Protoporphyrin IX formation after application of methyl aminolevulinate on the face and scalp with and without prior curettage

TY - JOUR

T1 - Protoporphyrin IX formation after application of methyl aminolevulinate on the face and scalp with and without prior curettage

AU - Heerfordt, Ida M

AU - Bieliauskiene, Giedre

AU - Wulf, Hans Christian

N1 - Copyright © 2018 Elsevier B.V. All rights reserved.

PY - 2018/6

Y1 - 2018/6

N2 - BACKGROUND: Pulse photodynamic therapy (PDT) is carried out as classical PDT except that methyl aminolaevulinate (MAL) is removed after 30 min. Protoporphyrin IX (PpIX) accumulation becomes lower after 3 h in pulse-PDT than in classical PDT, but pulse-PDT still has full treatment effect on actinic keratosis (AK). The present study aimed to investigate when PpIX formation in classical PDT without curettage reaches the PpIX level in pulse-PDT with curettage in the skin of the face and scalp.METHODS: Fourteen patients with AKs in the face and scalp were included in this pilot study. Each patient had two fields randomly allocated to two different regimes: (i) continuing MAL incubation without prior curettage (-Cur) and (ii) 30 min MAL incubation after curettage (+Cur). The PpIX level in each field was measured with a hand-held fluorescence photometer every 30 min for 6 h after MAL application. No illumination was performed.RESULTS: The median PpIX level in the +Cur field after 3 h was 22 arbitrary units (AU), which represents the amount of PpIX that could have been photobleached after pulse-PDT with maximal treatment effect. After 3 h the median PpIX level in the -Cur field was 20 AU, which was not significantly different from the level in the +Cur field (p = 0.9).CONCLUSIONS: We propose PDT without curettage as follows: 3 h of MAL incubation and subsequently sufficient illumination. The treatment effect of this regime should be tested to verify if curettage of the face and scalp area may be omitted in PDT.

AB - BACKGROUND: Pulse photodynamic therapy (PDT) is carried out as classical PDT except that methyl aminolaevulinate (MAL) is removed after 30 min. Protoporphyrin IX (PpIX) accumulation becomes lower after 3 h in pulse-PDT than in classical PDT, but pulse-PDT still has full treatment effect on actinic keratosis (AK). The present study aimed to investigate when PpIX formation in classical PDT without curettage reaches the PpIX level in pulse-PDT with curettage in the skin of the face and scalp.METHODS: Fourteen patients with AKs in the face and scalp were included in this pilot study. Each patient had two fields randomly allocated to two different regimes: (i) continuing MAL incubation without prior curettage (-Cur) and (ii) 30 min MAL incubation after curettage (+Cur). The PpIX level in each field was measured with a hand-held fluorescence photometer every 30 min for 6 h after MAL application. No illumination was performed.RESULTS: The median PpIX level in the +Cur field after 3 h was 22 arbitrary units (AU), which represents the amount of PpIX that could have been photobleached after pulse-PDT with maximal treatment effect. After 3 h the median PpIX level in the -Cur field was 20 AU, which was not significantly different from the level in the +Cur field (p = 0.9).CONCLUSIONS: We propose PDT without curettage as follows: 3 h of MAL incubation and subsequently sufficient illumination. The treatment effect of this regime should be tested to verify if curettage of the face and scalp area may be omitted in PDT.

KW - Aged

KW - Aged, 80 and over

KW - Aminolevulinic Acid/administration & dosage

KW - Curettage

KW - Face

KW - Female

KW - Humans

KW - Keratosis, Actinic/drug therapy

KW - Male

KW - Middle Aged

KW - Photochemotherapy/methods

KW - Photosensitizing Agents/administration & dosage

KW - Pilot Projects

KW - Protoporphyrins/pharmacokinetics

KW - Scalp

U2 - 10.1016/j.pdpdt.2018.03.008

DO - 10.1016/j.pdpdt.2018.03.008

M3 - Journal article

C2 - 29601904

SN - 1572-1000

VL - 22

SP - 155

EP - 157

JO - Photodiagnosis and Photodynamic Therapy

JF - Photodiagnosis and Photodynamic Therapy

ER -