, Warloe T, Kroon S, Funk J, Helsing P, Soler AM et al (2010) Guidelines for practical use of MAL-PDT in non-melanoma skin cancer. J Eur Acad Dermatol 24(5):505–512

    Article  CAS  Google Scholar 

  15. Gerritsen MJ, Smits T, Kleinpenning MM, van de Kerkhof PC, van Erp PE (2009) Pretreatment to enhance protoporphyrin IX accumulation in photodynamic therapy. Dermatology 218(3):193–202

    Article  PubMed  CAS  Google Scholar 

  16. Morton CA, Szeimies RM, Sidoroff A, Braathen LR (2013) European guidelines for topical photodynamic therapy part 1: treatment delivery and current indications - actinic keratoses, Bowen’s disease, basal cell carcinoma. J Eur Acad Dermatol Venereol 27(5):536–544

    Article  PubMed  CAS  Google Scholar 

  17. Gracia-Cazana T, Gonzalez S, Juarranz A, Gilaberte Y (2017) Methyl aminolevulinate photodynamic therapy combined with curettage debulking for pigmented basal cell carcinoma. Photodermatol Photo 33(4):228–232

    Article  CAS  Google Scholar 

  18. Lu YG, Yang YD, Wu JJ, Lei X, Cheng QH, He Y et al (2012) Treatment of perianal condyloma acuminate with topical ALA-PDT combined with curettage: outcome and safety. Photomed Laser Surg 30(3):186–190

    Article  PubMed  CAS  Google Scholar 

  19. Liu DH, Wu LS, Li JM, Shi W, Li FF, Su J et al (2019) Simple shaving combined with photodynamic therapy for refractory Bowen disease. Photodiagn Photodyn Ther 26:258–260

    Article  Google Scholar 

  20. Zhao S, Liu DH, Shi W, Kang YA, Li QL, Liu QP et al (2019) Efficacy of a new therapeutic option for vulvar intraepithelial neoplasia: superficial shaving combined with photodynamic therapy. Lasers Surg Med

  21. Huang K, Xie Y, Li M, Liu D, Su J, Li F et al (2020) A comparative study: superficial shaving combined with photodynamic therapy versus cryotherapy in the treatment of recalcitrant plantar warts. Lasers Surg Med

  22. Wu L, Chen W, Su J, Li F, Chen M, Zhu W et al (2019) Efficacy of the combination of superficial shaving with photodynamic therapy for recalcitrant periungual warts. Photodiagn Photodyn Ther 27:340–344

    Article  Google Scholar 

  23. Ko DY, Kim KH, Song KH (2014) A randomized trial comparing methyl aminolaevulinate photodynamic therapy with and without Er:YAG ablative fractional laser treatment in Asian patients with lower extremity Bowen disease: results from a 12-month follow-up. Br J Dermatol 170(1):165–172

    Article  PubMed  CAS  Google Scholar 

  24. Togsverd-Bo K, Lei U, Erlendsson AM, Taudorf EH, Philipsen PA, Wulf HC et al (2015) Combination of ablative fractional laser and daylight-mediated photodynamic therapy for actinic keratosis in organ transplant recipients - a randomized controlled trial. Br J Dermatol 172(2):467–474

    Article  PubMed  CAS  Google Scholar 

  25. Togsverd-Bo K, Haak CS, Thaysen-Petersen D, Wulf HC, Anderson RR, Haedesdal M (2012) Intensified photodynamic therapy of actinic keratoses with fractional CO2 laser: a randomized clinical trial. Br J Dermatol 166(6):1262–1269

    Article  PubMed  CAS  Google Scholar 

  26. Lu YG, Wang YY, Yang YD, Zhang XC, Gao Y, Yang Y et al (2014) Efficacy of topical ALA-PDT combined with excision in the treatment of skin malignant tumor. Photodiagn Photodyn Ther 11(2):122–126

    Article  CAS  Google Scholar 

  27. Wu Y, Wang PR, Zhang LL, Wang B, Wang XL (2018) Enhancement of photodynamic therapy for Bowen’s disease using plum-blossom needling to augment drug delivery. Dermatol Surg 44(12):1516–1524

    Article  PubMed  CAS  Google Scholar 

  28. Caccavale S, Iocco A, Pieretti G, Alfano R, Argenziano G (2019) Curettage + microneedling + topical ALA-PDT for the treatment of acral resistant warts: our experience. Photodiagn Photodyn Ther 27:276–279

    Article  CAS  Google Scholar 

  29. Morton CA, Wulf HC, Szeimies RM, Gilaberte Y, Basset-Seguin N, Sotiriou E et al (2015) Practical approach to the use of daylight photodynamic therapy with topical methyl aminolevulinate for actinic keratosis: a European consensus. J Eur Acad Dermatol 29(9):1718–1723

    Article  CAS  Google Scholar 

  30. Dirschka T, Ekanayake-Bohlig S, Dominicus R, Aschoff R, Herrera-Ceballos E, Botella-Estrada R et al (2019) A randomized, intraindividual, non-inferiority, phase III study comparing daylight photodynamic therapy with BF-200 ALA gel and MAL cream for the treatment of actinic keratosis. J Eur Acad Dermatol 33(2):288–297

    Article  CAS  Google Scholar 

  31. Fu C, Kuang BH, Qin L, Zeng XY, Wang BC (2019) Efficacy and safety of photodynamic therapy with amino-5-laevulinate nanoemulsion versus methyl-5-aminolaevulinate for actinic keratosis: a meta-analysis. Photodiagn Photodyn Ther 27:408–414

    Article  CAS  Google Scholar 

  32. Tyrrell JS, Morton C, Campbell SM, Curnow A (2011) Comparison of protoporphyrin IX accumulation and destruction during methylaminolevulinate photodynamic therapy of skin tumours located at acral and nonacral sites. Br J Dermatol 164(6):1362–1368

    Article  PubMed  CAS  Google Scholar 

  33. Werner RN, Stockfleth E, Connolly SM, Correia O, Erdmann R, Foley P et al (2015) Evidence- and consensus-based (S3) guidelines for the treatment of actinic keratosis - international league of dermatological societies in cooperation with the European dermatology forum - short version. J Eur Acad Dermatol Venereol 29(11):2069–2079

    Article  PubMed  CAS  Google Scholar 

  34. Torchia D, Cappugi P (2010) Intralesional photodynamic therapy: a comment on ‘Pretreatment to enhance protoporphyrin IX accumulation in photodynamic therapy’ by Gerritsen et al. Dermatology 220(1):44–45

    Article  PubMed  Google Scholar 

  35. Lindberg-Larsen R, Solvsten H, Kragballe K (2012) Evaluation of recurrence after photodynamic therapy with topical methylaminolaevulinate for 157 basal cell carcinomas in 90 patients. Acta Derm Venereol 92(2):144–147

    Article  PubMed  Google Scholar 

  36. Surrenti T, De Angelis L, Di Cesare A, Fargnoli MC, Peris K (2007) Efficacy of photodynamic therapy with methyl aminolevulinate in the treatment of superficial and nodular basal cell carcinoma: an open-label trial. Eur J Dermatol 17(5):412–415

    PubMed  CAS  Google Scholar 

  37. Ramirez DP, Kurachi C, Inada NM, Moriyama LT, Salvio AG, Vollet JD et al (2014) Experience and BCC subtypes as determinants of MAL-PDT response: preliminary results of a national Brazilian project. Photodiagn Photodyn Ther 11(1):22–26. https://doi.org/10.1016/j.pdpdt.2013.11.001

  38. Nguyen K, Khachemoune A (2019) An update on topical photodynamic therapy for clinical dermatologists. J Dermatol Treat 30(8):732–744

    Article  Google Scholar 

  39. Shi HJ, Zhang XM, Ma CM, Yu N, Wang JX, Xia L et al (2013) Clinical analysis of five methods used to treat condylomata acuminata. Dermatology 227(4):338–345

    Article  PubMed  Google Scholar 

  40. Morton CA, Birnie AJ, Eedy DJ (2014) British Association of Dermatologists’ guidelines for the management of squamous cell carcinoma in situ (Bowen’s disease) 2014. Br J Dermatol 170(2):245–260

    Article  PubMed  CAS  Google Scholar 

  41. Wong TW, Sheu HM, Lee JY, Fletcher RJ (2001) Photodynamic therapy for Bowen’s disease (squamous cell carcinoma in situ) of the digit. Dermatol Surg 27(5):452–456

    PubMed  CAS  Google Scholar 

  42. Abdel-Hady ES, Martin-Hirsch P, Duggan-Keen M, Stern PL, Moore JV, Corbitt G et al (2001) Immunological and viral factors associated with the response of vulval intraepithelial neoplasia to photodynamic therapy. Cancer Res 61(1):192–196

    PubMed  CAS  Google Scholar 

  43. Ozog DM, Rkein AM, Fabi SG, Gold MH, Goldman MP, Lowe NJ et al (2016) Photodynamic therapy: a clinical consensus guide. Dermatol Surg 42(7):804–827

    Article  PubMed  CAS  Google Scholar 

  44. Stender IM, Lock-Andersen J, Wulf HC (1999) Recalcitrant hand and foot warts successfully treated with photodynamic therapy with topical 5-aminolaevulinic acid: a pilot study. Clin Exp Dermatol 24(3):154–159

    Article  PubMed  CAS  Google Scholar 

  45. Del Rio-Sancho S, Lapteva M, Sonaje K, Bohler C, Ling V, Boehncke WH et al (2020) Targeted cutaneous delivery of etanercept using Er:YAG fractional laser ablation. Int J Pharm 580:119234

    Article  PubMed  CAS  Google Scholar 

  46. Hantash BM, Bedi VP, Kapadia B, Rahman Z, Jiang K, Tanner H et al (2007) In vivo histological evaluation of a novel ablative fractional resurfacing device. Lasers Surg Med 39(2):96–107

    Article  PubMed  Google Scholar 

  47. Varma S, Wilson H, Kurwa HA, Gambles B, Charman C, Pearse AD et al (2001) Bowen’s disease, solar keratoses and superficial basal cell carcinomas treated by photodynamic therapy using a large-field incoherent light source. Br J Dermatol 144(3):567–574

    Article  PubMed  CAS  Google Scholar 

  48. Cai H, Wang YX, Zheng JC, Sun P, Yang ZY, Li YL et al (2015) Photodynamic therapy in combination with CO2 laser for the treatment of Bowen’s disease. Lasers Med Sci 30(5):1505–1510

    Article  PubMed  Google Scholar 

  49. Alexiades M (2017) Randomized, controlled trial of fractional carbon dioxide laser resurfacing followed by ultrashort incubation aminolevulinic acid blue light photodynamic therapy for actinic keratosis. Dermatol Surg 43(8):1053–1064

    Article  PubMed  CAS  Google Scholar 

  50. Bu WB, Xu XL, Wang Y, Huang LM, Zeng R, Chen X et al (2017) Surgery combined with photodynamic therapy for the treatment of hidradenitis suppurativa: a report of 7 cases. Photodiagn Photodyn Ther 18:46–49

    Article  Google Scholar 

  51. Wang HWWX, Guo MX, Yu YF (2006) Topical 5-aminolevulinic acid—photodynamic therapy in the treatment of precancerous changes and carcinoma of the skin in situ. Chin J Dermatol 03:137–139

    Google Scholar 

  52. Wang PRZL, Zhou ZX, Wei ML (2015) Plum-blossom needle tapping enhances the efficacy of aminolevulinic acid-based photodynamic therapy for actinic keratosis, basal cell carcinoma and squamous cell carcinoma. Chin J Dermatol 48(2):80–84

    Google Scholar 

  53. Zhu DD, Wang QL, Liu XB, Guo XD (2016) Rapidly separating microneedles for transdermal drug delivery. Acta Biomater 41:312–319

    Article  PubMed  CAS  Google Scholar 

  54. Gupta J, Gill HS, Andrews SN, Prausnitz MR (2011) Kinetics of skin resealing after insertion of microneedles in human subjects. J Control Release 154(2):148–155

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  55. Rodrigues PGS, de Menezes PFC, Fujita AKL, Escobar A, de Nardi AB, Kurachi C et al (2015) Assessment of ALA-induced PpIX production in porcine skin pretreated with microneedles. J Biophotonics 8(9):723–729

    Article  PubMed  CAS  Google Scholar 

  56. Donnelly RF, Morrow DIJ, McCarron PA, David Woolfson A, Morrissey A, Juzenas P et al (2009) Microneedle arrays permit enhanced intradermal delivery of a preformed photosensitizer. Photochem Photobiol 85(1):195–204

    Article  PubMed  CAS  Google Scholar 

  57. Turani Z, Fatemizadeh E, Blumetti T, Daveluy S, Moraes AF, Chen W et al (2019) Optical radiomic signatures derived from optical coherence tomography images improve identification of melanoma. Cancer Res 79(8):2021–2030

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  58. Vienneau E, Vu T, Yao J (2019) Photoacoustic Imaging of Skin. In book: imaging technologies and transdermal delivery in skin disorders, pp 411–442. https://doi.org/10.1002/9783527814633.ch16

Download references

Funding

This work was supported by the National Natural Science Foundation of China (Grant number: 81673046).

Author information

Author notes

  1. Dihui Liu

    Present address: Department of Dermatology, Guangzhou Integrated Traditional Chinese and Western Medicine Hospital, 87 Yingbin Avenue, Huadu District, Guangzhou, 510800, Guangdong, China

  2. Dihui Liu and Shuang Zhao contributed equally to this work.

Authors and Affiliations

  1. Department of Dermatology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China

    Dihui Liu, Shuang Zhao, Jinmao Li, Mingliang Chen & Lisha Wu

  2. Institute of Medical Sciences, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China

    Lisha Wu

  3. National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China

    Lisha Wu

Authors
  1. Dihui Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shuang Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jinmao Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mingliang Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lisha Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Mingliang Chen or Lisha Wu.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This is a review work. The Xiangya Hospital, Central South University Research Ethics Committee has confirmed that no ethical approval is required.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Liu, D., Zhao, S., Li, J. et al. The application of physical pretreatment in photodynamic therapy for skin diseases. Lasers Med Sci 36, 1369–1377 (2021). https://doi.org/10.1007/s10103-020-03233-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10103-020-03233-6

Keywords

Search

Navigation